Jovan John D, Marcel Aaron J, Myrick Karen M, Feinn Richard S, Blaine Theodore
Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, U.S.A.
Hospital for Special Surgery, New York, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Jul 20;5(4):100764. doi: 10.1016/j.asmr.2023.100764. eCollection 2023 Aug.
To examine the 30-day postoperative outcomes of resident involvement in shoulder-stabilization surgical procedures using the American College of Surgeons National Surgical Quality Improvement database.
We conducted a retrospective review of the National Surgical Quality Improvement database for all shoulder-stabilization procedures from 2010 to 2018. Procedures included arthroscopic Bankart, arthroscopic Bankart with SLAP repair, arthroscopic Bankart with Remplissage, open Bankart, anterior bone block, posterior bone block, Latarjet coracoid process transfer, and capsular shift/capsulorrhaphy for multidirectional instability. Data included preoperative demographics, comorbidities, and 30-day postoperative outcomes. Cases were categorized into 2 groups: "attending alone" and "attending and resident." Statistical analysis comparing groups on demographics and comorbidities included independent -test for continuous variables and Pearson χ or Fischer exact for categorical variables. A logistic regression model including propensity score was used to calculate adjusted odds ratio for outcomes.
A total of 3,954 patients undergoing shoulder-stabilization procedures were included in the study and 28.8% of patients had a resident involved in their procedure. Residents were more likely to be involved in procedure for patients who were of minority ethnicity ( < .001), a lower body mass index ( < .001) and less likely to have a history of chronic obstructive pulmonary disease ( = .029). Resident involvement resulted in statistically significant longer total operation time (91 vs 85 minutes, < .001). In terms of postsurgical outcomes, complication rates were low for both groups (∼0.8%). Resident involvement was not associated with any significant increase in 30-day postsurgical complications.
Our results show that resident involvement in shoulder-stabilization surgery is associated with a significant increase in operative time without any significant increase in 30-day postsurgical complications.
Level III, retrospective comparative study.
利用美国外科医师学会国家外科质量改进数据库，研究住院医师参与肩部稳定手术的术后30天结局。
我们对2010年至2018年期间国家外科质量改进数据库中所有肩部稳定手术进行了回顾性研究。手术包括关节镜下Bankart修复术、关节镜下Bankart修复术联合SLAP损伤修复术、关节镜下Bankart修复术联合Remplissage术、开放性Bankart修复术、前路骨块移植术、后路骨块移植术、Latarjet喙突转移术以及针对多向不稳定的关节囊移位/关节囊缝合术。数据包括术前人口统计学资料、合并症以及术后30天结局。病例分为两组：“仅由主治医生操作”和“主治医生及住院医师操作”。对两组人口统计学资料和合并症进行统计学分析，连续变量采用独立样本t检验，分类变量采用Pearson χ²检验或Fisher精确检验。采用包含倾向评分的逻辑回归模型计算结局的调整比值比。
本研究共纳入3954例行肩部稳定手术的患者，其中28.8%的患者手术有住院医师参与。住院医师参与手术的患者更可能为少数族裔（P<0.001）、体重指数较低（P<0.001），且患慢性阻塞性肺疾病的可能性较小（P = 0.029）。住院医师参与手术导致总手术时间在统计学上显著延长（91分钟对85分钟，P<0.001）。就术后结局而言，两组并发症发生率均较低（约0.8%）。住院医师参与手术与术后30天并发症的显著增加无关。
我们的结果表明，住院医师参与肩部稳定手术会使手术时间显著延长，但术后30天并发症并无显著增加。
III级，回顾性比较研究。
