College of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH.
Clin Spine Surg. 2021 Jul 1;34(6):E364-E369. doi: 10.1097/BSD.0000000000001157.
A retrospective cohort study.
The aim was to compare rates of adverse events and additional posterior lumbar interbody fusion (PLIF) cases assisted by residents versus cases performed solely by an orthopedic attending.
PLIF is a widely accepted surgical technique for the management of a variety of spinal conditions requiring spinal stabilization and fusion. However, no published studies have assessed the effects of resident involvement on intraoperative and postoperative outcomes in PLIF.
This retrospective study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2007 to 2012 to identify patients who underwent PLIF procedures. A propensity score matching model was utilized to reduce patient cohort variances. The perioperative data and outcomes in the matched population were analyzed using paired t test and the McNemar test in order to assess, based on resident presence, the rates of postoperative adverse events, readmission, reoperation within 30 days, and operative time.
In total, 1633 patients undergoing PLIF were included in the study, with 24.62% involving resident participation. The propensity score matching algorithm yielded 396 well-matched resident and nonresident pairs. Patients undergoing PLIF involving a resident were associated with a higher rate of readmission (1.77% vs. 0.00%; P=0.008), and longer operative time (245.7 vs. 197.7 min; P<0.001). However, these procedures were not associated with any significant difference in minor or severe adverse events.
Resident involvement in PLIF was associated with an increased rate of readmissions, and operative time; however, was not associated with an increase in minor or severe adverse events. Further investigation is needed to characterize the role of resident involvement based on level of training experience, as well as methods to improve the learning curve to independence while reducing postoperative hospital length of stay.
Level III-retrospective comparative study.
回顾性队列研究。
旨在比较住院医师辅助与仅由骨科主治医生进行的后路腰椎间融合术（PLIF）的不良事件发生率和附加 PLIF 病例。
PLIF 是一种广泛接受的手术技术，用于治疗多种需要脊柱稳定和融合的脊柱疾病。然而，目前尚无研究评估住院医师参与对 PLIF 术中及术后结果的影响。
本回顾性研究利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）登记处 2007 年至 2012 年的数据，确定接受 PLIF 手术的患者。利用倾向评分匹配模型来减少患者队列的差异。在匹配人群中，采用配对 t 检验和 McNemar 检验分析围手术期数据和结果，以评估根据住院医师的存在，术后不良事件、再入院、30 天内再次手术以及手术时间的发生率。
共纳入 1633 例接受 PLIF 的患者，其中 24.62%涉及住院医师参与。倾向评分匹配算法得出 396 对匹配良好的住院医师和非住院医师。涉及住院医师的 PLIF 手术与再入院率较高相关（1.77%比 0.00%；P=0.008），且手术时间较长（245.7 分钟比 197.7 分钟；P<0.001）。然而，这些手术与轻微或严重不良事件发生率无显著差异。
住院医师参与 PLIF 与再入院率和手术时间增加相关；但与轻微或严重不良事件发生率增加无关。需要进一步研究以根据培训经验水平确定住院医师参与的作用，以及在减少术后住院时间的同时提高独立学习曲线的方法。
三级-回顾性比较研究。
