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Chen HA, Krishnamurthy VD, Siperstein A, Carty S, Chen H. Four decades of the American Association of Endocrine Surgeons (AAES): Past, present, and future. Surgery 2019; 167:1-3. [PMID: 31451295 DOI: 10.1016/j.surg.2019.06.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | - Herbert Chen
- Departments of Surgery, University of Alabama at Birmingham.
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How academically productive are endocrine surgeons in the United States? J Surg Res 2018; 229:122-126. [DOI: 10.1016/j.jss.2018.03.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 02/21/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
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Sho S, Singer ES, Kwok E, Hissom R, Harari A, Livhits MJ, Yeh MW. Sustained Growth of a University-Based Endocrine Surgery Program Over 10 Years. Ann Surg Oncol 2017; 24:3306-3311. [PMID: 28748444 DOI: 10.1245/s10434-017-6012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Endocrine surgery continues to mature as a subspecialty field. We describe the clinical performance of an academic endocrine surgery program (ESP) over its first 10 years. METHODS We examined all endocrine procedures performed during the 10-year period (2006-2015) following the inception of the ESP. Institutional and state-level data on case volume, patient geographic origin, and hospital-side costs were obtained. RESULTS Endocrine case volume increased by approximately ninefold over the study period (from 102 cases in 2006 to 919 cases in 2015). The rate of growth remained approximately linear, and was driven by geographic expansion of referral regions coupled with transitioning low- to moderate-acuity operations to venues outside of the main tertiary care hospital. Market share across the eight-county Southern California region grew by more than twofold over the study period. Increased utilization of outpatient surgery led to cost reductions, averaging 11.1% per case by 2015. CONCLUSIONS Establishment of an academic ESP can lead to sustained clinical growth and a fundamental shift in regional referral patterns. The nation's continued need for skilled high-volume endocrine surgeons represents opportunities for medical centers to institute their own dedicated endocrine surgery programs.
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Affiliation(s)
- Shonan Sho
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Emily S Singer
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Eric Kwok
- ValU Care Redesign, UCLA Health System, Los Angeles, CA, USA
| | - Randi Hissom
- Hospital Finance and Strategy, UCLA Health System, Los Angeles, CA, USA
| | - Avital Harari
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Mapping endocrine surgery: Workforce analysis from the last six decades. Surgery 2016; 159:102-10. [DOI: 10.1016/j.surg.2015.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/30/2015] [Accepted: 08/15/2015] [Indexed: 11/22/2022]
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Carty SE. 2014 American Association of Endocrine Surgeons presidential address: evolution. Surgery 2014; 156:1289-96. [PMID: 25456898 DOI: 10.1016/j.surg.2014.08.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/21/2014] [Indexed: 11/29/2022]
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Wang TS, Pasieka JL, Carty SE. Techniques of parathyroid exploration at North American endocrine surgery fellowship programs: what the next generation is being taught. Am J Surg 2014; 207:527-32. [DOI: 10.1016/j.amjsurg.2013.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/07/2013] [Accepted: 05/16/2013] [Indexed: 01/14/2023]
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Wang TS, Sippel RS. Expansion of endocrine surgery fellowships: if we increase the supply is there demand? Surgery 2013; 154:1470-2. [PMID: 24238060 DOI: 10.1016/j.surg.2013.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
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Shin JJ, Milas M, Mitchell J, Berber E, Gutnick J, Siperstein A. The endocrine surgery job market: a survey of fellows, department chairs, and surgery recruiters. JOURNAL OF SURGICAL EDUCATION 2013; 70:377-383. [PMID: 23618449 DOI: 10.1016/j.jsurg.2012.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/05/2012] [Accepted: 12/27/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Fifty endocrine surgery (ES) fellows have completed their training since the American Association of Endocrine Surgeons initiated a formal match process in 2007. This study was designed to better understand the job prospects of current and future endocrine surgeons and to evaluate the evolution of ES practices nationwide. METHODS Three surveys were conducted of former fellows, surgery department chairs, and surgery recruiters. RESULTS Of former fellows, 90% are working in academic centers and 10% in private practice. Average number of job interviews was 3.1 and job offers was 2.2. Eighty-eight percent have a practice that attends to ≥50% ES cases, and 45% practice entirely ES. Ninety-eight percent are satisfied with their job. Subjectively, 57% believe that there are not enough job opportunities for young endocrine surgeons, and 50% believe that there are too many ES fellowships. Department chair survey showed that the average number of endocrine surgeons in their department increased from 1.3 to 2.2 in the past decade. A recognized ES section exists in 49% of centers, and 39% of chairs feel that they will need to recruit another endocrine surgeon in the next 2 years. Only 3 of 10 recruiters were familiar with ES, and all had<5 of their hiring institutions asking for endocrine surgeons. CONCLUSIONS To date, there have been adequate job opportunities to sustain currently trained endocrine surgeons. This contrasts with their subjective belief of limited job prospects. This information can guide the optimal number of fellowship positions and alerts the American Association of Endocrine Surgeons to the opportunity to promote the creation of formal ES sections.
