外科医生数量:在接受腹壁重建的高风险患者群体中保持适当的外科结果
Artem Shmelev1, Molly A Olsen2, Jordan O Bray3
1Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Surgical endoscopy
|July 17, 2023
概括
进行复杂腹壁重建 (cAWR) 的高体积外科医生与低体积外科医生取得类似的结果,即使在更复杂的病例中. 这表明在cAWR方面的专业培训和经验导致了可比的结果.
科学领域:
- 腹部外科手术 腹部外科手术
- 外科手术的结果
- Hernia 修复 Hernia 修复 的方法
背景情况:
- 复杂腹壁重建 (cAWR) 需要专门的培训.
- 没有先前的研究评估了cAWR的体积-结果关系.
- 这项研究调查了外科医生体积对腹部核心健康质量协作 (ACHQC) 中cAWR结果的影响.
研究的目的:
- 为了确定患者对cAWR的结果是否根据外科医生的体积而有所不同.
- 分析外科医生经验和cAWR结果之间的关系.
主要方法:
- 对9206个选择性cAWR案件的回顾性分析,从ACHQC数据库中分离组件.
- 根据每年的手术数量,外科医生被分为低,中和高体积的第三者.
- 评估患者的人口统计,风险因素,手术细节和30天的结果.
主要成果:
- 高体积的外科医生 (n=66) 进行了88.7%的cAWRs,通常是患有更多并发症,复发性,更广泛的,以及相关的骨切割的患者.
- 尽管在更复杂的病例上进行手术,但高体积的外科医生表现出与低体积外科医生相比的30天手术部位感染率 (6.9%与7.1%) 和并发症率 (8.9%与10%).
- 大量的外科医生更频繁地使用后部件分离,永久网格和亚层网格放置.
结论:
- 在cAWR中的外科医生体积似乎不会对30天的结果产生负面影响,即使患者复杂性增加.
- 高体积的外科医生成功地管理复杂的腹壁重建与相似的安全性和有效性.
- 这些发现支持考虑将cAWR手术区域化到大量的专业外科医生.
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