Fallon W F, Wears R L, Tepas J J
Department of Surgery, University of Florida Health Science Center, Jacksonville.
J Trauma. 1993 Oct;35(4):556-60; discussion 560-1. doi: 10.1097/00005373-199310000-00010.
Resident supervision by faculty is a sine qua non of surgical education, yet objective standards for supervision are difficult to quantify. Over a 12-month period, using departmental data on morbidity, mortality outcome, and faculty status in the operating room, the association between complications, death, and attending physician presence were analyzed by Chi-square tests of association in 2 x 2 contingency tables, or by the Mantel-Haenszel Chi-square to control for a stratifying variable. A total of 4417 cases were reported. Attending physicians were either scrubbed or present in the OR 91.8% of the time, although there was considerable variation among services. The overall mortality rate was 6.2% and complications occurred in 7.0% overall. Greater attending physician presence was significantly associated with lower mortality and complication rates overall. When stratified by service, the association was less marked. However, presence of attending physicians varied significantly by service. To adjust for this variation, elective services were compared with all the "nonelective" services. When this categorization was used as the stratifying variable, the association between increased attending physician involvement and decreased complication and mortality rates was statistically significant (Mantel-Haenszel Chi-square, p < 0.0005 for both).
由教员对住院医师进行监督是外科教育的必要条件，但监督的客观标准却难以量化。在为期12个月的时间里，利用部门关于发病率、死亡率结果以及手术室教员状况的数据，通过2×2列联表中的关联卡方检验，或通过Mantel-Haenszel卡方检验以控制分层变量，分析并发症、死亡与主治医生在场之间的关联。共报告了4417例病例。主治医生在手术室洗手或在场的时间占91.8%，尽管各科室之间存在相当大的差异。总体死亡率为6.2%，总体并发症发生率为7.0%。主治医生在场时间越长，总体死亡率和并发症发生率就越低，这一关联具有显著意义。按科室分层时，这种关联不太明显。然而，主治医生的在场情况因科室而异。为了校正这种差异，将择期手术科室与所有“非择期”手术科室进行比较。当将这种分类用作分层变量时，主治医生参与度增加与并发症和死亡率降低之间的关联具有统计学意义（Mantel-Haenszel卡方检验，两者p均< 0.0005）。
