Arda Yasmin, Abiad May, Rafaqat Wardah, Lagazzi Emanuele, Zamudio Jefferson P, Argandykov Dias, Velmahos George C, DeWane Michael P, Paranjape Charudutt N, Hwabejire John O
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
J Surg Educ. 2025 Sep;82(9):103626. doi: 10.1016/j.jsurg.2025.103626. Epub 2025 Jul 26.
Although data concerning resident involvement in emergency general surgery (EGS) procedures is abundant, its impact on outcomes in the vulnerable older adult population has not been explored. This study aimed to assess the impact of resident involvement on postoperative outcomes in older adult patients undergoing EGS.
Propensity-score matched cohort study.
The 2007-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
Patients aged ≥65 years who underwent one of eight EGS procedures were included. Patients were stratified based on resident participation (RES vs. NO-RES). After propensity-score matching, each group included 2,796 patients with comparable baseline characteristics.
Among 24,452 patients identified, 14,381 (58.8%) underwent procedures with resident involvement. Patients in the RES group were more likely to be Black (11.3% vs. 6.1%) and have pre-existing comorbidities, such as ventilator dependence (7.7% vs. 4.0%), and were less likely to be admitted from home (84.3% vs. 88.4%) (all p<0.001). After matching, 30-day mortality was not different between the two groups. However, patients in the RES group demonstrated higher 30-day morbidity (38.8% vs. 36.0%, p = 0.031), likely driven by a greater incidence of superficial surgical site infection (5.6% vs. 3.9%, p = 0.003) and unplanned reoperation (11.0% vs. 7.4%, p<0.001). Operative time was significantly longer in the RES group (p<0.001).
Participation of residents in EGS procedures is associated with increased operative time, rate of surgical site infection, and unplanned reoperation. However, resident involvement had no effect on patient mortality. Efforts to improve surgical education while not compromising patient safety are needed.
尽管有关住院医师参与急诊普通外科（EGS）手术的数据丰富，但尚未探讨其对脆弱老年人群手术结果的影响。本研究旨在评估住院医师参与对接受EGS手术的老年患者术后结果的影响。
倾向评分匹配队列研究。
2007 - 2012年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库。
纳入年龄≥65岁且接受了八种EGS手术之一的患者。患者根据住院医师参与情况分层（RES组与NO - RES组）。倾向评分匹配后，每组包括2796例具有可比基线特征的患者。
在确定的24452例患者中，14381例（58.8%）接受了有住院医师参与的手术。RES组患者更可能为黑人（11.3%对6.1%）且有既往合并症，如呼吸机依赖（7.7%对4.0%），且从家中入院的可能性较小（84.3%对88.4%）（所有p<0.001）。匹配后，两组间30天死亡率无差异。然而，RES组患者30天发病率更高（38.8%对36.0%，p = 0.031），可能是由于浅表手术部位感染发生率更高（5.6%对3.9%，p = 0.003）和计划外再次手术发生率更高（11.0%对7.4%，p<0.001）。RES组手术时间明显更长（p<0.001）。
住院医师参与EGS手术与手术时间延长、手术部位感染率和计划外再次手术率增加有关。然而，住院医师参与对患者死亡率无影响。需要在不影响患者安全的情况下努力改进外科教育。
