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Hughes D, Hanson MN, Alseidi A, Bittner JG, Romanelli J, Vassiliou M, Feldman LS, Asbun H. The joy of surgery: how surgeons experience joy, time, and support. Surg Endosc 2024; 38:3494-3502. [PMID: 38872020 DOI: 10.1007/s00464-024-10961-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Burnout is a crisis in medicine, and especially in surgery it has serious implications not only for physician well-being but also for patient outcomes. This study builds on previous SAGES Reimagining the Practice of Surgery Task Force work to better understand how organizations might intervene to increase the "joy in surgery." METHODS This was a cross-sectional, descriptive study utilizing a REDCap survey with closed-ended questions for data collection across 5 domains: facilitators of joy, support for best work, time for work tasks, barriers to joy, and what they would do with more time. We calculated average scores and "percentage of respondents giving a high score" for each item. RESULTS There were 307 individuals who started the survey; 223 completed it and were surgeons who met the inclusion criteria. The majority (85.7%) were trained in general surgery, regardless of sub-specialty. Surgeons found joy in operating and its technical skills, curing disease, patient relationships, and working with a good team. They reported usually having what they needed to deliver care. A majority felt valued and respected. Most were dissatisfied with reimbursement, perceiving it as unfair. The most commonly worked range of hours was 51-70 per week. They reported having little time for paperwork and documentation, and if they had more time, they would spend it with friends and family. CONCLUSION Organizations should consider interventions to address the operative environment, provide appropriate staff support, and foster good teamwork. They can also consider interventions that alleviate time pressures and administrative burden while at the same time promoting sustainable workloads.
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Affiliation(s)
- Dorothy Hughes
- Departments of Population Health and Surgery, University of Kansas School of Medicine- Salina Campus, 138 N Santa Fe Ave, Salina, KS, 67401, USA.
| | - Melissa N Hanson
- Department of Surgery, Guelph General Hospital, Guelph, ON, Canada
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - James G Bittner
- Department of Surgery, Trinity Health of New England, Hartford, CT, USA
| | - John Romanelli
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA
| | - Melina Vassiliou
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Center, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Center, Montreal, QC, Canada
| | - Horacio Asbun
- Department of Hepato-Pancreato-Biliary Surgery, Miami Cancer Institute, Miami, FL, USA
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Ginzberg SP, Gasior JA, Passman JE, Stein J, Keddem S, Soegaard Ballester JM, Finn CB, Myers JS, Kelz RR, Shea JA, Wachtel H. Surgeon and Surgical Trainee Experiences After Adverse Patient Events. JAMA Netw Open 2024; 7:e2414329. [PMID: 38829617 PMCID: PMC11148685 DOI: 10.1001/jamanetworkopen.2024.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/01/2024] [Indexed: 06/05/2024] Open
Abstract
Importance Adverse patient events are inevitable in surgical practice. Objectives To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient. Design, Setting, and Participants In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system. Main Outcomes and Measures The personal impact of adverse patient events, current coping mechanisms, and desired forms of support. Results Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing. Conclusions and Relevance In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.
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Affiliation(s)
- Sara P. Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Julia A. Gasior
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jesse E. Passman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Jacob Stein
- Sackler School of Medicine New York State/American Program, Tel Aviv University, Tel Aviv, Israel
| | - Shimrit Keddem
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia
| | | | - Caitlin B. Finn
- Department of Surgery, Weill Cornell Medicine, Philadelphia, Pennsylvania
| | - Jennifer S. Myers
- Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, University of Pennsylvania Health System, Philadelphia
| | - Rachel R. Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judy A. Shea
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, University of Pennsylvania Health System, Philadelphia
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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D'Angelo JD, Rivera M, Rasmussen TE, Nelson MH, Behm KT, Kelley SR, D'Angelo ALD. Assessing the stops framework for coping with intraoperative errors: Evidence of efficacy, hints of hubris, and a bridge to abridging burnout. Surgery 2024:S0039-6060(24)00237-X. [PMID: 38763791 DOI: 10.1016/j.surg.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Answering calls in the literature, we developed and introduced an evidence-based tool for surgeons facing errors in the operating room: the STOPS framework (stop, talk to you team, obtain help, plan, succeed). The purpose of this research was to assess the impact of presenting this psychological tool on resident coping in the operating room and the related outcome of burnout while examining sex differences. METHODS In a natural experiment, general surgery residents were invited to attend 2 separate educational conferences regarding coping with errors in the operating room. Three months later, all residents were asked to fill out a survey assessing their coping in the operating room, level of burnout, and demographics. We assessed the impact of the educational intervention by comparing those who attended the coping conferences with those who did not attend. RESULTS Thirty-five residents responded to the survey (65% response rate, 54% female respondents, 49% junior residents). Our hypothesized moderated mediation model was supported. Sex was found to moderate the impact of the STOPS framework-female residents who attended the coping educational conference reported higher coping self-efficacy, whereas attendance had no statistically significant impact on male levels of coping self-efficacy. In turn, higher coping self-efficacy was associated with lower levels of burnout. CONCLUSION Our results suggest that there is evidence of efficacy in this instruction-female residents presented this material report higher levels of coping in the operating room compared to those who did not receive the framework. Further, increase in coping ability was associated with reduced levels of burnout for both genders.
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Affiliation(s)
| | - Mariela Rivera
- Divsion of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Kevin T Behm
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN
| | - Scott R Kelley
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, MN
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Yaow CYL, Ng QX, Chong RIH, Ong C, Chong NZY, Yap NLX, Hong ASY, Tan BKT, Loh AHP, Wong ASY, Tan HK. Intraoperative adverse events among surgeons in Singapore: a multicentre cross-sectional study on impact and support. BMC Health Serv Res 2024; 24:512. [PMID: 38659030 PMCID: PMC11040834 DOI: 10.1186/s12913-024-10998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND It is known that many surgeons encounter intraoperative adverse events which can result in Second Victim Syndrome (SVS), with significant detriment to their emotional and physical health. There is, however, a paucity of Asian studies in this space. The present study thus aimed to explore the degree to which the experience of an adverse event is common among surgeons in Singapore, as well as its impact, and factors affecting their responses and perceived support systems. METHODS A self-administered survey was sent to surgeons at four large tertiary hospitals. The 42-item questionnaire used a systematic closed and open approach, to assess: Personal experience with intraoperative adverse events, emotional, psychological and physical impact of these events and perceived support systems. RESULTS The response rate was 57.5% (n = 196). Most respondents were male (54.8%), between 35 and 44 years old, and holding the senior consultant position. In the past 12 months alone, 68.9% recalled an adverse event. The emotional impact was significant, including sadness (63.1%), guilt (53.1%) and anxiety (45.4%). Speaking to colleagues was the most helpful support source (66.7%) and almost all surgeons did not receive counselling (93.3%), with the majority deeming it unnecessary (72.2%). Notably, 68.1% of the surgeons had positive takeaways, gaining new insight and improving vigilance towards errors. Both gender and surgeon experience did not affect the likelihood of errors and emotional impact, but more experienced surgeons were less likely to have positive takeaways (p = 0.035). Individuals may become advocates for patient safety, while simultaneously championing the cause of psychological support for others. CONCLUSIONS Intraoperative adverse events are prevalent and its emotional impact is significant, regardless of the surgeon's experience or gender. While colleagues and peer discussions are a pillar of support, healthcare institutions should do more to address the impact and ensuing consequences.
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Affiliation(s)
- Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| | - Ryan Ian Houe Chong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nicolette Zy-Yin Chong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole Li Xian Yap
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ashley Shuen Ying Hong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
- Singhealth Duke-NUS Global Health Institute, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States
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Cacciamani GE, Sholklapper T, Eppler MB, Sayegh A, Storino Ramacciotti L, Abreu AL, Sotelo R, Desai MM, Gill IS. Study protocol for the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) global cross-specialty surveys and consensus. PLoS One 2024; 19:e0297799. [PMID: 38626051 PMCID: PMC11020956 DOI: 10.1371/journal.pone.0297799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/12/2024] [Indexed: 04/18/2024] Open
Abstract
Annually, about 300 million surgeries lead to significant intraoperative adverse events (iAEs), impacting patients and surgeons. Their full extent is underestimated due to flawed assessment and reporting methods. Inconsistent adoption of new grading systems and a lack of standardization, along with litigation concerns, contribute to underreporting. Only half of relevant journals provide guidelines on reporting these events, with a lack of standards in surgical literature. To address these issues, the Intraoperative Complications Assessment and Reporting with Universal Standard (ICARUS) Global Surgical Collaboration was established in 2022. The initiative involves conducting global surveys and a Delphi consensus to understand the barriers for poor reporting of iAEs, validate shared criteria for reporting, define iAEs according to surgical procedures, evaluate the existing grading systems' reliability, and identify strategies for enhancing the collection, reporting, and management of iAEs. Invitation to participate are extended to all the surgical specialties, interventional cardiology, interventional radiology, OR Staffs and anesthesiology. This effort represents an essential step towards improved patient safety and the well-being of healthcare professionals in the surgical field.
