早期独立执业期间手部手术的并发症：一位外科医生的5年经验
Complications in Hand Surgery During Early Independent Practice: A Single Surgeon's 5-Year Experience.
作者信息
Samade Richard, Gordon Adam M, Vaghani Parth, Goyal Kanu S
机构信息
UT Southwestern Medical Center, Richardson, Texas, USA.
Medical College of Wisconsin, Milwaukee, USA.
出版信息
Hand (N Y). 2025 Mar;20(2):296-304. doi: 10.1177/15589447231201875. Epub 2023 Oct 3.
BACKGROUND
The objective of this study was to understand the frequency and types of complications, and the associated postoperative outcomes within the first 5 years of practice after hand and upper extremity surgery fellowship.
METHODS
This was a retrospective observational study of all patients seen and surgically treated by a single surgeon at a single institution from August 2014 to September 2019. This corresponded to the first 5 years of practice after fellowship. Data collected included patient demographics, perioperative data, complication type, and outcome of the complication (better/same/worse than preoperative status). Complications were classified using the Clavien-Dindo system and a unique, self-derived system.
RESULTS
In total, 3301 surgeries were performed during the first 5 years of practice. The overall complication rate was 7.9% (261 complications from 239 patients). The 30-day complication rate was 5.2% (171/3301). Eleven (4.2%) of the 261 complications occurred intraoperatively. The total number of complications significantly declined during the first 5 years of practice as follows: 74, 71, 46, 37, and 33 ( = .010, = .92). Hand and wrist were the most frequent anatomic locations involved and bone pathology was the predominant indication.
CONCLUSION
The overall surgical complication rate for hand and upper extremity surgery was 7.9%, with a 30-day complication rate of 5.2% (171/3301). The rate of complications after fellowship declined over the first 5 years of independent practice. Superficial infections were the most common complication. More than 90% of patients ultimately improved after addressing the complication.
LEVEL OF EVIDENCE
IV.
背景
本研究的目的是了解手部和上肢外科 fellowship 培训后的头 5 年实践中并发症的频率和类型，以及相关的术后结果。
方法
这是一项回顾性观察研究，对象为 2014 年 8 月至 2019 年 9 月在单一机构由单一外科医生诊治并接受手术治疗的所有患者。这对应于 fellowship 培训后的头 5 年实践。收集的数据包括患者人口统计学资料、围手术期数据、并发症类型以及并发症的结果（比术前状态更好/相同/更差）。并发症采用 Clavien-Dindo 系统和一种独特的自行设计的系统进行分类。
结果
在实践的头 5 年中，共进行了 3301 例手术。总体并发症发生率为 7.9%（239 例患者发生 261 例并发症）。30 天并发症发生率为 5.2%（171/3301）。261 例并发症中有 11 例（4.2%）发生在术中。在实践的头 5 年中，并发症总数显著下降，如下所示：74 例、71 例、46 例、37 例和 33 例（ = .010， = .92）。手部和腕部是最常受累的解剖部位，骨病理是主要指征。
结论
手部和上肢手术的总体手术并发症发生率为 7.9%，30 天并发症发生率为 5.2%（171/3301）。fellowship 培训后的并发症发生率在独立实践的头 5 年中有所下降。浅表感染是最常见的并发症。超过 90%的患者在处理并发症后最终病情改善。
证据级别
IV 级。
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