Jang Eugene S, Artin Michael G, Boddapati Venkat, Chan Chung Min, Spiguel Andre R, Gibbs C Parker, Scarborough Mark T, Tyler Wakenda K
University of Florida, Department of Orthopaedics and Rehabilitation, 3450 Hull Road, Gainesville, FL 32607, USA.
Columbia University Medical Center, Department of Orthopaedic Surgery, 622 West 168th Street PH11, New York, NY 10032, USA.
Sarcoma. 2021 Dec 18;2021:2645737. doi: 10.1155/2021/2645737. eCollection 2021.
The complexity of sarcoma surgery often justifies surgical assistants of higher levels of academic training: senior residents, fellows, or co-surgeons. The association between the level of training of assistants and outcomes of these procedures has yet to be studied.
The Current Procedural Terminology (CPT) codes comprising the "core" procedures for musculoskeletal oncology fellowships were gathered. After CPTs primarily capturing nononcologic procedures were excluded, the National Surgical Quality Improvement Program (NSQIP) database was used to find procedures with these CPTs. The severity of complications was assessed using the Severity Weighting of Postoperative Adverse Events in Orthopedic Surgery (SWORD) score. Resident/fellow presence was analyzed both as a binary variable and stratified by level of training.
In 159 cases meeting inclusion criteria, higher-level assistants were associated with increased rate of any complication (=0.006) and greater need for transfusion (=0.001) but also tended to be used in cases of longer duration (=0.001) and with higher total work relative value units (wRVUs) (=0.001). Multivariate analysis showed that while higher-wRVU procedures persisted as an independent predictor of increased complications (OR 1.028 per RVU unit, =0.002), neither the presence nor level of training of assistants had an independent effect on complication rates. Other independent predictors of 30-day complications were treatment comorbidity (OR 3.433, =0.010) and lower extremity location of the tumor (OR 4.393, =0.006). Severity of complications did not differ between any of the groups on either univariate or multivariate analysis.
Trainees of higher levels of academic training tend to be present for longer, higher-complexity musculoskeletal oncology cases, but the overall severity of complications from these do not significantly differ from lower-risk cases without trainees. Orthopedic oncologists may reassure patients that the presence of trainees and co-surgeons is not only safe but it may also help reduce the severity of complications in more complex procedures.
肉瘤手术的复杂性常常使得具有更高学术培训水平的手术助手成为必要：高级住院医师、研究员或联合外科医生。手术助手的培训水平与这些手术的结果之间的关联尚未得到研究。
收集了构成肌肉骨骼肿瘤学研究员“核心”手术的当前手术操作术语（CPT）代码。在排除主要记录非肿瘤手术的CPT代码后，使用国家外科质量改进计划（NSQIP）数据库查找具有这些CPT代码的手术。使用骨科手术术后不良事件严重程度加权（SWORD）评分评估并发症的严重程度。将住院医师/研究员的参与情况作为二元变量进行分析，并按培训水平进行分层。
在159例符合纳入标准的病例中，更高水平的助手与任何并发症发生率增加（P = 0.006）以及输血需求增加（P = 0.001）相关，但也倾向于在手术时间较长（P = 0.001）和总工作相对价值单位（wRVU）较高（P = 0.001）的病例中使用。多变量分析显示，虽然较高wRVU的手术仍然是并发症增加的独立预测因素（每RVU单位的OR为1.028，P = 0.002），但助手的存在与否或培训水平对并发症发生率均无独立影响。30天并发症的其他独立预测因素是治疗合并症（OR 3.433，P = 0.010）和肿瘤位于下肢（OR 4.393，P = 0.006）。在单变量或多变量分析中，任何组之间并发症的严重程度均无差异。
学术培训水平较高的受训人员往往参与时间更长、复杂性更高的肌肉骨骼肿瘤病例，但这些病例并发症的总体严重程度与没有受训人员的低风险病例相比并无显著差异。骨科肿瘤学家可以向患者保证，受训人员和联合外科医生的参与不仅安全，而且可能有助于降低更复杂手术中并发症的严重程度。
