B.C. George is associate professor of surgery and director, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
A.E. Thelen is a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan.
Acad Med. 2023 Nov 1;98(11S):S143-S148. doi: 10.1097/ACM.0000000000005368. Epub 2023 Aug 1.
Despite ongoing efforts to improve surgical education, surgical residents face gaps in their training. However, it is unknown if differences in the training of surgeons are reflected in the patient outcomes of those surgeons once they enter practice. This study aimed to compare the patient outcomes among new surgeons performing partial colectomy-a common procedure for which training is limited-and cholecystectomy-a common procedure for which training is robust.
The authors retrospectively analyzed all adult Medicare claims data for patients undergoing inpatient partial colectomy and inpatient cholecystectomy between 2007 and 2018. Generalized additive mixed models were used to investigate the associations between surgeon years in practice and risk-adjusted rates of 30-day serious complications and death for patients undergoing partial colectomy and cholecystectomy.
A total of 14,449 surgeons at 4,011 hospitals performed 340,114 partial colectomy and 355,923 cholecystectomy inpatient operations during the study period. Patients undergoing a partial colectomy by a surgeon in their 1st vs 15th year of practice had higher rates of serious complications (5.22% [95% CI, 4.85%-5.60%] vs 4.37% [95% CI, 4.22%-4.52%]; P < .01) and death (3.05% [95% CI, 2.92%-3.17%] vs 2.83% [95% CI, 2.75%-2.91%]; P < .01). Patients undergoing a cholecystectomy by a surgeon in their 1st vs 15th year of practice had similar rates of 30-day serious complications (4.11% vs 3.89%; P = .11) and death (1.71% vs 1.70%; P = .93).
Patients undergoing partial colectomy faced a higher risk of serious complications and death when the operation was performed by a new surgeon compared to an experienced surgeon. Conversely, patient outcomes following cholecystectomy were similar for new and experienced surgeons. More attention to partial colectomy during residency training may benefit patients.
尽管一直在努力改进外科教育，但外科住院医师的培训仍存在差距。然而，尚不清楚外科医生培训方面的差异是否会反映在他们进入实践后的患者结果中。本研究旨在比较接受部分结肠切除术（一种培训有限的常见手术）和胆囊切除术（一种培训广泛的常见手术）的新外科医生的患者结局。
作者回顾性分析了 2007 年至 2018 年间接受住院部分结肠切除术和住院胆囊切除术的所有成年医疗保险索赔数据。广义加性混合模型用于研究外科医生执业年限与接受部分结肠切除术和胆囊切除术患者 30 天严重并发症和死亡风险调整率之间的关联。
在研究期间，共有 14449 名外科医生在 4011 家医院进行了 340114 例部分结肠切除术和 355923 例胆囊切除术住院手术。接受第 1 年和第 15 年手术的外科医生进行部分结肠切除术的患者，严重并发症发生率较高（5.22% [95%CI，4.85%-5.60%] vs. 4.37% [95%CI，4.22%-4.52%]；P<.01）和死亡率（3.05% [95%CI，2.92%-3.17%] vs. 2.83% [95%CI，2.75%-2.91%]；P<.01）。接受第 1 年和第 15 年手术的外科医生进行胆囊切除术的患者，30 天严重并发症发生率相似（4.11% vs. 3.89%；P=.11）和死亡率（1.71% vs. 1.70%；P=.93）。
与经验丰富的外科医生相比，接受部分结肠切除术的患者由新外科医生进行手术时，严重并发症和死亡的风险更高。相反，新外科医生和经验丰富的外科医生进行胆囊切除术的患者结局相似。在住院医师培训期间更多地关注部分结肠切除术可能使患者受益。
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