Anderson John, Geng Xue, Maxwell Jessica H
Georgetown University, Washington, District of Columbia.
MedStar Georgetown University Hospital, Washington, District of Columbia.
Fed Pract. 2025 Feb;42(2):82-89. doi: 10.12788/fp.0550. Epub 2025 Feb 15.
The US Department of Veterans Affairs (VA) has been an integral component of resident education in otolaryngology. However, the impact of resident surgical training on patient outcomes and productivity in the VA is unknown. This study sought to determine how resident participation impacted complications, operative time, and productivity in veterans undergoing total laryngectomy.
Patients who underwent total laryngectomy, with or without neck dissection, were identified in the VA Surgical Quality Improvement Program database between 2001 and 2021. Operative time, work relative value units (wRVU) generated per hour, and postoperative complications were compared for attending physicians with junior residents, attending physicians with senior residents, and attending physicians alone. Patient demographics and preoperative health variables were collected to determine their impact on postoperative outcomes, including complication rate, return to the operating room (OR), and death within 30 days.
This study identified 1857 veterans who underwent a total laryngectomy at a VA facility. Most laryngectomies were performed by an attending physician with a senior resident (64%), followed by attending physician alone (24%), and an attending physician with a junior resident (12%). Resident participation was significantly associated with increased operative time ( = .001) and lower wRVU per hour ( = .002). Resident participation did not significantly affect postoperative complication rate (21.3%; n = 395) or patient return to the OR (14.6%; n = 272). On multivariate analysis, junior resident involvement ( = .001), and weight loss > 10% ( = .007) were significantly associated with longer operative times. There was a statistically significant drop in the rate of resident participation in laryngectomies from 80.6% between 2001 and 2011 to 68.3% between 2012 and 2021 ( < .001).
Resident participation in total laryngectomies increased operative time and reduced wRVU generated per hour but did not impact complication rates or patient return to the OR. The VA remains an integral part of otolaryngology residency training programs, but there has been a decline in resident participation in total laryngectomies.
美国退伍军人事务部（VA）一直是耳鼻喉科住院医师教育的重要组成部分。然而，住院医师手术培训对VA患者预后和工作效率的影响尚不清楚。本研究旨在确定住院医师的参与如何影响接受全喉切除术的退伍军人的并发症、手术时间和工作效率。
在2001年至2021年期间，从VA手术质量改进计划数据库中识别出接受全喉切除术（无论是否行颈部清扫术）的患者。比较带低年资住院医师的主治医师、带高年资住院医师的主治医师以及单独的主治医师的手术时间、每小时产生的工作相对价值单位（wRVU）和术后并发症。收集患者人口统计学和术前健康变量，以确定它们对术后结局的影响，包括并发症发生率、返回手术室（OR）以及30天内死亡情况。
本研究确定了1857例在VA机构接受全喉切除术的退伍军人。大多数喉切除术由带高年资住院医师的主治医师完成（64%），其次是单独的主治医师（24%），以及带低年资住院医师的主治医师（12%）。住院医师的参与与手术时间延长（P = 0.001）和每小时wRVU降低（P = 0.002）显著相关。住院医师的参与并未显著影响术后并发症发生率（21.3%；n = 395）或患者返回手术室的情况（14.6%；n = 272）。多因素分析显示，低年资住院医师的参与（P = 0.001）和体重减轻>10%（P = 0.007）与手术时间延长显著相关。2001年至2011年期间，住院医师参与喉切除术的比例为80.6%，2012年至2021年期间降至68.3%，差异有统计学意义（P < 0.001）。
住院医师参与全喉切除术会延长手术时间并降低每小时产生的wRVU，但不影响并发症发生率或患者返回手术室的情况。VA仍然是耳鼻喉科住院医师培训计划的重要组成部分，但住院医师参与全喉切除术的比例有所下降。
