Association of Surgical Practice Patterns and Clinical Outcomes With Surgeon Training in University- or Nonuniversity-Based Residency Program

作者：Sellers Morgan M; Keele Luke J; Sharoky Catherine E; Wirtalla Christopher; Bailey Elizabeth A; Kelz Rachel R^*

来源：JAMA Surgery, 2018, 153(5): 418-425.

DOI：10.1001/jamasurg.2017.5449

IMPORTANCE Important metrics of residency program success include the clinical outcomes achieved by trainees after transitioning to practice. Previous studies have shown significant differences in reported training experiences of general surgery residents at nonuniversity-based residency (NUBR) and university-based residency (UBR) programs.
OBJECTIVE To examine the differences in practice patterns and clinical outcomes between surgeons trained in NUBR and those trained in UBR programs.
DESIGN, SETTING, AND PARTICIPANTS This observational cohort study linked the claims data of patients who underwent general surgery procedures in New York, Florida, and Pennsylvania between January 1, 2012, and December 31, 2013, to demographic and training information of surgeons in the American Medical Association Physician Masterfile. Patients who underwent a qualifying procedure were grouped by surgeon. Practice pattern analysis was performed on 3638 surgeons and 1237 621 patients, representing 214 residency programs. Clinical outcomes analysis was performed on 2301surgeons and 312 584 patients. Data analysis was conducted from February 1, 2017, to July 31, 2017.
EXPOSURES NUBR or UBR training status.
MAIN OUTCOMES AND MEASURES Inpatient mortality, complications, and prolonged length of stay.
RESULTS No significant differences were observed between the NUBR-trained surgeons and UBR-trained surgeons in age (mean, 53.3 years vs 53.7 years), sex (female, 18.2% vs 16.9%). or years of clinical experience (mean, 16.5 years vs 16.5 years). Overall, NUBR-trained surgeons compared with UBR-trained surgeons performed more procedures (median interquartile range [IQR], 328 [93-661] vs 164 [49-444]; P < .001) and performed a greater proportion of procedures in the outpatient setting (risk difference, 6.5; 95% CI, 6.4 to 6.7; P < .001). Before matching, the mean proportion of patients with documented inpatient mortality was lower for NUBR-trained surgeons than for UBR-trained surgeons (risk difference, -1.01; 95% CI, -1.41 to -0.61; P < .001). The mean proportion of patients with complications (risk difference, -3.17%; 95% CI, -4.21 to -2.13; P < .001) and prolonged length of stay (risk difference. -1.89%; 95% CI. -2.79 to -0.98; P < .001) was also lower for NUBR-trained surgeons. After matching, no significant differences in patient mortality, complications, and prolonged length of stay were found between NUBR- and UBR-trained surgeons.
CONCLUSIONS AND RELEVANCE Surgeons trained in NUBR and UBR programs have distinct practice patterns. After controlling for patient, procedure, and hospital factors, no differences were observed in the inpatient outcomes between the 2 groups.

• 出版日期2018-5