Drinane James J, Drolet Brian, Patel Ashit, Ricci Joseph A
Department of Surgery, The Division of Plastic Surgery, Albany Medical Center, Albany, New York, United States.
The Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
J Hand Microsurg. 2020 Jun 1;14(2):132-137. doi: 10.1055/s-0040-1713066. eCollection 2022 Apr.
Fellowship-trained hand surgeons may have residency training in either orthopedic, plastic, or general surgery, generating significant variability in education background. To study the effect of different training backgrounds on practice pattern variations, we utilized the NSQIP (National Surgical Quality Improvement Database) database to assess hand surgery volumes and case variety by specialty. NSQIP years 2008 to 2017 was queried with hand surgery current procedural terminology codes defined by the American Board of Orthopedic Surgery. Procedures were grouped according to type and specialty, and relative rates calculated. Hand society membership data were used to determine if procedural volume for each specialty in each category and overall contribution to the volume of hand surgery performed nationally was distributed in accordance with membership data. A total of 145,015 hand surgeries were performed; 13,267 (9.1%) by general surgeons, 28,402 (19.6%) by plastic surgeons, and 103,346 (71.3%) by orthopedic surgeons. Orthopedic surgeons performed significantly more bone, fracture, joint, and tendon cases. General surgeons and plastic surgeons performed higher than expected numbers of soft tissue coverage and cases overall with respective excesses of 183 and 22%. Hand surgery is an available fellowship pathway from multiple residencies. Fellowship training does not level the field of real-world practice patterns. Residency training experiences significantly impact practice.
接受过 fellowship 培训的手外科医生可能在骨科、整形外科或普通外科接受过住院医师培训，这导致教育背景存在很大差异。为了研究不同培训背景对实践模式差异的影响，我们利用 NSQIP（国家外科质量改进数据库）数据库，按专业评估手外科手术量和病例种类。
查询了 2008 年至 2017 年 NSQIP 中由美国骨科手术委员会定义的手外科当前手术操作术语代码。手术根据类型和专业进行分组，并计算相对比率。手部协会会员数据用于确定每个类别中每个专业的手术量以及对全国手外科手术量的总体贡献是否与会员数据一致。
共进行了 145,015 例手外科手术；普通外科医生进行了 13,267 例（9.1%），整形外科医生进行了 28,402 例（19.6%），骨科医生进行了 103,346 例（71.3%）。骨科医生进行的骨骼、骨折、关节和肌腱病例明显更多。普通外科医生和整形外科医生进行的软组织覆盖手术和总体病例数高于预期，分别超出 183 例和 22%。
手外科是多个住院医师培训项目都可选择的 fellowship 途径。fellowship 培训并不能使实际实践模式领域达到平衡。住院医师培训经历会显著影响实践。
