Ottesen Taylor D, Pathak Neil, Mercier Michael R, Kirwin David S, Lukasiewicz Adam M, Grauer Jonathan N, Rubin Lee E
Orthopedics. 2023 Jul-Aug;46(4):e237-e243. doi: 10.3928/01477447-20230125-05. Epub 2023 Jan 30.
During the past decade, US orthopedic residency graduates have become increasingly subspecialized presumably for decreased patient complications; however, no study has examined this clinical utility for foot and ankle (F&A) surgeries among different fellowship subspecialties. Data from American Board of Orthopaedic Surgery 1999 to 2016 Part II Board Certification Examinations were used to assess patients treated by F&A fellowship-trained, trauma fellowship-trained, and all other fellowship-trained orthopedic surgeons performing ankle fracture repair. Adverse events were compared by surgical complexity and fellowship status. Factors independently associated with surgical complications were identified using a binary multivariate logistic regression. A total of 45,031 F&A cases met inclusion criteria. From 1999 to 2016, the percentage of F&A procedures performed by F&A fellowship surgeons steadily increased. Surgical complications were significantly different between fellowship trainings (F&A, 7.23%; trauma, 6.65%; and other, 7.84%). This difference became more pronounced with more complicated fracture pattern. On multivariate regression, F&A fellowship training was associated with significantly decreased likelihood of surgeon-reported complications (odds ratio, 0.83; 95% CI, 0.76-0.92; <.001), as was trauma fellowship training (odds ratio, 0.90; 95% CI, 0.81-0.99; =.035). Despite presumed increased complexity of cases treated by F&A fellowship-trained surgeons, these patients had significantly decreased risk of surgeon-reported surgical complications, thus highlighting the value of F&A fellowship training. In the absence of vital patient comorbidity data in the American Board of Orthopaedic Surgery database, further research must examine specific patient comorbidities and case acuity and their influence on treatments and surgical complications between fellowship-trained and other orthopedic surgeons to further illuminate the value of subspecialty training. [. 2023;46(4):e237-e243.].
在过去十年中，美国骨科住院医师毕业生的专科化程度越来越高，据推测这是为了减少患者并发症；然而，尚无研究探讨不同专科 fellowship 培训在足踝（F&A）手术中的临床效用。利用美国骨科医师学会 1999 年至 2016 年第二部分委员会认证考试的数据，评估接受过 F&A fellowship 培训、创伤 fellowship 培训以及所有其他 fellowship 培训的骨科外科医生进行踝关节骨折修复治疗的患者。通过手术复杂性和 fellowship 状态比较不良事件。使用二元多变量逻辑回归确定与手术并发症独立相关的因素。共有 45,031 例 F&A 病例符合纳入标准。从 1999 年到 2016 年，由 F&A fellowship 外科医生进行的 F&A 手术比例稳步上升。不同 fellowship 培训之间的手术并发症存在显著差异（F&A 为 7.23%；创伤为 6.65%；其他为 7.84%）。随着骨折模式变得更加复杂，这种差异变得更加明显。在多变量回归分析中，F&A fellowship 培训与外科医生报告的并发症可能性显著降低相关（优势比为 0.83；95%置信区间为 0.76 - 0.92；P <.001），创伤 fellowship 培训也是如此（优势比为 0.90；95%置信区间为 0.81 - 0.99；P =.035）。尽管推测接受 F&A fellowship 培训的外科医生治疗的病例复杂性增加，但这些患者外科医生报告的手术并发症风险显著降低，从而凸显了 F&A fellowship 培训的价值。由于美国骨科医师学会数据库中缺乏重要的患者合并症数据，进一步的研究必须检查特定的患者合并症和病例严重程度，以及它们对接受 fellowship 培训的外科医生和其他骨科外科医生之间的治疗和手术并发症的影响，以进一步阐明专科培训的价值。[. 2023;46(4):e237 - e243.]
