Hassan Abbas M, Egro Francesco M, Talanker Michael M, Shah Nikhil R, Liu Jun, Maricevich Renata S, Chang Edward I, Hanasono Matthew M, Selber Jesse C, Butler Charles E
Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Plastic Surgery, Baylor College of Medicine, Houston, Tex.
Plast Reconstr Surg Glob Open. 2023 Mar 8;11(3):e4709. doi: 10.1097/GOX.0000000000004709. eCollection 2023 Mar.
We compared the surgical skills and outcomes of microsurgical fellows who completed an independent versus integrated plastic surgery residency.
We reviewed outcomes of abdominal wall reconstructions performed autonomously by microsurgical fellows at our institution from March 2005 to June 2019; outcome measures included hernia recurrence, surgical site occurrence, surgical site infection, length of hospital stay, unplanned return to the operating room, and 30-day readmission. The microsurgical skills were prospectively evaluated using the validated Structured Assessment of Microsurgical Skills at the start and end of the fellowship, in an animal laboratory model and clinical microsurgical cases. Multivariable hierarchical models were constructed to evaluate study outcomes.
We identified 44 fellows and 118 consecutive patients (52% women) who met our inclusion criteria. Independent fellows performed 55% (n = 65) of cases, and 45% were performed by integrated fellows. We found no significant difference in hernia recurrence, surgical site occurrences, surgical site infections, 30-day readmission, unplanned return to the operating room, or length of stay between the two groups in adjusted models. Although laboratory scores were similar between the groups, integrated fellows demonstrated higher initial clinical scores (42.0 ± 4.9 versus 37.7 ± 5.0, = 0.04); however, the final clinical scores were similar (50.8 ± 6.0 versus 48.9 ± 5.2, = 0.45).
Independent and integrated fellows demonstrated similar long-term patient outcomes. Although integrated fellows had better initial microsurgical skills, evaluation at the conclusion of fellowship revealed similar performance, indicating that fellowship training allows for further development of competent surgeons.
我们比较了完成独立整形外科学住院医师培训与综合整形外科学住院医师培训的显微外科住院医师的手术技能和手术结果。
我们回顾了2005年3月至2019年6月期间在本机构由显微外科住院医师自主进行的腹壁重建手术结果；结果指标包括疝复发、手术部位事件、手术部位感染、住院时间、非计划重返手术室和30天再入院率。在住院医师培训开始和结束时，在动物实验室模型和临床显微外科病例中，使用经过验证的显微外科技能结构化评估对显微外科技能进行前瞻性评估。构建多变量分层模型以评估研究结果。
我们确定了44名住院医师和118例连续患者（52%为女性）符合我们的纳入标准。独立住院医师完成了55%（n = 65）的病例，45%由综合住院医师完成。在调整模型中，我们发现两组在疝复发、手术部位事件、手术部位感染、30天再入院率、非计划重返手术室或住院时间方面没有显著差异。尽管两组之间实验室评分相似，但综合住院医师的初始临床评分更高（42.0±4.9对37.7±5.0，P = 0.04）；然而，最终临床评分相似（50.8±6.0对48.9±5.2，P = 0.45）。
独立住院医师和综合住院医师显示出相似的长期患者结果。尽管综合住院医师最初的显微外科技能更好，但在住院医师培训结束时的评估显示表现相似，这表明住院医师培训能够促进有能力的外科医生的进一步发展。
