Chief Residents Can Safely Operate on Older and Frail Patients.
Chief Residents Can Safely Operate on Older and Frail Patients.
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DOI：
10.1016/j.jss.2022.12.005
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发表时间：
2023-05
影响因子：
2.2
通讯作者：
Balentine, Courtney
中科院分区：
文献类型：
--
作者：
Meier, Jennie;Stevens, Audrey;Nunez, Johanna;Jacob, Alison;Garza, Amanda;Bisgaard, Erika;Abdelfattah, Kareem;Balentine, Courtney
年龄较大和身体虚弱会增加手术后恢复不良的风险。我们假设，由住院总医师而不是主治医生进行的普通外科手术对这些脆弱的患者来说仍然是安全的。我们使用退伍军人事务部手术质量改进计划数据库确定了114，525名年龄在65岁以上的患者，包括18，030名年龄在80岁以上的患者和47，555名被归类为虚弱的患者，他们在1999年至2019年期间接受了由主治医生或监督的总住院医师进行的普通外科手术。虚弱定义为风险分析指数评分≥30。我们使用逆概率加权的倾向得分，比较发病率和死亡率之间的手术主治医生与总住院医师。当手术由住院总医师而不是主治医师进行时，65岁及以上患者的术后并发症增加2.1%（95%CI 1.2%-3.0%，P < 0.0001）。对于年龄≥80岁的患者（+2.3%，95% CI 0.7%-3.9%，P = 0.004）和体弱患者（+2.7%，95% CI 1.4%-4.0%，P < 0.0001），并发症风险也同样增加。当由住院总医师进行手术时，65岁以上（+0.2%，95% CI −0.1%-0.5%，P = 0.2）、80岁以上（+0.3%，95% CI −0.6%-1.1%，P = 0.5）或体弱患者（+0.2%，95% CI −0.5%-0.8%，P = 0.6）的死亡率无差异。我们发现，由住院总医师而不是主治医师为年老或体弱的患者进行手术时，发病率略有增加，死亡率无差异。我们的研究结果表明，这是合理和安全的培训计划，让适当的监督总住院医师操作的老年或体弱患者。
Older age and frailty increase the risk of poor recovery after surgery. We hypothesized that general surgery operations performed by supervised chief residents, as opposed to attending physicians, would still be safe for these vulnerable patients. We used the Veterans Affairs Surgical Quality Improvement Program database to identify 114,525 patients age 65+ y, including 18,030 patients age 80+ y and 47,555 categorized as frail, who had a general surgery procedure from 1999 to 2019 that was performed by an attending physician or by a supervised chief resident. Frailty was defined by a Risk Analysis Index score ≥30. We used inverse probability weighting on the propensity score to compare morbidity and mortality between operations performed by attendings versus chief residents. Patients 65 y and above had a 2.1% increase in postoperative complications when the surgery was performed by a chief resident instead of an attending surgeon (95%CI 1.2%−3.0%, P < 0.0001). A similarly increased risk of complications was seen for patients age ≥80 y old (+2.3%, 95%CI 0.7%−3.9%, P = 0.004) and for frail patients (+2.7%, 95%CI 1.4%−4.0%, P < 0.0001). There were no differences in mortality for patients age 65+ y (+0.2%, 95%CI −0.1%–0.5%, P = 0.2), 80+ y (+0.3%, 95%CI −0.6%–1.1%, P = 0.5), or frail patients (+0.2%, 95% CI −0.5%–0.8%, P = 0.6) when their operations were performed by chief residents. We found a small increase in morbidity and no difference in mortality when older or frail patients were operated on by chief residents rather than attending surgeons. Our findings suggest that it is reasonable and safe for training programs to allow appropriately supervised chief residents to operate on older or frail patients.
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影响因子：
2.4
作者：
Hersey, Alicia E.;Durand, Wesley M.;Daniels, Alan H.
通讯作者：
Daniels, Alan H.
影响因子：
3.8
作者：
Ejaz, Aslam;Spolverato, Gaya;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
15.3
作者：
Jeon, Byeong Geon;Kim, Hyuk Jung;Lee, Sang-Jeon
通讯作者：
Lee, Sang-Jeon
影响因子：
3
作者：
Meier J;Berger M;Hogan T;Reisch J;Zeh H;Cullum CM;Lee SC;Skinner CS;Brown CJ;Balentine CJ
通讯作者：
Balentine CJ
影响因子：
--
作者：
Pessaux, P;Msika, S;Flamant, Y
通讯作者：
Flamant, Y