The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections
The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections
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DOI：
10.1016/j.surg.2015.01.027
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发表时间：
2015-08-01
期刊：
影响因子：
3.8
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Ejaz, Aslam;Spolverato, Gaya;Pawlik, Timothy M.
背景资料。居民在肝和胰腺切除过程中的参与程度各不相同。在肝脏和胰腺手术中，居民参与对手术结果的影响还没有明确的定义。我们使用美国外科学会国家外科质量改进计划数据库确定了2006至2012年间接受肝或胰腺切除的25,511名患者。建立了多元回归模型，以确定居民参与和手术结果之间的任何关联。胰腺切除术(n=16,045；62。9%)比肝切除(n=9,466；37%)更常见。住院医生参与了大多数病例(n=21,857；86%)，其中最多的是高级(研究生3年，n=21,147；97%)。居民参与导致平均手术时间略长(肝脏，9分钟；胰腺，22分钟；P<；.01)。PEN手术输血需求、住院时间和再手术率不受居民参与的影响(均P>；0.05)。居民参与导致肝脏和胰腺切除后总体发病率较高(优势比[OR]，1.14；95%CI，1.05-1.24；P=.001)，但不会导致重大发病率(OR，1.05；95%CI，0.931.20；P=.40)。居民的参与降低了肝脏和胰腺切除术后30天的死亡率(OR，0.75；95%CI，0.60-0.94；P=0.01)。虽然居民的参与导致手术时间略长，肝和胰腺切除后的总体并发症略有增加，但其他指标，如住院时间、主要发病率和死亡率并未受到影响。这些数据对教育患者了解住院医生在这些复杂病例中的参与有重要意义。
Background. Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined.Methods. We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006 and 2012 using the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models were constructed to determine any association between resident participation and surgical outcomes.Results. Pancreatic resections (n = 16,045; 62. 9%) were more common than liver resections (n = 9,466; 37%). Residents participated in the majority of cases (n = 21,857; 86%), with most involvement at the senior level (postgraduate year >= 3, n = 21,147; 97%). Resident participation resulted in slightly longer mean operative times (hepatic, 9 minutes; pancreatic, 22 minutes; both P < .01). Need for pen operative transfusion, hospital duration of stay, and reoperation rates were unaffected by resident participation (all P > .05). Resident participation resulted in a higher risk of overall morbidity (odds ratio [OR], 1.14; 95% CI, 1.05-1.24; P = .001), but not major morbidity (OR, 1.05; 95% CI, 0.93 1.20; P = .40) after liver and pancreas resection. Resident participation resulted in lower odds of 30-day mortality after liver and pancreas resections (OR, 0.75; 95% CI, 0.60-0.94; P = .01).Conclusion. Although resident participation resulted in slightly longer operative times and a modest increase in overall complications after liver and pancreatic resection, other metrics such as duration of stay, major morbidity, and mortality were unaffected. These data have important implications for educating patients regarding resident participation in these complex cases.