Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Geisinger Health System, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Geisinger Health System, Danville, PA.
J Hand Surg Am. 2024 Mar;49(3):222-229. doi: 10.1016/j.jhsa.2023.11.019. Epub 2023 Dec 28.
The purpose of this study was to compare the complication rates of endoscopic carpal tunnel release (ECTR) relative to orthopedic resident trainee involvement in the procedure.
All patients undergoing isolated, elective ECTR by two attending surgeons within a 59-month period were analyzed. Cases were categorized as the following according to the degree of resident involvement: ECTR performed by attending with either no resident or a resident as an assistant (group 1), resident performing a portion of the procedure (group 2), and resident performing the entire procedure (group 3). Early postoperative complications and/or intraoperative conversion to an open procedure were the outcomes of interest. We used a noninferiority design, hypothesizing that resident involvement would not be associated with inferior outcomes compared with cases without resident involvement. Multiple logistic regression models, adjusted for patient demographic and surgical characteristics, were fit to assess the relationship between resident involvement groups and complication/conversion outcomes.
A total of 1,167 ECTR cases (895 patients) were performed and returned for postoperative follow-up for at least 2 weeks after surgery. Operative time was significantly shorter for group 1 cases versus group 2 and 3 cases. The early postoperative complication and conversion rates were 1.7% and 1.0%, respectively. Superficial infection (1.2%), deep infection (0.3%), and transient neuropraxia (0.3%) occurred infrequently and did not differ relative to resident involvement. No differences in the odds of complication and/or conversion relative to resident involvement were observed.
The results of ECTR performed entirely or in part by attending-supervised resident trainees were not inferior to ECTR performed by an attending surgeon regarding the odds of experiencing complications or conversion to an open procedure. With appropriate supervision, ECTR can be performed safely by orthopedic and plastic surgery residents.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
本研究旨在比较内镜腕管松解术（ECTR）的并发症发生率与骨科住院医师参与手术的关系。
分析了两位主治医生在 59 个月内进行的所有择期单纯 ECTR 患者。根据住院医师参与程度将病例分为以下几类：主治医生完成手术，无住院医师或住院医师担任助手（组 1）、住院医师完成部分手术（组 2）和住院医师完成全部手术（组 3）。早期术后并发症和/或术中转为开放手术是研究的结果。我们采用非劣效性设计，假设住院医师的参与不会导致比无住院医师参与的病例更差的结果。使用多因素逻辑回归模型，根据患者的人口统计学和手术特征进行调整，评估住院医师参与组与并发症/转换结果之间的关系。
共进行了 1167 例 ECTR（895 例患者），术后至少 2 周进行了随访。与组 2 和 3 相比，组 1 的手术时间明显缩短。早期术后并发症和转化率分别为 1.7%和 1.0%。浅表感染（1.2%）、深部感染（0.3%）和短暂性神经病变（0.3%）发生率较低，与住院医师的参与无关。与住院医师的参与相比，并发症和/或转换的可能性没有差异。
在经历并发症或转为开放手术的几率方面，由主治医生监督的住院医师完全或部分进行的 ECTR 结果并不劣于由主治医生进行的 ECTR。在适当的监督下，骨科和整形外科住院医师可以安全地进行 ECTR。
研究类型/证据水平：治疗性 II 级。