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Affiliation(s)
- Giovanni E. Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, United States of America
- Norris Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, United States of America
| | - Michael B. Eppler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Aref Sayegh
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Department of Surgery, MedStar Good Samaritan Hospital, Baltimore, MD, United States of America
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Andre L. Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, United States of America
- Norris Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Mihir M. Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Inderbir S. Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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6
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Reitz ACW, Massarweh NN. Video-Based Assessment of Surgical Quality-Will Video Kill the Radio Star? JAMA Netw Open 2024; 7:e246477. [PMID: 38639941 DOI: 10.1001/jamanetworkopen.2024.6477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Affiliation(s)
- Alexandra C W Reitz
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Nader N Massarweh
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
- Surgery and Perioperative Care, Atlanta VA Health Care System, Decatur, Georgia
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
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7
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Olivero A, Tappero S, Chierigo F, Maltzman O, Secco S, Palagonia E, Piccione A, Bocciardi AM, Galfano A, Dell’Oglio P. A Comprehensive Overview of Intraoperative Complications during Retzius-Sparing Robot-Assisted Radical Prostatectomy: Single Series from High-Volume Center. Cancers (Basel) 2024; 16:1385. [PMID: 38611063 PMCID: PMC11010834 DOI: 10.3390/cancers16071385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Intraoperative complications (ICs) are invariably underreported in urological surgery despite the recent endorsement of new classification systems. We aimed to provide a detailed overview of ICs during Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). METHODS We prospectively collected data from 1891 patients who underwent RS-RARP at a single high-volume European center from January 2010 to December 2022. ICs were collected based on surgery reports and categorized according to the Intraoperative Adverse Incident Classification (EAUiaiC). The quality criteria for accurate and comprehensive reporting of intraoperative adverse events proposed by the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project were fulfilled. To better classify the role of the RS-RARP approach, ICs were classified into anesthesiologic and surgical ICs. Surgical ICs were further divided according to the timing of the complication in RARP-related ICs and ePNLD-related ICs. RESULTS Overall, 40 ICs were reported in 40 patients (2.1%). Ten out of thirteen ICARUS criteria were satisfied. According to EAUiaiC grading of ICs, 27 (67.5%), 7 (17.5%), 2 (5%), 2 (5%), and 2 (5%) patients experienced Grade 1, 2, 3, 4A, and 4B, respectively. When we classified the ICs, two cases (5%) were classified as anesthesiologic ICs. Among the 38 surgical ICs, 16 (42%) were ePNLD-related, and 22 (58%) were RARP-related. ICs led to seven (0.37%) post-operative sequelae (four non-permanent and three permanent). Patients who suffered ICs were significantly older (67 years vs. 65 years, p = 0.02) and had a higher median BMI (27.0 vs. 26.1, p = 0.01), but did not differ in terms of comorbidities or tumor characteristics (all p values ≥ 0.05). CONCLUSIONS Intraoperative complications during RS-RARP are relatively infrequent, but should not be underestimated. Patients suffering from ICs are older, have a higher body mass index, a higher rate of intraoperative blood transfusion, and a longer length of stay.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16126 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16126 Genova, Italy
| | - Francesco Chierigo
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16126 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16126 Genova, Italy
| | - Ofir Maltzman
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
| | - Erika Palagonia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
| | - Antonio Piccione
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16126 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16126 Genova, Italy
| | - Aldo Massimo Bocciardi
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
| | - Paolo Dell’Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (S.T.); (F.C.); (O.M.); (S.S.); (E.P.); (A.P.); (A.M.B.); (A.G.)
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Scrimgeour G, Turner K. Hospital and departmental level strategies for managing the impact of adverse events on surgeons. Urol Oncol 2024:S1078-1439(24)00347-8. [PMID: 38514276 DOI: 10.1016/j.urolonc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
Adverse events have a profound impact on surgeons. This impact extends to physical and mental health, psychological wellbeing, and professional performance. Surgeons are ill prepared for these consequences of adverse events and are under-supported when they inevitably occur. Here we review the data on how adverse events affect surgeons. We explore the efforts made to date to both prepare surgeons before and support them after such events and we make recommendations regarding how this should and could be done better.
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Affiliation(s)
- Gemma Scrimgeour
- Department of Urology, Royal Bournemouth Hospital, University Hospitals Dorset, Castle Lane East, Bournemouth, UK
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9
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Chong RIH, Yaow CYL, Chong NZY, Yap NLX, Hong ASY, Ng QX, Tan HK. Scoping review of the second victim syndrome among surgeons: Understanding the impact, responses, and support systems. Am J Surg 2024; 229:5-14. [PMID: 37838505 DOI: 10.1016/j.amjsurg.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND It is thought that 50% of healthcare providers experience Second Victim Syndrome (SVS) in the course of their practice. The manifestations of SVS varies between individuals, with potential long-lasting emotional effects that impact both the personal lives and professional clinical practice of affected persons. Although surgeons are known to face challenging and high-stress situations in their profession, which can increase their vulnerability to SVS, majority of studies and reviews have focused squarely on nonsurgical physicians. METHODS This scoping review aimed to consolidate existing studies pertaining to a surgeon's experience with SVS, by broadly examining the prevalence and impact, identifying the types of responses, and evaluating factors that could influence these responses. The scoping review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Three databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception till March 19, 2023. RESULTS A total of 13 articles were eligible for thematic analysis based on pre-defined inclusion criteria. Effects of SVS were categorized into Psychological, Physical and Professional impacts, of which Psychological and Professional impacts were particularly significant. Factors affecting the response were categorized into complication type, surgeon factors and support systems. CONCLUSION SVS adds immense psychological, emotional and physical burden to the individual surgeon. There are key personal, interpersonal and environmental factors that can mitigate or exacerbate the effects of SVS, and greater emphasis needs to be placed on improving availability and access to services to help surgeons at risk of SVS.
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Affiliation(s)
- Ryan Ian Houe Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Nicole Li Xian Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore; MOH Holdings Pte Ltd., Singapore.
| | - Hiang Khoon Tan
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore
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10
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Eidt JF, Mannoia K. A toolkit for individualizing interventions to mitigate second-victim syndrome in a diverse surgery community. J Vasc Surg Venous Lymphat Disord 2024; 12:101680. [PMID: 37699443 DOI: 10.1016/j.jvsv.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/03/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023]
Abstract
Adverse outcomes are an inevitable consequence of surgical care. The term "second victim" was introduced by Wu to describe the emotional trauma experienced by a clinician who feels responsibility for an adverse clinical outcome. Second victims may feel shame, guilt, sadness, and a crisis of confidence. Surgeons rarely seek professional support following an adverse event but are more likely to confide in colleagues. Surgeons who represent groups traditionally underrepresented in medicine may be less likely to seek assistance following an adverse clinical outcome. There is a need for surgeons to have sufficient training to provide peer-to-peer support for wounded colleagues. The PEARLS Toolkit provides a blueprint toward this end.
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Affiliation(s)
- John F Eidt
- Department of Vascular Surgery, Baylor Scott and White Heart and Vascular Hospital, Dallas, TX; Department of Surgery, Texas A&M School of Medicine, College Station, TX.
| | - Kristyn Mannoia
- Department of Surgery, Loma Linda University Health, Loma Linda, CA
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11
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Pakkasjärvi N, Anttila H, Pyhältö K. What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework. BMC MEDICAL EDUCATION 2024; 24:119. [PMID: 38321437 PMCID: PMC10848354 DOI: 10.1186/s12909-024-05068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes. BACKGROUND Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies. METHODS A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents. RESULTS Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored. CONCLUSION The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Department of Pediatric Surgery, Section of Urology, University Children's Hospital, Uppsala, Sweden.
| | - Henrika Anttila
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kirsi Pyhältö
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Centre for Higher and Adult Education, Faculty of Education, Stellenbosch University, Stellenbosch, South Africa
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12
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Khalil S, Olds A, Chin K, Erkmen CP. Implementation of Well-Being for Cardiothoracic Surgeons. Thorac Surg Clin 2024; 34:63-76. [PMID: 37953054 DOI: 10.1016/j.thorsurg.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Well-being is a quality of positive physical, mental, social, and environmental experiences. Well-being enables thoracic surgeons to achieve their full potential across personal and work domains. Evidence-based guidelines to promote individual well-being include (1) progress toward a goal; (2) actions commensurate with experience, interest, mission; (3) interconnectivity with others; (4) social relatedness of the work one does; (5) safety; and (6) autonomy. Successful pursuit of well-being includes the development of individual skills of mindfulness, resilience, and connection with others. However, well-being among individuals cannot be achieved without support of workplace leaders and durable institutional infrastructure.
