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Ryan JF, Lesniak DM, Cordeiro E, Campbell SM, Rajaee AN. Surgeon Factors Influencing Breast Surgery Outcomes: A Scoping Review to Define the Modern Breast Surgical Oncologist. Ann Surg Oncol 2023; 30:4695-4713. [PMID: 37036590 DOI: 10.1245/s10434-023-13472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Modern breast surgical oncology incorporates many aspects of care including preoperative workup, surgical management, and multidisciplinary collaboration to achieve favorable oncologic outcomes and high patient satisfaction. However, there is variability in surgical practice and outcomes. This review aims to identify modifiable surgeon factors influencing breast surgery outcomes and provide a definition of the modern breast surgical oncologist. METHODS A systematic literature search with additional backward citation searching was conducted. Studies describing modifiable surgeon factors with associated breast surgery outcomes such as rates of breast conservation, sentinel node biopsy, re-excision, complications, acceptable esthetic outcome, and disease-free and overall survival were included. Surgeon factors were categorized for qualitative analysis. RESULTS A total of 91 studies met inclusion criteria describing both modifiable surgeon factor and outcome data. Four key surgeon factors associated with improved breast surgery outcomes were identified: surgical volume (45 studies), use of oncoplastic techniques (41 studies), sub-specialization in breast surgery or surgical oncology (9 studies), and participation in professional development activities (5 studies). CONCLUSIONS On the basis of the literature review, the modern breast surgical oncologist has a moderate- to high-volume breast surgery practice, understands the use and application of oncoplastic breast surgery, engages in additional training opportunities, maintains memberships in relevant societies, and remains up to date on key literature. Surgeons practicing in breast surgical oncology can target these modifiable factors for professional development and quality improvement.
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Affiliation(s)
- Joanna F Ryan
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - David M Lesniak
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Sandra M Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - A Nikoo Rajaee
- Department of Surgery, University of Alberta, Edmonton, Canada.
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Brancato SC, Wang M, Spinelli KJ, Gandhavadi M, Worrall NK, Lehr EJ, DeBoard ZM, Fitton TP, Leiataua A, Piccini JP, Gluckman TJ. Temporal trends and predictors of surgical ablation for atrial fibrillation across a multistate healthcare system. Heart Rhythm O2 2021; 3:32-39. [PMID: 35243433 PMCID: PMC8859806 DOI: 10.1016/j.hroo.2021.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Multiple class I and class IIa recommendations exist related to surgical ablation (SA) of atrial fibrillation (AF) in patients undergoing cardiac surgery. Objective Examine temporal trends and predictors of SA for AF in a large US healthcare system. Methods We retrospectively analyzed data from the Society for Thoracic Surgery (STS) Adult Cardiac Surgery Database for 21 hospitals in the Providence St. Joseph Health system. All patients with preoperative AF who underwent isolated coronary artery bypass graft (CABG) surgery, isolated aortic valve replacement (AVR), AVR with CABG surgery (AVR+CABG), isolated mitral valve repair or replacement (MVRr), and MVRr with CABG surgery (MVRr+CABG) from July 1, 2014, to March 31, 2020 were included. Temporal trends in SA were evaluated using the Cochran-Armitage trends test. A multilevel logistic regression model was used to examine patient-, hospital-, and surgeon-level predictors of SA. Results Among 3124 patients with preoperative AF, 910 (29.1%) underwent SA. This was performed most often in those undergoing isolated MVRr (n = 324, 44.8%) or MVRr+CABG (n = 75, 35.2%). Rates of SA increased over time and were highly variable between hospitals. Years since graduation from medical school for the primary operator was one of the few predictors of SA: odds ratio (95% confidence interval) = 0.71 (0.56–0.90) for every 10-year increase. Annual surgical (both hospital and operator) and AF catheter ablation volumes were not predictive of SA. Conclusion Wide variability in rates of SA for AF exist, underscoring the need for greater preoperative collaboration between cardiologists, electrophysiologists, and cardiac surgeons.
