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Rahimi AO, Hsu CH, Maegawa F, Soliman D, King RJ, Ashouri Y, Ghaderi I. First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016-2019). Obes Surg 2024; 34:866-873. [PMID: 38114775 DOI: 10.1007/s11695-023-06996-3] [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: 09/01/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The first assistant (FA) plays an important role in the operating room for bariatric surgery. The aim of this study was to examine the relationship between the type of FA and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery. METHODS AND MATERIALS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data for 2016-2019 was queried. Log-normal regression was performed to evaluate the association of FAs and OT variations within and between groups. We used logistic regression to examine the relationship between the type of FA and 30-day outcomes across all procedures and approaches. RESULTS A total of 691,789 patients who underwent robotic (R), and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS) were included. The percentage variation of OT was higher in the laparoscopic group (L-SG: 8.18%, L-RYGB: 9.88%, and L-DS: 15.00%) compared to the robotic group (R-SG: 2.43%, R-RYGB: 5.76%, and R-DS: 0.80%). There was not a significant difference in 30-day outcomes between laparoscopic and robotic approaches for the same procedures. CONCLUSIONS The FA was associated with a decreased variability in OT in the robotic cohort compared to the laparoscopic group with no significant difference in complication rates. These results suggest that the robotic approach may decrease the need for skilled FAs in bariatric procedures.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ, USA
| | - Felipe Maegawa
- Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Robert J King
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Yazan Ashouri
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA.
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Kawa N, Araji T, Kaafarani H, Adra SW. A Narrative Review on Intraoperative Adverse Events: Risks, Prevention, and Mitigation. J Surg Res 2024; 295:468-476. [PMID: 38070261 DOI: 10.1016/j.jss.2023.11.045] [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: 09/12/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Adverse events from surgical interventions are common. They can occur at various stages of surgical care, and they carry a heavy burden on the different parties involved. While extensive research and efforts have been made to better understand the etiologies of postoperative complications, more research on intraoperative adverse events (iAEs) remains to be done. METHODS In this article, we reviewed the literature looking at iAEs to discuss their risk factors, their implications on surgical care, and the current efforts to mitigate and manage them. RESULTS Risk factors for iAEs are diverse and are dictated by patient-related risk factors, the nature and complexity of the procedures, the surgeon's experience, and the work environment of the operating room. The implications of iAEs vary according to their severity and include increased rates of 30-day postoperative morbidity and mortality, increased length of hospital stay and readmission, increased care cost, and a second victim emotional toll on the operating surgeon. CONCLUSIONS While transparent reporting of iAEs remains a challenge, many efforts are using new measures not only to report iAEs but also to provide better surveillance, prevention, and mitigation strategies to reduce their overall adverse impact.
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Affiliation(s)
- Nisrine Kawa
- Department of Dermatology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York
| | - Tarek Araji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haytham Kaafarani
- Division of Trauma, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Emergency Surgery and Critical Care, Boston, Massachusetts
| | - Souheil W Adra
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Pasquer A, Ducarroz S, Lifante JC, Skinner S, Poncet G, Duclos A. Operating room organization and surgical performance: a systematic review. Patient Saf Surg 2024; 18:5. [PMID: 38287316 PMCID: PMC10826254 DOI: 10.1186/s13037-023-00388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate further investigation. METHODS We conducted a systematic review according to PRISMA guidelines to identify original studies in Pubmed and Scopus from January 1, 2000 to December 31, 2019. Studies evaluating the association between five determinants (team composition, stability, teamwork, work scheduling, disturbing elements) and three outcomes (operative time, patient safety, costs) were included. Methodology was assessed based on criteria such as multicentric investigation, accurate population description, and study design. RESULTS Out of 2625 studies, 76 met inclusion criteria. Of these, 34 (44.7%) investigated surgical team composition, 15 (19.7%) team stability, 11 (14.5%) teamwork, 9 (11.8%) scheduling, and 7 (9.2%) examined the occurrence of disturbing elements in the operating room. The participation of surgical residents appeared to impact patient outcomes. Employing specialized and stable teams in dedicated operating rooms showed improvements in outcomes. Optimization of teamwork reduced operative time, while poor teamwork increased morbidity and costs. Disturbances and communication failures in the operating room negatively affected operative time and surgical safety. CONCLUSION While limited, existing scientific evidence suggests that operating room staffing and environment significantly influences patient outcomes. Prioritizing further research on these organizational drivers is key to enhancing surgical performance.
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Affiliation(s)
- Arnaud Pasquer
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France.
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France.
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France.
| | - Simon Ducarroz
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
| | - Jean Christophe Lifante
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Endocrine Surgery, Hospices Civils de Lyon, Lyon, France
| | - Sarah Skinner
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Gilles Poncet
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France
- INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Faculté Laennec, Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Antoine Duclos
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
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Tian WM, Chang D, Pressley M, Muhammed M, Fong P, Webster W, Herbert G, Gallagher S, Watters CR, Yoo JS, Zani S, Agarwal S, Allen PJ, Seymour KA. Development of a prospective biliary dashboard to compare performance and surgical cost. Surg Endosc 2023; 37:8829-8840. [PMID: 37626234 DOI: 10.1007/s00464-023-10376-4] [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: 04/03/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Transparency around surgeon level data may align healthcare delivery with quality care for patients. Biliary surgery includes numerous procedures performed by both general surgeons and subspecialists alike. Cholecystectomy is a common surgical procedure and an optimal cohort to measure quality outcomes within a healthcare system. METHODS Data were collected for 5084 biliary operations performed by 68 surgeons in 11 surgical divisions in a health system including a tertiary academic hospital, two regional community hospitals, and two ambulatory surgery centers. A privacy protected dashboard was developed to compare surgeon performance and cost between July 2018 and June 2022. A sample cohort of patients ≥ 18 years who underwent cholecystectomy were compared by operative time, cost, and 30-day outcomes. RESULTS Over 4 years, 4568 cholecystectomy procedures were performed by 57 surgeons. Operations were done by 57 surgeons in four divisions and included 3846 (84.2%) laparoscopic cholecystectomies, 601 (13.2%) laparoscopic cholecystectomies with cholangiogram, and 121 (2.6%) open cholecystectomies. Patients were admitted from the emergency room in 2179 (47.7%) cases while 2389 (52.3%) cases were performed in the ambulatory setting. Individual surgeons were compared to peers for volume, intraoperative data, cost, and outcomes. Cost was lowest at ambulatory surgery centers, yet only 4.2% of elective procedures were performed at these facilities. Prepackaged kits with indocyanine green were more expensive than cholangiograms that used iodinated contrast. The rate of emergency department visits was lowest when cases were performed at ambulatory surgery centers. CONCLUSION Data generated from clinical dashboards can inform surgeons as to how they compare to peers regarding quality metrics such as cost, time, and complications. In turn, this may guide strategies to standardize care, optimize efficiency, provide cost savings, and improve outcomes for cholecystectomy procedures. Future application of clinical dashboards can assist surgeons and administrators to define value-based care.
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Affiliation(s)
| | - Doreen Chang
- Department of Surgery, Duke University, Durham, NC, USA
| | - Melissa Pressley
- Performance Services, Duke University Health System, Durham, NC, USA
| | - Makala Muhammed
- Performance Services, Duke University Health System, Durham, NC, USA
| | - Philip Fong
- Department of Surgery, Duke University, Durham, NC, USA
| | - Wendy Webster
- Department of Surgery, Duke University, Durham, NC, USA
| | - Garth Herbert
- Department of Surgery, Duke University, Durham, NC, USA
| | | | | | - Jin S Yoo
- Department of Surgery, Duke University, Durham, NC, USA
| | - Sabino Zani
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Peter J Allen
- Department of Surgery, Duke University, Durham, NC, USA
| | - Keri A Seymour
- Department of Surgery, Duke University, Durham, NC, USA.
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Marder RS, Shah NV, Naziri Q, Maheshwari AV. The impact of surgical trainee involvement in total knee arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:255-298. [PMID: 35022881 DOI: 10.1007/s00590-021-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. RESULTS Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. CONCLUSION Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion.
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Affiliation(s)
- Ryan S Marder
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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Alexander B, Sowers M, Jacob R, McGwin G, Maffulli N, Naranje S. The Impact of Resident Involvement on Patient Outcomes in Revision Total Hip Arthroplasty. Rev Bras Ortop 2023; 58:133-140. [PMID: 36969789 PMCID: PMC10038725 DOI: 10.1055/s-0041-1736469] [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: 02/21/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022] Open
Abstract
Objective The aim of the present study was to determine the influence of resident involvement on acute complication rates in revision total hip arthroplasty (THA). Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 1,743 revision THAs were identified from 2008 to 2012; 949 of them involved a resident physician. Demographic information including gender and race, comorbidities including lung disease, heart disease and diabetes, operative time, length of stay, and acute postoperative complications within 30 days were analyzed. Results Resident involvement was not associated with a significant increase in the risk of acute complications. Total operative time demonstrated a statistically significant association with the involvement of a resident (161.35 minutes with resident present, 135.07 minutes without resident; p < 0.001). There was no evidence that resident involvement was associated with a longer hospital stay (5.61 days with resident present, 5.22 days without resident; p = 0.46). Conclusion Involvement of an orthopedic resident during revision THA does not appear to increase short-term postoperative complication rates, despite a significant increase in operative times.
