کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
4292396 1612237 2014 8 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Effects of Resident Involvement on Complication Rates after Laparoscopic Gastric Bypass
ترجمه فارسی عنوان
تأثیر مشارکت ساکنین بر میزان عوارض بعد از بایپس معده لاپاروسکوپی
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی عمل جراحی
چکیده انگلیسی

BackgroundAlthough resident involvement has been shown to be safe for most procedures, the impact of residents on outcomes after complex laparoscopic procedures is not well understood. We sought to examine the impact of resident involvement on outcomes after bariatric surgery using a population-based clinical registry.Study DesignWe analyzed 17,057 patients who underwent a primary laparoscopic gastric bypass in the 35-hospital Michigan Bariatric Surgery Collaborative from July 2006 to August 2012. Resident involvement was characterized at the surgeon level. Using hierarchical logistic regression, we examined the influence of resident involvement on 30-day complications, accounting for patient characteristics as well as hospital and surgeon case volume. To evaluate potential mediating factors for specific complications, we also adjusted for operative duration.ResultsRisk-adjusted 30-day complication rates with and without residents were 13.0% and 8.5%, respectively (p < 0.01). Resident involvement was independently associated with wound infection (odds ratio [OR] = 2.06; 95% CI, 1.24−3.43) and venous thromboembolism (OR = 2.01; 95% CI, 1.19−3.40), but not with any other medical or surgical complications. Operative duration was longer with resident involvement (median duration with residents 129 minutes vs 88 minutes without; p < 0.01). After adjusting for operative duration, resident involvement was still independently associated with wound infection (OR = 1.67; 95% CI, 1.01−2.76), but not venous thromboembolism (OR = 1.73; 95% CI, 0.99−3.04).ConclusionsResident involvement in laparoscopic gastric bypass is independently associated with wound infections and venous thromboembolism. The effect appears to be mediated in part by longer operative times. These findings highlight the importance of strategies to assess and improve resident technical proficiency outside the operating room.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of the American College of Surgeons - Volume 218, Issue 2, February 2014, Pages 253–260
نویسندگان
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