Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in California.
Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in California.
复制标题
外科实习生的参与会对患者的治疗结果产生不利影响吗？
DOI：
10.1067/msy.2000.107416
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Mulvihill,SJ
中科院分区：
文献类型：
--
作者：
Hutter,MM;Glasgow,RE;Mulvihill,SJ
背景一些患者担心外科实习生对他们在教学医院接受的护理质量的影响。不存在基于人群的数据来描述教学医院和非教学医院的外科手术结果；然而，机构数据表明教学医院提供高质量的护理。我们假设普通外科住院医师计划 (GSRP) 的存在与胰腺切除术（一种复杂的外科手术）的优良结局相关。方法对 5696 名接受大胰腺切除术的患者进行回顾性、基于人群的风险调整分析，比较了在有 GSRP 的医院 (GSRP+) 和没有 GSRP 的医院 (GSRP-) 接受治疗的患者的结局。结果 GSRP+ 医院的手术死亡率较低（8.3% vs 8.3%）与 GSRP 医院相比，出院到另一家急症护理医院或专业护理机构的患者比例较低（6.5% vs 13.0%；P < .001），住院时间较长（22.1 ± 0.4 天 vs 19.6 ± 0.3 天；P < .001）。在对患者组合和医院容量进行调整后，观察到的医院死亡率差异并不显着（9.7% vs 10.0%）。然而，与附属教学医院和非教学医院相比，大学教学医院的治疗效果更好（5.3% [P < .001] vs 11.4% vs 11.0%；风险调整后，8.0% [P < .05] vs 10.9% vs 10.0%）。 结论 外科实习生的存在不会对胰腺切除术这一复杂手术的护理质量产生不利影响，并且与大学教学医院较高的手术死亡率相关。 （外科手术 2000；128：286-92。）
BackgroundSome patients have concerns regarding the impact of surgical trainees on the quality of care that they receive in teaching hospitals. No population-based data exist that describe outcomes of surgical procedures in teaching and nonteaching hospitals; however, institutional data suggest that teaching hospitals provide high-quality care. We hypothesized that the presence of a general surgery residency program (GSRP) is associated with superior outcomes for pancreatic resection, a complex surgical procedure.MethodsA retrospective, population-based, risk-adjusted analysis of 5696 patients who underwent major pancreatic resection compares the outcomes of patients treated at hospitals with a GSRP (GSRP+) and those hospitals without a GSRP (GSRP–).ResultsGSRP+ hospitals had a lower operative mortality rate (8.3% vs 11.0%; P < .001), a lower percentage of patients discharged to another acute care hospital or skilled nursing facility (6.5% vs 13.0%; P < .001), and a longer length of stay compared with GSRP- hospitals (22.1 ± 0.4 days vs 19.6 ± 0.3 days; P < .001). The observed difference in hospital mortality rates was not significant after an adjustment was made for patient mix and hospital volume (9.7% vs 10.0%). However, superior outcomes were found in the university teaching hospitals, as compared with the affiliated teaching and the nonteaching hospitals (5.3% [P < .001] vs 11.4% vs 11.0%; risk adjusted, 8.0% [P < .05] vs 10.9% vs 10.0%).ConclusionsThe presence of surgical trainees does not have an adverse impact on the quality of care for one complex procedure, pancreatectomy, and is associated with superior operative mortality rate in university teaching hospitals. (Surgery 2000;128:286-92.)