Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
J Surg Educ. 2022 Sep-Oct;79(5):1246-1252. doi: 10.1016/j.jsurg.2022.05.010. Epub 2022 May 29.
We hypothesized that a Chief Resident Service educational model provides safe care for patients compared to that received on standard academic services where rotating residents adopt the practices and preferences of their attending.
We retrospectively identified patients undergoing inguinal hernia repairs from July 2016 through June 2019 and matched Chief's service patients to standard academic service patients 1:1 on CPT, sex and age. We compared patient characteristics, recurrence rates, outcomes and complications.
Tertiary care center, single institution.
Overall, 77 patients undergoing inguinal hernia repairs (66% open and 34% laparoscopic) on the Chief's service matched successfully to 77 standard academic service patients during the study period.
Age, BMI and ASA were similar between the services, but Chief's service patients were less likely to be current smokers (1.3% vs. 24.7%) and more likely to be former smokers (59.7% vs. 26.0%) than standard academic service patients (p < 0.01). Patients presenting with incarcerated hernias (5.2% vs. 9.1%), recurrent (10.4% vs. 5.2%) and bilateral hernias (19.5% vs. 10.4%) were similar between the Chief's service and standard academic services, respectively (all p > 0.05). Operative times were longer for the Chief's service for open (123 min vs. 67, p < 0.01) and laparoscopic (112 min vs. 79, p = 0.02) repairs. Recurrence rates (6.5% vs. 3.9%, p = 0.47) and complications including infection, seroma or hematoma requiring evacuation and need for reoperation were similarly low (p > 0.05) between the Chief's and standard academic services, respectively. Despite low complication rates, Chief's service patients were more likely to present to the ED post-op (14.3% vs. 1.3%; p = 0.001), but readmission rates were similarly low (2.6% vs. 0%, p = 0.09).
Providing general surgery chief residents with a supervised opportunity to direct, plan and provide surgical care in clinic and the operating room, as a transition to independent practice following graduation, is safe for patients presenting with inguinal hernias. Concerns about patient safety should not be a barrier to maximizing entrustment for the evaluation and operative management of select core general surgery diagnoses and operations.
我们假设住院总医师服务教育模式为患者提供的安全保障与标准学术服务相当，而后者中轮转住院医师采用主治医生的实践和偏好。
我们回顾性地确定了 2016 年 7 月至 2019 年 6 月间接受腹股沟疝修补术的患者，并按照 CPT、性别和年龄将住院总医师服务的患者与标准学术服务的患者 1:1 匹配。我们比较了患者特征、复发率、结果和并发症。
三级医疗中心，单机构。
总体而言，在研究期间，共有 77 名在住院总医师服务下接受腹股沟疝修补术的患者（66%为开放式，34%为腹腔镜式）成功与 77 名标准学术服务患者相匹配。
服务间的年龄、BMI 和 ASA 相似，但与标准学术服务患者相比，住院总医师服务患者中当前吸烟者（1.3% vs. 24.7%）较少，而前吸烟者（59.7% vs. 26.0%）较多（p<0.01）。嵌顿疝（5.2% vs. 9.1%）、复发（10.4% vs. 5.2%）和双侧疝（19.5% vs. 10.4%）的患者在住院总医师服务和标准学术服务间相似（均 p>0.05）。开放手术（123 分钟 vs. 67 分钟，p<0.01）和腹腔镜手术（112 分钟 vs. 79 分钟，p=0.02）的手术时间在住院总医师服务中更长。复发率（6.5% vs. 3.9%，p=0.47）和并发症发生率，包括感染、血清肿或血肿需要引流和需要再次手术，在住院总医师服务和标准学术服务间相似（均 p>0.05）。尽管并发症发生率较低，但住院总医师服务患者术后更有可能到急诊就诊（14.3% vs. 1.3%；p=0.001），但再入院率相似（2.6% vs. 0%，p=0.09）。
为即将毕业的住院总医师提供监督机会，使其在诊所和手术室中直接、计划和提供手术护理，作为毕业后独立执业的过渡，对患有腹股沟疝的患者是安全的。对于患者安全的担忧不应该成为限制对特定核心普通外科诊断和手术进行评估和手术管理的委托权限的障碍。