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Affiliation(s)
- Joyce J Shin
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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9
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Training of a thyroid surgeon: From Scalpel to Robot. Surgery 2012; 152:943-52. [DOI: 10.1016/j.surg.2012.08.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/29/2012] [Indexed: 11/20/2022]
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Wiseman JE, Ituarte PHG, Hwang RS, Safir I, Pasternak JD, Van Nuys K, Yeh MW. Strategic impact of a new academic endocrine surgery program. Ann Surg Oncol 2011; 18:2260-4. [PMID: 21347789 PMCID: PMC3136701 DOI: 10.1245/s10434-011-1586-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Indexed: 02/06/2023]
Abstract
Background A minority of medical centers possess a dedicated endocrine surgery program. Here we assess the short-term impact of a new endocrine surgery program on institutional case volumes and financial endpoints. Methods We studied all endocrine procedures performed over a 5-year period spanning the inception of the endocrine surgery program at UCLA. Institutional and state-level data on patient geographic origin, discharges for endocrine diagnosis-related groups (DRGs), and hospital-side charges and costs were examined. Results Total endocrine case volume increased 112% (264 to 559 cases annually) over the study period. The relative increase was greater for parathyroid (56 to 196, 250%, P < 0.0001) and adrenal (11 to 31, 181%, P = 0.06) procedures compared to thyroid procedures (317 to 442, 39%). The endocrine case volume of nonspecialist surgeons remained stable over the study period. Growth in referrals arose from previously unrepresented zip codes and was associated with an increase in the mean distance traveled for care (2006, 44 miles vs. 2009, 92 miles, P < 0.01). In each DRG, UCLA attained the top market position within one year of the program’s inception, corresponding to an overall 27% increase in regional market share. Total hospital charges for endocrine DRGs rose 161% to $14.7 million annually, while the cost of parathyroid surgery fell 34% (P < 0.001). Conclusions The establishment of an academic endocrine surgery program can cause fundamental shifts in referral patterns within a competitive, densely populated metropolitan environment. Hospitals should consider the inclusion of an endocrine surgery program in strategic planning initiatives.
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Affiliation(s)
- James E Wiseman
- Endocrine Surgical Unit, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Goldfarb M, Gondek S, Hodin R, Parangi S. Resident/fellow assistance in the operating room for endocrine surgery in the era of fellowships. Surgery 2011; 148:1065-71; discussion 1071-2. [PMID: 21134534 DOI: 10.1016/j.surg.2010.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/14/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Historically, a high percentage of endocrine surgical procedures are performed by general surgeons in nonteaching environments. With the institution of accredited fellowships, we sought to determine whether that dynamic is changing. MATERIALS AND METHODS The American College of Surgeons-National Surgeons Quality Improvement Program was queried for all thyroid, parathyroid, and adrenal operations performed during 2005-2008. Resident assistance was classified as none, junior (postgraduate years 1-3), senior (postgraduate years 4 and 5) or fellow (≥ postgraduate year 6). Data were also examined for associations between resident/fellow assistance and surgical outcomes. RESULTS In all, 24.7% of endocrine operations (7,140/29,161) were performed by an attending surgeon operating alone (17.1% adrenals, 27.4% thyroids, and 20.6% parathyroids). Fellows assisted in 6.6% of operations (18.3% adrenals, 4.7% thyroids, and 8.2% parathyroids; 2006: 586 operations, 2007: 629 operations, and 2008: 720 operations). Comparing attending surgeons operating alone with those assisted by residents/fellows, they had shorter operative times (P < .001), longer surgical duration of stay (parathyroid: 1.73 days, thyroid: 1.80 days, P < .001), and a higher prevalence of obese, diabetic, or octogenarian patients. However, no significant difference was found in the rates of wound infections, medical complications, return to the operating room, or overall morbidity. CONCLUSION Even with the increase in endocrine surgery fellowships, almost one fourth of all endocrine operations are still performed by attending surgeons operating alone. Although operations assisted by residents/fellows took longer and patients had a greater duration of stay, there were no significant differences in measured outcomes.