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Affiliation(s)
- Sarah Khalil
- Department of General Surgery, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Anna Olds
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA
| | - Kristine Chin
- Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Suite 501, Parkinson Pavilion, Philadelphia, PA 19140, USA.
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Panagides JC, Hancel K, Kalva S, Schenker M, Saini S, Glazer DI, Khorasani R, Daye D. Interventional Radiology Peer Learning Platform and Adverse Event Reporting (IR-PEER): Initial Experience Implementing a Team-based Novel Peer Learning System in Interventional Radiology. J Am Coll Radiol 2024; 21:93-102. [PMID: 37659453 DOI: 10.1016/j.jacr.2023.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 09/04/2023]
Abstract
Although the transition from peer review to peer learning has had favorable outcomes in diagnostic radiology, experience with implementing a team-based peer review system in interventional radiology (IR) remains limited. Peer learning systems benefit diverse IR teams composed of multiple clinical roles and could contribute value in archiving events that have potential educational value. With multiple stakeholder input from clinical roles within the IR division at our institution (ie, radiologic technologists, nurses, advanced practice providers, residents, fellows, and attending physicians), we launched a HIPAA-compliant secure IR complication and learning opportunity reporting platform in April 2022. Case submissions were monitored over the subsequent 24 weeks, with monthly dashboard reports provided to departmental leadership. Preintervention and postintervention surveys were used to assess the impact of the peer learning platform and adverse event reporting in IR (IR-PEER) on perceptions of complication reporting in the IR division across clinical roles. Ninety-two peer learning submissions were collected for a weekly average ± standard error of 3.8 ± 0.6 submissions per week, and an additional 26 submissions were collected as part of the division's ongoing monthly complication review conference, for a total of 98 unique total case references. A total of 64.1% of submissions (59 of 92) involved a complication and/or adverse event, and 35.9% of submissions (33 of 92) identified a learning opportunity (no complication or adverse event). Nurses reported that IR-PEER made the complication-reporting process easier (P = .01), and all clinical roles reported that IR-PEER improved the overall process of complication reporting. Peer learning frameworks such as IR-PEER provide a more equitable communication platform for multidisciplinary teams to capture and archive learning opportunities that support quality and safety improvement efforts.
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Affiliation(s)
| | - Kayesha Hancel
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sanjeeva Kalva
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Schenker
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sanjay Saini
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel I Glazer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramin Khorasani
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dania Daye
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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D'Angelo ALD, Rivera M, Rasmussen TE, Nelson MH, Behm KT, Kelley SR, D'Angelo JD. Implementation of a Brief Evidence-Based Intraoperative Coping Curriculum. JOURNAL OF SURGICAL EDUCATION 2023; 80:1737-1740. [PMID: 37679289 DOI: 10.1016/j.jsurg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND RATIONALE Recent research has called for further resident training in coping with errors and adverse events in the operating room. To the best of our knowledge, there currently exists no evidence-based curriculum or training on this topic. MATERIALS AND METHODS Synthesizing three prior studies on how experienced surgeons react to errors and adverse events, we developed the STOPS framework for handling surgical errors and adverse events (Stop, Talk to your team, Obtain help, Plan, Succeed). This material was presented to residents in two teaching sessions. RESULTS AND CONCLUSION In this paper, we describe the presentation of, and the uniformly positive resident reaction to, the STOPS framework: an empirically based psychological tool for surgeons who experience operative errors or adverse events.
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Affiliation(s)
| | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Megan H Nelson
- Division of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Kevin T Behm
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
| | - Scott R Kelley
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
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16
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Jella TK, Patel VR, Cwalina TB, Schmidt JE, Lawler EA, Vallier HA. What Factors Are Associated With Early Career Attrition Among Orthopaedic Surgeons in the United States? Clin Orthop Relat Res 2023; 481:1895-1903. [PMID: 36881550 PMCID: PMC10499099 DOI: 10.1097/corr.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/15/2023] [Accepted: 02/15/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The attrition of medical personnel in the United States healthcare system has been an ongoing concern among physicians and policymakers alike. Prior studies have shown that reasons for leaving clinical practice vary widely and may range from professional dissatisfaction or disability to the pursuit of alternative career opportunities. Whereas attrition among older personnel has often been understood as a natural phenomenon, attrition among early-career surgeons may pose a host of additional challenges from an individual and societal perspective. QUESTIONS/PURPOSES (1) What percentage of orthopaedic surgeons experience early-career attrition, defined as leaving active clinical practice within the first 10 years after completion of training? (2) What are the surgeon and practice characteristics associated with early-career attrition? METHODS In this retrospective analysis drawn from a large database, we used the 2014 Physician Compare National Downloadable File (PC-NDF), a registry of all healthcare professionals in the United States participating in Medicare. A total of 18,107 orthopaedic surgeons were identified, 4853 of whom were within the first 10 years of training completion. The PC-NDF registry was chosen because it has a high degree of granularity, national representativeness, independent validation through the Medicare claims adjudication and enrollment process, and the ability to longitudinally monitor the entry and exit of surgeons from active clinical practice. The primary outcome of early-career attrition was defined by three conditions, all of which had to be simultaneously satisfied ("condition one" AND "condition two" AND "condition three"). The first condition was presence in the Q1 2014 PC-NDF dataset and absence from the same dataset the following year (Q1 2015 PC-NDF). The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77% (13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced at academic centers. Surgeons not enrolled in the Medicare program are not represented in this study cohort. A multivariable logistic regression model with adjusted odds ratios and 95% confidence intervals was constructed to investigate characteristics associated with early-career attrition. RESULTS Among the 4853 early-career orthopaedic surgeons identified in the dataset, 2% (78) were determined to experience attrition between the first quarter 2014 and the same point in 2015. After controlling for potential confounding variables such as years since training completion, practice size, and geographic region, we found that women were more likely than men to experience early-career attrition (adjusted OR 2.8 [95% CI 1.5 to 5.0]; p = 0.006]), as were academic orthopaedic surgeons compared with private practitioners (adjusted OR 1.7 [95% CI 1.02 to 3.0]; p = 0.04), while general orthopaedic surgeons were less likely to experience attrition than subspecialists (adjusted OR 0.5 [95% CI 0.3 to 0.8]; p = 0.01). CONCLUSION A small but important proportion of orthopaedic surgeons leave the specialty during the first 10 years of practice. Factors most-strongly associated with this attrition were academic affiliation, being a woman, and clinical subspecialization. CLINICAL RELEVANCE Based on these findings, academic orthopaedic practices might consider expanding the role of routine exit interviews to identify instances in which early-career surgeons face illness, disability, burnout, or any other forms of severe personal hardships. If attrition occurs because of such factors, these individuals could benefit from connection to well-vetted coaching or counseling services. Professional societies might be well positioned to conduct detailed surveys to assess the precise reasons for early attrition and characterize any inequities in workforce retention across a diverse range of demographic subgroups. Future studies should also determine whether orthopaedics is an outlier, or whether 2% attrition is similar to the proportion in the overall medical profession.
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Affiliation(s)
- Tarun K. Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vishal R. Patel
- Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Thomas B. Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Ericka A. Lawler
- Department of Orthopedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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D'Angelo ALD, Kapur N, Kelley SR, Rivera M, Busch RA, Tevis SE, Hoedema RE, D'Angelo JD. The good, the bad, and the ugly: Operative staff perspectives of surgeon coping with intraoperative errors. Surgery 2023; 174:222-228. [PMID: 37188581 DOI: 10.1016/j.surg.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/15/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Intraoperative errors are inevitable, and how surgeons respond impacts patient outcomes. Although previous research has queried surgeons on their responses to errors, no research to our knowledge has considered how surgeons respond to operative errors from a contemporary first-hand source: the operating room staff. This study evaluated how surgeons react to intraoperative errors and the effectiveness of employed strategies as witnessed by operating room staff. METHODS A survey was distributed to operating room staff at 4 academic hospitals. Items included multiple-choice and open-ended questions assessing surgeon behaviors observed after intraoperative error. Participants reported the perceived effectiveness of the surgeon's actions. RESULTS Of 294 respondents, 234 (79.6%) reported being in the operating room when an error or adverse event occurred. Strategies positively associated with effective surgeon coping included the surgeon telling the team about the event and announcing a plan. Themes emerged regarding the importance of the surgeon remaining calm, communicating, and not blaming others for the error. Evidence of poor coping also emerged: "Yelling, feet stomping and throwing objects onto the field. [The surgeon] cannot articulate needs well because of anger." CONCLUSION These data from operating room staff corroborates previous research presenting a framework for effective coping while shedding light on new, often poor, behaviors that have not emerged in prior research. Surgical trainees will benefit from the now-enhanced empirical foundation on which coping curricula and interventions can be built.
