Wiseman James E, Morris-Wiseman Lilah F, Hsu Chiu-Hsieh, Riall Taylor S
Department of Surgery, The University of Arizona College of Medicine - Tucson, Tucson, Arizona.
Department of Surgery, The University of Arizona College of Medicine - Tucson, Tucson, Arizona.
J Surg Res. 2022 Feb;270:564-570. doi: 10.1016/j.jss.2021.09.038. Epub 2021 Nov 26.
Prior studies on laparoscopic cholecystectomy (LC) have concluded that resident involvement lengthens operative time without impacting outcomes. However, the lack of effect of resident level on operative duration has not been explained. We hypothesized that attending-specific influence on average operative time for LC is more pronounced than resident post-graduate year level.
We retrospectively analyzed all LC cases performed on patients 18 y and older between November 2018 and March 2020 at 2 academic medical center-affiliated hospitals. Regression models were used to compare operative times, conversion to open rates, and complication rates by attending surgeon and resident level.
Nine hundred twenty-five LCs were performed over the study period, 862 (93.1%) with resident participation. Of the 44.5% variation in operative time was explained by differences in attending surgeon, as compared to 11.0% attributable to differences in resident level (P < 0.0001). This effect persisted after adjusting for patient and disease factors (33.0% versus 7.1%, P < 0.0001). Neither attending surgeon (P = 0.80), nor the level of the involved resident (P = 0.94) demonstrated a significant effect on the conversion-to-open rate (4.9%). Similarly, neither the attending surgeon (P = 0.33), nor resident level (P = 0.81) significantly affected the complication rate (8.58%).
Operative time for LC is primarily determined by patient- and disease-specific factors; resident level has no effect on conversion to open or complication rates. Attending influence on operative time was more pronounced than resident level influence. These findings suggest attending surgeon-related factors are more important than resident experience in determining operative duration for LC.
先前关于腹腔镜胆囊切除术（LC）的研究得出结论，住院医师参与会延长手术时间，但不影响手术结果。然而，住院医师水平对手术时长缺乏影响这一点尚未得到解释。我们推测，主刀医生对LC平均手术时间的特定影响比住院医师的研究生年级水平更为显著。
我们回顾性分析了2018年11月至2020年3月期间在两家学术医学中心附属医院为18岁及以上患者进行的所有LC病例。采用回归模型比较主刀医生和住院医师水平的手术时间、转为开腹手术的比例以及并发症发生率。
在研究期间共进行了925例LC手术，其中862例（93.1%）有住院医师参与。手术时间44.5%的差异可由主刀医生的不同来解释，相比之下，11.0%可归因于住院医师水平的差异（P<0.0001）。在对患者和疾病因素进行调整后，这种影响仍然存在（33.0%对7.1%，P<0.0001）。主刀医生（P=0.80）和参与手术的住院医师水平（P=0.94）对转为开腹手术的比例（4.9%）均未显示出显著影响。同样，主刀医生（P=0.33）和住院医师水平（P=0.81）对并发症发生率（8.58%）均无显著影响。
LC的手术时间主要由患者和疾病的特定因素决定；住院医师水平对转为开腹手术或并发症发生率没有影响。主刀医生对手术时间比住院医师水平的影响更为显著。这些发现表明，在确定LC手术时长方面，主刀医生相关因素比住院医师经验更为重要。
