Quanbeck Zachary, Bhatt Etasha, Quanbeck Deborah, Schiffern Alison
University of Minnesota Department of Orthopedic Surgery, Minneapolis, Minnesota.
University of Minnesota Department of Orthopedic Surgery, Minneapolis, Minnesota; Twin Cities Orthopedics, Eagan, Minnesota.
J Surg Educ. 2025 Jan;82(1):103353. doi: 10.1016/j.jsurg.2024.103353. Epub 2024 Nov 30.
We sought to compare operative times and complications for attending surgeons operating alone or with an assistant including an orthopedic resident, fellow, or physician assistant (PA) for closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCH), an archetypal procedure integral to the education of orthopedic trainees.
Using a retrospective database collected following institutional review board approval, a 1-way ANOVA (non-parametric) was used to assess the effect of assistant absence or presence by type of assistant on mean operative time. We analyzed the association between the attending surgeon assistant categories and the complication rate using Fisher's Exact Test.
The study was performed at Gillette Children's Specialty Healthcare, St. Paul, Minnesota, and Children's Minnesota in St. Paul and Minneapolis. These three affiliated metropolitan hospitals, the last of which is a level 1 trauma facility, all share the same group of orthopedic surgeons, trainees, and physician assistants.
All patients under 14 years of age treated with CRPP for Gartland type 2, 3, 4 and flexion type closed supracondylar fractures between April 2006 and September 2016 were analyzed. Of 1053 patients identified by Current Procedure Terminology code 24358, data was available for 888 patients.
Out of the 888 patients, 44.1% were operated on by a surgeon alone, 48.4% with a resident, 4.8% with a fellow and 2.6% with a physician assistant. The ANOVA revealed a statistically significant increase (p < 0.001) in operative times when a resident participated compared to the other categories. The shortest mean surgery time (34.7 minutes) occurred when an attending surgeon and PA were present. The longest mean time (44.3 minutes) occurred with a surgeon and resident. This difference, at 9.6 minutes, constituted 28% more time. There were 40 patients with a complication, a rate of 4.5%. The rate for each of the assistant categories was surgeon alone 5.6%, with a resident 3.3%, with a fellow 4.7%, with a PA 8.7%. The Fisher's Exact Test results showed no statistically significant association between the type or absence of assistant and the complication rate.
Differences in operative times were observed across assistant categories although the mean time difference was statistically insignificant between the surgeon unassisted versus assisted by the fellow or a PA. The finding of statistically increased operative times with resident participation in this study for this specific procedure is consistent with results for most other reported orthopedic surgeries. Complication rates did not vary based on the participating personnel.
我们试图比较主治医生单独手术或与助手（包括骨科住院医师、专科住院医师或医师助理）一起进行小儿肱骨髁上骨折（SCH）闭合复位及经皮穿针固定（CRPP）手术的手术时间和并发症情况，这是骨科住院医师培训中一项典型的重要手术。
利用经机构审查委员会批准后收集的回顾性数据库，采用单向方差分析（非参数）评估有无助手及助手类型对平均手术时间的影响。我们使用Fisher精确检验分析主治医生助手类别与并发症发生率之间的关联。
该研究在明尼苏达州圣保罗市的吉列儿童专科医疗中心以及圣保罗市和明尼阿波利斯市的明尼苏达儿童医院进行。这三家附属的大城市医院，其中最后一家是一级创伤中心，所有医院的骨科医生、住院医师和医师助理均为同一团队。
分析了2006年4月至2016年9月期间接受CRPP治疗的所有14岁以下Gartland 2型、3型、4型及屈曲型闭合性肱骨髁上骨折患者。通过当前手术操作术语代码24358识别出1053例患者，其中888例患者有可用数据。
在888例患者中，44.1%由外科医生单独手术，48.4%由住院医师协助，4.8%由专科住院医师协助，2.6%由医师助理协助。方差分析显示，与其他类别相比，住院医师参与手术时手术时间有统计学显著增加（p < 0.001）。当主治医生和医师助理在场时，平均手术时间最短（34.7分钟）。当外科医生和住院医师在场时，平均手术时间最长（44.分钟）。相差9.6分钟，多出28%的时间。有40例患者出现并发症，发生率为4.5%。各助手类别的发生率分别为：外科医生单独手术时为5.6%，住院医师协助时为3.3%，专科住院医师协助时为4.7%，医师助理协助时为8.7%。Fisher精确检验结果显示，助手类型或有无助手与并发症发生率之间无统计学显著关联。
不同助手类别之间手术时间存在差异，尽管外科医生无助手与有专科住院医师或医师助理协助之间的平均时间差异无统计学意义。本研究中该特定手术住院医师参与时手术时间在统计学上增加这一发现与大多数其他报道的骨科手术结果一致。并发症发生率不因参与人员不同而有所差异。