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Affiliation(s)
| | | | - Scott R Kelley
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | | | - Rebecca A Busch
- Division of Acute Care and Regional General Surgery, University of Wisconsin, Madison, WI
| | - Sarah E Tevis
- Division of Surgical Oncology, University of Colorado, Aurora, CO
| | - Rebecca E Hoedema
- Spectrum Health Medical Group, Colon and Rectal Surgery Center for Digestive Diseases, Grand Rapids, MI
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Hughes D, Hanson MN, Alseidi A, Romanelli J, Vassiliou M, Feldman LS, Asbun H. Factors influencing surgeon well-being: qualitatively exploring the joy of surgery. Surg Endosc 2023:10.1007/s00464-023-10135-5. [PMID: 37221414 PMCID: PMC10204656 DOI: 10.1007/s00464-023-10135-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND There has been considerable research into burnout but much less into how surgeons thrive and find joy. This study, conducted by the SAGES Reimagining the Practice of Surgery Task Force, explored factors influencing surgeon well-being, the eventual goal being translating findings into tangible changes to help restore the joy in surgery. METHODS This was a qualitative, descriptive study. Purposive sampling ensured representation across ages, genders, ethnicities, practice types, and geographies. Semi-structured interviews were recorded and transcribed. We coded inductively, finalized the codebook by consensus, and then constructed a thematic network. Global themes formed our conclusions; organizing themes gave additional detail. Analysis was facilitated by NVivo. RESULTS We interviewed 17 surgeons from the US and Canada. Total interview time was 15 hours. Our global and organizing themes were: Stressors (Work-life Integration, Administration-related Concerns, Time and Productivity Pressures, Operating Room Factors, and Lack of Respect). Satisfaction (Service, Challenge, Autonomy, Leadership, and Respect and Recognition). Support (Team, Personal Life, Leaders, and Institutions). Values (Professional and Personal). Suggestions (Individual, Practice, and System level). Values, stressors, and satisfaction influenced perspectives on support. Experiences of support shaped suggestions. All participants reported stressors and satisfiers. Surgeons at all stages enjoyed operating and being of service. Supports and suggestions included compensation and infrastructure, but human resources were most critical. To experience joy, surgeons needed high-functioning clinical teams, good leaders/mentors, and supportive family/social networks. CONCLUSIONS Our results indicated organizations could (1) better understand surgeons' values, like autonomy; (2) provide more time for satisfiers, like patient relationship building; (3) minimize stressors, like time and financial pressures; and (4) at all levels focus on (4a) building teams and leaders and (4b) giving surgeons time and space for healthy family/social lives. Next steps include developing an assessment tool for individual institutions to build "joy improvement plans" and to inform surgical associations' advocacy efforts.
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Affiliation(s)
- Dorothy Hughes
- Departments of Population Health and Surgery, University of Kansas School of Medicine-Salina, 138 N Santa Fe Ave, Salina, KS, 67401, USA.
| | - Melissa N Hanson
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Center, Montreal, QC, Canada
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John Romanelli
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate Medical Center, Springfield, MA, USA
| | - Melina Vassiliou
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Center, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Center, Montreal, QC, Canada
| | - Horacio Asbun
- Department of Hepato-Pancreato-Biliary Surgery, Miami Cancer Institute, Miami, FL, USA
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Lin JS, Olutoye OO, Samora JB. To Err is human, but what happens when surgeons Err? J Pediatr Surg 2023; 58:496-502. [PMID: 35914964 DOI: 10.1016/j.jpedsurg.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physicians involved in adverse events may suffer from second victim syndrome and can experience emotional and physical distress long after the complication occurred. We sought determine the prevalence of second victim syndrome among surgeons at our children's hospital and evaluate any differences in how surgeons respond to adverse events based on their age, position, and gender. METHODS An anonymous 19-question questionnaire distributed via institutional emails linking to an anonymous Research Electronic Data Capture (REDCap) survey. Eligible participants included all surgeons and rotating surgical trainees at our hospital. RESULTS Of 64 faculty surgeons eligible to participate, 63 surveys were returned for a 98% completion rate. Ten additional surveys from surgical trainees were completed for a total of 73 participants. Eighty-four percent reported having had difficulty dealing with a poor outcome or unhappy patient/family. Speaking with a colleague was the most common coping strategy, reported by 82%. Fifty-six percent indicated they believed reporting a poor outcome would have negative ramifications for them. Younger surgeons were more likely to suppress their feelings following an adverse event, and trainees were less likely to advise their peers to speak to a superior about the event (p < 0.05). CONCLUSION There is a high prevalence of second victim syndrome among surgeons at our children's hospital. There exist differences in ways that surgeons respond to adverse events based on age and position. Healthcare institutions should establish formal mechanisms of support to shift the culture towards one where help is actively sought and offered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- James S Lin
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Oluyinka O Olutoye
- The Ohio State University College of Medicine, Columbus, OH, United States of America; Nationwide Children's Hospital, Columbus, OH, United States of America
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Cacciamani GE, Sholklapper T, Dell'Oglio P, Rocco B, Annino F, Antonelli A, Amenta M, Borghesi M, Bove P, Bozzini G, Cafarelli A, Celia A, Leonardo C, Ceruti C, Cindolo L, Crivellaro S, Dalpiaz O, Falabella R, Falsaperla M, Galfano A, Gallo F, Greco F, Minervini A, Parma P, Chiara Sighinolfi M, Pastore AL, Pini G, Porreca A, Pucci L, Sciorio C, Schiavina R, Umari P, Varca V, Veneziano D, Verze P, Volpe A, Zaramella S, Lebastchi A, Abreu A, Mitropoulos D, Shekhar Biyani C, Sotelo R, Desai M, Artibani W, Gill I. The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course. Eur Urol Focus 2022; 8:1847-1858. [PMID: 35177353 DOI: 10.1016/j.euf.2022.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. OBJECTIVE To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. DESIGN, SETTING, AND PARTICIPANTS The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS AND LIMITATIONS The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. CONCLUSIONS The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. PATIENT SUMMARY We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bernardo Rocco
- Urological Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | | | - Michele Amenta
- Department of Urology, Azienda ULSS n.4 Veneto Orientale, Portogruaro, Italy
| | | | | | | | | | - Antonio Celia
- Urology Unit, Ospedale San Bassiano, Bassano del Grappa, Italy
| | | | - Carlo Ceruti
- Urology Unit, AOU Citta della Salute e della Scienza, Turin, Italy
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, Mantova, Italy
| | | | | | | | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Luigi Pucci
- Urology Unit, Azienda Ospedaliera A. Cardarelli, Naples, Italy
| | | | | | - Paolo Umari
- Urology Unit, Ospedale Maggiore della Carita, Novara, Italy
| | - Virginia Varca
- Urology Unit, ASAT Rhodense Ospedale Guido Salvini di Garbagnate, Garbagnate, Italy
| | | | - Paolo Verze
- Urology Unit, AOU San Giovanni di Rio e Ruggi d'Aragona, Salerno, Italy
| | | | | | - Amir Lebastchi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dionysios Mitropoulos
- Department of Urology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chandra Shekhar Biyani
- Department of Urology, St. James' Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Inderbir Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
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Filiberto AC, Efron PA, Frantz A, Bihorac A, Upchurch GR, Loftus TJ. Personalized decision-making for acute cholecystitis: Understanding surgeon judgment. Front Digit Health 2022; 4:845453. [PMID: 36339515 PMCID: PMC9632988 DOI: 10.3389/fdgth.2022.845453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/30/2022] [Indexed: 12/07/2022] Open
Abstract
Background There is sparse high-level evidence to guide treatment decisions for severe, acute cholecystitis (inflammation of the gallbladder). Therefore, treatment decisions depend heavily on individual surgeon judgment, which is highly variable and potentially amenable to personalized, data-driven decision support. We test the hypothesis that surgeons' treatment recommendations misalign with perceived risks and benefits for laparoscopic cholecystectomy (surgical removal) vs. percutaneous cholecystostomy (image-guided drainage). Methods Surgery attendings, fellows, and residents applied individual judgement to standardized case scenarios in a live, web-based survey in estimating the quantitative risks and benefits of laparoscopic cholecystectomy vs. percutaneous cholecystostomy for both moderate and severe acute cholecystitis, as well as the likelihood that they would recommend cholecystectomy. Results Surgeons predicted similar 30-day morbidity rates for laparoscopic cholecystectomy and percutaneous cholecystostomy. However, a greater proportion of surgeons predicted low (<50%) likelihood of full recovery following percutaneous cholecystostomy compared with cholecystectomy for both moderate (30% vs. 2%, p < 0.001) and severe (62% vs. 38%, p < 0.001) cholecystitis. Ninety-eight percent of all surgeons were likely or very likely to recommend cholecystectomy for moderate cholecystitis; only 32% recommended cholecystectomy for severe cholecystitis (p < 0.001). There were no significant differences in predicted postoperative morbidity when respondents were stratified by academic rank or self-reported ability to predict complications or make treatment recommendations. Conclusions Surgeon recommendations for severe cholecystitis were discordant with perceived risks and benefits of treatment options. Surgeons predicted greater functional recovery after cholecystectomy but less than one-third recommended cholecystectomy. These findings suggest opportunities to augment surgical decision-making with personalized, data-driven decision support.
