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Proksimal femoral çivileme uygulamasında öğrenme eğrisi

Yıl 2014, Cilt: 48 Sayı: 4, 396 - 400, 03.09.2014

Öz

Amaç: Bu çalışmanın amacı asistanlık eğitimi sırasında uygulanan proksimal femoral çivilemenin operasyon süresi ve cerrahi komplikasyon oranını değerlendirmek idi.

Çalışma planı: Bu retrospektif değerlendirmeye 1998 ile 2010 yılları arasında gözetim altındaki 63 asistan tarafından ameliyat edilen 659 hasta (508 kadın, 151 erkek; ortalama yaş: 80.7) dahil edildi. Tüm hastalara aynı implant uygulandı (Targon® PF). Kırık sınıflandırması, ameliyat süresi ve erken dönemde tekrar ameliyata ya da hastaneye yatırılmaya neden olan cerrahi komplikasyonlar (hematom, enfeksiyon, kalça perforasyonu, kemik kaynamaması, implantın hatalı yerleşimi) kaydedildi ve asistanın ameliyat tecrübesi gerçekleştirilen ameliyat sayısı ile karşılaştırılarak korelasyonu sağlandı.

Bulgular: Ortalama ameliyat süresi 61.3 (dağılım: 59.8-62.8) dakika olarak ölçüldü. Bir asistanın eğitim amaçlı ilk 15 ameliyatının ortalama süresi daha sonraki ameliyatların süresinden 8.7 dakika daha uzundu (p<0.001). İlk 15 eğitim amaçlı ameliyat sonrası ameliyat süresinde bunun ötesinde anlamlı bir azalma gözlenmedi. Olguların %9.3’ünde (dağılım: %7-%11.5) cerrahi komplikasyona rastlandı. Eğitim ameliyatları ile bunları takip eden ilk 10 ameliyattaki komplikasyon oranı (%9.9 ile %8.2; p=0.47), hematom oluşumu oranı (%2.5 ile %0.8; p=0.07), enfeksiyon oranı (%2.7 ile %3.9; p=0.52), kaynamama oranı (%0.7 ile %1.6; p=0.51), sıyrılma oranı (%1.2 ile %2.4; p=0.31), vida perforasyonu oranı (%3.2 ile %0.4; p=0.07), implantın hatalı yerleşimi oranı (%0.5 ile %0.0; p=0.26) olarak bulunurken, oranlar arasında anlamlı farklılık saptanmadı.

Çıkarımlar: Bir asistanın eğitim amaçlı 15 ameliyat sonrasındaki cerrahi hızı ile daha deneyimli meslektaşlarının hızı arasında anlamlı bir fark olmadığı belirlendi. Erken dönem cerrahi komplikasyonlar ile asistanın deneyimi arasında anlamlı bir ilişki saptanmadı.

