Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC.
Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC.
J Surg Res. 2021 Aug;264:474-480. doi: 10.1016/j.jss.2021.02.042. Epub 2021 Apr 12.
The chief resident service provides surgical trainees in their final year of training the opportunity to maximize responsibility, continuity, and decision-making. Although supervised, chief residents operate according to personal preferences instead of adapting to their attendings' preferences. We hypothesized that outcomes following cholecystectomy are equivalent between the chief resident service and standard academic services.
We matched adults undergoing cholecystectomy from 07/2016-06/2019 on the chief resident service to two standard academic service patients based on operative indication and age. We compared demographics, operative details, and 30-d complications.
This study included 186 patients undergoing cholecystectomy. Body mass index (32.4 versus 32.0, P = 0.49) and Charlson comorbidity index (0.9 versus 1.4, P = 0.16) were similar between chief resident and standard academic services, respectively. Operative approach was similar (95.2% laparoscopic on chief resident service versus 94.4% on standard service), but residents on the chief resident service performed cholangiograms more often (48.4% versus 22.6%, P < 0.01) and averaged longer operative times during laparoscopic cholecystectomy with cholangiogram (146±28 versus 85±22 min, P < 0.01) and without (94±31 versus 76±35 min, P < 0.01) compared with standard academic services, respectively. 30-d complication rates were similar (5.2% chief resident versus 5.0% standard, P = 0.95). No patients suffered bile leak, bile duct injury, or reoperation. Emergency Department visits were similar (12.1% chief resident versus 7.4% standard, P = 0.32); readmissions were less frequent on the chief resident service (0.0% versus 5.0% standard, P = 0.03).
With appropriate supervision, chief residents provide safe care for patients undergoing cholecystectomy while directing medical decisions and practicing according to their preferences.
住院总医师服务为培训的最后一年的外科受训者提供了最大限度地承担责任、保持连续性和决策的机会。尽管有监督，但住院总医师根据个人偏好而不是适应主治医生的偏好来进行操作。我们假设胆囊切除术的结果在住院总医师服务和标准学术服务之间是等效的。
我们根据手术指征和年龄，将 2016 年 7 月至 2019 年 6 月期间在住院总医师服务下进行胆囊切除术的成年人与两名标准学术服务患者相匹配。我们比较了人口统计学、手术细节和 30 天并发症。
这项研究包括 186 名接受胆囊切除术的患者。住院总医师服务和标准学术服务组的体重指数（32.4 与 32.0，P=0.49）和 Charlson 合并症指数（0.9 与 1.4，P=0.16）相似。手术方法相似（住院总医师服务中 95.2%为腹腔镜，标准服务中 94.4%为腹腔镜），但住院总医师服务中的住院医师更常进行胆管造影术（48.4%与 22.6%，P<0.01），并且在有胆管造影的腹腔镜胆囊切除术时平均手术时间更长（146±28 与 85±22 min，P<0.01），无胆管造影时平均手术时间更长（94±31 与 76±35 min，P<0.01）。30 天并发症发生率相似（住院总医师 5.2%与标准 5.0%，P=0.95）。没有患者发生胆漏、胆管损伤或再次手术。急诊就诊率相似（住院总医师 12.1%与标准 7.4%，P=0.32）；住院总医师服务的再入院率较低（0.0%与标准 5.0%，P=0.03）。
在适当的监督下，住院总医师为接受胆囊切除术的患者提供安全的护理，同时指导医疗决策并根据自己的偏好进行实践。
