背景:血管创伤的治疗需要专门的培训和专业知识。虽然创伤性血管损伤目前由血管和创伤外科医生在现代实践中进行治疗,目前尚不清楚谁将在未来几十年继承血管创伤管理的角色.在这项研究中,我们研究了不同外科专业的外科受训者在血管创伤方面的手术经验差异.
方法:研究生医学教育认证委员会收集了血管外科毕业生(VSR)的全国手术日志报告,血管外科研究员(VSF),和2012年至2022年的普外科居民(GSR)。检查了创伤性血管损伤的总手术体积,五个主要的手术领域(颈部,胸廓,腹部,外围,和筋膜切开术)。
结果:总共22,052GSR,334VSR,1,672名VSF在十年的学习期间毕业。VSR的血管创伤病例量最高(24.9±3.9例/5年),其次是VSF(22.1±1.5例/2年),然后是GSR(2.4±0.3例/5年,p<0.001)。胸血管探查/修复(0.7vs0.6vs0.0例),腹部血管探查/修复(1.0vs0.9vs0.0例),颈部血管探查/修复(4.0vs3.4vs0.2例),外周血管探查/修复(12.1例/9.5例/1.1例),在VSR和VSF组中,下肢筋膜切开术(7.2vs7.6vs1.1例)最常见(p<0.001)。在线性回归分析中,两个VSF(+0.5例/年,R2=0.81,p<0.001)和GSR(+0.1例/年,R2=0.75,p=0.001)组经历了血管创伤体积的增长。相反,血管创伤体积在VSR毕业时没有变化(R2=0.13,p=0.31).
结论:在美国,专用血管外科训练对平民血管创伤的手术暴露率最高。
BACKGROUND: The management of vascular trauma requires specialized training and expertise. While traumatic vascular injury is currently treated by both vascular and trauma surgeons in modern practice, it remains unclear who will inherit the role of managing vascular trauma in the coming decades. In this study, we examined disparities in operative experience in vascular trauma among surgical trainees across different surgical specialties.
METHODS: Accreditation Council for Graduate Medical Education national operative log reports were collected for graduating vascular surgery residents (VSR), vascular surgery fellows (VSF), and general surgery residents (GSR) from 2012 to 2022. Total operative volume for traumatic vascular injury was examined, as were the five major contributing operative domains (neck, thoracic, abdominal, peripheral, and fasciotomy).
RESULTS: A total of 22,052 GSR, 334 VSR, and 1,672 VSF graduated over the ten-year study period. VSR had the highest vascular trauma case volume (24.9 ± 3.9 cases/five yrs), followed by VSF (22.1 ± 1.5 cases/two yrs) then GSR (2.4 ± 0.3 cases/five yrs, p<0.001). Thoracic vessel exploration/repair (0.7 vs 0.6 vs 0.0 cases), abdominal vessel exploration/repair (1.0 vs 0.9 vs 0.0 cases), neck vessel exploration/repair (4.0 vs 3.4 vs 0.2 cases), peripheral vessel exploration/repair (12.1 vs 9.5 vs 1.1 cases), and lower extremity fasciotomy for trauma (7.2 vs 7.6 vs 1.1 cases) were most frequent among VSR and VSF groups (p<0.001 each). On linear regression analysis, both VSF (+0.5 cases/yr, R2=0.81, p<0.001) and GSR (+0.1 cases/yr, R2=0.75, p=0.001) groups experienced a growth in vascular trauma volume. Contrariwise, vascular trauma volume did not change among graduating VSR (R2=0.13, p=0.31).
CONCLUSIONS: Dedicated vascular surgical training provides the highest operative exposure to civilian vascular trauma in the United States.