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Affiliation(s)
- Amanda C. Filiberto
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Philip A. Efron
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Amanda Frantz
- Department of Anesthesiology, University of Florida Health, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida Health, Gainesville, FL, United States
- Intelligent Critical Care Center, University of Florida Health, Gainesville, FL, United States
| | - Gilbert R. Upchurch
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Tyler J. Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
- Intelligent Critical Care Center, University of Florida Health, Gainesville, FL, United States
- Correspondence: Tyler J. Loftus
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22
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STOPS: A Coping Framework for Surgeons Who Experience Intraoperative Error. Ann Surg 2022; 276:288-292. [PMID: 35797637 DOI: 10.1097/sla.0000000000005447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the steps faculty surgeons take upon experiencing intraoperative error and synthesize these actions to offer a framework for coping with errors. BACKGROUND While intraoperative errors are inevitable, formal training in error recovery is insufficient and there are no established curricula that teach surgeons how to deal with the intraoperative error. This is problematic because insufficient error recovery is detrimental to both patient outcomes and surgeon psychological well-being. METHODS We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with faculty surgeons from 3 hospitals. Surgeons described recent experiences with intraoperative error. Interviews were transcribed and coded. Analysis allowed for development of themes regarding responses to errors and coping strategies. RESULTS Twenty-seven surgeons (30% female) participated. Upon completion of the analysis, themes emerged in 3 distinct areas: (1) Exigency, or a need for training surgical learners how to cope with intraoperative errors, (2) Learning, or how faculty surgeons themselves learned to cope with intraoperative errors, and (3) Responses, or how surgeons now handle intraoperative errors. The latter category was organized into the STOPS framework: Intraoperative errors could produce STOPS: Stop, Talk to your Team, Obtain Help, Plan, Succeed. CONCLUSIONS AND RELEVANCE This study provides both novel insight into how surgeons cope with intraoperative errors and a framework that may be of great use to trainees and faculty alike.
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The Association Between Factors Promoting Nonbeneficial Surgery and Moral Distress: A National Survey of Surgeons. Ann Surg 2022; 276:94-100. [PMID: 33214444 PMCID: PMC9635854 DOI: 10.1097/sla.0000000000004554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence of moral distress among surgeons and test the association between factors promoting non-beneficial surgery and surgeons' moral distress. SUMMARY BACKGROUND DATA Moral distress experienced by clinicians can lead to low-quality care and burnout. Older adults increasingly receive invasive treatments at the end of life that may contribute to surgeons' moral distress, particularly when external factors, such as pressure from colleagues, institutional norms, or social demands, push them to offer surgery they consider non-beneficial. METHODS We mailed surveys to 5200 surgeons randomly selected from the American College of Surgeons membership, which included questions adapted from the revised Moral Distress Scale. We then analyzed the association between factors influencing the decision to offer surgery to seriously ill older adults and surgeons' moral distress. RESULTS The weighted adjusted response rate was 53% (n = 2161). Respondents whose decision to offer surgery was influenced by their belief that pursuing surgery gives the patient or family time to cope with the patient's condition were more likely to have high moral distress (34% vs 22%, P < 0.001), and this persisted on multivariate analysis (odds ratio 1.44, 95% confidence interval 1.02-2.03). Time required to discuss nonoperative treatments or the consulting intensivists' endorsement of operative intervention, were not associated with high surgeon moral distress. CONCLUSIONS Surgeons experience moral distress when they feel pressured to perform surgery they believe provides no clear patient benefit. Strategies that empower surgeons to recommend nonsurgical treatments when they believe this is in the patient's best interest may reduce nonbeneficial surgery and surgeon moral distress.
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Ching HL, Lau MS, Azmy IA, Hopper AD, Keuchel M, Gyökeres T, Kuvaev R, Macken EJ, Bhandari P, Thoufeeq M, Leclercq P, Rutter MD, Veitch AM, Bisschops R, Sanders DS. Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54:712-722. [PMID: 35636453 DOI: 10.1055/a-1832-4232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology have defined performance measures for upper and lower gastrointestinal, pancreaticobiliary, and small-bowel endoscopy. Quality indicators to guide endoscopists in the growing field of advanced endoscopy are also underway. We propose that equal attention is given to developing the entire advanced endoscopy team and not the individual endoscopist alone.We suggest that the practice of teams intending to deliver high quality advanced endoscopy is underpinned by six crucial principles concerning: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED).
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Affiliation(s)
- Hey-Long Ching
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Michelle S Lau
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Iman A Azmy
- Department of Breast Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Andrew D Hopper
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Center Hungarian Defence Forces, Budapest, Hungary
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation.,Gastroenterology Department, Faculty of Additional Professional Education, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Elisabeth J Macken
- Division of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mo Thoufeeq
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Belgium
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
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25
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Cacciamani GE. Intraoperative adverse events grading tools and their role in honest and accurate reporting of surgical outcomes. Surgery 2022; 172:1035-1036. [PMID: 35597615 DOI: 10.1016/j.surg.2022.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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26
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Akyol C, Celik SU, Koc MA, Bayindir DS, Gocer MA, Karakurt B, Kaya M, Kekec SN, Simsek FA. The Impact of Patient Deaths on General Surgeons’ Psychosocial Well-Being and Surgical Practices. Front Surg 2022; 9:898274. [PMID: 35574543 PMCID: PMC9096651 DOI: 10.3389/fsurg.2022.898274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient deaths are an unavoidable occurrence in surgical practice. Although these events have negative effects on patients and their families, they can also have a profound adverse impact on surgeons who are unprepared for these deep emotional experiences. This study aims to investigate the impact of patient deaths on general surgeons’ psychosocial well-being and surgical practices. Methods A national cross-sectional survey of a 30-item questionnaire was conducted. The survey evaluated the surgeons’ demographics, professional and practice characteristics, and the impact of patient deaths on their emotional well-being, professional career, and social life. Results Four hundred eighty participants completed the survey. One-third of the participants reported that patient deaths affected their emotional well-being, 23.3% reported that patient deaths affected their social life, and 34.2% reported that patient deaths affected their professional career. Surgeons who reported suffering from the emotional impact of death exhibited no differences in terms of place of practice, academic title, surgical experience, work hours, or annual surgical volume. Middle-aged surgeons (p = 0.004), females (p = 0.041), and surgeons who reported feeling burned out (p < 0.001) were more likely to be affected by patient loss. Feelings of sadness, worry, and stress were most reported. A total of 18.1% of the participants indicated that they considered taking a break after patient death, and 11.9% thought they would abandon their surgical career. Conclusions The findings of this study suggest that patient death affects surgeons’ psychosocial well-being and surgical practices. Greater awareness and effort are required at the personal, institutional, and organizational level to provide effective support, helping surgeons to cope with the emotional burden of patient deaths.
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Affiliation(s)
- Cihangir Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
- Correspondence: Cihangir Akyol Suleyman Utku Celik
| | - Suleyman Utku Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
- Correspondence: Cihangir Akyol Suleyman Utku Celik
| | - Mehmet Ali Koc
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Duygu Sezen Bayindir
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Ali Gocer
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Buket Karakurt
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kaya
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Sena Nur Kekec
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Furkan Aydin Simsek
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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27
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Sharma D, Yadav SK, Agarwal P. A Clarion Call for More Qualitative Studies in Surgery. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Kuppusamy MK, Low DE. Evaluation of International Contemporary Operative Outcomes and Management Trends Associated With Esophagectomy: A 4-Year Study of >6000 Patients Using ECCG Definitions and the Online Esodata Database. Ann Surg 2022; 275:515-525. [PMID: 33074888 DOI: 10.1097/sla.0000000000004309] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to verify the utility of international online datasets to benchmark and monitor treatment and outcomes in major oncologic procedures. BACKGROUND The Esophageal Complication Consensus Group (ECCG) has standardized the reporting of complications after esophagectomy within the web-based Esodata.org database. This study will utilize the Esodata dataset to update contemporary outcomes and to monitor trends in practice in an era of rapid technical change. METHODS This observational study, based on a prospectively developed specific database, updates esophagectomy outcomes collected between 2015 and 2018. Evolution in patient and operative demographics, treatment, complications, and quality outcome measures were compared between patients undergoing surgery in 2015 to 2016 and 2017 to 2018. RESULTS Between 2015 and 2018, 6022 esophagectomies from 39 centers were entered into Esodata. Most patients were male (78.3%) with median age 63. Patients having minimally invasive esophagectomy constituted 3177 (52.8%), a chest anastomosis 3838 (63.7%), neoadjuvant chemoradiotherapy 2834 (48.7%), and R0 resections 5441 (93.5%). For quality measures, 30- and 90-day mortality was 2.0% and 4.5%, readmissions 9.7%, transfusions 12%, escalation in care 22.1%, and discharge home 89.4%. Trends in quality measures between 2015 and 2016 (2407 patients) and 2017 and 2018 (3318 patients) demonstrated significant (P < 0.05) improvements in readmissions 11.1% to 8.5%, blood transfusions 14.3% to 10.2%, and escalation in care from 24.5% to 20% A significantly (P < 0.05) reduced incidence in pneumonia (15.3%-12.8%) and renal failure (1.0%-0.4%) was observed. Anastomotic leak rates increased from 11.7% to 13.1%, whereas leaks requiring surgery decreased 3.3% and 3.0%, respectively. CONCLUSIONS The Esodata database provides a valuable resource for assessing contemporary international outcomes. This study highlights an increased application of minimally invasive approaches, a high percentage of complications, improvements in pneumonia and key quality metrics, but with anastomotic leak rates still >10%.
