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居民参与对经历全喉切除术的退伍军人手术时间和结果的影响
John Anderson1, Xue Geng2, Jessica H Maxwell3,4
1Georgetown University, Washington, District of Columbia.
概括
住院参与VA的全喉切除术增加了手术时间,降低了生产力,但没有影响患者并发症率. 居民参与这些程序的比例显著下降.
科学领域:
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
- 外科教育的外科教育
- 医疗保健服务研究 医疗服务研究
背景情况:
- 美国退伍军人事务部 (VA) 对耳鼻喉科住院手术培训至关重要.
- 住院参与对VA耳鼻喉科手术患者结果和生产力的影响仍未得到充分研究.
研究的目的:
- 评估住户参与全喉切除手术如何影响VA系统内的手术时间,生产力 (每小时工作相对值单位) 和患者的结果.
- 确定影响全喉切除术患者手术时间和术后并发症的因素.
主要方法:
- 从VA外科手术质量改进计划数据库中对1857例全喉切除术 (2001-2021) 的回顾性分析.
- 操作时间的比较,每小时的wRVU,以及与初级住院医生,高级住院医生和单独的主治医生之间的并发症率.
- 多变量分析以确定手术时间和术后结果的预测因素.
主要成果:
- 住院参与与增加的操作时间 (P=.001) 和每小时减少的wRVU (P=.002) 相关.
- 没有观察到对术后并发症率 (21.3%) 或恢复OR (14.6%) 的显著影响.
- 年轻居民参与和显著的体重减轻 (>10%) 与更长的手术时间有关.
- 居民参与率从80.6% (2001-2011) 显著下降到68.3% (2012-2021) 已经注意到 (P<.001).
结论:
- 居民参与全喉切除术延长了手术时间,降低了生产力,但不会对患者安全结果产生负面影响.
- 退伍军人医院在耳鼻喉学培训中的作用至关重要,但住院人员参与喉切除术的比例有所下降.
- 进一步研究优化住院外科培训,同时保持效率和患者安全是有必要的.
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