1
|
Urman B, Ata B, Gomel V. Reproductive surgery remains an essential element of reproductive medicine. Facts Views Vis Obgyn 2024; 16:145-162. [PMID: 38950529 DOI: 10.52054/fvvo.16.2.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Reproductive surgery has long been neglected and is perceived to be simple surgery that can be undertaken by all gynaecologists. However, given the ever-expanding knowledge in the field, reproductive surgery now comprises surgical interventions on female reproductive organs that need to be carefully planned and executed with consideration given to the individuals symptoms, function of the organ and fertility concerns. Objectives To discuss the different perspectives of reproductive surgeons and other gynaecological surgeons, e.g., gynaecological oncologists, and advanced minimally invasive surgeons, regarding diagnosis and management of pelvic pathology that affects reproductive potential. Furthermore, to highlight the gaps in knowledge and numerous controversies surrounding reproductive surgery, while summarising the current opinion on management. Materials and Methods Narrative review based on literature and the cumulative experience of the authors. Main outcome measures The paper does not address specific research questions. Conclusions Reproductive surgery encompasses all reproductive organs with the aim of alleviating symptoms whilst restoring and preserving function with careful consideration given to alternatives such as expectant management, medical treatments, and assisted reproductive techniques. It necessitates utmost technical expertise and sufficient knowledge of the female genital anatomy and physiology, together with a thorough understanding of and respect to of ovarian reserve, tubal function, and integrity of the uterine anatomy, as well as an up-to-date knowledge of alternatives, mainly assisted reproductive technology. What is new? A holistic approach to infertile women is only possible by focusing on the field of reproductive medicine and surgery, which is unattainable while practicing in multiple fields.
Collapse
|
2
|
Eu D, Daly MJ, Taboni S, Sahovaler A, Gilbank AN, Irish JC. Evaluation of a 3D Printed Silicone Oral Cavity Cancer Model for Surgical Simulations. J Pers Med 2024; 14:450. [PMID: 38793031 PMCID: PMC11121819 DOI: 10.3390/jpm14050450] [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: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
Adequate surgical margins are essential in oral cancer treatment, this is, however, difficult to appreciate during training. With advances in training aids, we propose a silicone-based surgical simulator to improve training proficiency for the ablation of oral cavity cancers. A silicone-based tongue cancer model constructed via a 3D mold was compared to a porcine tongue model used as a training model. Participants of varying surgical experience were then asked to resect the tumors with clear margins, and thereafter asked to fill out a questionnaire to evaluate the face and content validity of the models as a training tool. Eleven participants from the Otolaryngology-Head and Neck Surgery unit were included in this pilot study. In comparison to the porcine model, the silicone model attained a higher face (4 vs. 3.6) and content validity (4.4 vs. 4.1). Tumor consistency was far superior in the silicone model compared to the porcine model (4.1 vs. 2.8, p = 0.0042). Fellows and staff demonstrated a better margin clearance compared to residents (median 3.5 mm vs. 1.0 mm), and unlike the resident group, there was no incidence of positive margins. The surgical simulation was overall useful for trainees to appreciate the nature of margin clearance in oral cavity cancer ablation.
Collapse
Affiliation(s)
- Donovan Eu
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Otolaryngology-Head and Neck Surgery, National University Health Systems, Singapore 119228, Singapore
| | - Michael J. Daly
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
| | - Stefano Taboni
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, 35122 Padua, Italy
| | - Axel Sahovaler
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Oral and Maxillofacial Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Ashley N. Gilbank
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
| | - Jonathan C. Irish
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
| |
Collapse
|
3
|
Descamps J, Apard T. From teaching to practice: Evaluating the impact of an upper-limb ultrasound surgery diploma on surgical practice. HAND SURGERY & REHABILITATION 2024; 43:101647. [PMID: 38296188 DOI: 10.1016/j.hansur.2024.101647] [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: 01/09/2024] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES This study evaluates the impact of an upper-limb ultrasound surgery diploma on surgical practices, specifically assessing how this specialized training influences the adoption and application of ultrasound techniques in upper limb surgeries. MATERIAL AND METHODS A comprehensive survey was conducted from August to November 2023, targeting individuals who completed the upper-limb ultrasound surgery diploma program between 2013 and 2023. The survey, distributed online, comprised 31 questions spanning demographic information, professional background, specifics about the diploma program, motivations for pursuing the diploma, post-diploma practices, challenges faced, and financing of ultrasound equipment. RESULTS Out of the 181 actually receiving the questionnaire. 94 (52%) completed the survey. The results showed an increase in ultrasound-guided interventions from 14.9% to 47.9% post-diploma. The diploma significantly influenced diagnostic ultrasound usage, though not statistically significant (35.3%-74.5%). The primary motivation for pursuing the diploma was the desire to embrace innovation (76.6%). Post-diploma, over half of the graduates observed a positive impact on patient recruitment. Challenges included lack of confidence and time constraints. Over 56% of graduates planned to increase their ultrasound-guided surgery practice. Net Promoter Score of the ultrasound interventions practices was 54.8. CONCLUSION The study demonstrates the considerable impact of the upper-limb ultrasound surgery diploma on surgical practices, notably in increasing the adoption and application of ultrasound-guided techniques. It highlights the importance of specialized training in adapting to technological advancements and enhancing patient care, suggesting directions for future surgical education and clinical practice integration.
