Journal of Medical Education and Training
نویسندگان
چکیده
Background: There are little data evaluating level of postgraduate training on outcomes following colorectal surgery. We hypothesized that involvement of senior surgical trainees in colorectal procedures is associated with an overall improvement in outcomes. Methods: A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We included patients with common open and laparoscopic colorectal surgery cases. Cases in which no trainee was involved were excluded. Major outcome measures include NSQIP 30-day adverse events and mortality. Results: A total of 145,964 patients met procedure criteria and trainees were involved in 68,327 (47%) cases. On univariate analysis, fellow involvement in procedures was associated with a decrease in the incidence of septic shock, stroke, acute renal failure, unplanned intubation, pneumonia, wound disruption, deep incisional surgical site infection, and unplanned return to the operating room compared to cases with junior and senior residents. After adjusting for NSQIP recommended variables, multivariate analysis revealed a 20% reduction in mortality (OR 0.8, p=0.01) when fellows were present for colorectal surgery procedures as compared to senior residents. Conclusions: After adjustment for NSQIP co-variates, fellow trainee involvement was associated with improved outcomes suggesting increased years of training in colorectal surgery lead to improved clinical outcomes.
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تاریخ انتشار 2017