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首页> 外文期刊>Clinical neurosurgery. >Higher Complications and No Improvement in Mortality in the ACGME Resident Duty-Hour Restriction EraAn Analysis of More Than 107 000 Neurosurgical Trauma Patients in the Nationwide Inpatient Sample Database
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Higher Complications and No Improvement in Mortality in the ACGME Resident Duty-Hour Restriction EraAn Analysis of More Than 107 000 Neurosurgical Trauma Patients in the Nationwide Inpatient Sample Database

机译：ACGME住院时间限制时代的并发症更高，死亡率没有改善在全国住院患者样本数据库中分析超过107,000名神经外科创伤患者

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1 Among 115 604 neurosurgical trauma patients treated in nonteaching hospitals, no increased complication rate was found. Therefore, the authors attributed the increased complication rate in teaching hospitals to the implementation of ACGME resident duty-hour restrictions. In our opinion, this conclusion appears to be based on the wrong assumptions.The authors' conclusion is based on logistic regression analysis in which a number of variables, such as sex and age, are included as covariates, but the injury severity index (ISS) is excluded. However, because the severity of a trauma is the key factor in determining both mortality and the occurrence of complications, the ISS should be included as a primary covariate. No differences in the complication and mortality rates were found after the ISS was included as a covariate in the logistic regression analysis. Therefore, the increased ISS of 1.1 in the teaching hospital group versus the much smaller increase of 0.2 in the nonteaching hospitals is a much more likely culprit than the implementation of ACGME resident duty-hour restrictions.We strongly agree with evaluating new rules. However, in such delicate matters as resident duty-hours, that evaluation should be as careful as possible. Hoh et al performed an admirable analysis of 4 large cohorts of patients, but the conclusion from these data that the ACGME duty-hour regulations have led to increased complication rates in neurosurgical trauma patients appears to be preemptive at best.1.Hoh BL, Neal DW, Kleinhenz DT, et al. Higher complications and no improvement in mortality in the ACGME resident duty-hour restriction era: an analysis of more than 107,000 neurosurgical trauma patients in the Nationwide Inpatient Sample database. Neurosurgery. 2012;70(6):1369–1381; discussion 1381-1382. Copyright ? 2012 by the Congress of Neurological Surgeons Issue Section:.
机译：1在非教学医院接受治疗的115 604名神经外科创伤患者中，未发现并发症发生率增加。因此，作者将教学医院中并发症发生率的增加归因于ACGME居民工作时间限制的实施。我们认为，该结论似乎是基于错误的假设。作者的结论基于对数回归分析，其中包括许多变量（例如性别和年龄）作为协变量，但伤害严重性指数（ISS） ）除外。但是，由于创伤的严重程度是确定死亡率和并发症发生率的关键因素，因此应将ISS作为主要协变量。在将Logistic回归分析中将ISS包括为协变量后，在并发症和死亡率上没有发现差异。因此，与实施ACGME居民工作时间限制相比，教学医院组的ISS增加1.1而不是非教学医院的ISS增加0.2小得多。我们强烈同意评估新规则。但是，在诸如居民工作时间之类的棘手问题上，应尽可能谨慎地进行评估。 Hoh等人对4个大型患者群进行了令人钦佩的分析，但从这些数据得出的结论是ACGME工时规定已导致神经外科创伤患者并发症的发生率似乎是最好的替代方法1.Hoh BL，Neal DW，Kleinhenz DT等。在ACGME住院时间限制时代，更高的并发症发生率并没有改善死亡率：全国住院患者样本数据库中超过107,000名神经外科创伤患者的分析。神经外科。 2012; 70（6）：1369–1381;讨论1381-1382。版权？ 2012年由神经外科医师大会发行：

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