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Affiliation(s)
- Bradley Alexander
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
| | - Mackenzie Sowers
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
| | - Roshan Jacob
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
| | - Gerald McGwin
- Departamento de Epidemiologia, Universidade do Alabama em Birmingham, Universidade Boulevard Birmingham, Alabama, Estados Unidos
| | - Nicola Maffulli
- Departamento de Distúrbios Musculoesqueléticos, Faculdade de Medicina e Cirurgia, Universidade de Salerno, Baronissi, Itália
| | - Sameer Naranje
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
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Anyomih TT, Jennings T, Mehta A, O'Neill JR, Panagiotopoulou I, Gourgiotis S, Tweedle E, Bennett J, Davies RJ, Simillis C. Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon. Am J Surg 2023; 225:168-179. [PMID: 35927089 DOI: 10.1016/j.amjsurg.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/23/2022] [Accepted: 07/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Appendectomy is a benchmark operation for trainee progression, but this should be weighed against patient safety and perioperative outcomes. METHODS Systematic literature review and meta-analysis comparing outcomes of appendectomy performed by trainees versus trained surgeons. RESULTS Of 2086 articles screened, 29 studies reporting on 135,358 participants were analyzed. There was no difference in mortality (Odds ratio [OR] 1.08, P = 0.830), overall complications (OR 0.93, P = 0.51), or major complications (OR 0.56, P = 0.16). There was no difference in conversion from laparoscopic to open surgery (OR 0.81, P = 0.12) and in intraoperative blood loss (Mean Difference [MD] 5.58 mL, P = 0.25). Trainees had longer operating time (MD 7.61 min, P < 0.0001). Appendectomy by trainees resulted in shorter duration of hospital stay (MD 0.16 days, P = 0.005) and decreased reoperation rate (OR 0.78, P = 0.05). CONCLUSIONS Appendectomy performed by trainees does not compromise patient safety. Due to statistical heterogeneity, further randomized controlled trials, with standardized reported outcomes, are required.
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Affiliation(s)
- Theophilus Tk Anyomih
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Jennings
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alok Mehta
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Robert O'Neill
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ioanna Panagiotopoulou
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stavros Gourgiotis
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elizabeth Tweedle
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Bennett
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Justin Davies
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Constantinos Simillis
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Siddiqui NA, Pirzada A, Badini S, Shaikh FA. Role of Simulated Training for Carotid Endarterectomy: A Systematic Review. Ann Vasc Dis 2022; 15:253-259. [PMID: 36644270 PMCID: PMC9816038 DOI: 10.3400/avd.ra.22-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022] Open
Abstract
Vascular surgery trainees often do not get to perform carotid endarterectomy (CEA) directly on the patients as it requires meticulous surgical technique and has a high risk of procedure-related complications. Hence, the role of simulation in training future vascular surgeons becomes essential. This review aims to assess the types and utility of simulators available for CEA. In this systematic review, all the studies performed on CEA simulation were included. The purpose of this review was to assess different types of simulators and their usefulness for CEA. We identified 122 articles, of which 10 were eligible for review. A variety of simulators, ranging from animal models, virtual reality simulators and commercially designed models with high fidelity options were used. Technical competence was the major domain assessed in the majority of the studies (n=8), whereas four studies evaluated anatomical and procedural knowledge. Blinding was done in five studies for assessment purposes. The majority of studies (n=9) found the simulation to be an effective tool for achieving technical competence. This review shows the potential usefulness of simulation in acquiring technical skills and procedural acumen for CEA. The available literature is unfortunately too diverse to have a common recommendation.
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Affiliation(s)
- Nadeem A. Siddiqui
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ammar Pirzada
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shoaib Badini
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Fareed A. Shaikh
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan,Corresponding author: Fareed A. Shaikh, MBBS, MRCSEd, FCPS-GS, FCPS-Vascular Surgery. Cardiothoracic and Vascular offices, Link Building, Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, 74800, Stadium road, Karachi, Pakistan Tel: +92-3218110155, Fax: +92-21-34934294, E-mail:
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Cost analysis of training residents in robotic-assisted surgery. Surg Endosc 2022; 37:2765-2769. [PMID: 36471060 DOI: 10.1007/s00464-022-09794-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Use of robotic-assisted surgery is increasing, and resident involvement may lead to higher costs. We investigated whether senior resident involvement in noncomplex robotic cholecystectomy (RC) and inguinal hernia (RIH) would take more time and cost more when compared to non-robotic cholecystectomy (NRC) and inguinal hernia repair (NRIH). METHODS We extracted surgery duration and total cost of NRC, NRIH, RC, and RIH from 7/2016 to 6/2020 with senior resident (PGY4-5) involvement. We excluded complex cases as well as prisoner cases and those with new faculty and research residents. We assessed differences between robotic and non-robotic cases in surgery duration and total cost per minute, using one-way ANOVA. RESULTS We included 1608 cases (non-robotic 1145 vs. robotic 463). On average, RC cases with a senior resident took less time than NRC (179.4 < 185.8, p = 0.401); surgery duration of RIH cases was similar with NRIH cases. The total cost per minute of RC cases with a senior resident on average was $9.30 higher than NRC cases for each minute incurred in the operating room but did not lead to a significant change in overall cost. RIH cases, on the other hand, cost less per minute than NRIH cases (114.1 < 126.5, p = 0.399). CONCLUSION Training in robotic surgery is important. Noncomplex RC and RIH involving senior residents were not significantly longer nor did they incur significantly more cost than non-robotic procedures. Senior resident training in noncomplex robotic surgery can be efficient and can be included in the residency curriculum.
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Emery M, Wolff M, Merritt C, Ellinas H, McHugh D, Zaher M, Semiao ML, Gruppen LD. An outcomes research perspective on medical education: Has anything changed in the last 18 years? MEDICAL TEACHER 2022; 44:1400-1407. [PMID: 35856851 DOI: 10.1080/0142159x.2022.2099259] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Medical education research focused on patient-centered outcomes holds the promise of improved decision-making by medical educators. In 2001, Prystowsky and Bordage demonstrated that patient-centered outcomes were evaluated in fewer than one percent of studies published in a survey of major medical education journals. Though many have called for increased inclusion of patient-centered outcomes in medical education literature, it remains uncertain to what degree this need has been addressed systematically. METHODS Using the same data sources as in the original report (Academic Medicine, Medical Education, and Teaching and Learning in Medicine), we sought to replicate Prystowsky and Bordage's study. We extracted data from original empirical research reports from these three journal sources for the years 2014-2016. We selected 652 articles that met the inclusion criteria for further analysis. RESULTS Study participants were largely trainees (64% of studies) or faculty (25% of studies). Only 2% of studies included patients as active or passive participants. Study outcomes reported were satisfaction (40% of studies), performance (39%), professionalism (20%), and cost (1%). CONCLUSIONS These results do not differ significantly from the original 2001 study. The medical education literature as represented in these three prominent journals has made little progress in placing a greater focus on patient-centered outcomes.
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Affiliation(s)
- Matt Emery
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Margaret Wolff
- Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Chris Merritt
- Department of Emergency Medicine & Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Herodotos Ellinas
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Douglas McHugh
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Mohammad Zaher
- Department of Academic and Training Affairs, Prince Mohammad Bin AbdulAziz Hospital, Riyadh, Saudi Arabia
| | - Meghan L Semiao
- Manager, Medical Simulation & Education Standardized Patient Program, Inova Health System, Falls Church, VA, USA
| | - Larry D Gruppen
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Varone A, Stephen A, Kheirbek T, Adams C, Cioffi W. Outcomes of PEG placement by acute care surgeons compared to those placed by gastroenterology. Surg Endosc 2022; 36:8214-8220. [PMID: 35477805 DOI: 10.1007/s00464-022-09262-2] [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: 10/27/2021] [Accepted: 04/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes are placed by gastroenterologists (GI) and surgeons throughout the country. At Rhode Island Hospital, before July of 2017, all PEGs were placed by GI. In July of 2017, in response to a growing need for PEGs, acute care surgeons (ACS) also began performing PEGs at the bedside in ICUs. The purpose of this study was to review and compare outcomes of PEG tubes placed by ACS and GI. METHODS Retrospective chart review of patients who received a PEG placed by ACS or GI at the bedside in any ICU from December 2016 to September 2019. Charts were reviewed for the following outcomes: Success rates of placing PEG, duration of procedure, major complications, and death. Secondary outcomes included discharge disposition, and rates of comfort measures only after PEG. RESULTS In 2017, 75% of PEGs were placed by GI and 25% surgery. In 2018, 47% were placed by GI and 53% by surgery. In 2019, 33% were placed by GI and 67% by surgery. There was no significant difference in success rates between surgery (146/156 93.6%) and GI (173/185 93.5%) (p 0.97). On average, GI performed the procedure faster than surgery [Median 10 (7-16) min vs 16 (13-21) mins, respectively, p < 0.001]. There were no significant differences between groups in any of the PEG outcomes or complications investigated. CONCLUSION Bedside PEG tube placement appears to be a safe procedure in the ICU population. GI and Surgery had nearly identical success rates in placing PEGs. GI performed the procedure faster than surgery. There were no significant differences in the reviewed patient outcomes or complications between PEGs placed by ACS or GI. Of note, when a complication occurred, ACS PEG patients typically were managed in the OR while GI tended to re-PEG patients highlighting a potential difference in management that should be further investigated.
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Affiliation(s)
- Andrew Varone
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA.
| | - Andrew Stephen
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Tareq Kheirbek
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Charles Adams
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - William Cioffi
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
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Tomei KL, Selby LV, Kirk LM, Bello JA, Nolan NS, Varma SK, Turner PL, Elliott VS, Brotherton SE. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1592-1596. [PMID: 35731593 PMCID: PMC9592142 DOI: 10.1097/acm.0000000000004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.