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Affiliation(s)
- Madhan K Kuppusamy
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Cambridge Oesophago-Gastric Centre, Addenbrookes Hospital, Cambridge, UK
- Claude Huriez University Hospital, Lille, France; Erasmus Medical Center, Rotterdam
- Netherlands; Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA
- Guy's & St Thomas' NHS Foundation Trust, London, UK
- Hirslanden Medical Center, Zürich, Switzerland; Hôpital Nord, Aix-Marseille Université, Marseille, France
- Hospital Universitario del Mar, Barcelona, Spain
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Katholieke Universiteit Leuven, Leuven, Belgium; Keio University, Tokyo, Japan
- Massachusetts General Hospital, Boston, MA
- MD Anderson Cancer Center, Houston, TX
- Memorial Sloan Kettering Cancer Center, New York City, NY
- National University Hospital, Singapore, Singapore
- Northern Oesophagogastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Odense University Hospital, Odense, Denmark
- Oregon Health and Science University, Portland, OR
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
- Queen Elizabeth Hospital University of Birmingham, Birmingham, UK
- Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Royal Victoria Hospital, Belfast, Northern Ireland
- Sichuan Cancer Hospital & Institute, Chengdu, China
- St. James's Hospital Trinity College, Dublin, Ireland
- Tata Memorial Center, Mumbai, India
- The University of Chicago Medicine, Chicago, IL
- Toronto General Hospital, Toronto, Canada
- University Hospital of Cologne, Cologne, Germany
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University Medical Center, Utrecht, Netherlands
- University of Michigan Health System, Ann Arbor, MI
- University of São Paulo School of Medicine, São Paulo, Brazil
- University of Verona, Verona, Italy
- Virginia Mason Medical Center, Seattle, WA
- Vita-Salute San Raffaele University, Milan, Italy
| | - Donald E Low
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Cambridge Oesophago-Gastric Centre, Addenbrookes Hospital, Cambridge, UK
- Claude Huriez University Hospital, Lille, France; Erasmus Medical Center, Rotterdam
- Netherlands; Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA
- Guy's & St Thomas' NHS Foundation Trust, London, UK
- Hirslanden Medical Center, Zürich, Switzerland; Hôpital Nord, Aix-Marseille Université, Marseille, France
- Hospital Universitario del Mar, Barcelona, Spain
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Katholieke Universiteit Leuven, Leuven, Belgium; Keio University, Tokyo, Japan
- Massachusetts General Hospital, Boston, MA
- MD Anderson Cancer Center, Houston, TX
- Memorial Sloan Kettering Cancer Center, New York City, NY
- National University Hospital, Singapore, Singapore
- Northern Oesophagogastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Odense University Hospital, Odense, Denmark
- Oregon Health and Science University, Portland, OR
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
- Queen Elizabeth Hospital University of Birmingham, Birmingham, UK
- Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Royal Victoria Hospital, Belfast, Northern Ireland
- Sichuan Cancer Hospital & Institute, Chengdu, China
- St. James's Hospital Trinity College, Dublin, Ireland
- Tata Memorial Center, Mumbai, India
- The University of Chicago Medicine, Chicago, IL
- Toronto General Hospital, Toronto, Canada
- University Hospital of Cologne, Cologne, Germany
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University Medical Center, Utrecht, Netherlands
- University of Michigan Health System, Ann Arbor, MI
- University of São Paulo School of Medicine, São Paulo, Brazil
- University of Verona, Verona, Italy
- Virginia Mason Medical Center, Seattle, WA
- Vita-Salute San Raffaele University, Milan, Italy
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Iatrogenic Bile Duct Injury: Call for Help, Refer Early, Reduce Infection. Invited Commentary: Liver Transplantation as Definitive Treatment of Postcholecystectomy Bile Duct Injury: Experience in a High-volume Repair Center. Ann Surg 2021; 275:e733-e734. [PMID: 34913898 DOI: 10.1097/sla.0000000000005342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Perez AW, Brelsford KM, Diehl CJ, Langerman AJ. Surgeon Perspectives on Benefits and Downsides of Overlapping Surgery: In-depth, Qualitative Interviews. Ann Surg 2021; 274:e403-e409. [PMID: 32282374 DOI: 10.1097/sla.0000000000003722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of the study was to characterize surgeon perspectives regarding the benefits and downsides of conducting overlapping surgery. BACKGROUND Although surgeons are key stakeholders in current discussions surrounding overlapping surgery, little has been published regarding their opinions on the practice. Further characterization of surgeon perspectives is needed to guide future studies and policy development regarding overlapping surgery. METHODS Study information was sent to all members of 3 professional surgical societies. Interested individuals were eligible to participate if they identified as attending surgeons in an academic setting who work with trainees. Purposive selection was used to diversify surgeons interviewed across multiple dimensions, including subspecialty and opinion regarding appropriateness of overlapping surgery. In-depth, qualitative interviews were conducted with participants regarding their opinions on overlapping surgery. RESULTS The 51 surgeons interviewed identified a wide array of potential benefits and disadvantages of overlapping surgery, some of which have not previously been measured, including downsides to surgeon wellness and patient experience, less surgeon control over procedures, and difficulty in scheduling cases. Interviewees often disagreed as to whether overlapping surgery negatively or positively affects each dimension discussed, particularly regarding the impact on resident training. CONCLUSIONS The utilization of the novel perspectives presented here will allow for targeted assessment of physician perspectives in future quantitative studies and increase the likelihood that variables measured encompass the range of factors that surgeons find meaningful and relevant. Priority areas of future research should include examining effects of overlapping surgery on surgical training and surgeon wellness.
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Affiliation(s)
| | - Kathleen M Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - Carolyn J Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander J Langerman
- Program in Surgical Ethics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
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Sjöberg RL. Five psychological mechanisms that might bias learning from neurosurgical complications: case discussions and a narrative review. Br J Neurosurg 2021; 36:323-328. [PMID: 34615418 DOI: 10.1080/02688697.2021.1981242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The ability of neurosurgeons to analyze and reflect on their complications in a constructive way is important both for professional development and for patient safety. The purpose of the present paper is to highlight some psychological factors that might impair or bias the ability of the neurosurgeon to do this successfully. METHODS Five fictitious cases, loosely inspired by real events and situations, are used as a basis for a discussion of some of the most important potential sources of psychological bias in the context of understanding neurosurgical complications. RESULTS The issues of a) self-serving bias and the actor-observer effect; b) heuristics and biases in interpreting probabilistic events; c) emotional avoidance and denial; d) limitations of attention (dual systems theory) and e) errors of memory, are discussed. CONCLUSION There are a number of psychological factors, that are well known to science that may be ubiquitous sources of influence on the ability of neurosurgeons to grow by reflection on their own complications. Exactly how these factors can and should be efficiently adressed by the individual neurosurgeon and/or the organisation and team in which the neurosurgeon works may vary according to type of bias, context and circumstances. However, being aware of these issues and addressing them on an individual and organizational level remains important to the quality of our craft.
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Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN. New-Onset Depression After Total Knee Arthroplasty: Consideration of the At-Risk Patient. J Arthroplasty 2021; 36:3131-3136. [PMID: 33934951 DOI: 10.1016/j.arth.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postoperative new-onset depression (NOD) has gained recent attention as a previously unrecognized complication which may put patients at risk for poor outcomes after elective total hip arthroplasty. We aimed to investigate risk factors for the development of NOD after total knee arthroplasty (TKA) and assess its association with postoperative complications. METHODS This is a retrospective, population-level investigation of elective TKA patients. Patients with a preoperative diagnosis of depression were excluded from this study. Two groups were compared: patients who were diagnosed with depression within one year after TKA (NOD) and those who did not (control). The association of both preoperative patient factors and postoperative surgical and medical complications with NOD was then determined using multivariate and univariate analyses. RESULTS Of 196,728 unique TKA patients in our cohort, 5351 (2.72%) were diagnosed with NOD within one year of TKA. Age <54 year old, female gender, preoperative anxiety disorder, drug, alcohol, and/or tobacco use, multiple comorbidities, and opioid use before TKA were all associated with a diagnosis of NOD postoperatively (all P < .001). Postoperative NOD was associated with periprosthetic fracture (OR 2.11; 95% CI 1.29-3.52; P = .033), aseptic failure (OR 1.61; 95% CI 1.24-2.07; P = .020), prosthetic joint infection (OR 1.55, 95% CI 1.30-1.85; P < .001), stroke (OR 1.24; 95% CI 1.09-1.42; P = .006), and venous thromboembolism (OR 1.24; 95% CI 1.12-1.37; P < .001). CONCLUSION Post-TKA NOD is common and is associated with poor outcomes. This may aid surgeons in developing both anticipatory measures and institute preventative measures for patients at risk for developing NOD.
