评估老年人急诊普通外科住院医师参与的影响

IF 2.1 3区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Journal of Surgical Education Pub Date : 2025-07-26 DOI:10.1016/j.jsurg.2025.103626

Yasmin Arda MD, May Abiad MD, Wardah Rafaqat MBBS, Emanuele Lagazzi MD, Jefferson P. Zamudio MD, Dias Argandykov MD, George C. Velmahos MD, PhD, Michael P. DeWane MD, Charudutt N. Paranjape MBBS, John O. Hwabejire MD, MPH

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引用次数: 0

摘要

目的：虽然关于急诊普通外科（EGS）手术的住院患者参与的数据丰富，但其对弱势老年人预后的影响尚未探讨。本研究旨在评估住院医师参与对接受EGS的老年成人患者术后预后的影响。设计倾向-得分匹配的队列研究。2007-2012年美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库。年龄≥65岁且接受8种EGS手术之一的患者被纳入研究。根据住院医师参与（RES vs. NO-RES）对患者进行分层。在倾向评分匹配后，每组纳入2,796例具有可比较基线特征的患者。结果在24452例患者中，14381例（58.8%）接受了住院医师参与的手术。RES组的患者更有可能是黑人（11.3%对6.1%），并且有预先存在的合并症，例如呼吸机依赖（7.7%对4.0%），并且不太可能从家中入院（84.3%对88.4%）（所有p<；0.001）。配对后，两组的30天死亡率无差异。然而，RES组患者30天的发病率较高（38.8%比36.0%,p = 0.031），可能是由于手术部位浅表感染发生率较高（5.6%比3.9%,p = 0.003）和计划外再手术发生率较高（11.0%比7.4%,p = 0.001）。RES组的手术时间明显更长（p < 0.001）。结论住院医师参与EGS手术可增加手术时间、手术部位感染率和意外再手术率。然而，住院医师参与对患者死亡率没有影响。需要在不损害患者安全的情况下努力改进外科教育。

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Assessing the Impact of Resident Participation in Emergency General Surgery in the Older Adult Population

OBJECTIVE

Although data concerning resident involvement in emergency general surgery (EGS) procedures is abundant, its impact on outcomes in the vulnerable older adult population has not been explored. This study aimed to assess the impact of resident involvement on postoperative outcomes in older adult patients undergoing EGS.

DESIGN

Propensity-score matched cohort study.

SETTING

The 2007–2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

PARTICIPANTS

Patients aged ≥65 years who underwent one of eight EGS procedures were included. Patients were stratified based on resident participation (RES vs. NO-RES). After propensity-score matching, each group included 2,796 patients with comparable baseline characteristics.

RESULTS

Among 24,452 patients identified, 14,381 (58.8%) underwent procedures with resident involvement. Patients in the RES group were more likely to be Black (11.3% vs. 6.1%) and have pre-existing comorbidities, such as ventilator dependence (7.7% vs. 4.0%), and were less likely to be admitted from home (84.3% vs. 88.4%) (all p<0.001). After matching, 30-day mortality was not different between the two groups. However, patients in the RES group demonstrated higher 30-day morbidity (38.8% vs. 36.0%, p = 0.031), likely driven by a greater incidence of superficial surgical site infection (5.6% vs. 3.9%, p = 0.003) and unplanned reoperation (11.0% vs. 7.4%, p<0.001). Operative time was significantly longer in the RES group (p<0.001).

CONCLUSIONS

Participation of residents in EGS procedures is associated with increased operative time, rate of surgical site infection, and unplanned reoperation. However, resident involvement had no effect on patient mortality. Efforts to improve surgical education while not compromising patient safety are needed.

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来源期刊

Journal of Surgical Education EDUCATION, SCIENTIFIC DISCIPLINES-SURGERY

CiteScore

5.60

自引率

10.30%

发文量

261

审稿时长

48 days

期刊介绍： The Journal of Surgical Education (JSE) is dedicated to advancing the field of surgical education through original research. The journal publishes research articles in all surgical disciplines on topics relative to the education of surgical students, residents, and fellows, as well as practicing surgeons. Our readers look to JSE for timely, innovative research findings from the international surgical education community. As the official journal of the Association of Program Directors in Surgery (APDS), JSE publishes the proceedings of the annual APDS meeting held during Surgery Education Week.