Kaynakça

  • Acun Z, Cihan A, Ulukent SC, Comert M, Ucan B, Cakmak GK, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;34:997-1001.
  • Patel SP, Gauger PG, Brown DL, Englesbe MJ, Cederna PS. Resident participation does not affect surgical outcomes, despite introduction of new techniques. J Am Coll Surg 2010;211:540-5.
  • Wilkiemeyer M, Pappas TN, Giobbie-Hurder A, Itani KM, Jonasson O, Neumayer LA. Does resident post graduate year influence the outcomes of inguinal hernia repair? Ann Surg 2005;241:879-84.
  • Kauvar DS, Braswell A, Brown BD, Harnisch M. Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy. J Surg Res 2006;132:159-63.
  • Biber R, Möllers M, Wicklein S, Singler K, Sieber C, Bail HJ. Hemiarthroplasty for femoral neck fracture in the elderly-an operation suitable for teaching?. [Article in German] Zentralbl Chir 2013;138 Suppl 2:e41-6.
  • Biber R, Grüninger S, Singler K, Sieber CC, Bail HJ. Is proximal femoral nailing a good procedure for teaching in orthogeriatrics? Arch Orthop Trauma Surg 2012;132:997-1002.
  • Peacock JL, Peacock PJ. Oxford Handbook of Medical Statistics. Oxford: Oxford University Press; 2011.
  • Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer-Verlag; 1990.
  • Moran M, Yap SL, Walmsley P, Brenkel IJ. Clinical and radiologic outcome of total hip arthroplasty performed by trainee compared with consultant orthopedic surgeons. J Arthroplasty 2004;19:853-7.
  • Palan J, Gulati A, Andrew JG, Murray DW, Beard DJ; EPOS study group. The trainer, the trainee and the surgeons’ assistant: clinical outcomes following total hip replacement. J Bone Joint Surg Br 2009;91:928-34.
  • Pardiwala D, Prabhu V, Dudhniwala G, Katre R. The AO distal locking aiming device: an evaluation of efficacy and learning curve. Injury 2001;32:713-8.
  • Harris IA, Lin C. Orthopaedic trauma surgery performed by unsupervised and supervised trainees: complication rates compared. J Orthop Surg (Hong Kong) 2007;15:264-6.
  • Bjorgul K, Novicoff WM, Saleh KJ. Learning curves in hip fracture surgery. Int Orthop 2011;35:113-9.
  • Kawaguchi S, Sawada K, Nabeta Y. Cutting-out of the lag screw after internal fixation with the Asiatic gamma nail. Injury 1998;29:47-53.
  • Zirngibl B, Biber R, Bail HJ. How to prevent cut-out and cut-through in biaxial proximal femoral nails: is there anything beyond lag screw positioning and tip-apex distance? Int Orthop 2013;37:1363-8.

The learning curve of proximal femoral nailing

Yıl 2014, Cilt: 48 Sayı: 4, 396 - 400, 03.09.2014

Öz

Objective: The aim of this study was to evaluate operation time and surgical complication rate of proximal femoral nailing during resident training.

Methods: This retrospective evaluation included 659 patients (508 females, 151 males; mean age: 80.7 years), operated by 63 supervised residents between 1998 and 2010. All patients received the same implant (Targon® PF). Fracture classification, operation time and early surgical complications causing reoperation or hospital readmission (i.e. hematoma, infection, hip perforation, nonunion, implant malpositioning) were recorded and correlated with the resident’s operative experience measured by the number of operations performed.

Results: Mean operation time was 61.3 (range: 59.8 to 62.8) minutes. Mean operation time of a resident’s first 15 training operations was 8.7 minutes longer than that of later operations (p<0.001). No further significant shortening of operation time was experienced after the first 15 training operations. Overall surgical complication rate was 9.3% (range: 7.0% to 11.5%). There were no significant differences in complication rate (9.9% vs. 8.2%; p=0.47), hematoma formation (2.5% vs. 0.8%; p=0.07), infection (2.7% vs. 3.9%; p=0.52), nonunion (0.7% vs. 1.6%; p=0.51), cut-out (1.2% vs. 2.4%; p=0.31), lag screw perforation (3.2% vs. 0.4%; p=0.07) or implant malpositioning (0.5% vs. 0.0%; p=0.26) between the first 10 and subsequent training operations the subsequent training operations.

Conclusion: After 15 training operations, a resident’s operative speed did not significantly differ from that of more experienced collegues. Early surgical complications were not significantly affected by the resident’s experience.

