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Trainee participation affects outcomes in emergency general surgery procedures: An analysis of the national surgical quality improvement program database.

机译：学员的参与会影响紧急普外科手术的结果：对国家手术质量改善计划数据库的分析。

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摘要

Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. With the current project, we aim to identify if a similar effect exists in emergency general surgery. A total of 141,010 patients who underwent emergency general surgery procedures were identified in the 2005-2010 National Surgical Quality Improvement Program database. Due to the non-random assignment of the more complex cases to resident participation, patients were matched (1:1) on known risk factors [age, gender, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol use, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and on preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t- or chi-squared test. The impact of resident participation on outcomes was quantified with multivariable regression modeling, adjusting for both the aforementioned risk factors and operative time. The most common procedures in the matched cohort (n=83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%) and adhesiolysis (6.6%). Our findings suggest that trainee participation in emergency general surgery procedures prolongs operative time, increases intraoperative transfusions, and is independently associated with adverse postoperative outcomes, including wound, pulmonary, and venous thromboembolic complications, as well as urinary tract infections. This effect appears to be independent of the total intraoperative time, case complexity, and preexisting comorbid conditions. We also demonstrate that operative time is another important factor independently associated with intra- and post-operative transfusions, unplanned reoperations, longer hospital stays, infections, as well as wound, pulmonary, and venous thromboembolic complications, when baseline comorbidities and resident participation were adjusted for. Remediation strategies could include increased use of simulation training and increased faculty supervision of residents.
机译：先前的研究表明，在广泛的外科手术患者群体中，实习生的参与对结局具有重大影响。在当前项目中，我们旨在确定紧急普外科手术中是否存在类似的效果。在2005-2010年国家外科手术质量改善计划数据库中，确定了总共141,010例接受了紧急普外科手术的患者。由于将较复杂的病例非随机分配给居民参与，因此将患者与已知风险因素[年龄，性别，住院状态，既往合并症（肥胖，糖尿病，吸烟，饮酒，使用类固醇）进行匹配（1：1） ，冠状动脉疾病，慢性肾功能衰竭，肺部疾病）以及术前计算出的发病率和死亡率。将临床相关结局与t或卡方检验进行比较。居民参与对结局的影响通过多变量回归模型进行量化，并针对上述风险因素和手术时间进行调整。配对队列中最常见的程序（n = 83,790）为阑尾切除术（39.9％），探索性剖腹手术（8.8％）和粘连溶解（6.6％）。我们的研究结果表明，受训人员参加紧急普外科手术会延长手术时间，增加术中输血量，并且与不良的术后结果（包括伤口，肺和静脉血栓栓塞性并发症以及尿路感染）独立相关。这种效果似乎与总的术中时间，病例复杂性和既往合并症无关。我们还证明，在调整基线合并症和住院病人参与度时，手术时间是与术中和术后输血，计划外手术，更长的住院时间，感染以及伤口，肺部和静脉血栓栓塞并发症无关的另一个重要因素。对于。补救策略可以包括增加对模拟培训的使用以及对居民的教职监督。

著录项

  • 作者

    Lakha, Aliya Anne.;

  • 作者单位

    Boston University.;

  • 授予单位 Boston University.;
  • 学科 Health Sciences Surgery.;Health Sciences Medicine and Surgery.;Education Evaluation.
  • 学位 M.S.
  • 年度 2014
  • 页码 53 p.
  • 总页数 53
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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