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Affiliation(s)
- Krystal L. Tomei
- K.L. Tomei is associate professor of pediatric neurosurgery, Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luke V. Selby
- L.V. Selby is assistant professor of surgery, Department of Surgery, Division of Colorectal and Oncologic Surgery, University of Kansas Medical Center, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-0202-9646
| | - Lynne M. Kirk
- L.M. Kirk is chief of accreditation and recognition, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jacqueline A. Bello
- J.A. Bello is director of neuroradiology and professor of radiology and neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York
| | - Nathan S. Nolan
- N.S. Nolan is medical education fellow and infectious disease physician, Washington University Hospital, St. Louis, Missouri
| | - Surendra K. Varma
- S.K. Varma is executive associate dean for graduate medical education and resident affairs, university distinguished professor, and vice chair, Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Patricia L. Turner
- P.L. Turner is executive director, American College of Surgeons, and clinical associate professor of surgery, University of Chicago Medicine, Chicago, Illinois
| | - Victoria Stagg Elliott
- V.S. Elliott is a technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1223-0084
| | - Sarah E. Brotherton
- S.E. Brotherton is director, Data Acquisition Services, American Medical Association, Chicago, Illinois
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Bayat Z, Guidolin K, Elsolh B, De Castro C, Kennedy E, Govindarajan A. Impact of surgeon and hospital factors on length of stay after colorectal surgery systematic review. BJS Open 2022; 6:6704875. [PMID: 36124901 PMCID: PMC9487584 DOI: 10.1093/bjsopen/zrac110] [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: 06/09/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although length of stay (LOS) after colorectal surgery (CRS) is associated with worse patient and system level outcomes, the impact of surgeon and hospital-level factors on LOS after CRS has not been well investigated. The aim of this study was to synthesize the evidence for the impact of surgeon and hospital-level factors on LOS after CRS. Methods A comprehensive database search was conducted using terms related to LOS and CRS. Studies were included if they reported the effect of surgeon or hospital factors on LOS after elective CRS. The evidence for the effect of each surgeon and hospital factor on LOS was synthesized using vote counting by direction of effect, taking risk of bias into consideration. Results A total of 13 946 unique titles and abstracts were screened, and 69 studies met the inclusion criteria. All studies were retrospective and assessed a total of eight factors. Surgeon factors such as increasing surgeon volume, colorectal surgical specialty, and progression along a learning curve were significantly associated with decreased LOS (effect seen in 87.5 per cent, 100 per cent, and 93.3 per cent of studies respectively). In contrast, hospital factors such as hospital volume and teaching hospital status were not significantly associated with LOS. Conclusion Provider-related factors were found to be significantly associated with LOS after elective CRS. In particular, surgeon-related factors related to experience specifically impacted LOS, whereas hospital-related factors did not. Understanding the mechanisms underlying these relationships may allow for tailoring of interventions to reduce LOS.
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Affiliation(s)
- Zubair Bayat
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
- Sinai Health System , Toronto, Ontario , Canada
| | - Keegan Guidolin
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
| | - Basheer Elsolh
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
| | | | - Erin Kennedy
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
- Sinai Health System , Toronto, Ontario , Canada
| | - Anand Govindarajan
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
- Sinai Health System , Toronto, Ontario , Canada
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Cheung KT, An V, Sorensen JC, Lin OM, Lie E, Mercier LL, Marguccio SA, Gumulia EN, Goonawardena J, Chan LH, Wong E. Elective Laparoscopic Cholecystectomy as an Entrustable Professional Activity (EPA) for General Surgical Trainees in Australia. JOURNAL OF SURGICAL EDUCATION 2022; 79:655-660. [PMID: 35123911 DOI: 10.1016/j.jsurg.2022.01.008] [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: 08/31/2021] [Revised: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To evaluate the operation time and surgical outcomes of elective laparoscopic cholecystectomy performed by surgical trainees at different levels of training at Eastern health and hence, to establish the efficacy and safety of elective laparoscopic cholecystectomy as an Entrustable Professional Activity for surgical trainees in general surgery. OBJECTIVE Elective laparoscopic cholecystectomies performed at our institution between January 2018 and January 2019 were included. Analyses were divided among three groups - consultants (C), fellows (F) and registrars (R). Standard technique with critical view of safety was used. RESULTS A total of 592 patients was included, with a mean age of 54 ± 63 years old. The average operation time was 84 ± 51 minutes. Surgical education and training (SET) 2 trainees took significantly longer when compared to their SET3 and above counterparts as a primary operator (SET2: 131 ± 32 min, Reference; SET3: 78 ± 21 min, p = 0.003; SET4: 80 ± 33 min, p = 0.004; SET5: 77 ± 28 min, p = 0.003; F: 93 ± 77 min, p = 0.036; C: 85 ± 59 min; p = 0.007). Consultant primary operators took an average of 15 minutes longer to complete the operation when assisted by a SET trainee compared to the non-SET registrars (p = 0.03). The overall complication rate was 3.2% and was not significantly different among all three groups (p = 0.17). No death was recorded during the study period. The readmission and return to theatre rates were 7.8% and 0.8% respectively and were not significantly different among the groups (p-values = 0.61 and 0.69). All conversion to open were performed by the consultant primary operator. CONCLUSIONS Elective laparoscopic cholecystectomy can be safely performed by surgical trainees at all SET levels when under appropriate supervision, although junior surgical trainees that is SET 2 took longer to complete the procedure. This operation seems to have a steep, but relatively short, learning curve and it may be broken down into various components. These components, with the addition of time, may be suitable as an Entrustable Professional Activity tool for assessing the competency of early SET trainees.
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Affiliation(s)
- King Tung Cheung
- Department of Upper Gastrointestinal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia.
| | - Vinna An
- Department of Colorectal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - James C Sorensen
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Olivia Miki Lin
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Elisa Lie
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Laura Le Mercier
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | | | | | - Janindu Goonawardena
- Department of Upper Gastrointestinal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Lok Hang Chan
- Department of Agriculture and Food, The University of Melbourne, Victoria, Australia
| | - Enoch Wong
- Department of Upper Gastrointestinal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
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Simmonds A, Otoya D, Lavingia KS, Amendola MF. Assessing Resident Impact on Surgical Outcomes in Below-the-Knee Amputations Based on Operative Autonomy. Ann Vasc Surg 2022; 87:57-63. [PMID: 35472501 DOI: 10.1016/j.avsg.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gradual increases in resident autonomy with attending physician oversight is crucial to developing safe and competent surgeons1. The Veterans Affairs Surgical Quality Improvement Program (VASQIP) follows surgical outcomes within the VA. We set forth to examine the VASQIP database to compare outcomes between resident independent cases and nonindependent cases during below-the-knee amputations (BKA). METHODS All VASQIP records for BKA from 2000 to 2020 were examined and categorized based on whether the attending was scrubbed during the case. Case matching was performed based on preoperative comorbidities; 30-day postoperative outcomes, including a return to the operating room, wound infection, and mortality, were assessed in addition to operative time, hospital length of stay, and transfusion requirements. Student's t-test and Fisher's Exact Test were utilized. RESULTS A total of 13,208 BKA VASQIP records were obtained. After case control matching, 2,688 cases remained. Cases were identified with the attending surgeon noted as being scrubbed during the case (n = 1,344), or not scrubbed (n = 1,344). Patients were similar in comorbidities across both groups. No statistically significant difference in operative time (1.52 hr ± 0.78 vs. 1.47 hr ± 0.75, P = 0.08), 30-day mortality (3.3% vs. 4.8%, P = 0.05), or complication rate (19.5% vs. 21.3%, P = 0.25). Resident independent cases were noted to have slightly longer postop length of stay (12.47 days ± 12.69 vs. 15.33 days ± 20.56, P < 0.01) and operative bleeding requiring more than 4 units transfused (0.3% vs. 1.3%, P ≤ 0.01). CONCLUSIONS Resident independent operating during below-the-knee amputation at VA hospitals is associated with an increased length of stay and blood transfusion. There was no statistically significant increase in operative time, 30-day mortality, or total complication rate. Further research is required to assess the risks associated with surgical training, resident supervision, and resident preparedness for independent practice.
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Affiliation(s)
- Alexander Simmonds
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA
| | - Diana Otoya
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA
| | - Kedar S Lavingia
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA.
| | - Michael F Amendola
- Division of Vascular Surgery, Central Virginia Veterans Administration Health System, Richmond, VA
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16
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Stevens A, Meier J, Balentine C. Resident Involvement in Inguinal Hernia Repair is Safe but Associated With Increased Operative Time. J Surg Res 2022; 276:305-313. [PMID: 35421741 DOI: 10.1016/j.jss.2022.03.002] [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: 03/04/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Understanding how resident participation in surgery affects outcomes is critical for academic surgeons. The purpose of this study was to evaluate if resident participation was associated with adverse outcomes for inguinal hernia repair. METHODS We used the Veterans Affairs Surgical Quality Improvement Program to look at 61,737 patients aged ≥18 y who had open inguinal hernia repairs from 1998 to 2018. Propensity weighting was used to compare postoperative complications and operative time for patients having surgery performed by an attending alone versus attending with a postgraduate year (PGY) 1, 3, or 5 residents. RESULTS There were 29,806 hernias (48%) repaired by an attending, 12,024 (19%) by an intern, 9008 (15%) by a PGY-3 resident, and 10,898 (18%) by a PGY-5 resident. After propensity weighting, there was a 0.13% (95% CI -0.11% to 0.38%, P = 0.29) increase in complications with PGY-1 participation compared to cases performed by attendings alone, a 0.3% increase (95% CI 0.01% to 0.59%, P = 0.04) for PGY-3 residents, and a 0.4% increase (95% CI 0.11% to 0.69%, P = 0.007) for PGY-5 residents. There was also an increase in operative time of 26 min (95% CI 25 to 27, P < 0.001) with PGY-1 participation, 19 min (95% CI 18 to 20, P < 0.001) with PGY-3 participation, and 23 min (95% CI 22 to 24, P < 0.001) with PGY-5 participation. CONCLUSIONS Resident involvement in inguinal hernia surgery was associated with a significant increase in operative time but had a minimal impact on postoperative complications. Although resident participation in hernia surgery is safe, surgical programs should focus on enhancing operative efficiency for residents.