Kaynakça

  • Acun Z, Cihan A, Ulukent SC, Comert M, Ucan B, Cakmak GK, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;34:997-1001.
  • Patel SP, Gauger PG, Brown DL, Englesbe MJ, Cederna PS. Resident participation does not affect surgical outcomes, despite introduction of new techniques. J Am Coll Surg 2010;211:540-5.
  • Wilkiemeyer M, Pappas TN, Giobbie-Hurder A, Itani KM, Jonasson O, Neumayer LA. Does resident post graduate year influence the outcomes of inguinal hernia repair? Ann Surg 2005;241:879-84.
  • Kauvar DS, Braswell A, Brown BD, Harnisch M. Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy. J Surg Res 2006;132:159-63.
  • Biber R, Möllers M, Wicklein S, Singler K, Sieber C, Bail HJ. Hemiarthroplasty for femoral neck fracture in the elderly-an operation suitable for teaching?. [Article in German] Zentralbl Chir 2013;138 Suppl 2:e41-6.
  • Biber R, Grüninger S, Singler K, Sieber CC, Bail HJ. Is proximal femoral nailing a good procedure for teaching in orthogeriatrics? Arch Orthop Trauma Surg 2012;132:997-1002.
  • Peacock JL, Peacock PJ. Oxford Handbook of Medical Statistics. Oxford: Oxford University Press; 2011.
  • Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer-Verlag; 1990.
  • Moran M, Yap SL, Walmsley P, Brenkel IJ. Clinical and radiologic outcome of total hip arthroplasty performed by trainee compared with consultant orthopedic surgeons. J Arthroplasty 2004;19:853-7.
  • Palan J, Gulati A, Andrew JG, Murray DW, Beard DJ; EPOS study group. The trainer, the trainee and the surgeons’ assistant: clinical outcomes following total hip replacement. J Bone Joint Surg Br 2009;91:928-34.
  • Pardiwala D, Prabhu V, Dudhniwala G, Katre R. The AO distal locking aiming device: an evaluation of efficacy and learning curve. Injury 2001;32:713-8.
  • Harris IA, Lin C. Orthopaedic trauma surgery performed by unsupervised and supervised trainees: complication rates compared. J Orthop Surg (Hong Kong) 2007;15:264-6.
  • Bjorgul K, Novicoff WM, Saleh KJ. Learning curves in hip fracture surgery. Int Orthop 2011;35:113-9.
  • Kawaguchi S, Sawada K, Nabeta Y. Cutting-out of the lag screw after internal fixation with the Asiatic gamma nail. Injury 1998;29:47-53.
  • Zirngibl B, Biber R, Bail HJ. How to prevent cut-out and cut-through in biaxial proximal femoral nails: is there anything beyond lag screw positioning and tip-apex distance? Int Orthop 2013;37:1363-8.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Burak Altintas Bu kişi benim

Roland Biber Bu kişi benim

Hermann Josef Bail Bu kişi benim

Yayımlanma Tarihi 3 Eylül 2014
Yayımlandığı Sayı Yıl 2014 Cilt: 48 Sayı: 4

Kaynak Göster

APA Altintas, B., Biber, R., & Bail, H. J. (2014). The learning curve of proximal femoral nailing. Acta Orthopaedica Et Traumatologica Turcica, 48(4), 396-400.
AMA Altintas B, Biber R, Bail HJ. The learning curve of proximal femoral nailing. Acta Orthopaedica et Traumatologica Turcica. Eylül 2014;48(4):396-400.
Chicago Altintas, Burak, Roland Biber, ve Hermann Josef Bail. “The Learning Curve of Proximal Femoral Nailing”. Acta Orthopaedica Et Traumatologica Turcica 48, sy. 4 (Eylül 2014): 396-400.
EndNote Altintas B, Biber R, Bail HJ (01 Eylül 2014) The learning curve of proximal femoral nailing. Acta Orthopaedica et Traumatologica Turcica 48 4 396–400.
IEEE B. Altintas, R. Biber, ve H. J. Bail, “The learning curve of proximal femoral nailing”, Acta Orthopaedica et Traumatologica Turcica, c. 48, sy. 4, ss. 396–400, 2014.
ISNAD Altintas, Burak vd. “The Learning Curve of Proximal Femoral Nailing”. Acta Orthopaedica et Traumatologica Turcica 48/4 (Eylül 2014), 396-400.
JAMA Altintas B, Biber R, Bail HJ. The learning curve of proximal femoral nailing. Acta Orthopaedica et Traumatologica Turcica. 2014;48:396–400.
MLA Altintas, Burak vd. “The Learning Curve of Proximal Femoral Nailing”. Acta Orthopaedica Et Traumatologica Turcica, c. 48, sy. 4, 2014, ss. 396-00.
Vancouver Altintas B, Biber R, Bail HJ. The learning curve of proximal femoral nailing. Acta Orthopaedica et Traumatologica Turcica. 2014;48(4):396-400.