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Scott L, Lim R, Foxcroft L, Lum PA. How can surgical programs use peer support programs in times of crisis? Can Urol Assoc J 2021; 15:S36-S39. [PMID: 34406930 DOI: 10.5489/cuaj.7302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Leslie Scott
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rodrick Lim
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Laura Foxcroft
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - P Andrea Lum
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Siddaiah-Subramanya M, To H, Haigh C. The psychosocial impact of surgical complications on the operating surgeon: A scoping review. Ann Med Surg (Lond) 2021; 67:102530. [PMID: 34276982 PMCID: PMC8267492 DOI: 10.1016/j.amsu.2021.102530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aim Surgical complications are common, and their management is an integral part of surgical care. The impact on the surgeon, the “second victim” is significant, particularly in terms of psychological health. The aim of this review is to describe the nature of psychosocial consequences of surgical complications on the surgeons involved. Method Following scoping review protocols, we set out to identify the evidence-base for psychosocial consequences on the operating surgeon, predominantly general surgeons, following surgical complications. Results This scoping review identified 19 articles, mainly survey and interview based (n = 8), with all but one article from first world countries. Seven articles reported on negative emotions or depressive behavioural responses. All original studies reported on difficulty in coping (37.5%), and a range of behaviours. There was little evidence for support structures or active interventions to aid the surgeon post complication. Conclusions The review suggests that the psychosocial impact, following a complication, is variable but affects every surgeon irrespective of the level of impact on the patient. The main variables differentiating impact are severity, and outcome of the complication and seniority of the surgeon. Reported emotions and behaviours were generally negative and persist across the surgeon's journey towards recovery. Surgeons who manage stress well exhibit largely constructive behaviours and actively work to recover. Identification of variables underpinning complications, and affected surgeons is paramount, as is the provision of services to support recovery. Efforts should be made to proactively prevent complications, via education, awareness and to formalise support processes. Surgical complications negatively impact the operating surgeon (the second victim). Negative emotions and behaviours manifested may persist throughout surgeon’s career. Surgeons’ reaction can negatively influence social and professional relationships. Range of factors affect coping and recovery, and the support sought tend not to focus on psychosocial aspects of coping. Need to develop management resources for surgeons to manage the psychosocial impact.
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Affiliation(s)
- Manjunath Siddaiah-Subramanya
- Department of Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK.,University of Melbourne, Melbourne, Australia
| | - Henry To
- University of Melbourne, Melbourne, Australia.,Department of General Surgery, Northern Hospital Epping, Melbourne, Australia
| | - Catherine Haigh
- Monash Rural Health Gippsland, Monash University, Traralgon, Australia
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35
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Phelps EE, Tutton E, Costa M, Hing C. Unattainable equipoise in randomized controlled trials : staff views of a feasibility study of surgical treatments for segmental tibial fractures. Bone Jt Open 2021; 2:486-492. [PMID: 34236209 PMCID: PMC8325976 DOI: 10.1302/2633-1462.27.bjo-2021-0055.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims To explore staff experiences of a multicentre pilot randomized controlled trial (RCT) comparing intramedullary nails and circular frame external fixation for segmental tibial fractures. Methods A purposeful sample of 19 staff (nine surgeons) involved in the study participated in an interview. Interviews explored participants’ experience and views of the study and the treatments. The interviews drew on phenomenology, were face-to-face or by telephone, and were analyzed using thematic analysis. Results The findings identify that for the treatment of segmental tibial fractures equipoise was a theoretical ideal that was most likely unattainable in clinical practice. This was conveyed through three themes: the ambiguity of equipoise, where multiple definitions of equipoise and a belief in community equipoise were evident; an illusion of equipoise, created by strong treatment preferences and variation in collective surgical skills; and treating the whole patient, where the complexity and severity of the injury required a patient-centred approach and doing the best for the individual patient took priority over trial recruitment. Conclusion Equipoise can be unattainable for rare injuries such as segmental tibial fractures, where there are substantially different surgical treatments requiring specific expertise, high levels of complexity, and a concern for poor outcomes. Surgeons are familiar with community equipoise. However, a shared understanding of factors that limit the feasibility of RCTs may identify instances where community equipoise is unlikely to translate into practice. Cite this article: Bone Jt Open 2021;2(7):486–492.
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Affiliation(s)
- Emma Elizabeth Phelps
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Trauma and MTC, Oxford University NHS Foundation Hospital Trust, John Radcliffe, Oxford, UK
| | - Matthew Costa
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caroline Hing
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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36
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Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury. J Am Coll Surg 2021; 233:213-222.e1. [PMID: 34111530 DOI: 10.1016/j.jamcollsurg.2021.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile duct injury sustained during laparoscopic cholecystectomy is associated with high morbidity and mortality, and can be a devastating complication for a general surgeon. We introduce a novel, individualized surgical coaching program for surgeons who recently injured a bile duct in laparoscopic cholecystectomy. We aim to explore the perception of coaching among these surgeons and to assess surgeons' experiences in the coaching program. STUDY DESIGN Six general surgeons who injured a bile duct at an emergency laparoscopic cholecystectomy participated in a 1-on-1 coaching session with a hepatopancreatobiliary surgeon. The session focused on debriefing the index case with video feedback, and discussion of strategies for safe laparoscopic cholecystectomy. The pilot program ran from March to November 2020. Exit interviews were then conducted. Themes covering perception of surgical training, perception of complications, and experience in the coaching program were explored. RESULTS Surgeons were generally accepting of the coaching program, especially when the goals aligned with their self-identified areas of development. One-on-1 sessions with a local expert in the area, and the use of video feedback created a unique and interactive coaching opportunity. Peer coaching was identified as a valuable resource in helping surgeons regain confidence and maintain well-being after a bile duct injury. Maintaining a collegial, nonjudgmental relationship is critical in establishing positive coaching experiences. CONCLUSIONS An individualized surgical coaching program creates a unique opportunity for professional development and may help promote safe laparoscopic cholecystectomy.
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37
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The effect of surgical complications on ENT trainees. The Journal of Laryngology & Otology 2021; 135:293-296. [PMID: 33769237 DOI: 10.1017/s0022215121000797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The 'second victim phenomenon' is a term attributed to the traumatic effect a medical error can have on healthcare professionals. Patient safety incidents have been shown to occur in as many as one in seven patients in hospital. These incidents cause significant, potentially devastating, trauma to patients and their relatives, and can have deep and long-lasting effects on the health professionals involved. These incidents can have a negative impact on doctors' emotional wellbeing; their professional practice in relation to this impact has not been extensively investigated in surgical trainees. METHOD A survey of UK otolaryngology trainees was conducted to investigate the effects of complications and medical errors on trainees, and examine how these are discussed within departments. RESULTS AND CONCLUSION The findings suggest that further training is required and would be warmly received by otolaryngology trainees as part of higher surgical training.
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38
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Smith JM, Boe EA, Will R. Physician Wellness in Orthopedic Surgery: Challenges and Solutions. Orthop Clin North Am 2021; 52:41-52. [PMID: 33222983 DOI: 10.1016/j.ocl.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The growing epidemic of physician burnout suggests that a change is needed. Physician wellness is an ever-growing consideration, especially in orthopedic surgery, where the challenges to wellness are significant. This review provides many common sense wellness principles and solutions in four main components of wellness (physical, mental, emotional, and spiritual) interwoven with current research on the topic. Although directed to orthopedic surgeons, this guide can be applied to all physicians, because they are based on common human principles of wellness. Wellness is not created overnight, so wellness practices that increase the likelihood of experiencing wellness are encouraged.