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Murphy S, Yu YC, Kerrigan C, Sprague B, Sowden M. Gradual adoption of needle biopsy for breast lesions in a rural state. Cancer Med 2021; 10:8320-8327. [PMID: 34755489 PMCID: PMC8633243 DOI: 10.1002/cam4.4282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Minimally invasive breast biopsy (MIBB) is the standard of care for the diagnosis of breast cancer, with consensus guidelines suggesting MIBB goals of 90% of total biopsies. In a previous study of patients in the rural state of Vermont, USA (population size of 640,000), rural breast cancer patients had open biopsies 42% of the time compared to 29% of urban breast cancer patients. The aim of this study was to assess overall population‐based biopsy trends in Vermont. Methods The Vermont Breast Cancer Surveillance System (VBCSS) was used to identify women receiving MIBB and excisional breast biopsies in Vermont. Patient zip code at the time of initial biopsy was used to determine the patient residence rurality by rural–urban commuting area codes (RUCA 2.0™). Results There were 9122 diagnostic episodes from 1999 to 2018. MIBB was the initial biopsy method in 7524 (82.5%) cases, while surgical excision was the initial biopsy method in 1598 (17.5%) cases. A linear trend fit estimated an increase of 1.3% per year (p < 0.001, 95% CI 1.1%–1.5%) in the fraction of patients undergoing MIBB. Patients living in rural areas were less likely to receive MIBB (78.5%) than those living in urban areas (94.9%), p < 0.001. Multivariate analysis showed that urban patients and those patients in the years 2014–2018 were more likely to receive MIBB (OR 5.00, 95% CI 4.13–6.05 [p < 0.05] and OR 4.41, 95%CI 3.68–5.28 [p < 0.05], respectively). The rate of MIBB for rural patients increased and met the 90% quality standard in 2013 and ultimately matched urban patient rates of MIBB in 2018. Conclusions For the first time, we show that MIBB usage is above 90% in the state of Vermont and that there no longer exist disparities in breast biopsies between urban and rural patients or rural/urban facilities in the state, overall.
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Affiliation(s)
- Serena Murphy
- Department of Surgery, University of Vermont Medical Center, Burlington, VT, USA
| | - Yi-Chuan Yu
- College of Agricultural and Life Sciences, University of Vermont, Burlington, VT, USA
| | - Colleen Kerrigan
- Department of Surgery, University of Vermont Medical Center, Burlington, VT, USA
| | - Brian Sprague
- Department of Surgery, Vermont Breast Cancer Surveillance System, University of Vermont, Burlington, VT, USA
| | - Michelle Sowden
- Department of Surgery, University of Vermont Medical Center, Burlington, VT, USA
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Goodwin JS, Agrawal P, Li S, Raji M, Kuo YF. Growth of Physicians and Nurse Practitioners Practicing Full Time in Nursing Homes. J Am Med Dir Assoc 2021; 22:2534-2539.e6. [PMID: 34274320 DOI: 10.1016/j.jamda.2021.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective was to describe the growth of physicians, nurse practitioners (NPs), and physician assistants (PAs) who practice full time in nursing homes, to assess resident and nursing home characteristics associated with receiving care from full-time providers, and describe variation among nursing homes in use of full-time providers. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS A 20% national sample Medicare data on long-term care residents in 2008 to 2018 and the physicians, NPs, and PAs who submitted charges to Medicare for their care. METHODS We measured the percentage of provider charges for services rendered in nursing homes, in addition to resident and facility characteristics. RESULTS Full-time nursing home providers increased from 26.0% of all nursing home providers in 2008 to 44.6% in 2017. The largest increase was in NPs: from 1986 in 2008 to 4479 in 2017. Resident age, sex, Medicaid eligibility, and race/ethnicity had minimal association with the odds of having a full-time provider, whereas residents with an NP primary care provider were 23.0 times more likely (95% confidence interval = 21.6, 24.6) to have a full-time provider. Residents who received care from both a physician and an NP or PA increased from 33.6% in 2008 to 62.5% in 2018. There was large variation among facilities in the percentage of residents with full-time providers, from 5.72% of residents with full-time providers in the bottom quintile of facilities to 91.44% in the top quintile. Individual nursing homes accounted for 59% of the variation in whether a resident had a full-time provider. CONCLUSIONS AND IMPLICATIONS The percentage of nursing home residents with full-time providers continues to grow, with very large variation among nursing homes.