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Affiliation(s)
- Audrey Stevens
- Department of Surgery, University of Texas Southwestern, Dallas, Texas; Department of Surgery, VA North Texas Healthcare System, Dallas, Texas; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Department of Surgery, Dallas, Texas.
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern, Dallas, Texas; Department of Surgery, VA North Texas Healthcare System, Dallas, Texas; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Department of Surgery, Dallas, Texas
| | - Courtney Balentine
- Department of Surgery, University of Texas Southwestern, Dallas, Texas; Department of Surgery, VA North Texas Healthcare System, Dallas, Texas; Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Department of Surgery, Dallas, Texas
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Residents versus minimally invasive surgery fellows as first assistant: Outcome differences for laparoscopic Roux-en-Y gastric bypass. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Quiroga-Centeno AC, Hoyos-Rizo K, Chaparro-Zaraza AF, Pinilla-Merchán PF, Pinilla Chávez MC, Serrano-Pastrana JP, Gómez Ochoa SA. Infección temprana de la malla quirúrgica en herniorrafia incisional. Incidencia, factores de riesgo y desenlaces en más de 60.000 pacientes. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La infección de la malla en cirugía de reparación de hernias de pared abdominal es un desenlace pobre, asociado a un incremento en el riesgo de complicaciones. El objetivo del presente estudio fue analizar la incidencia, los factores asociados y desenlaces en pacientes llevados a herniorrafia incisional con malla con posterior diagnóstico de infección temprana.
Métodos. Estudio de cohorte retrospectiva. Se utilizaron los datos de egresos hospitalarios de la National Inpatient Sample (NIS) de los Estados Unidos de América para identificar a todos los pacientes adultos llevados a herniorrafia incisional durante los años 2010 a 2015. Se utilizaron modelos de regresión logística bivariada y multivariada para evaluar los factores de riesgo en infección temprana de la malla, y finalmente, modelos de regresión logística y lineal, según el tipo de variable dependiente, de tipo stepwise forward para evaluar la asociación entre el diagnóstico de infección de malla y los desenlaces adversos.
Resultados. En total se incluyeron 63.925 pacientes. La incidencia de infección temprana de la malla fue de 0,59 %, encontrando como factores asociados: comorbilidades (obesidad, desnutrición proteico calórica, anemia carencial y depresión), factores clínico-quirúrgicos (adherencias peritoneales, resección intestinal, cirugía laparoscópica y complicaciones no infecciosas de la herida) y administrativos o asistenciales.
Conclusiones. La infección temprana, aunque infrecuente, se asocia con un aumento significativo en el riesgo de complicaciones. La optimización prequirúrgica con base en los factores de riesgo para este desenlace nefasto es un elemento clave para la reducción de la incidencia y mitigación del impacto de la infección en los pacientes con herniorrafía incisional con malla.
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Richards WO. For the People and the Profession. Am Surg 2021; 88:332-338. [PMID: 34786966 DOI: 10.1177/00031348211054703] [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: 11/16/2022]
Abstract
In 1982 Dean Warren delivered the presidential address "Not for the Profession… For the People" in which he identified substandard surgical residency programs graduating residents who were unable to pass American Board of Surgery exams. Drs. Warren and Shires as members of the independent ACGME began to close the substandard programs in order to improve surgical care for average Americans i.e. "for the people". By 2003 these changes dramatically reduced the failure rate for the ABS exams and trained good surgeons who could operate independently however the residents were on duty for every other or every third night. In 2003 the ACGME mandated duty hour restrictions in order improve resident wellness and improve the training environment for the profession. However, work hour restrictions reduced the time surgical residents spent in the hospital environment primarily when residents had more autonomy and had exposure to emergency cases which degraded readiness for independent practice. Surgical educators in the 2 decades after the work hour restrictions have improved techniques of training so graduates could not only pass the board exams but also be prepared for independent practice. Surgical residency training has improved by both the changes implemented by the independent ACGME in 1981 and by the work hour restrictions mandated in 2003. Five recommendations are made to ensure that Dr Warren's culture of excellence in surgical training continues in an environment that enhances wellbeing of the trainee i.e. "For the People and the Profession".
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Guidolin K, Spence RT, Azin A, Hirpara DH, Lam-Tin-Cheung K, Quereshy F, Chadi S. The effect of operative duration on the outcome of colon cancer procedures. Surg Endosc 2021; 36:5076-5083. [PMID: 34782967 DOI: 10.1007/s00464-021-08871-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolonged operative duration has been associated with increased post-operative morbidity in numerous surgical subspecialties; however, data are limited in operations for colon cancer specifically and existing literature makes unwarranted methodological assumptions of linearity. We sought to assess the effects of extended operative duration on perioperative outcomes in those undergoing segmental colectomy for cancer using a methodologically sound approach. METHODS We conducted a retrospective cohort study of patients undergoing segmental colectomy for cancer between 2014 and 2018, logged in the National Surgical Quality Improvement Program datasets. Our primary outcome was a composite of any complication within 30 days; secondary outcomes included length of stay and discharge disposition. Our main factor of interest was operative duration. RESULTS We analyzed 26,380 segmental colectomy cases, the majority of which were approached laparoscopically (64.95%) and were right sided (62.93%). Median operative duration was 152 (95% CI 112-206) minutes. On multivariable regression, increased operative duration was linearly associated with any complication (OR = 1.003, 95% CI 1.003-1.003, p < 0.0001) in the overall cohort, as was length of stay (p < 0.0001). All subgroups except for the laparoscopic left colectomy group were linearly associated with operative duration. In the laparoscopic left colectomy group, an inflection point in the odds of any complication was found at 176 min (OR = 1.39, 95% CI 1.20-1.61, p < 0.0001). CONCLUSIONS This study suggests that the risk of perioperative complications increases linearly with increasing operative duration, where each additional 30 min increases the odds of complication by 10%. In those undergoing laparoscopic left colectomy, the risk of complications sharply increases after ~ 3 h, suggesting that surgeons should aim to complete these procedures within 3 h where possible.
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Affiliation(s)
- Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Richard T Spence
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Arash Azin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Fayez Quereshy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Sami Chadi
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Department of Surgery, University Health Network, Toronto, ON, Canada.
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Pohl L, Naidoo M, Rickard J, Abahuje E, Kariem N, Engelbrecht S, Kloppers C, Sibomana I, Chu K. Surgical Trainee Supervision During Non-Trauma Emergency Laparotomy in Rwanda and South Africa. JOURNAL OF SURGICAL EDUCATION 2021; 78:1985-1992. [PMID: 34183277 DOI: 10.1016/j.jsurg.2021.05.013] [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: 01/23/2021] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The primary objective was to describe the level of surgical trainee autonomy during non-trauma emergency laparotomy (NTEL) operations in Rwanda and South Africa. The secondary objective was to identify potential associations between trainee autonomy, and patient mortality and reoperation. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, observational study of NTEL operations at 3 teaching hospitals in South Africa and Rwanda over a 1-year period from September 1, 2017 to August 31, 2018. The study included 543 NTEL operations performed by the acute care and general surgery services on adults over the age of 18 years. RESULTS Surgical trainees led 3-quarters of NTEL operations and, of these, 72% were performed autonomously in Rwanda and South Africa. Notably, trainee autonomy was not significantly associated with reoperation or mortality. CONCLUSIONS Trainees were able to gain autonomous surgical experience without impacting mortality or reoperation outcomes, while still providing surgical support in a high-demand setting.
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Affiliation(s)
- Linda Pohl
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nazmie Kariem
- Department of Surgery, University of Cape Town, Cape Town, South Africa; Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | | | - Christo Kloppers
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
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Resident Involvement in Hip Arthroscopy Procedures Does Not Affect Short-Term Surgical Outcomes. Arthrosc Sports Med Rehabil 2021; 3:e1367-e1376. [PMID: 34712975 PMCID: PMC8527250 DOI: 10.1016/j.asmr.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate whether the presence of residents in hip arthroscopy (HA) procedures affects short-term surgical outcomes. Methods The American College of Surgeons National Surgical Quality Improvement Program Database was used to identify patients who underwent HA from 2006 to 2012. Demographic and 30-day outcome variables were compared between cohorts of patients with and without residents. Multivariate logistic regression was used to identify whether resident involvement was an independent risk factor for adverse outcomes. Propensity score matching was performed to control for all demographic and intraoperative variables. Results A total of 869 patients (59.7% female) were included in this study, 626 of which reported data on resident involvement. Patients were mostly White (73.4% of cases without a resident, 51.8% with a resident, P < .05). Those with residents were younger (P = .016), had lower modified 5-item frailty index (mFI-5) scores (P = .028), and had fewer cardiac comorbidities (P = .008). There was no difference in diabetic status, dyspnea symptoms, history of chronic obstructive pulmonary disease, renal comorbidity, neurologic comorbidity, cumulative comorbidities, history of bleeding disorders, inpatient vs. outpatient treatment, preoperative functional status, smoking history, and steroid use for chronic conditions. There was no difference in all complications, operative time, length of stay, reoperation, readmission, wound complication, venous thromboembolism, blood transfusions, or sepsis. Propensity score match for demographic and intraoperative differences found no association between resident involvement and increased complications. Resident involvement was not an independent risk factor for all complications studied. Conclusion Resident involvement in HA procedures was not a risk factor for 30-day complications between 2006 and 2012. Resident involvement did not increase the risk of adverse outcomes, readmission, reoperation, or length of stay, nor did it significantly increase operative times.
