Comparable Operative Times With and Without Surgery Resident Participation
Comparable Operative Times With and Without Surgery Resident Participation
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DOI：
10.1016/j.jsurg.2013.06.011
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发表时间：
2013-11-01
影响因子：
2.9
通讯作者：
Brown, Carlos
中科院分区：
文献类型：
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作者：
Uecker, John;Luftman, Kevin;Brown, Carlos
背景：医生和患者都可能认为外科住院医师参与手术可能会延长手术时间，并使预后恶化。我们假设住院医师的参与会延长手术时间，并可能对术后结果产生不利影响。目的：评价普外科住院医师参与手术对手术时间和术后患者预后的影响。设计：回顾性研究2007年无住院医生和2011年有住院医生两个1年时间段内进行的普通外科手术。手术包括腹腔镜阑尾切除术、胆囊切除术、甲状腺切除术、乳房手术、疝修补术、下肢截肢、隧道静脉导管和经皮内镜胃造口术。主要结局是手术时间，次要结局包括住院时间（LOS）和死亡率。背景：学术普通外科住院医师项目。结果：2期共行手术2280例，住院医师参与组1150例，无住院医师参与组1130例。RES组和NORES组在患者年龄（42 vs 41, p = 0.14）和男性性别（46% vs 45%, p = 0.68）方面相似，总手术时间（68 min vs 66 mm, p = 0.58）无差异。更具体地说，腹腔镜阑尾切除术（67 vs 71, p = 0.8）、甲状腺切除术（125 vs 109, p = 0.16）、乳房手术（38 vs 26, p = 0.79）、疝修补术（61 vs 60, p = 0.74）、下肢截肢（65 vs 77, p = 0.16）、隧道静脉导管（49 vs 47, p = 0.75）和经皮内镜胃造口术（49 vs 46, p = 0.76）的手术时间（分钟）没有差异。然而，RES组腹腔镜胆囊切除术时间稍长（71 vs 66, p = 0.02）。住院医师参与的一年中，LOS较短（2.6天vs 3.7天，p = 0.0004），死亡率无差异（0.17% vs 0.35%, p = 0.45）。结论：有或没有住院医师参与的普通外科手术在手术时间上没有差异。此外，住院医师的参与与LOS的减少有关。这些信息应该用来改变医生和病人对住院医生参与手术的负面看法。(C) 2013年外科项目主任协会。Elsevier Inc.出版。版权所有。)
BACKGROUND: Both physicians and patients may perceive that having surgical residents participate in operative procedures may prolong operations and worsen outcomes. We hypothesized that resident participation would prolong operative times and potentially adversely affect postoperative outcomes.OBJECTIVE: To evaluate the effect of general surgery resident participation in surgical procedures on operative times and postoperative patient outcomes.DESIGN: Retrospective study of general surgery procedures performed during two 1-year time periods, 2007 without residents and 2011 with residents. Procedures included laparoscopic appendectomy and cholecystectomy, thyroidectomy, breast procedure, hernia repair, lower extremity amputation, tunneled venous catheter, and percutaneous endoscopic gastrostomy. The primary outcome was operative time and secondary outcomes included length of stay (LOS) and mortality.SETTING: Academic general surgery residency program.RESULTS: There were 2280 operative procedures performed during the 2 periods: 1150 with resident involvement (RES group) and 1130 without residents (NORES group). The RES and NORES groups were similar for patient age (42 vs 41, p = 0.14) and male gender (46% vs 45%, p = 0.68), and there was no difference in overall operative time (68 min vs 66 mm, p = 0.58). More specifically there was no difference in operative time (minutes) for specific procedures including laparoscopic appendectomy (67 vs 71, p = 0.8), thyroidectomy (125 vs 109, p = 0.16), breast procedure (38 vs 26, p = 0.79), hernia repair (61 vs 60, p = 0.74), lower extremity amputation (65 vs 77, p = 0.16), tunneled venous catheter (49 vs 47, p = 0.75), and percutaneous endoscopic gastrostomy (49 vs 46, p = 0.76). However, laparoscopic cholecystectomy took slightly longer in the RES group (71 vs 66, p = 0.02). LOS was shorter during the year with resident involvement (2.6 days vs 3.7 days, p = 0.0004) and there was no difference in mortality (0.17% vs 0.35%, p = 0.45).CONCLUSIONS: There is no difference in operative time for common general surgery procedures with or without resident involvement. In addition, resident involvement is associated with a decrease in LOS. This information should be used to change physician and patient negative perceptions regarding resident involvement while performing surgical procedures. ((C) 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)