Crutchfield Connor R, Zhong Jack R, Lee Nathan J, Trofa David P, Lynch T Sean
Columbia University Irving Medical Center, New York, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2021 Aug 19;3(5):e1367-e1376. doi: 10.1016/j.asmr.2021.06.005. eCollection 2021 Oct.
To evaluate whether the presence of residents in hip arthroscopy (HA) procedures affects short-term surgical outcomes.
The American College of Surgeons National Surgical Quality Improvement Program Database was used to identify patients who underwent HA from 2006 to 2012. Demographic and 30-day outcome variables were compared between cohorts of patients with and without residents. Multivariate logistic regression was used to identify whether resident involvement was an independent risk factor for adverse outcomes. Propensity score matching was performed to control for all demographic and intraoperative variables.
A total of 869 patients (59.7% female) were included in this study, 626 of which reported data on resident involvement. Patients were mostly White (73.4% of cases without a resident, 51.8% with a resident, < .05). Those with residents were younger ( = .016), had lower modified 5-item frailty index (mFI-5) scores ( = .028), and had fewer cardiac comorbidities ( = .008). There was no difference in diabetic status, dyspnea symptoms, history of chronic obstructive pulmonary disease, renal comorbidity, neurologic comorbidity, cumulative comorbidities, history of bleeding disorders, inpatient vs. outpatient treatment, preoperative functional status, smoking history, and steroid use for chronic conditions. There was no difference in all complications, operative time, length of stay, reoperation, readmission, wound complication, venous thromboembolism, blood transfusions, or sepsis. Propensity score match for demographic and intraoperative differences found no association between resident involvement and increased complications. Resident involvement was not an independent risk factor for all complications studied.
Resident involvement in HA procedures was not a risk factor for 30-day complications between 2006 and 2012. Resident involvement did not increase the risk of adverse outcomes, readmission, reoperation, or length of stay, nor did it significantly increase operative times.
评估髋关节镜检查（HA）手术中住院医师的参与是否会影响短期手术效果。
利用美国外科医师学会国家外科质量改进计划数据库，确定2006年至2012年期间接受HA手术的患者。比较有和没有住院医师参与的患者队列的人口统计学和30天结局变量。采用多因素逻辑回归分析确定住院医师参与是否是不良结局的独立危险因素。进行倾向评分匹配以控制所有人口统计学和术中变量。
本研究共纳入869例患者（59.7%为女性），其中626例报告了住院医师参与情况的数据。患者大多为白人（无住院医师参与的病例中占73.4%，有住院医师参与的病例中占51.8%，P<0.05）。有住院医师参与的患者更年轻（P=0.016），改良5项虚弱指数（mFI-5）得分更低（P=0.028），心脏合并症更少（P=0.008）。糖尿病状态、呼吸困难症状、慢性阻塞性肺疾病病史、肾脏合并症、神经合并症、累积合并症、出血性疾病病史、住院与门诊治疗、术前功能状态、吸烟史以及慢性病类固醇使用情况方面无差异。所有并发症、手术时间、住院时间、再次手术、再次入院、伤口并发症、静脉血栓栓塞、输血或败血症方面均无差异。对人口统计学和术中差异进行倾向评分匹配后发现，住院医师参与与并发症增加之间无关联。住院医师参与并非所研究的所有并发症的独立危险因素。
2006年至2012年期间，住院医师参与HA手术并非30天并发症的危险因素。住院医师参与并未增加不良结局、再次入院、再次手术或住院时间的风险，也未显著增加手术时间。
