Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA.
Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA.
Ann Vasc Surg. 2022 Nov;87:57-63. doi: 10.1016/j.avsg.2022.04.032. Epub 2022 Apr 23.
Gradual increases in resident autonomy with attending physician oversight is crucial to developing safe and competent surgeons. The Veterans Affairs Surgical Quality Improvement Program (VASQIP) follows surgical outcomes within the VA. We set forth to examine the VASQIP database to compare outcomes between resident independent cases and nonindependent cases during below-the-knee amputations (BKA).
All VASQIP records for BKA from 2000 to 2020 were examined and categorized based on whether the attending was scrubbed during the case. Case matching was performed based on preoperative comorbidities; 30-day postoperative outcomes, including a return to the operating room, wound infection, and mortality, were assessed in addition to operative time, hospital length of stay, and transfusion requirements. Student's t-test and Fisher's Exact Test were utilized.
A total of 13,208 BKA VASQIP records were obtained. After case control matching, 2,688 cases remained. Cases were identified with the attending surgeon noted as being scrubbed during the case (n = 1,344), or not scrubbed (n = 1,344). Patients were similar in comorbidities across both groups. No statistically significant difference in operative time (1.52 hr ± 0.78 vs. 1.47 hr ± 0.75, P = 0.08), 30-day mortality (3.3% vs. 4.8%, P = 0.05), or complication rate (19.5% vs. 21.3%, P = 0.25). Resident independent cases were noted to have slightly longer postop length of stay (12.47 days ± 12.69 vs. 15.33 days ± 20.56, P < 0.01) and operative bleeding requiring more than 4 units transfused (0.3% vs. 1.3%, P ≤ 0.01).
Resident independent operating during below-the-knee amputation at VA hospitals is associated with an increased length of stay and blood transfusion. There was no statistically significant increase in operative time, 30-day mortality, or total complication rate. Further research is required to assess the risks associated with surgical training, resident supervision, and resident preparedness for independent practice.
在主治医生监督下逐渐增加住院医师的自主权，对于培养安全且有能力的外科医生至关重要。退伍军人事务部外科质量改进计划（VASQIP）在退伍军人事务部内跟踪外科手术结果。我们着手检查 VASQIP 数据库，以比较在膝下截肢（BKA）期间住院医师独立病例和非独立病例的结果。
检查了 2000 年至 2020 年期间所有 VASQIP 记录，并根据手术期间主治医生是否进行了擦洗来进行分类。根据术前合并症进行病例匹配；评估了 30 天术后结果，包括返回手术室、伤口感染和死亡率，以及手术时间、住院时间和输血需求。使用学生 t 检验和 Fisher 精确检验。
共获得 13208 例 BKA VASQIP 记录。在病例对照匹配后，剩下 2688 例。将手术中记录主治医生进行擦洗的病例（n=1344）和未进行擦洗的病例（n=1344）确定为病例。两组患者的合并症相似。手术时间（1.52 小时±0.78 与 1.47 小时±0.75，P=0.08）、30 天死亡率（3.3%与 4.8%，P=0.05）或并发症发生率（19.5%与 21.3%，P=0.25）无统计学差异。独立手术的住院医师术后住院时间稍长（12.47 天±12.69 与 15.33 天±20.56，P<0.01），需要输注超过 4 单位血液的手术出血（0.3%与 1.3%，P≤0.01）更多。
退伍军人事务部医院在膝下截肢手术中住院医师独立操作与住院时间延长和输血增加有关。手术时间、30 天死亡率或总并发症率没有统计学显著增加。需要进一步研究评估与手术培训、住院医师监督和住院医师独立实践准备相关的风险。