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Affiliation(s)
- James S Goodwin
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Pooja Agrawal
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Shuang Li
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Mukaila Raji
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Gao YH, Zhu SC, Xu Y, Gao SJ, Zhang Y, Huang QA, Gao WH, Zhu J, Xiang HJ, Gao XH. Clinical Value of Ultrasound-Guided Minimally Invasive Biopsy in the Diagnosis or Treatment of Breast Nodules. Cancer Manag Res 2020; 12:13215-13222. [PMID: 33380829 PMCID: PMC7767640 DOI: 10.2147/cmar.s281605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To explore the clinical value of ultrasound-guided minimally invasive biopsy of breast nodules for diagnosis and treatment of patients with no positive clinical signs on manual breast examination. Methods We performed a retrospective review of 136 patients with no signs on breast palpation who underwent ultrasound-guided minimally invasive biopsy. A total of 63 patients underwent breast nodule resection from October 2018 to December 2019 at the General Hospital of Central Theater Command of the People's Liberation Army. Clinical data, including indications for minimally invasive biopsy or resection, pathological and surgical results were retrospectively analyzed. Results A total of 199 patients were studied; 136 underwent minimally invasive biopsy and 63 underwent resection. No severe surgical complications occurred. Minimally invasive biopsy of breast nodules was superior to resection with respect to operation time, incision length, and postoperative complication rate. Conclusion Ultrasound-guided minimally invasive biopsy of breast nodules is feasible for treatment of patients with negative breast nodules and can achieve accurate diagnosis and satisfactory resection.
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Affiliation(s)
- Yan-Hong Gao
- Department of Ultrasound, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Shi-Cong Zhu
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China
| | - Ya Xu
- Department of Respiratory Medicine, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Shun-Ji Gao
- Department of Ultrasound, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Yu Zhang
- Department of Pathology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Qun-An Huang
- Department of Ultrasound, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Wen-Hong Gao
- Department of Ultrasound, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Hui-Juan Xiang
- Department of Ultrasound, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Xu-Hui Gao
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
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Osagiede O, Haehn DA, Spaulding AC, Otto N, Cochuyt JJ, Lemini R, Merchea A, Kelley S, Colibaseanu DT. Influence of surgeon specialty and volume on the utilization of minimally invasive surgery and outcomes for colorectal cancer: a retrospective review. Surg Endosc 2020; 35:5480-5488. [PMID: 32989545 DOI: 10.1007/s00464-020-08039-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Utilization of minimally invasive surgery (MIS) has multiple determinants, one being the specialization of the surgeon. The purpose of this study was to assess the differences in the utilization of MIS, associated length of stay (LOS), and complications for colorectal cancer between colorectal (CRS) and general surgeons (GS). Previous studies have documented the influence of surgical volume and surgeon specialty on clinical outcomes and patient survival following colorectal cancer surgery. It is unclear whether there are differences in the utilization of MIS for colorectal cancer based on surgeon's specialization and how this influences clinical outcomes. METHODS Using the 2013-2015 Florida Inpatient Discharge Dataset and the National Plan & Provider Enumeration System, colorectal cancer patients experiencing a colorectal surgery were identified as well as the operating physician's specialty. Mixed-effects regression models were used to identify associations between the use of MIS, complications during the hospital stay, and patient LOS with patient, physician, and hospital characteristics. RESULTS There is no difference in the use of MIS, complication, nor LOS between GS and CRS for colorectal cancer surgery. However, physician volume was associated with increased use of MIS (OR 1.26, 95% CI 1.09, 1.46) and MIS was associated with decreases in certain complications as well as reductions in LOS overall (β = - 0.16, p < 0.001) and for each specialty (GS: β = - 0.18, p < 0.001; CRS β = - 0.12, p < 0.001) CONCLUSIONS: Despite the higher amount of proctectomies performed by CRS, no difference in MIS utilization, complication rate, or LOS was found for colorectal cancer patients based on surgeon specialty. While there are some differences in clinical outcomes attributable to specialized training, results from this study indicate that differences in surgical approach (MIS vs. Open), as well as the patient populations encountered by these two specialties, are key factors in the outcomes observed.
