《提升急诊腹部外科住院医师培训条件与地位法案实施效果的影响》。
Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery.
机构信息
Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
出版信息
Yonsei Med J. 2022 Aug;63(8):751-758. doi: 10.3349/ymj.2022.63.8.751.
PURPOSE
In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented in South Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who underwent emergency abdominal surgery.
MATERIALS AND METHODS
A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergency room (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a comparative analysis was performed for patient groups treated before and after AITR implementation.
RESULTS
The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis (82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was 439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after (post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and diagnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementation (434 min vs. 443 min, =0.230). AITR was not a significant risk factor for mortality (=0.225).
CONCLUSION
The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and there was no difference in the patients' clinical outcomes.
目的
2018 年，韩国全面实施了《改善住院医师培训条件与地位法案》（AITR）。本研究旨在探讨 AITR 实施对接受急诊腹部手术患者临床结局的影响。
材料与方法
共纳入 2015 年至 2019 年期间因就诊于急诊室（ER）而接受急诊腹部手术的 2571 例患者。回顾性分析电子病历。此外，还对 AITR 实施前后的患者组进行了对比分析。
结果
患者中位年龄为 48.0 岁，49.2%为男性。最常见的诊断是阑尾炎（82.6%），其次是主要腹部急症（9.9%）和胆囊炎（7.5%）。从到达 ER 到手术的中位时间为 439 分钟，52 例（2.0%）患者死亡。对接受手术的患者进行比较，手术前（pre-AITR；1453 例，56.5%）和手术后（post-AITR；1118 例，43.5%），年龄、24 小时轮班的住院医师人数和诊断均有显著差异。与 pre-AITR 相比，post-AITR 实施后从 ER 到达手术室的时间并没有明显延长（434 分钟 vs. 443 分钟，=0.230）。AITR 不是死亡的显著危险因素（=0.225）。
结论
实施 AITR 后，从 ER 到达急诊手术的时间没有明显增加，患者的临床结局也没有差异。
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