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Abstract
Within general surgery education circles, the state of autonomy for residents in surgery training programs has been of growing concern. Although there is no direct evidence showing less autonomy in modern surgical training, multiple surrogates have been cited as reasons for concern. Many reasons have been given for lost autonomy including the 80-hour work week, financial constraints, concerns over quality of patient care, patient expectations, new and innovative technologies, legal limitations, and public opinion. This article discusses the current state of general surgery resident autonomy, why autonomy is important, barriers to autonomy, and ways to support autonomy.
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Lederhuber H, Hanßke B, Dahlstrand U. Impact of Trainee Participation on Inguinal Hernia Repair Outcome: A Study Based on the Swedish Hernia Register. Ann Surg 2021; 274:e62-e69. [PMID: 31365364 DOI: 10.1097/sla.0000000000003497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether differences in postoperative outcome exist between open inguinal hernia repairs performed by surgical trainees and those performed by specialist surgeons. SUMMARY OF BACKGROUND DATA Inguinal hernia repair is the prototype educational surgical procedure. The impact of trainee participation on postoperative outcome is still controversial and despite earlier studies no reliable hernia-specific data exist. METHODS The study cohort was based on the Swedish Hernia Register and consisted of 61,161 cases of male patients aged 18 years and older with open anterior mesh repair of a primary inguinal hernia between January 1, 2002, and December 31, 2014. The study cohort was selected to represent the typical trainee procedure in Sweden. Primary outcome measures were reoperation due to hernia recurrence and postoperative 30-day complications. RESULTS Procedures with longer operating times were at a higher risk for reoperation when performed by supervised trainees [57 to 72 minutes: hazard ratio (HR) 1.55, 99% confidence interval (99% CI) 1.05-2.27] or unsupervised trainees (57 to 72 minutes: HR 1.60, 99% CI 1.18-2.17; >72 minutes: HR 1.72, 99% CI 1.25-2.37). The same was true for specialist and trainee-assisted specialists with operating times <43 minutes (HR 1.63, 99% CI 1.25-2.13; HR 1.58, 99% CI 1.09-2.28). Postoperative 30-day complications were generally associated with longer operating times and occurred at all levels of experience. CONCLUSION Trainee participation in open inguinal repair in combination with longer operating time is a risk factor associated with higher reoperation rates. This calls for a more structured supervision of trainees in an assumedly basic procedure.
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Affiliation(s)
- Hans Lederhuber
- Department of General Surgery, Torsby Hospital, Region Värmland County Council, Värmland, Sweden
| | - Bengt Hanßke
- Department of General Surgery, Torsby Hospital, Region Värmland County Council, Värmland, Sweden
| | - Ursula Dahlstrand
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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Martínez-Martínez JA, Cómbita-Rojas HA, Pinillos Navarro PC, Casallas-Cristancho D, Paez-Sosa LA, Ruiz-Gómez SM. Impacto de la participación del residente y su rol en desenlaces clínicos de los pacientes llevados a colecistectomía en un hospital universitario. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introducción. La colecistectomía es uno de los procedimientos quirúrgicos más realizados a nivel mundial, por lo que su aprendizaje es cada vez más necesario para los médicos residentes en entrenamiento, pero sin comprometer la seguridad de los pacientes. El objetivo de este estudio fue determinar el impacto de la participación de los médicos residentes en los principales desenlaces clínicos de la colecistectomía.
Métodos. Se realizó un estudio prospectivo de cohortes, donde se incluyeron los pacientes llevados a colecistectomía laparoscópica, desde junio de 2019 hasta julio de 2020. Se llevó a cabo el análisis estadístico para describir medidas de frecuencia, tendencia central, dispersión y análisis bivariados para los desenlaces de interés.
Resultados. Se incluyeron 482 pacientes a quienes se les practicó colecistectomía, 475 de ellas por vía laparoscópica. El 62,5 % fueron mujeres y el 76,2 % se realizaron de carácter urgente. En el 96 % de los procedimientos se contó con la participación de un residente. En el análisis bivariado no se encontró una diferencia estadísticamente significativa entre la participación del residente y un impacto negativo en los desenlaces clínicos de las variables relevantes.
Discusión. No hay evidencia de que la participación de médicos residentes en la colecistectomía laparoscópica se asocie con desenlaces adversos en los pacientes, lo que sugiere estar en relación con una introducción temprana y responsable a este procedimiento por parte de los docentes, permitiendo que la colecistectomía sea un procedimiento seguro.
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Salvia R, Andrianello S, Ciprani D, Deiro G, Malleo G, Paiella S, Casetti L, Landoni L, Tuveri M, Esposito A, Marchegiani G, Bassi C. Pancreatic surgery is a safe teaching model for tutoring residents in the setting of a high-volume academic hospital: a retrospective analysis of surgical and pathological outcomes. HPB (Oxford) 2021; 23:520-527. [PMID: 32859493 DOI: 10.1016/j.hpb.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Academic hospitals must train future surgeons, but whether residents could negatively affect the outcomes of major procedures is a matter of concern. The aim of this study is to assess if pancreatic surgery is a safe teaching model. METHODS Outcomes of 1230 major pancreatic resections performed at a high-volume pancreatic teaching hospital between 2015 and 2018 were compared according to the first surgeon type, attending vs resident. RESULTS Residents performed a selection of 132 (16%) pancreaticoduodenectomies (PD) and 46 (11%) distal pancreatectomies (DP). For PD, pancreatic fistula (25% vs 0, p < 0.001), biliary fistula (7.1% vs 3.5%, p = 0.04) and operative time (400 vs 390 min, p < 0.001) were lower for residents but post-pancreatectomy hemorrhage was higher (20.5% vs 13% p = 0.024). For DP, pancreatic fistula rate was lower for residents (31.7% vs 17.5% p = 0.046). There was no difference in terms of lymph nodes retrieval both for PDs and DPs, while the R1 resections were more frequent among PDs performed by attending surgeons (31.5% vs 15.7%, p = 0.023). CONCLUSION The active participation of residents does not negatively affect outcomes of major pancreatic resections in a high-volume center. By means of case selection and continuous tutoring, pancreatic surgery represents a safe and valid teaching model.
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Affiliation(s)
- Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Debora Ciprani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giacomo Deiro
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Massimiliano Tuveri
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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Impact of fellow compared to resident assistance on outcomes of minimally invasive surgery. Surg Endosc 2021; 36:1554-1562. [PMID: 33763745 DOI: 10.1007/s00464-021-08444-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION As fellowship training after general surgery residency has become increasingly common, the impact on resident education must be considered. Patient safety and procedure outcomes are often used as justification by attendings who favor fellows over residents in certain minimally invasive surgery (MIS) operations. The aim of the present study was to compare the impact of trainee level on the outcomes of selected MIS operations to determine if giving preference to fellows on grounds of outcomes is warranted. METHODS Patients who underwent elective laparoscopic hiatal hernia repair (LHHR), laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic splenectomy (LS), laparoscopic cholecystectomy (LC), or laparoscopic ventral hernia repair (LVHR) with assistance of a general surgery chief resident or fellow were identified from the American College of Surgeon's National Surgical Quality Improvement Program database (2007-2012). Patients were matched 1:1 based on propensity score for the odds of undergoing operations assisted by a fellow. RESULTS 5145 patients underwent LHHR, 1396 LSG, 9656 LRYGB, 863 LS, 13,434 LC, and 3069 LVHR. Fellows assisted in 41.7% of LHHR, 49.2% of LSG, 56.4% of LRYGB, 25.7% of LS, 17.1% of LC, and 27.0% of LVHR cases. After matching, overall and severe complication rates were comparable between cases performed with assistance of a fellow or chief resident. Median operative time was longer for LSG, LRYGB, and LC when a fellow assisted. CONCLUSIONS Surgical outcomes were similar between fellow and chief resident assistance in MIS operations, arguing that increased resident participation in basic and complex laparoscopic operations is appropriate without compromising patient safety.
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Canal C, Scherer J, Birrer DL, Vehling MJ, Turina M, Neuhaus V. Appendectomy as Teaching Operation: No Compromise in Safety-An Audit of 17,106 Patients. JOURNAL OF SURGICAL EDUCATION 2021; 78:570-578. [PMID: 32855104 DOI: 10.1016/j.jsurg.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In a surgical career, teaching of surgical procedures plays a central role. In this study we want to evaluate the influence of teaching in appendectomies on the in-hospital outcome. DESIGN AND SETTING Retrospectively, 26,436 cases from the national quality measurement database (AQC) between the years 2009 and 2017 were evaluated using the diagnosis and the procedure codes. Included were all cases with appendicitis (International Classification of Diseases diagnostic codes K35-K37), surgical treatment (appendectomy), and a documented teaching status of the procedure. Variables were sought in bivariate and multivariate analyses. The occurrence of any complication was the primary outcome, whereas in-hospital mortality was the secondary outcome. PARTICIPANTS A total of 17,106 patients with a mean age of 37 ± 19 years remained for final analysis. A total of 6267 operations (37%), were conducted as teaching-operations. Seventy-four percent of all teaching procedures were performed by residents. RESULTS We found no statistical association between teaching operations and complication rates or mortality. However, the teaching group showed longer duration of surgery (+ 11%). CONCLUSIONS There was no influence of the training status of the appendectomy procedure on complication rates and in-hospital mortality. However, there was a prolonged duration of surgery. Despite these statistically significant differences, a comparable clinical outcome was observed in all patients, thus justifying the benefits of resident training.
