Does Resident Experience Affect Outcomes in Complex Abdominal Surgery? Pancreaticoduodenectomy as an Example
Does Resident Experience Affect Outcomes in Complex Abdominal Surgery? Pancreaticoduodenectomy as an Example
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住院医师经验会影响复杂腹部手术的结果吗？
DOI：
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发表时间：
2014
影响因子：
3.2
通讯作者：
C. Yeo
中科院分区：
文献类型：
--
作者：
Daniel M. Relles;R. Burkhart;M. Pucci;J. Sendecki;Renée M. Tholey;R. Drueding;P. Sauter;E. Kennedy;J. Winter;H. Lavu;C. Yeo
目的了解有助于改善术后患者预后的因素仍然是至关重要的。对于复杂的腹部手术，如胰腺癌切除术（PD），供应商和医院容量对手术结果的影响已被描述。住院医师经验的影响是不太好理解。MethodsWe回顾了围手术期的结果后，PD在一个单一的高容量中心2006年和2012年之间。在一个前瞻性维护的数据库中收集了居民参与情况和成果。住院医师的经验被定义为研究生年（PGY）和PDs performed. ResultsForty三个居民和四个主治外科医生完成686 PD数。总体并发症发生率为44%; 28%的患者发生PD特异性并发症（定义为胰瘘、胃排空延迟、腹腔内脓肿、伤口感染和胆漏）。当比较PGY 4和PGY 5居民时，总体并发症发生率相似（55.3%对43.0%; p > 0.05）。在单变量分析中，PGY 4与PGY 5居民之间观察到的PD特异性并发症存在差异（分别为44 vs. 27%; p = 0.016）。然而，当调整主治外科医生时，这在统计学上并不显著。Logistic回归分析显示，随着住院医师手术次数的增加，PD特异性并发症减少（OR = 0.97; p < 0.01）。对于住院医师的第一个PD病例，PD特异性并发症的预测概率为27%;到住院医师病例数为15时，这一概率降至19%。结论复杂病例，如PD，提供了无与伦比的学习机会，仍然是外科培训的重要组成部分。我们强调了住院医师参与复杂腹部手术的影响，首次证明了随着住院医师积累PD经验，患者预后得到改善。这与主治医生和高容量医院的容量-结果关系一致。最大限度地重复暴露于复杂的程序住院医生受益于病人和受训者。
ObjectivesUnderstanding the factors contributing to improved postoperative patient outcomes remains paramount. For complex abdominal operations such as pancreaticoduodenectomy (PD), the influence of provider and hospital volume on surgical outcomes has been described. The impact of resident experience is less well understood.MethodsWe reviewed perioperative outcomes after PD at a single high-volume center between 2006 and 2012. Resident participation and outcomes were collected in a prospectively maintained database. Resident experience was defined as postgraduate year (PGY) and number of PDs performed.ResultsForty-three residents and four attending surgeons completed 686 PDs. The overall complication rate was 44 %; PD-specific complications (defined as pancreatic fistula, delayed gastric emptying, intraabdominal abscess, wound infection, and bile leak) occurred in 28 % of patients. The overall complication rates were similar when comparing PGY 4 to PGY 5 residents (55.3 vs. 43.0 %; p > 0.05). On univariate analysis, there was a difference in PD-specific complications seen between a PGY 4 as compared to a PGY 5 resident (44 vs. 27 %, respectively; p = 0.016). However, this was not statistically significant when adjusted for attending surgeon. Logistic regression demonstrated that as residents perform more cases, PD-specific complications decrease (OR = 0.97; p < 0.01). For a resident's first PD case, the predicted probability of a PD-specific complication is 27 %; this rate decreases to 19 % by resident case number 15.ConclusionsComplex cases, such as PD, provide unparalleled learning opportunities and remain an important component of surgical training. We highlight the impact of resident involvement in complex abdominal operations, demonstrating for the first time that as residents build experience with PD, patient outcomes improve. This is consistent with volume–outcome relationships for attending physicians and high-volume hospitals. Maximizing resident repetitive exposure to complex procedures benefits both the patient and the trainee.
影响因子：
9
作者：
Yeo, CJ;Cameron, JL;Abrams, RA
通讯作者：
Abrams, RA
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
发表时间：
2000
期刊：
Surgery.
影响因子：
--
作者：
Hutter,MM;Glasgow,RE;Mulvihill,SJ
通讯作者：
Mulvihill,SJ
外科住院医生的参与对于常见的择期普通外科手术是安全的。
影响因子：
5.2
作者：
Tseng,WarrenH;Jin,Leah;Canter,RobertJ;Martinez,SteveR;Khatri,VijayP;Gauvin,Jeffrey;Bold,RichardJ;Wisner,David;Taylor,Sandra;Chen,StevenL
通讯作者：
Chen,StevenL