Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, USA; West Chester Statistical Institute and Department of Mathematics, West Chester University, 25 University Ave, West Chester, PA, USA.
Clin Neurol Neurosurg. 2022 Oct;221:107388. doi: 10.1016/j.clineuro.2022.107388. Epub 2022 Jul 25.
A hallmark of surgical training is resident involvement in operative procedures. While resident-assisted surgeries have been deemed generally safe, few studies have rigorously isolated the impact of resident post-graduate year (PGY) level on post-operative outcomes in a neurosurgical patient population. The objective of this study is to evaluate the relationship between resident training level and outcomes following single-level, posterior-only lumbar fusion, after matching on key patient demographic/clinical characteristics and attending surgeon.
This coarsened-exact matching (CEM) study analyzed 2338 consecutive adult patients who underwent single-level lumbar fusion with a resident assistant surgeon at a multi-hospital university health system from 2013 to 2019. Primary outcomes were 30-day and 90-day readmissions, Emergency Department (ED) visits, reoperations, surgical complications, and mortality. First, univariate logistic regression examined the relationship between PGY level and outcomes. Then, CEM was used to control for key patient characteristics - such as race and comorbid status - and supervising attending surgeon, between the most junior (PGY-2)-assisted cases and the most senior (PGY-7)-assisted cases, thereby isolating the relationship between training level and outcomes.
Among all patients, resident training level was not associated with risk of adverse post-surgical outcomes. Similarly, between exact-matched cohorts of PGY-2- and PGY-7-assisted cases, no significant differences in adverse events or discharge disposition were observed. Patients with the most senior resident assistant surgeons demonstrated longer length of stay (mean 100.5 vs. 93.8 h, p = 0.022) and longer duration of surgery (mean 173.5 vs. 159.8 min, p = 0.036).
Training level of the resident assistant surgeon did not impact adverse outcomes provided to patients in the setting of single-level, posterior-only lumbar fusion. These findings suggest that attending surgeons appropriately manage cases with resident surgeons at different levels of training.
外科培训的一个标志是住院医师参与手术操作。虽然住院医师辅助手术被认为是相对安全的，但很少有研究严格分离住院医师毕业后年限（PGY）水平对神经外科患者术后结果的影响。本研究的目的是评估在多医院大学健康系统中，在匹配关键患者人口统计学/临床特征和主治医生后，住院医师培训水平与单节段后路腰椎融合术后结果之间的关系。
这项粗糙精确匹配（CEM）研究分析了 2013 年至 2019 年期间，在多医院大学健康系统中，有一名住院医师助理外科医生参与的 2338 例连续成年患者的单节段腰椎融合术。主要结果是 30 天和 90 天的再入院、急诊（ED）就诊、再次手术、手术并发症和死亡率。首先，单变量逻辑回归分析了 PGY 水平与结果之间的关系。然后，使用 CEM 来控制关键患者特征，如种族和合并症状态，以及主治医生，在最年轻（PGY-2）辅助病例和最年长（PGY-7）辅助病例之间，从而隔离培训水平与结果之间的关系。
在所有患者中，住院医师培训水平与术后不良结果的风险无关。同样，在 PGY-2 和 PGY-7 辅助病例的精确匹配队列之间，观察到不良事件或出院处置没有显著差异。具有最高级住院医师助理外科医生的患者表现出更长的住院时间（平均 100.5 比 93.8 小时，p=0.022）和更长的手术时间（平均 173.5 比 159.8 分钟，p=0.036）。
在单节段后路腰椎融合术的情况下，住院医师助理外科医生的培训水平并不影响患者的不良结局。这些发现表明主治医生可以适当管理具有不同培训水平的住院医师外科医生的病例。
