Maheshwari Aditya V, Garnett Christopher T, Cheng Tzu H, Buksbaum Joshua R, Singh Vivek, Shah Neil V
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA.
Department of Anesthesiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA.
Arthroplast Today. 2022 Apr 8;15:202-209.e4. doi: 10.1016/j.artd.2022.02.029. eCollection 2022 Jun.
Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs).
Fifty patients undergoing single-staged sequential bilateral primary TKAs were evaluated. The more symptomatic side was performed by the attending surgeon first, followed by the contralateral side performed by a chief resident under direct supervision and assistance of the same attending surgeon. Surgery was subdivided into 8 critical steps on both sides. The overall time and critical stepwise surgical time and short-term clinical outcomes were then compared between the 2 sides.
The attending surgeon completed the surgery (skin incision to dressing) significantly faster than the resident (70.2 vs 96.9 minutes) by a mean of 26.7 minutes ( < .05) and was also faster in all steps. The most significant differences in time were in "exposure" (9.5 vs 16.5 minutes) and "closure" steps (13.2 vs 24.9 minites), all < .001. Adverse events occurred in 7 patients; 5 of these resolved uneventfully. There were no significant differences in surgical complications, objective outcome scores, or patient satisfaction scores between both sides.
Resident participation in TKA increased operative time without jeopardizing short-term patient clinical outcomes, satisfaction, and complications. This may alleviate concerns from patients and policymakers about TKA in an academic setting. Surgical "exposure" and "closure" were the most prolonged steps for the residents, and they may benefit with more focus and/or simulation studies during training.
尽管多项研究间接比较了教学医院和非教学医院，但结果相互矛盾，且缺乏对实习生参与的直接影响的评估。我们调查了住院医师参与初次全膝关节置换术（TKA）的直接影响。
对50例行单阶段序贯双侧初次TKA的患者进行评估。症状较重的一侧由主刀医生先进行手术，然后由一名总住院医师在同一名主刀医生的直接监督和协助下对另一侧进行手术。两侧手术均细分为8个关键步骤。然后比较两侧的总手术时间、关键步骤手术时间和短期临床结果。
主刀医生完成手术（从皮肤切口到包扎）的速度明显快于住院医师（70.2分钟对96.9分钟），平均快26.7分钟（P<0.05），且在所有步骤中都更快。时间差异最显著的是“暴露”步骤（9.5分钟对16.5分钟）和“缝合”步骤（13.2分钟对24.9分钟），均P<0.001。7例患者发生不良事件；其中5例顺利解决。两侧在手术并发症、客观结果评分或患者满意度评分方面无显著差异。
住院医师参与TKA增加了手术时间，但不影响患者的短期临床结果、满意度和并发症。这可能会减轻患者和政策制定者对学术环境中TKA的担忧。手术“暴露”和“缝合”是住院医师耗时最长的步骤，他们可能会从培训期间更多的专注和/或模拟研究中受益。
