Benito D A, Mamidi I, Pasick L J, Sparks A D, Badger C, Thakkar P, Goodman J F, Joshi A S
Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, USA.
J Laryngol Otol. 2021 May;135(5):452-457. doi: 10.1017/S0022215121000578. Epub 2021 Apr 29.
This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014.
There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05-0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11-0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters.
Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.
本研究旨在评估住院医师参与及“七月效应”对腮腺切除术后围手术期并发症的影响。
查询美国外科医师学会国家外科质量改进计划数据库中2005年至2014年间有住院医师参与的腮腺切除术病例。
共识别出11733例病例,其中932例有住院医师参与(7.9%)。住院医师参与导致再次手术率显著降低(调整后的优势比为0.18;95%置信区间为0.05 - 0.73;p = 0.02)和再入院率显著降低(调整后的优势比为0.30;95%置信区间为0.11 - 0.80;p = 0.02)。然而,住院医师参与与调整后的手术时间平均延长24分钟以及调整后的总住院时间延长23.5%相关(p均<0.01)。比较各学年季度的病例时,未发现手术或医疗并发症发生率及死亡率有显著差异。
住院医师参与与再次手术率和再入院率显著降低以及平均手术时间和总住院时间延长相关。七月期间住院医师的交接与腮腺切除术后围手术期不良结局风险增加无关。