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Affiliation(s)
- Melanie Goldfarb
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Endocrine surgery: Where are we today? A national survey of young endocrine surgeons. Surgery 2010; 147:536-41. [DOI: 10.1016/j.surg.2009.10.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 10/08/2009] [Indexed: 11/18/2022]
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Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 2007; 142:887-99; discussion 887-99. [DOI: 10.1016/j.surg.2007.09.003] [Citation(s) in RCA: 247] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 08/29/2007] [Accepted: 09/01/2007] [Indexed: 10/22/2022]
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Valentine RJ. Presidential address: the neglected specialty. JOURNAL OF SURGICAL EDUCATION 2007; 64:318-323. [PMID: 18063262 DOI: 10.1016/j.jsurg.2007.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 04/24/2007] [Accepted: 04/24/2007] [Indexed: 05/25/2023]
Affiliation(s)
- R James Valentine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9031, USA
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Richmond BK, Eads K, Flaherty S, Belcher M, Runyon D. Complications of Thyroidectomy and Parathyroidectomy in the Rural Community Hospital Setting. Am Surg 2007. [DOI: 10.1177/000313480707300404] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to examine the complications encountered in a series of 150 consecutive thyroid and parathyroid procedures performed by a single surgeon in a rural community hospital setting. The goal was to demonstrate that these procedures may be performed safely and with outcomes equivalent to those of academic hospitals in major metropolitan areas despite the lack of availability of specific technologies that are being increasingly used for these procedures in tertiary care settings. Specifically, these include intraoperative parathyroid hormone measurements, intraoperative recurrent laryngeal nerve monitoring, and the use of the gamma probe for detection of parathyroid adenoma. A retrospective chart review was conducted on a series of 150 patients undergoing any thyroid or parathyroid operation by a single surgeon in a rural setting over a 4-year period. Data was reported regarding success at achieving the goal of the operation and any perioperative complications such as recurrent laryngeal nerve injury, permanent hypoparathyroidism, wound hematoma, infection, or pneumonia. One hundred thirty-one thyroid procedures were performed (71 lobectomies, 60 total or near total procedures) for a diverse range of patholological conditions: multinodular goiter, 76 (50.7%) patients, follicular adenoma, 9 (6.0%) patients, Hashimoto's thyroiditis, 13 (8.7%) patients, papillary carcinoma, 14 (9.3%) patients, follicular carcinoma, 5 (3.3%) patients, follicular variant of papillary carcinoma, 13 (8.7%) patients, and medullary carcinoma, 1 (0.7%) patient. Nineteen successful parathyroid explorations were performed for primary hyperparathyroidism. The overall incidence of recurrent nerve injury was 1.33 per cent overall (0.99% for each nerve encountered). The incidence of transient postoperative hypocalcemia was 13 per cent, with one patient suffering permanent hypoparathyroidism (0.8%). Two patients developed wound hematomas requiring evacuation. The overall complication rate with respect to recurrent laryngeal nerve injury and permanent hypoparathyroidism was consistent with or below that that in recent large series, despite the absence of specialized equipment for nerve monitoring. The success of identifying parathyroid adenoma was 100 per cent, despite the absence of intraoperative parathormone assays, and the decision not to perform radio-guided parathyroidectomy. We conclude that outcomes and complications in thyroid and parathyroid surgical procedures are largely dependent on surgeon skill and experience, and can be performed safely in the community setting by an experienced general surgeon despite the absence of advanced technology in this setting. We encourage all surgeons to continually examine their operative results with all technically demanding procedures when deciding the composition of their individual practices.
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Affiliation(s)
- Bryan K. Richmond
- West Virginia University/Charleston Division, Charleston, West Virginia
| | - K. Eads
- West Virginia University/Charleston Division, Charleston, West Virginia
| | - Sarah Flaherty
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia; and
| | | | - David Runyon
- Beckley Area Surgical Associates, Beckley, West Virginia
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