Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany.
Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany.
J Surg Educ. 2024 Nov;81(11):1683-1690. doi: 10.1016/j.jsurg.2024.08.011. Epub 2024 Sep 17.
The study is intended to show that the operative quality of a resident in orthopedic trauma surgery is comparable to that of a senior physician in the most common orthopaedic trauma surgeries (Plate osteosynthesis in ankle fractures and distal radius fractures, ESIN in pediatric forearm fractures, implantation of a proximal femoral nail in pertrochanteric femur fractures and hemiarthroplasty in femoral neck fractures) with appropriate supervision by a senior physician. With only minimal deviations in the operating time, which is becoming increasingly relevant in everyday clinical practice, surgical training of residents could be supported.
200 patients of the above-mentioned fracture patterns each, who were treated surgically between January 1, 2016 and December 31, 2020, were detected and categorized. In particular, a qualitative characteristic was determined for each fracture on the basis of the standard pre and postoperative X-rays taken during surgery and statistically evaluated with the surgery time, the fracture classification and the training status of the anonymized surgeon. Anonymized x-rays were evaluated by 2 senior physicians and 2 residents.
Operations were performed by residents in 33.5 % of the cases (ankle fractures 42.0%; distal radius fractures 30.5%; pediatric forearm fractures 30.5%; pertrochanteric femur fractures 50.5%; femoral neck fractures 14.0%). Surgical complication rate was 4.8% in the resident group and 9.0% in the attending surgeon group. Revision surgeries were performed in 2.1% of resident cases, and in 4.1% of attending surgeon cases. In the resident group, time of surgery was 7.4 min longer for ankle fractures, 4.4 min for distal radius fractures, 2.8 min for forearm fractures, 2.3 min longer in proximal femur fractures 8.2 min longer for femoral neck fractures. No statistically significant difference in radiological outcome was observed in any of the groups after evaluation of the x-rays.
This study shows that only slightly more than one third of all mentioned operations are performed by residents, although there is no statistical difference in quality. The operating time is extended on average by only 5 minutes. The surgical complication rate as well as the revision rate is higher in the group of senior physicians, whereby the more complicated fractures were treated by them. Resident involvement in trauma surgery is therefore not associated with increased morbidity or mortality of patients.
本研究旨在表明，住院医师在骨科创伤手术中的手术质量与资深医师相当，可完成最常见的骨科创伤手术（踝关节骨折和桡骨远端骨折的钢板内固定术、儿童前臂骨折的 ESIN 术、股骨转子间骨折的股骨近端髓内钉植入术和股骨颈骨折的人工半髋关节置换术），同时接受资深医师的适当监督。通过适当的监督，可以在手术时间上只进行微小的偏差，这在日常临床实践中变得越来越重要，从而支持住院医师的手术培训。
检测并分类了 200 名上述骨折类型的患者，这些患者分别于 2016 年 1 月 1 日至 2020 年 12 月 31 日接受了手术治疗。特别是，根据手术过程中拍摄的标准术前和术后 X 光片，确定了每种骨折的定性特征，并通过手术时间、骨折分类和匿名手术医生的培训状态对其进行了统计评估。匿名 X 光片由 2 名资深医生和 2 名住院医生进行评估。
在 33.5%的病例中由住院医师进行了手术（踝关节骨折 42.0%；桡骨远端骨折 30.5%；儿童前臂骨折 30.5%；股骨转子间骨折 50.5%；股骨颈骨折 14.0%）。住院医师组的手术并发症发生率为 4.8%，主治医生组为 9.0%。在住院医师组中，有 2.1%的病例需要进行翻修手术，而主治医生组为 4.1%。在住院医师组中，踝关节骨折的手术时间延长了 7.4 分钟，桡骨远端骨折延长了 4.4 分钟，前臂骨折延长了 2.8 分钟，股骨转子间骨折延长了 2.3 分钟，股骨颈骨折延长了 8.2 分钟。在对 X 光片进行评估后，在任何一组中都没有观察到放射学结果的统计学差异。
本研究表明，尽管质量上没有统计学差异，但只有略多于三分之一的上述手术是由住院医师完成的。手术时间平均仅延长 5 分钟。高级医师组的手术并发症发生率和翻修率较高，他们治疗了更复杂的骨折。因此，住院医师参与创伤手术并不会增加患者的发病率或死亡率。