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Affiliation(s)
- Claudio Canal
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Julian Scherer
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Dominique Lisa Birrer
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Malte Johannes Vehling
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Turina
- Department of General and Transplant Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Switzerland.
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Ussia A, Vaccari S, Gallo G, Grossi U, Ussia R, Sartarelli L, Minghetti M, Lauro A, Barbieri P, Di Saverio S, Cervellera M, Tonini V. Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve. Updates Surg 2021; 73:187-195. [PMID: 33398773 DOI: 10.1007/s13304-020-00950-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
Abstract
Surgical training is essential to maintain safety standards in healthcare. The aim of this study is to evaluate learning curves and short-term postoperative outcomes of laparoscopic appendectomy (LA) performed by trainees (TRN) and attendings (ATT). The present study included the medical records of patients with acute appendicitis who underwent a fully LA in our department between January 2013 and December 2018. Cases were divided into trainees (TRN and ATT groups based on the experience of the operating surgeon. The primary outcome measures were 30-day morbidity and mortality. Preoperative patients' clinical characteristics, intraoperative findings, operative times, and postoperative hospitalization were compared. Operative times were used to extrapolate learning curves and evaluate the effects of changes in faculty using CUSUM charts. A propensity score matching analysis was performed to reduce differences between cohorts regarding both preoperative characteristics and intraoperative findings. A total of 1173 patients undergoing LA for acute appendicitis were included, of whom 521 (45%) in the TRN group and 652 (55%) in the ATT group. No significant differences were found between the two groups in terms of complication rates, operative times and length of hospital stay. However, CUSUM chart analysis showed decreased operating times in the TRN group. Operative times improved more quickly for advanced cases. The results of this study indicate that LA can be performed by trainees without detrimental effects on clinical outcomes, procedural safety, and operative times. However, the learning curve is longer than previously acknowledged.
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Affiliation(s)
- Alessandro Ussia
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Samuele Vaccari
- Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, Catanzaro, Italy.
| | - Ugo Grossi
- IV Surgery Unit, Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, DISCOG, University of Padua, Treviso, Italy
| | - Riccardo Ussia
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Lodovico Sartarelli
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | | | - Augusto Lauro
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Paolo Barbieri
- Center for Health Economics, University of Gothenburg, Gothenburg, Sweden
| | - S Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy
| | - Maurizio Cervellera
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Valeria Tonini
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
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Woelfel I, Smith BQ, Strosberg D, Villarreal M, Harzman A, Salani R, Cochran A, Chen X(P. Residents’ method for gaining operative autonomy. Am J Surg 2020; 220:893-898. [DOI: 10.1016/j.amjsurg.2020.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022]
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Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised? Cir Esp 2020; 99:200-207. [PMID: 32693919 DOI: 10.1016/j.ciresp.2020.05.032] [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: 04/13/2020] [Revised: 05/23/2020] [Accepted: 05/30/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Laparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) are technically demanding and require a long learning curve. Little is known about whether surgical resident (SR) training programs to perform these procedures are safe and feasible. This study aims to evaluate the results of our SR training program to perform LRYGB. METHODS We designed a retrospective study including patients with LRYGB between January 2014 and December 2018, comparing SR results to experienced bariatric surgeons (EBS). In our country, SR have a five-year surgical formative period, and in the fourth year they are trained for 6 months in our bariatric surgery unit, from January to June. In the beginning, they perform different steps of this procedure, to finally complete an LRYGB. We collected demographic data, comorbidities, intraoperative outcomes, and postoperative complications and outcomes after a one-year follow-up. RESULTS Two hundred and eight patients were eligible for inclusion: 67 in group I (SR), and 141 in group II (EBS). Both groups were comparable. There was no statistically significant difference in operating time (166.45min in group I vs. 156.69min in group II; P=0.156). Conversion to open surgery, hospital stay, postoperative complications, and short-term outcomes had no significant differences between the two groups. There was no mortality registered during this period. CONCLUSION Implementation of LRYGB stepwise learning as part of an SR training program is safe, and results are comparable to EBS, without loss of efficiency. Therefore, it is feasible to train SR in bariatric surgery under EBS supervision.
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Shin TH, Naples R, French JC, Khandelwal CM, Rose W, Alaedeen D, Dai J, Lipman J, Rosen MJ, Petro C. Effect modification of resident autonomy and seniority on perioperative outcomes in laparoscopic cholecystectomy. Surg Endosc 2020; 35:3387-3397. [PMID: 32642848 DOI: 10.1007/s00464-020-07780-5] [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: 03/27/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Resident operative involvement is an integral aspect of general surgery residency training. However, current data examining the effect of resident autonomy on perioperative outcomes remain limited. METHODS Patient and operator-specific data were collected from 344 adult laparoscopic cholecystectomies at a tertiary academic institution and its regional affiliates between 2018 and 2019. Multivariate modeling compared postoperative outcomes between cases completed with or without resident involvement and its effect modification by resident seniority and autonomy per Zwisch scale. Outcomes include 30-day postoperative complications, hospital readmission rate, and operative time. RESULTS Multivariate analysis revealed resident involvement in laparoscopic cholecystectomy did not significantly change odds of 30-day postoperative complications (OR 2.52, p = 0.185, 95% CI 0.64-9.92) or hospital readmission (OR 1.61, p = 0.538, 95% CI 0.36-7.23). Operative time is significantly increased compared to faculty-only cases (IRR 1.37, p < 0.001, 95% CI 1.26-1.48). While accounting for case difficulty and resident performance evaluated by SIMPL criteria, stratification by resident autonomy measured by Zwisch scale or seniority reveal no effect modification on 30-day postoperative complications, readmissions, or operative time. The effect of resident involvement on longer relative rates of operative time loses its significance in supervision-only cases (IRR 1.18, p = 0.069, 95% CI 0.99-1.41). CONCLUSION While resident involvement and autonomy are associated with significantly longer operative times in laparoscopic cholecystectomy, their lack of significant effect on postoperative outcomes argues strongly for continued resident involvement and supervised operative independence.
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Affiliation(s)
- Thomas H Shin
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA. .,Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
| | - Robert Naples
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Judith C French
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Warren Rose
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Diya Alaedeen
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jie Dai
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeremy Lipman
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Rosen
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Clayton Petro
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Leijte E, Claassen L, Arts E, de Blaauw I, Rosman C, Botden SMBI. Training benchmarks based on validated composite scores for the RobotiX robot-assisted surgery simulator on basic tasks. J Robot Surg 2020; 15:69-79. [PMID: 32314094 PMCID: PMC7875949 DOI: 10.1007/s11701-020-01080-9] [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] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
The RobotiX robot-assisted virtual reality simulator aims to aid in the training of novice surgeons outside of the operating room. This study aimed to determine the validity evidence on multiple levels of the RobotiX simulator for basic skills. Participants were divided in either the novice, laparoscopic or robotic experienced group based on their minimally invasive surgical experience. Two basic tasks were performed: wristed manipulation (Task 1) and vessel energy dissection (Task 2). The performance scores and a questionnaire regarding the realism, didactic value, and usability were gathered (content). Composite scores (0–100), pass/fail values, and alternative benchmark scores were calculated. Twenty-seven novices, 21 laparoscopic, and 13 robotic experienced participants were recruited. Content validity evidence was scored positively overall. Statistically significant differences between novices and robotic experienced participants (construct) was found for movements left (Task 1 p = 0.009), movements right (Task 1 p = 0.009, Task 2 p = 0.021), path length left (Task 1 p = 0.020), and time (Task 1 p = 0.040, Task 2 p < 0.001). Composite scores were statistically significantly different between robotic experienced and novice participants for Task 1 (85.5 versus 77.1, p = 0.044) and Task 2 (80.6 versus 64.9, p = 0.001). The pass/fail score with false-positive/false-negative percentage resulted in a value of 75/100, 46/9.1% (Task 1) and 71/100, 39/7.0% (Task 2). Calculated benchmark scores resulted in a minority of novices passing multiple parameters. Validity evidence on multiple levels was assessed for two basic robot-assisted surgical simulation tasks. The calculated benchmark scores can be used for future surgical simulation training.
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Affiliation(s)
- Erik Leijte
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands. .,Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Linda Claassen
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands
| | - Elke Arts
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands.,Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands
| | - Sanne M B I Botden
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands.,Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Long-Term Outcomes Following Laparoscopic Repair of Large Hiatus Hernias Performed by Trainees Versus Consultant Surgeons. J Gastrointest Surg 2020; 24:749-755. [PMID: 31012041 DOI: 10.1007/s11605-019-04218-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/25/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The laparoscopic approach is the preferred method for repair of large hiatus hernias but can be technically challenging. Training surgeons need experience as the primary operator to gain competency in this operation. However, learning the procedure should not compromise the functional long-term outcome for patients. The aim of this study was to determine whether any difference in long-term outcomes exists for patients having a laparoscopic large hiatus hernia repair performed by a trainee versus a consultant surgeon. METHODS A total of 648 suitable patients who had undergone laparoscopic repair of a large hiatus hernia were identified from a prospective database. Cases were divided into two groups based on whether the primary operator was a trainee or a consultant surgeon. Demographics, perioperative data, revisions and patient-reported clinical outcomes via standardised questionnaires were compared. RESULTS There were no statistically significant differences in the clinical outcomes for patients undergoing laparoscopic repair of a large hiatus hernia performed by a trainee versus a consultant surgeon, with comparable patient-reported outcomes for heartburn, dysphagia, and overall satisfaction with the outcome following surgery. Median operative time was approximately 20 min longer for trainees (p = <0.0001). Revisional surgery rates were similar for the two groups. CONCLUSIONS Patients operated on by trainees have equivalent long-term clinical outcomes to patients operated on by consultant surgeons. For these patients, surgery can be safely performed by supervised trainees.
