Abstract：
We studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident\'s development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications.
Retrospective hospital registry study.
Two university-affiliated hospitals networks (MA and NY, USA).
140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021.
Multivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery.
In 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03-1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01-1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02-1.42; p = 0.026, p-for-interaction = 0.056).
Patients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.
Retrospective hospital registry study.
Two university-affiliated hospitals networks (MA and NY, USA).
140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021.
Multivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery.
In 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03-1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01-1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02-1.42; p = 0.026, p-for-interaction = 0.056).
Patients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.
摘要：
目的：我们研究了麻醉住院医师培训水平（第一临床麻醉年，CA1与CA2/3居民）与术后早期去饱和（氧饱和度<90％）有关。我们还分析了居民从CA1发展到CA2/3居民的去饱和率(轨迹)的变化。及其对术后呼吸系统并发症的影响。
方法：回顾性医院注册研究。
方法：两个大学附属医院网络(MA和NY，美国）。
方法：140,818名成年人在2005年至2021年期间在手术室内进行全身麻醉和拔管的非心脏手术（n=378）。
方法：在分析中使用多变量logistic和分位数回归。次要结果是术后7天内的主要呼吸道并发症。
结果：在6.5%和1.6%的病例中，术后早期去饱和<90％和80％发生。与CA2/3居民相比，CA1居民经历术后早期去饱和的几率较高，分别为<90％和80％（调整后的优势比[ORadj]，1.07；95CI1.03-1.12；p=0.002，ORadj1.10；95CI1.01-1.20；p=0.037）。从CA1过渡到CA2/3状态期间，术后去饱和率的变化从ORadj0.80（风险降低）到1.33（风险增加）。主要呼吸系统并发症在经验水平之间没有差异（p=0.52）。然而,在CA1向CA2/3过渡期间,术后去饱和率的改善显著下降,同时CA2/3居民出现重大呼吸系统并发症的几率增加(ORadj1.20;95CI1.02-1.42;p=0.026,p-for-interaction=0.056).
结论：接受CA1患者治疗的患者术后去饱和的风险增加。一些居民显示出改善，而另一些居民显示出术后去饱和率下降。我们的次要分析表明，应该更多地关注那些尽管经验越来越丰富但术后去饱和表现下降的居民。
方法：回顾性医院注册研究。
方法：两个大学附属医院网络(MA和NY，美国）。
方法：140,818名成年人在2005年至2021年期间在手术室内进行全身麻醉和拔管的非心脏手术（n=378）。
方法：在分析中使用多变量logistic和分位数回归。次要结果是术后7天内的主要呼吸道并发症。
结果：在6.5%和1.6%的病例中，术后早期去饱和<90％和80％发生。与CA2/3居民相比，CA1居民经历术后早期去饱和的几率较高，分别为<90％和80％（调整后的优势比[ORadj]，1.07；95CI1.03-1.12；p=0.002，ORadj1.10；95CI1.01-1.20；p=0.037）。从CA1过渡到CA2/3状态期间，术后去饱和率的变化从ORadj0.80（风险降低）到1.33（风险增加）。主要呼吸系统并发症在经验水平之间没有差异（p=0.52）。然而,在CA1向CA2/3过渡期间,术后去饱和率的改善显著下降,同时CA2/3居民出现重大呼吸系统并发症的几率增加(ORadj1.20;95CI1.02-1.42;p=0.026,p-for-interaction=0.056).
结论：接受CA1患者治疗的患者术后去饱和的风险增加。一些居民显示出改善，而另一些居民显示出术后去饱和率下降。我们的次要分析表明，应该更多地关注那些尽管经验越来越丰富但术后去饱和表现下降的居民。
