倾向性评分匹配分析：资深住院医师与研究员参与对复杂肿瘤外科学治疗结果的影响。
A propensity score matching analysis: Impact of senior resident versus fellow participation on outcomes of complex surgical oncology.
机构信息
Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
Department of Surgery, Boston Medical Center, Boston, MA, USA.
出版信息
Surg Oncol. 2023 Jun;48:101925. doi: 10.1016/j.suronc.2023.101925. Epub 2023 Mar 9.
BACKGROUND
Teaching hospitals that train both general surgery residents and fellows in complex general surgical oncology have become more common. This study investigates whether participation of a senior resident versus a fellow has an impact on outcomes of patients undergoing complex cancer surgery.
METHODS
Patients who underwent esophagectomy, gastrectomy, hepatectomy, or pancreatectomy between 2007 and 2012 with assistance from a senior resident (post-graduate years 4-5) or a fellow (post-graduate years 6-8) were identified from the ACS NSQIP. Based on age, sex, body mass index, ASA classification, diagnosis of diabetes mellitus, and smoking status, propensity-scores were created for odds of undergoing the operation assisted by a fellow. Patients were matched 1:1 based on propensity score. Postoperative outcomes including risk of major complication were compared after matching.
RESULTS
In total, 6934 esophagectomies, 13,152 gastrectomies, 4927 hepatectomies, and 8040 pancreatectomies were performed with assistance of a senior resident or fellow. After matching, overall rates of major complications were equivalent across all four anatomic locations between cases performed with the participation of a senior resident versus a surgical fellow: esophagectomy (37.0%% vs 31.6%, p = 0.10), gastrectomy (22.6% vs 22.3%, p = 0.93), hepatectomy (15.8% v 16.0%, p = 0.91), and pancreatectomy (23.9% vs 25.2%, p = 0.48). Operative time was shorter for gastrectomy (212 vs. 232 min; p = 0.004) involving a resident compared to a fellow, but comparable for esophagectomy (330 vs. 336 min; p = 0.41), hepatectomy (217 vs. 219 min; p = 0.85), and pancreatectomy (320 vs. 330 min; p = 0.43).
CONCLUSIONS
Senior resident participation in complex cancer operations does not appear to negatively impact operative time or postoperative outcomes. Future research is needed to further assess this domain of surgical practice and education, particularly with regard to case selection and operative complexity.
背景
培训普通外科住院医师和外科住院医师的教学医院在复杂普通外科肿瘤学方面变得越来越普遍。本研究调查了高级住院医师与住院医师参与复杂癌症手术对患者结局的影响。
方法
从 ACS NSQIP 中确定了 2007 年至 2012 年期间接受食管切除术、胃切除术、肝切除术或胰腺切除术并由高年级住院医师（研究生第 4-5 年）或住院医师（研究生第 6-8 年）协助的患者。根据年龄、性别、体重指数、ASA 分类、糖尿病诊断和吸烟状况，为接受住院医师协助手术的可能性创建倾向评分。根据倾向评分对患者进行 1:1 匹配。匹配后比较术后主要并发症风险。
结果
共有 6934 例食管切除术、13152 例胃切除术、4927 例肝切除术和 8040 例胰腺切除术由高年级住院医师或住院医师协助完成。匹配后，在所有四个解剖部位，由高级住院医师参与的病例与由外科住院医师参与的病例的主要并发症总体发生率相当：食管切除术（37.0% 比 31.6%，p=0.10），胃切除术（22.6% 比 22.3%，p=0.93），肝切除术（15.8% 比 16.0%，p=0.91），和胰腺切除术（23.9% 比 25.2%，p=0.48）。与住院医师相比，胃切除术（212 分钟比 232 分钟；p=0.004）的手术时间更短，但与食管切除术（330 分钟比 336 分钟；p=0.41），肝切除术（217 分钟比 219 分钟；p=0.85）和胰腺切除术（320 分钟比 330 分钟；p=0.43）的手术时间相当。
结论
高级住院医师参与复杂癌症手术似乎不会对手术时间或术后结果产生负面影响。需要进一步研究来进一步评估这一外科实践和教育领域，特别是在病例选择和手术复杂性方面。
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