小児複雑性急性虫垂炎に対する開腹手術の安全性評価：研修医と専門医の比較

Safety assessment of open appendectomies for complicated acute appendicitis in children: a comparison of trainees and specialists.

• George Vaos
• Nick Zavras
• Anastasia Dimopoulou
• Emmanouil Iakomidis
• George Pantalos
• Alexander Passalides

抄録

目的:

本研究の目的は、SPSの直接指導の下で研修医が行った開腹手術（OA）とSPSが行った開腹手術（OA）のいずれかを受けた複雑性急性虫垂炎（CAA）児の転帰を比較することであった。

PURPOSE: The aim of this study was to compare the outcome of children with complicated acute appendicitis (CAA) who underwent open appendectomy (OA) performed either by trainees under the direct supervision of an SPS, or an SPS.

方法:

CAA患者238人を対象に、SPSの直接監督下にあるジュニアトレーニー（JT）またはシニアトレーニー（ST）が手術を行ったか、SPSが手術を行ったかを検討した。アウトカム指標は、合併症全体の割合、手術時間（OT）、入院期間（LHS）、30日間の再入院率であった。

METHODS: Two hundred thirty eight patients with CAA were reviewed operated on either by a junior trainee (JT) or a senior trainee (ST) under the direct supervision of an SPS or by an SPS. The outcome measures were the overall rate of complications, operative time (OT), length of hospital stay (LHS) and 30-day readmission rate.

結果:

全体的な合併症率と30日再入院率については、3群間で統計的な差は認められなかった。平均OTには3群間で統計的差は認められなかったが、穿孔性虫垂炎(PA)の平均OTは、JTが行った場合、SPSが行った場合に比べて有意に長かった(p 0.012)。さらに、穿孔性虫垂炎患者のLHSについては、JTとSPSの間に統計的に有意な差があった(p 0.028)。

RESULTS: No statistical differences were observed between the three groups regarding the overall complication rates and 30-day readmission rate. Although, no statistical differences were observed in the mean OT between the three groups, the mean OT for perforated appendicitis (PA) performed by JTs was significantly longer than when performed by SPSs (p 0.012). Furthermore, there was a statistically significant difference between JTs and SPSs in terms of LHS for patients with PA (p 0.028).

結論:

以上のことから、GAまたはPAのOAを行った場合の全体的な合併症率と30回の再入院率については、JTが行ったPAのOTとLHSの長さを除いて、指導研修者とSPSの間に統計的な差は認められなかったと考えられる。

CONCLUSION: This study suggests that no statistical differences were observed between the supervised trainees and SPSs regarding the overall complication rate and 30-readmission rate when they performed OA for GA or PA except of a longer OT and LHS for PA performed by JTs.