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Kim CW, Jeon SY, Paik B, Bong JW, Kim SH, Lee SH. Resident Learning Curve for Laparoscopic Appendectomy According to Seniority. Ann Coloproctol 2020; 36:163-171. [PMID: 32054238 PMCID: PMC7392570 DOI: 10.3393/ac.2019.07.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/20/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose This study sought to delineate the learning curve (LC) for laparoscopic appendectomy (LA) in surgical residency according to seniority and experience. Methods Between October 2015 and November 2016, 150 patients underwent LA performed by one of 3 residents (who were in their first [A], second [B], or third [C] year of training) under supervision. The patients were nonrandomly assigned to each resident. Data from a prospectively collected database were reviewed and analyzed retrospectively. Perioperative outcomes including operation time, complications, and conversion were compared among the 3 residents. The LC was evaluated using the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion. Results Baseline characteristics and perioperative outcomes were similar among the 3 groups except for age and location of the appendix. The operation time did not vary among the 3 residents (43.9, 45.3, and 48.4 minutes for A, B, and C, respectively; P=0.392). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM results for operation time revealed peak points achieved at the 24th, 18th, and 31st cases for residents A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after their 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure. Conclusion The resident LC for LA was 11 to 35 cases according to multidimensional statistical analyses. The accumulation of surgical experience among residents might influence the LC for surgical completion but not that for operation time.
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Affiliation(s)
- Chang Woo Kim
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sook Young Jeon
- Department of General Surgery, Graduate School, Kyung Hee University, Seoul, Korea, Seoul, Korea
| | - Bomina Paik
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jun Woo Bong
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Hyun Kim
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Suk-Hwan Lee
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Prasad P, Navidi M, Immanuel A, Griffin Obe SM, Phillips AW. Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature. Dis Esophagus 2019; 32:1-8. [PMID: 31398254 DOI: 10.1093/dote/doz063] [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: 10/30/2018] [Revised: 05/08/2019] [Accepted: 06/23/2019] [Indexed: 12/11/2022]
Abstract
Changes in the structure of surgical training have affected trainees' operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)-this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11-15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.
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Affiliation(s)
- P Prasad
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - M Navidi
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - A Immanuel
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - S M Griffin Obe
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - A W Phillips
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
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de Geus SWL, Geary AD, Arinze N, Ng SC, Carter CO, Sachs TE, Hall JF, Hess DT, Tseng JF, Pernar LIM. Resident involvement in minimally-invasive vs. open procedures. Am J Surg 2019; 219:289-294. [PMID: 31722797 DOI: 10.1016/j.amjsurg.2019.10.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the impact of resident involvement on surgical outcomes in laparoscopic compared to open procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program 2007-2012 was queried for open and laparoscopic ventral hernia repair (VHR), inguinal hernia repair (IHR), splenectomy, colectomy, or cholecystectomy (CCY). Multivariable regression analyses were performed to assess the impact of resident involvement on surgical outcomes. RESULTS In total, 88,337 VHR, 20,586 IHR, 59,254 colectomies, 3301 splenectomies, and 95,900 CCY were identified. Resident involvement was predictive for major complication during open VHR (AOR, 1.29; p < 0.001), but not during any other procedure. Resident participation significantly prolonged operative time for open, as well as laparoscopic VHR, IHR, colectomy, splenectomy, and CCY (all p < 0.01). CONCLUSIONS The results of this study suggest that resident participation has a similar impact on surgical outcomes during laparoscopic and open surgery, and is generally safe.
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Affiliation(s)
- Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alaina D Geary
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Nkiruka Arinze
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Cullen O Carter
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jason F Hall
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Donald T Hess
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Luise I M Pernar
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Santangelo G, Mix D, Ghazi A, Stoner M, Vates GE, Stone JJ. Development of a Whole-Task Simulator for Carotid Endarterectomy. Oper Neurosurg (Hagerstown) 2019; 14:697-704. [PMID: 29029228 DOI: 10.1093/ons/opx209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/03/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Surgical education relies on operative exposure with live patients. Carotid endarterectomy (CEA) demands an experienced surgeon with a very low complication rate. The high-risk nature of this procedure and the decline in number of CEAs performed annually has created a gap in residency training. OBJECTIVE To develop a high-fidelity whole-task simulation for CEA that demonstrates content, construct, and face validity. METHODS Anatomically accurate models of the human neck were created using multilayered poly-vinyl alcohol hydrogels. Graded polymerization of the hydrogel was achieved by inducing crosslinks during freeze/thaw cycles, stiffening the simulated tissues to achieve realistic tactile properties. Venous bleeding was simulated using pressure bags and a ventricular assistive device created pulsatile flow in the carotid. Ten surgeons performed the simulation under operating room conditions, and metrics were compared among experience levels to determine construct validity. Participants completed surveys about realism and usefulness to evaluate face validity. RESULTS A significant difference was found in operative measures between attending and resident physicians. The mean operative time for the expert group was 63.6 min vs 138.8 for the resident group (P = .002). There was a difference in mean internal carotid artery clamp time of 43.4 vs 83.2 min (P = .04). There were only 2 hypoglossal nerve injuries, both in the resident group (P = .009). CONCLUSION The whole-task CEA simulator is a realistic, inexpensive model that offers comprehensive training and allows residents to master skills prior to operating on live patients. Overall, the model demonstrated face and construct validity among neurosurgery and vascular surgeons.
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Affiliation(s)
| | - Doran Mix
- Division of Vascular Surgery, Strong Memorial Hospital, University of Rochester, Rochester New York
| | - Ahmed Ghazi
- Department of Urology, Strong Memorial Hospital, University of Rochester, Rochester, New York
| | - Michael Stoner
- Division of Vascular Surgery, Strong Memorial Hospital, University of Rochester, Rochester New York
| | - G Edward Vates
- Department of Neurosurgery, Strong Memorial Hospital, University of Rochester, Rochester, New York
| | - Jonathan J Stone
- Department of Neurosurgery, Strong Memorial Hospital, University of Rochester, Rochester, New York
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Peterson EC, Ghosh TD, Qureshi AA, Myckatyn TM, Tenenbaum MM. Impact of Residents on Operative Time in Aesthetic Surgery at an Academic Institution. Aesthet Surg J Open Forum 2019; 1:ojz026. [PMID: 33791617 PMCID: PMC7671284 DOI: 10.1093/asjof/ojz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Duration of surgery is a known risk factor for increased complication rates. Longer operations may lead to increased cost to the patient and institution. While previous studies have looked at the safety of aesthetic surgery with resident involvement, little research has examined whether resident involvement increases operative time of aesthetic procedures. Objectives We hypothesized that resident involvement would potentially lead to an increase in operative time as attending physicians teach trainees during aesthetic operations. Methods A retrospective cohort analysis was performed from aesthetic surgery cases of two surgeons at an academic institution over a 4-year period. Breast augmentation and abdominoplasty with liposuction were examined as index cases for this study. Demographics, operative time, and resident involvement were assessed. Resident involvement was defined as participating in critical portions of the cases including exposure, dissection, and closure. Results A total of 180 cases fit the inclusion criteria with 105 breast augmentation cases and 75 cases of abdominoplasty with liposuction. Patient demographics were similar for both procedures. Resident involvement did not statistically affect operative duration in breast augmentation (41.8 ± 9.6 min vs 44.7 ± 12.4 min, P = 0.103) or cases for abdominoplasty with liposuction (107.3 ± 20.5 min vs 122.2 ± 36.3 min, P = 0.105). Conclusions There was a trend toward longer operative times that did not reach statistical significance with resident involvement in two aesthetic surgery cases at an academic institution. This study adds to the growing literature on the effect resident training has in aesthetic surgery. Level of Evidence: 2 ![]()
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Affiliation(s)
- Erin C Peterson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Trina D Ghosh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ali A Qureshi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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First assistant impact on early morbidity and mortality in bariatric surgery. Surg Obes Relat Dis 2019; 15:1541-1547. [DOI: 10.1016/j.soard.2019.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
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Nasri B, Saxe J. Impact of Residents on Safety Outcomes in Laparoscopic Cholecystectomy. World J Surg 2019; 43:3013-3018. [DOI: 10.1007/s00268-019-05141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Inaba CS, Koh CY, Sujatha-Bhaskar S, Gallagher S, Chen Y, Nguyen NT. Operative time as a marker of quality in bariatric surgery. Surg Obes Relat Dis 2019; 15:1113-1120. [DOI: 10.1016/j.soard.2019.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/16/2019] [Accepted: 04/06/2019] [Indexed: 12/29/2022]
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Second Place Award: Residents or hip surgeons for the treatment of displaced femoral neck fractures? A 10-year survivorship rate analysis. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Giordano L, Oliviero A, Peretti GM, Maffulli N. The presence of residents during orthopedic operation exerts no negative influence on outcome. Br Med Bull 2019; 130:65-80. [PMID: 31049559 DOI: 10.1093/bmb/ldz009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operative procedural training is a key component of orthopedic surgery residency. It is unclear how and whether residents participation in orthopedic surgical procedures impacts on post-operative outcomes. SOURCES OF DATA A systematic search was performed to identify articles in which the presence of a resident in the operating room was certified, and was compared with interventions without the presence of residents. AREAS OF AGREEMENT There is a likely beneficial role of residents in the operating room, and there is only a weak association between the presence of a resident and a worse outcome for orthopedic surgical patients. AREAS OF CONTROVERSY Most of the studies were undertaken in USA, and this represents a limit from the point of view of comparison with other academic and clinical realities. GROWING POINT The data provide support for continued and perhaps increased involvement of resident in orthopedic surgery. AREAS OF RESEARCH To clarify the role of residents on clinically relevant outcomes in orthopedic patients, appropriately powered randomized control trials should be planned.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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Holland BC, Patel N, Sulaver R, Stevenson B, Healey J, Severino W, Baron T, Lieber D, Roszhart D, McVary KT, Köhler TS. Resident Impact on Patient & Surgeon Satisfaction and Outcomes: Evidence for Health System Support for Urology Education. Urology 2019; 132:49-55. [PMID: 31195011 DOI: 10.1016/j.urology.2019.04.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the effect of resident involvement on patient and physician satisfaction, we evaluated the outcomes from a private urology group both prior to and after initiation of resident coverage. METHODS Urologic procedures completed by attending surgeons without residents from October 2010 to December 2011 were compared to the same surgeons working with residents from January 2012 to March 2013. Surgical case times, postoperative complications, readmission rate, length of stay, Press-Ganey consumer assessments, resident and physician self-report of training quality and quality of life were collected. RESULTS 3316 operative and nonoperative cases were measured.Total 1565 were in preresident periods and 1751 were in postresident periods. With resident coverage, there was an increase in OR times. There was no difference in complications for surgical and nonsurgical cases (P = .2269 and P = 1.000, respectively). There was a statistically significant improvement of readmission rate in nonsurgical patients with resident coverage (P = .0344). Patients' satisfaction scores were higher in every category and they more often reported that they "always" received quality care (78.6 % vs 82.5%) with resident coverage. Resident and faculty perceptions of training, patient care, and satisfaction increased with resident coverage. CONCLUSION Resident coverage of a private practice urology group resulted in no difference in surgical complications and improvement in readmission rates in nonsurgical patients. It resulted in longer OR times but greater satisfaction of faculty, residents and most important, patients. Our data demonstrate the beneficial effect of resident participation in patient care and provides further justification of residency financial support.
