Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA.
Case Western Reserve University, Cleveland, OH, USA.
Surg Endosc. 2024 Oct;38(10):6017-6025. doi: 10.1007/s00464-024-11122-0. Epub 2024 Aug 6.
It has been reported that higher surgeon experience leads to better patient outcomes. In this study, we look at surgeon experience and its association with postoperative outcomes and variation among the practice of surgeons performing paraesophageal hernia repairs (PEH).
This was a retrospective study of 1155 patients who underwent PEH repair at a single institution (2010-2023). Surgeon experience was defined as the number of surgeries performed per surgeon and was split using the median surgeries (n = 100), with surgeons performing at or above the median categorized as high-experience and below the median as low-experience surgeons. A multivariable logistic regression model was used to test correlation between surgeon experience and variables, including demographics and intra- and post-operative outcomes.
High-experience surgeons performed more elective cases (93.4% vs 85.5%), but low-experience surgeons operated more on emergent (2.7% vs 0.9%), semi-elective (2.3% vs 1.4%), and urgent cases (9.5% vs 4.3%). Low-experience surgeons operated more on patients who were older (67.5 vs 63.2 years, p < 0.001) and had an increased risk of CVD (72.9% vs 61.5%, p < 0.001). Intraoperative OR time was considerably less for high-experience surgeons (115.8 vs 172.9 min, p < 0.001). Low-experience surgeons had increased risk of intra-operative complications (4.5% vs 1.8%, p = 0.021) and post-op pneumonia within 30 days (1.8% vs 0.3%). However, long-term outcomes such as hernia recurrence (OR: 1.10, CI: 0.78-1.54) and redo-operations for hiatal hernia (OR: 1.10, CI: 0.65-1.75) were similar for both groups.
High-experience surgeons perform more complex revisional surgeries in less time with fewer complications. Low-experience surgeons operated more on patients with higher comorbidities but had significantly higher OR times. Long-term results of recurrence and redo-operations were comparable. These variations suggest that high-experience surgeons are more efficient while operating on more complex cases. These findings have pivotal implications to facilitate mentorship and education among less-experienced surgeons.
已有报道称，外科医生经验越丰富，患者的预后越好。在这项研究中，我们观察了外科医生的经验及其与术后结果的关联，并分析了行食管裂孔疝修补术（PEH）的外科医生之间的实践差异。
这是一项对单中心（2010-2023 年）1155 例 PEH 修复患者进行的回顾性研究。外科医生经验定义为每位外科医生完成的手术次数，并采用中位数手术次数（n=100）进行划分，将手术次数等于或超过中位数的外科医生归类为高经验组，低于中位数的外科医生归类为低经验组。采用多变量逻辑回归模型检验外科医生经验与变量（包括人口统计学和围手术期结果）之间的相关性。
高经验组行择期手术的比例更高（93.4% vs 85.5%），但低经验组行急诊（2.7% vs 0.9%）、半择期（2.3% vs 1.4%）和紧急手术（9.5% vs 4.3%）的比例更高。低经验组手术患者的年龄更大（67.5 岁 vs 63.2 岁，p<0.001），合并心血管疾病（CVD）的风险更高（72.9% vs 61.5%，p<0.001）。高经验组的手术时间明显更短（115.8 分钟 vs 172.9 分钟，p<0.001）。低经验组术中并发症的风险更高（4.5% vs 1.8%，p=0.021），术后 30 天内肺炎的风险更高（1.8% vs 0.3%）。然而，两组在疝复发（OR：1.10，CI：0.78-1.54）和贲门裂孔疝再次手术（OR：1.10，CI：0.65-1.75）等长期结果方面相似。
高经验组的外科医生在更短的时间内完成更复杂的翻修手术，且并发症更少。低经验组的外科医生为更多合并症患者实施手术，但手术时间明显更长。复发和再次手术的长期结果相似。这些差异表明，高经验组的外科医生在处理更复杂的病例时效率更高。这些发现对于促进低经验外科医生的指导和教育具有重要意义。