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Affiliation(s)
- Jeffrey M Smith
- Orthopaedic Trauma & Fracture Specialists Medical Corp., 3750 Convoy Street, Suite #201, San Diego, CA 92111, USA.
| | - Eric A Boe
- Unite Orthopaedics Foundation, 3750 Convoy Street, Suite 201, San Diego, CA 92111, USA
| | - Ryan Will
- Olympia Orthopedic Associates, 615 Lilly Road, Suite #120, Olympia, WA 98506, USA
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Tou S, Gómez Ruiz M, Gallagher AG, Eardley NJ, Matzel KE. Do surgical skills affect outcomes? Colorectal Dis 2020; 22:1826-1829. [PMID: 32790893 DOI: 10.1111/codi.15316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- S Tou
- Department of Colorectal Surgery, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - M Gómez Ruiz
- Cirugía Colorrectal - Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - N J Eardley
- Department of Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - K E Matzel
- Section of Coloproctology, Department of Surgery, University of Erlangen-Nürnberg, FAU, Erlangen, Germany
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40
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Biggs S, Waggett HB, Shabbir J. Impact of surgical complications on the operating surgeon. Colorectal Dis 2020; 22:1169-1174. [PMID: 32065472 DOI: 10.1111/codi.15021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023]
Abstract
AIM The involvement of surgeons in major adverse outcomes can have a negative impact on their personal and professional lives, as well as on patient outcomes. Healthcare professionals involved in such incidents have been referred to as 'second victims'. We designed an online survey to study the impact of operative complications on surgeons' professional and personal lives. METHOD An online survey of general, gastrointestinal, hepato-pancreato-biliary and vascular surgeons was conducted using the Twitter feed of the Association of Coloproctology of Great Britain and Ireland, the Association of Surgeons of Great Britain and Ireland and the European Society of Coloproctology over an 8-week period. RESULTS Questionnaires were completed by 82 participants. Ninety-one per cent of respondents were consultant surgeons, 37% with more than 15 years' experience. Eighty-three per cent were colorectal surgeons. The majority of surgeons (95%) reported that their practice had been affected as a result of serious complications and 54% suggested that it had had a negative impact on their family life. Fifty-five per cent of respondents mentioned lack of support in their institution for healthcare professionals involved in adverse outcomes and an existing blame culture. Suggestions for improvement included mentoring (41%), counselling (38%), openness (66%), peer support groups (52%) and human factors training (32%). CONCLUSION This survey highlights that the majority of surgeons involved in serious complications are adversely affected. Those involved in the running of surgical services need to improve support for surgeons in the aftermath of such events.
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Affiliation(s)
- S Biggs
- Department of Colorectal Surgery, University Hospitals Bristol NHS Trust, Bristol, UK
| | - H B Waggett
- Department of Colorectal Surgery, University Hospitals Bristol NHS Trust, Bristol, UK
| | - J Shabbir
- Department of Colorectal Surgery, University Hospitals Bristol NHS Trust, Bristol, UK
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41
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Sutherland M, Kinslow K, Boneva D, McKenney M, Elkbuli A. Perceived Burnout Among Burn Surgeons: Results From a Survey of American Burn Association Members. J Burn Care Res 2020; 42:186-192. [PMID: 32845002 DOI: 10.1093/jbcr/iraa146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burnout is a significant and increasingly recognized issue. They aimed to investigate burn surgeons'(BSurg) perceptions regarding burnout, contributing factors, and implications to better identity possible targeted interventions. A 42-question anonymous online survey was distributed by the ABA to BSurg members. Respondents included BSurgs in university or nonuniversity hospital settings. Experience of burnout was reported among 89.8% of university and 84.6% of nonuniversity hospital-affiliated respondents. After adjusting for confounders, university BSurgs exhibited a higher risk of perceived burnout compared with nonuniversity settings (aOR: 1.081, 95% CI: 0.237, 4.937). Women BSurgs were at 5 times higher risk of reporting burnout compared with men (aOR: 5.048, 95% CI: 0.488, 52.255). BSurgs aged 40 to 44 had twice the risk of reporting burnout as ≥50 (aOR: 1.985, 95% CI:0.018, 216.308). Practicing for 21 to 30 years had 12 times higher risk of reporting burnout than practicing >30 (aOR: 12.264, 95% CI: 0.611, 246.041). Those working <50 hr/wk reported burnout more frequently than those who work ≥80 hr/wk (aOR: 2.469, 95% CI: 0.80, 76.662). Overall reports of burnout were high amongst burn surgeon respondents. Those with 21 to 30 years of clinical practice were at significantly higher risk of reporting burnout despite believing that their colleagues' burnout was more frequent than their own. Interventions addressing perceived burnout in younger burn surgeons may be limited by lack of participation due to fear of repercussions from administration or peers. Future administration-led burnout initiatives should acknowledge the differences between burn surgeon groups and offer resources unique to the individual physician's needs for burnout prevention to be successful.
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Affiliation(s)
- Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Kyle Kinslow
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Dessy Boneva
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.,Department of Surgery, University of South Florida, Tampa, Florida
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.,Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
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Svensson K, Rolfson O, Mohaddes M, Malchau H, Erichsen Andersson A. Reflecting on and managing the emotional impact of prosthetic joint infections on orthopaedic surgeons-a qualitative study. Bone Joint J 2020; 102-B:736-743. [PMID: 32475242 DOI: 10.1302/0301-620x.102b6.bjj-2019-1383.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the experience and emotional impact of prosthetic joint infection (PJI) on orthopaedic surgeons and identify holistic strategies to improve the management of PJI and protect surgeons' wellbeing. METHODS In total, 18 prosthetic joint surgeons in Sweden were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between December 2017 and February 2018. RESULTS PJI had a negative emotional impact on Swedish surgeons. Many felt guilt, stress, and a sense of failure, and several aspects of PJI management were associated with psychosocial challenges. Peer support was reported as the most important coping strategy as was collaborating with infectious disease specialists. CONCLUSION Our study affirms that there is a negative emotional impact of PJI on surgeons which can be minimized by improved peer support and working in multidisciplinary teams. Based on the surgeons' experiences we have identified desired improvements that may facilitate the management of PJI. These may also be applicable within other surgical specialties dealing with postoperative infections, but need to be evaluated for their efficacy. Cite this article: Bone Joint J 2020;102-B(6):736-743.
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Affiliation(s)
- Karin Svensson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Mölndal Hospital, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Mölndal Hospital, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Mölndal Hospital, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA.,Consultant Orthopaedic Surgeon, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Annette Erichsen Andersson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cacciamani GE, Tafuri A, Iwata A, Iwata T, Medina L, Gill K, Nassiri N, Yip W, de Castro Abreu A, Gill I. Quality Assessment of Intraoperative Adverse Event Reporting During 29 227 Robotic Partial Nephrectomies: A Systematic Review and Cumulative Analysis. Eur Urol Oncol 2020; 3:780-783. [PMID: 32474006 DOI: 10.1016/j.euo.2020.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
The definition of intraoperative adverse events (IAEs) still lacks standardization, hampering the assessment of surgical performance in this regard. Over the years, efforts to address this issue have been carried out to improve the reporting of outcomes. In 2019, the European Association of Urology (EAU) proposed a standardized reporting tool for IAEs in urology. The objective of the present study is to distill systematically published data on IAEs in patients undergoing robotic partial nephrectomy (RPN) for renal masses to answer three key questions (KQs). (KQ1) Which system is used to report the IAEs? (KQ2) What is the frequency of IAEs? (KQ3) What types of IAEs are reported? A comprehensive systematic review of all English-language publications on RPN was carried out. We followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines to evaluate PubMed, Scopus, and Web of Science databases (from January 1, 2000 to January 1, 2019). Quality of reporting and grading complications were assessed according to the EAU recommendations. Globally, 59 (35.3%) and 108 (64.7%) studies reported zero and one or more IAEs, respectively. Overall, 761 (2.6%) patients reported at least one IAE. Intraoperative bleeding is reported as the most common IAE (58%). Our analysis showed no improvement in reporting and grading of IAEs over time. PATIENT SUMMARY: Up to now, an agreement regarding the definition and reporting of intraoperative adverse events (IAEs) in the literature has not been achieved. The aim of this study is to evaluate the reporting of IAEs in patients undergoing robotic partial nephrectomy (RPN) after a systematic review of the literature. More rigorous reporting of IAEs during RPN is needed to measure their impact on patients' perioperative care.
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Affiliation(s)
- Giovanni E Cacciamani
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Alessandro Tafuri
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Atsuko Iwata
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tsuyoshi Iwata
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luis Medina
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Karanvir Gill
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nima Nassiri
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wesley Yip
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre de Castro Abreu
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Nicholson KJ, Lee JA, Lundgren CI, Meade SP, Triponez F, Carty SE. Proceedings and Insights of the 2019 International Association of Endocrine Surgeons Symposium on Surgeon Well-Being. World J Surg 2020; 44:625-637. [DOI: 10.1007/s00268-019-05345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Spotlight in Plastic Surgery. Plast Reconstr Surg 2019. [DOI: 10.1097/prs.0000000000006091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Gurland B. Mindfulness-Based Training Improves Technical Skills and Emotional Regulation for Surgical Residents. JAMA Netw Open 2019; 2:e194087. [PMID: 31125093 DOI: 10.1001/jamanetworkopen.2019.4087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brooke Gurland
- Deparment of Surgery, Stanford University, Palo Alto, California
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