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Affiliation(s)
- Bradley C Holland
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL.
| | - Neil Patel
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL
| | | | | | - Jessica Healey
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL
| | | | | | | | | | - Kevin T McVary
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL
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Madni TD, Barrios E, Imran JB, Taveras L, Clark AT, Cunningham HB, Christie A, Luk S, Phelan HA, Cripps MW. Prospective validation of the safety of a laparoscopic cholecystectomy training paradigm featuring incremental autonomy. Am J Surg 2019; 217:787-793. [DOI: 10.1016/j.amjsurg.2018.10.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/12/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022]
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Quick JA, Bukoski AD, Doty J, Bennett BJ, Crane M, Randolph J, Ahmad S, Barnes SL. Case Difficulty, Postgraduate Year, and Resident Surgeon Stress: Effects on Operative Times. JOURNAL OF SURGICAL EDUCATION 2019; 76:354-361. [PMID: 30146460 DOI: 10.1016/j.jsurg.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We aimed to evaluate resident operative times in relation to postgraduate year (PGY), case difficulty and resident stress while performing a single surgical procedure. DESIGN We prospectively examined operative times for 268 laparoscopic cholecystectomies, and analyzed relationships between PGY, case difficulty, and resident surgeon stress utilizing electrodermal activity. Each case operative times were divided into 3 separate time periods. Case Start and End times were recorded, as well as the time between the start of the operation and the time until the cystic structures were divided (Division). Case difficulty was determined by multiple trained observers with a high inter-rater concordance. SETTING University of Missouri, a tertiary academic medical institution. PARTICIPANTS All categorical general surgery residents at our institution. RESULTS For each operative time period examined during laparoscopic cholecystectomy, operative time increased, with each incremental increase in difficulty resulting in approximately 130% longer times. Minimal differences in operative times were seen between PGY levels, except during the easiest cases (Start-End times: 38.5 ± 10.4 minutes vs 34.2 ± 10.8 minutes vs 28.9 ± 10.9 minutes, p 0.002). Resident stress poorly correlated with operative times regardless of case difficulty (Pearson coefficient range 0.0-0.22). CONCLUSIONS Operative times are longer with increasing case difficulty. PGY level and resident surgeon stress appear to have minimal to no correlation with operative times, regardless of case difficulty.
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Affiliation(s)
- Jacob A Quick
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri.
| | - Alex D Bukoski
- University of Missouri, College of Veterinary Medicine, Columbia, Missouri
| | - Jennifer Doty
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri
| | - Bethany J Bennett
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri
| | - Megan Crane
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri
| | - Jennifer Randolph
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri
| | - Salman Ahmad
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri
| | - Stephen L Barnes
- University of Missouri, School of Medicine, Department of Surgery, Columbia, Missouri
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Mustafa S, Handren E, Farmer D, Ontiveros E, Ogola GO, Leeds SG. Robotic Curriculum Enhances Minimally Invasive General Surgery Residents' Education. JOURNAL OF SURGICAL EDUCATION 2019; 76:548-553. [PMID: 30217777 DOI: 10.1016/j.jsurg.2018.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/31/2018] [Accepted: 08/19/2018] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Resident education is evolving as more cases move from open to minimally invasive. Many programs struggle to incorporate minimally invasive surgery education due to increased operative time and higher cost when residents participate. The aim of this paper is to examine if the implementation of a robotics curriculum enhances minimally invasive surgical training. DESIGN A retrospective review of all ventral and inguinal hernia cases performed from March 2013 to November 2017 was conducted to determine operative technique utilized (open, laparoscopic, or robotic) and resident involvement. The study cohorts surrounded the introduction of a robotic curriculum in July 2014, and the time frames examined were labeled as Before-robotic, After-robotic, and re-visited examination was done labeled Long-term. SETTING The study was performed at a large quaternary care referral center. PARTICIPANTS The participants were all patients who underwent ventral and inguinal hernia repairs on the general surgery, transplant, or colorectal service. RESULTS Before-robotic had 739 hernia cases performed: 642 (87%) open, 93 (13%) laparoscopic, and 4 (0.5%) robotic. After-robotic had 682 hernia cases performed: 529 (78%) open, 54 (8%) laparoscopic, and 99 (15%) robotic. Long-term had 792 hernia cases performed: 603 (76%) open, 25 (3%) laparoscopic, and 164 (21%) robotic. The general trend was towards an institutional decrease in open cases and an increase in robotic hernia cases. Resident participation in the robotics cases across all levels increased after the implementation of the robotic curriculum. CONCLUSIONS Implementation of a robotic curriculum can enhance minimally invasive surgical training experience for general surgery resident education.
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Affiliation(s)
- Sarah Mustafa
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Elizabeth Handren
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Drew Farmer
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Estrellita Ontiveros
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, Texas; Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Gerald O Ogola
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas.
| | - Steven G Leeds
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, Texas; Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
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Malyar M, Peymani A, Johnson AR, Chen AD, Van Der Hulst RRWJ, Lin SJ. The Impact of Resident Postgraduate Year Involvement in Body-Contouring and Breast Reduction Procedures. Ann Plast Surg 2019; 82:310-315. [DOI: 10.1097/sap.0000000000001714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sui TQ, Zhang FY, Jiang AL, Zhang XQ, Zhang ZW, Yang Y, Sun LP. A randomized study on the effect of sequential acupoint stimulation on pulmonary function of patients with spontaneous pneumothorax during VATS perioperative period. Medicine (Baltimore) 2019; 98:e14575. [PMID: 30855442 PMCID: PMC6417522 DOI: 10.1097/md.0000000000014575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to explore the effect of sequential acupoint stimulation on the postoperative pulmonary function of patients with spontaneous pneumothorax who underwent video-assisted thoracoscopic surgery (VATS).Using a random number table, the patients were randomly divided into 2 groups: routine nursing group and sequential acupoint stimulation group. Patients in the routine nursing group received standard nursing care of thoracic surgery, while patients in the acupoint group received sequential acupoint stimulation on Shenshu (BL23), Gaohuang (BL43), Feishu (BL13), and Tiantu (CV22). Then, the maximal ventilatory volume (MVV), oxygen saturation (SpO2), postoperative drainage volume, postoperative drainage time, postoperative hospitalization days, and procalcitonin (PCT) were observed on the first, third, fifth and 30th day after VATS operation.On the fifth day after spontaneous pneumothorax was treated with VATS, MVV, and SpO2 of the sequential acupoint stimulation group were significantly higher than those of the routine nursing group (P < .05). On both the third day and fifth day after VATS, PCT of the sequential acupoint stimulation group was significantly lower than that of the routine nursing group (P < .01). Furthermore, the difference in postoperative drainage volume between the 2 groups was not statistically significant (P > .05), while chest tube drainage time (P < .01) and postoperative hospitalization days (P < .05) of the sequential acupoint stimulation group were significantly lower than those of the routine nursing group.In spontaneous pneumothorax patients who underwent VATS, sequential acupoint stimulation nursing was significantly more effective than routine postoperative nursing in promoting postoperative recovery of lung function, alleviating inflammatory response and shortening hospitalization days.
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Affiliation(s)
| | | | | | | | | | | | - Li-Ping Sun
- Department of Emergency Services, The 5th Central Hospital of Tianjin, Tianjin, China
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