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Affiliation(s)
- Osayande Osagiede
- Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, USA
| | | | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Fl, 32224, USA. .,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Jacksonville, FL, USA.
| | - Nolan Otto
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Fl, 32224, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Jacksonville, FL, USA
| | - Jordan J Cochuyt
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Fl, 32224, USA
| | - Riccardo Lemini
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Jacksonville, FL, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Amit Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Scott Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dorin T Colibaseanu
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Jacksonville, FL, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
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Teberian I, Kaufman T, Shames J, Rao VM, Liao L, Levin DC. Trends in the Use of Percutaneous Versus Open Surgical Breast Biopsy: An Update. J Am Coll Radiol 2020; 17:1004-1010. [DOI: 10.1016/j.jacr.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
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Ahn KS, Han HS, Cho JY, Yoon YS, Kim C, Lee WW. Long-term follow-up of non-operated patients with symptomatic gallbladder stones: a retrospective study evaluating the role of Hepatobiliary scanning. BMC Gastroenterol 2015; 15:136. [PMID: 26472428 PMCID: PMC4608107 DOI: 10.1186/s12876-015-0368-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/06/2015] [Indexed: 01/06/2023] Open
Abstract
Background To assess hepatobiliary (HB) scans for predicting recurrent symptoms in nonoperated patients with mild or vague symptomatic gallstones. Methods Data of 170 patients with symptomatic gallstone and who had not undergone cholecystectomy were retrospectively enrolled. These patients were divided into two groups according to whether or not operations were performed due to recurrent symptoms during the follow-up period. The demographic factors and gallbladder ejection fraction (GBEF) of HB scans were compared between the groups. Additionally, symptom-free rate was obtained beginning from the date of the HB scan to the date of surgery, and analyzed based on the level of GBEF. Results Among the 170 enrolled patients, two patients who underwent cholecystectomy for other disease were excluded. Thirty-four patients underwent cholecystectomy due to recurrent symptoms (OP group), and the remaining 136 patients did not experience recurrent symptoms and therefore did not undergo cholecystectomy (non-OP group). In the OP group, the mean GBEF was significantly lower than that of the non-OP group (28.8 ± 29.9 vs. 66.3 ± 20.0; P < 0.001). The rate of lower GBEF (<30 %, including non-visualization of the gallbladder) was significantly higher in the OP group than the non-OP group (54.9 vs. 5.1 %; P < 0.001). In patients with non-visualization of the gallbladder or GBEF <30 %, the 10-year symptom-free rate was significantly lower than those with a GBEF ≥ 30 % (19.8 % vs. 81.9 %; P < 0.001). Conclusion HB scanning is a useful objective modality to differentiate gallstone-related symptoms from other etiologies and predict recurrent symptoms.
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Affiliation(s)
- Keun Soo Ahn
- Department of Surgery, Keimyung University Dongsan Medical Center, 56 Chungho-ro, Jung-gu, Daegu city,, 41931, Korea.
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea, 300 Gumi-dong, Bundagn-gu, Seongnam city, Gyeonggido, 463-707, Korea.
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea, 300 Gumi-dong, Bundagn-gu, Seongnam city, Gyeonggido, 463-707, Korea.
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea, 300 Gumi-dong, Bundagn-gu, Seongnam city, Gyeonggido, 463-707, Korea.
| | - Chulhan Kim
- Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan city, Gyeonggido,, 425-707, Korea.
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea, Gyeonggido, 463-707, Korea.
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