早期新冠疫情期间手术室限制措施对美国神经外科住院医师培训的教育影响：一项多中心研究
Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study.
作者信息
Zhang Justin K, Del Valle Armando, Ivankovic Sven, Patel Niel, Alexopoulos Georgios, Khan Maheen, Durrani Sulaman, Patel Mayur, Tecle Najib El, Sujijantarat Nanthiya, Jenson Amanda V, Zammar Samer G, Huntoon Kristin, Goulart Carlos R, Wilkinson Brandon M, Bhimireddy Sujit, Britz Gavin W, DiLuna Michael, Prevedello Daniel M, Dinh Dzung H, Mattei Tobias A
机构信息
Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US.
Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US.
出版信息
N Am Spine Soc J. 2022 Feb 19;9:100104. doi: 10.1016/j.xnsj.2022.100104. eCollection 2022 Mar.
BACKGROUND
The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads.
METHODS
A retrospective review of neurosurgical caseloads among seven residency programs between March 2019 and April 2020 was conducted. Cases were grouped by ACGME Neurosurgery Case Categories, subspecialty, and urgency (elective vs. emergent). Residents caseloads were stratified into junior (PGY1-3) and senior (PGY4-7) levels. Descriptive statistics are reported for individual programs and pooled across institutions.
RESULTS
When pooling across programs, the 2019 monthly mean (SD) case volume was 214 (123) cases compared to 217 (129) in January 2020, 210 (115) in February 2020, 157 (81), in March 2020 and 82 (39) cases April 2020. There was a 60% reduction in caseload between April 2019 (207 [101]) and April 2020 (82 [39]). Adult spine cases were impacted the most in the pooled analysis, with a 66% decrease in the mean number of cases between March 2020 and April 2020. Both junior and senior residents experienced a similar steady decrease in caseloads, with the largest decreases occurring between March and April 2020 (48% downtrend).
CONCLUSIONS
Results from our multicenter study reveal considerable decreases in caseloads in the neurosurgical specialty with elective adult spine cases experiencing the most severe decline. Both junior and senior neurosurgical residents experienced dramatic decreases in case volumes during this period. With the steep decline in elective spine cases, it is possible that fellowship directors may see a disproportionate increase in spine fellowships in the coming years. In the face of the emerging Delta and Omicron variants, programs should pay attention toward identifying institution-specific deficiencies and developing plans to mitigate the negative educational effects secondary to such caseloads reduction.
背景
冠状病毒（COVID-19）大流行导致神经外科择期手术史无前例地暂停，其中很大一部分涉及脊柱手术。本研究的目的是报告关于COVID-19大流行早期手术室限制对学术机构神经外科病例数量影响的详细数据，并关注其对神经外科住院医师培训的间接影响。这是第一项研究这些早期影响对神经外科住院医师病例量的多中心定量研究。
方法
对2019年3月至2020年4月期间七个住院医师培训项目的神经外科病例量进行回顾性分析。病例按美国研究生医学教育认证委员会（ACGME）神经外科病例分类、亚专业和紧急程度（择期与急诊）进行分组。住院医师的病例量分为初级（PGY1-3）和高级（PGY4-7）级别。报告了各个项目的描述性统计数据，并汇总了各机构的数据。
结果
汇总各项目的数据后，2019年月均（标准差）病例量为214（123）例，2020年1月为217（129）例，2020年2月为210（115）例，2020年3月为157（81）例，2020年4月为82（39）例。2019年4月（207[101]）至2020年4月（82[39]）病例量减少了60%。在汇总分析中，成人脊柱病例受影响最大，2020年3月至2020年4月间平均病例数减少了66%。初级和高级住院医师的病例量均出现了类似的稳步下降，最大降幅出现在2020年3月至4月之间（下降趋势为48%）。
结论
我们的多中心研究结果显示，神经外科专业的病例量大幅下降，择期成人脊柱病例下降最为严重。在此期间，初级和高级神经外科住院医师的病例量均大幅下降。由于择期脊柱病例急剧减少，未来几年专科培训主任可能会看到脊柱专科培训名额不成比例地增加。面对新出现的德尔塔和奥密克戎变种，各项目应注意识别机构特有的不足，并制定计划以减轻因病例量减少而产生的负面教育影响。
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