Collapse
Affiliation(s)
- Jules Descamps
- Department of Orthopedics and Trauma Surgery, Lariboisière Hospital, 2 Rue Ambroise Paré, 75010 Paris, France.
| | | |
Collapse
|
4
|
Moen EL, Schmidt RO, Onega T, Brooks GA, O’Malley AJ. Association between a network-based physician linchpin score and cancer patient mortality: a SEER-Medicare analysis. J Natl Cancer Inst 2024; 116:230-238. [PMID: 37676831 PMCID: PMC10852616 DOI: 10.1093/jnci/djad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients with cancer frequently require multidisciplinary teams for optimal cancer outcomes. Network analysis can capture relationships among cancer specialists, and we developed a novel physician linchpin score to characterize "linchpin" physicians whose peers have fewer ties to other physicians of the same oncologic specialty. Our study examined whether being treated by a linchpin physician was associated with worse survival. METHODS In this cross-sectional study, we analyzed Surveillance, Epidemiology, and End Results-Medicare data for patients diagnosed with stage I to III non-small cell lung cancer or colorectal cancer (CRC) in 2016-2017. We assembled patient-sharing networks and calculated linchpin scores for medical oncologists, radiation oncologists, and surgeons. Physicians were considered linchpins if their linchpin score was within the top 15% for their specialty. We used Cox proportional hazards models to examine associations between being treated by a linchpin physician and survival, with a 2-year follow-up period. RESULTS The study cohort included 10 081 patients with non-small cell lung cancer and 9036 patients with CRC. Patients with lung cancer treated by a linchpin radiation oncologist had a 17% (95% confidence interval = 1.04 to 1.32) greater hazard of mortality, and similar trends were observed for linchpin medical oncologists. Patients with CRC treated by a linchpin surgeon had a 22% (95% confidence interval = 1.03 to 1.43) greater hazard of mortality. CONCLUSIONS In an analysis of Medicare beneficiaries with nonmetastatic lung cancer or CRC, those treated by linchpin physicians often experienced worse survival. Efforts to improve outcomes can use network analysis to identify areas with reduced access to multidisciplinary specialists.
Collapse
Affiliation(s)
- Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Rachel O Schmidt
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Tracy Onega
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Science, University of Utah, Salt Lake City, UT, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - A James O’Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
5
|
Tan J, Korduke O, Smith NL, Eglinton T, Fischer J. What are heads of department looking for in new general surgeons in Aotearoa New Zealand? ANZ J Surg 2024; 94:89-95. [PMID: 37962098 DOI: 10.1111/ans.18769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/01/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Training pathways vary significantly after completion of the general surgery surgical education and training (SET) program due to increasing sub-specialization. Aotearoa New Zealand requires a diverse range of general surgeons. Appointment of new consultant surgeons can be an opaque process; trainees are often uncertain how to tailor their training to that required by potential employers. Heads of departments (HODs) are influential in new appointments, and their opinions on desirable candidate attributes are valuable. METHODS An online survey was conducted in March 2023. All public hospital general surgery HODs were invited to participate. The survey sought opinions on the importance of attributes, skills and experience when appointing a new consultant general surgeon. RESULTS The response rate was 70% (14/20) including 6 of 7 HODs from tertiary hospitals and 8 of 13 from secondary hospitals. The top three desirable factors were all personal attributes (being a team player, having a strong work ethic, and good interpersonal skills). 10 of 14 respondents disagreed that SET completion alone is sufficient without the need for further training. Most respondents preferred at least 2 years of fellowship training, except for trauma and endocrine surgery, where 1 year was frequently considered sufficient. Only one respondent agreed formal research training is highly valued. CONCLUSION Trainees would be wise to obtain training desired by the majority of HODs while building an individualized profile of attributes, skills and experience tailored to hospitals they may wish to work in. The findings should be considered by organizations responsible for general surgical training and workforce planning.
Collapse
Affiliation(s)
- Jeffrey Tan
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Olga Korduke
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | | | - Tim Eglinton
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Jesse Fischer
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland - Waikato Clinical Campus, Hamilton, New Zealand
| |
Collapse
|
6
|
Reis ME, Ulusahin M, Cekic AB, Usta MA, Guner A. Does surgeon specialization add value to surgeon volume in gastric cancer surgery? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107091. [PMID: 37757682 DOI: 10.1016/j.ejso.2023.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND This study aimed to assess the combined impact of surgeon specialization and surgeon volume on both short- and long-term outcomes in patients underwent curative gastrectomy for gastric cancer. METHODS Patients with cStage1-3 gastric adenocarcinoma who underwent curative-intent surgery between January 2010 and December 2020 were evaluated. The impact of surgeon specialization and surgeon volume on clinical outcomes was scrutinized, both individually and in combination. For the purpose of assessing the combined effect, surgeons were classified into three groups: Non-specialized low-volume (NS-low), non-specialized high-volume (NS-high), and specialized high-volume (S-high). Postoperative outcomes and survival were evaluated. The adjusted effect sizes were expressed as odds ratio (OR) or hazard ratio (HR) with the corresponding 95% confidence interval. RESULTS Total of 537 patients operated by twelve surgeons were included in the analysis. For all cohort, the 30d-, in-hospital and 90d-mortality were 3.5%, 3%, and 6.3%, respectively. High surgeon volume alone had a significant impact (OR: 0.31 [0.10-0.82, p = 0.023]) on 30-day mortality. However, upon evaluating the combined effects of the parameters, while the most favorable 30-day mortality rate was observed in the S-high group, neither the NS-low group (OR: 3.82 [1.10-18.17, p = 0.054]) nor the NS-high group (OR: 1.37 [0.23-8.37, p = 0.724]) demonstrated a statistically significant difference when compared to the S-high group. The NS-low group showed poor results for several types of postoperative outcomes. In terms of overall survival, the S-high group outperformed, while the NS-low and NS-high groups presented with notably worse outcomes (HRs: 2.04 [1.51-2.75, p < 0.001], and 1.75 [1.25-2.44, p = 0.001], respectively). CONCLUSION The primary factor influencing short-term outcomes for patients who underwent gastric cancer surgery was found to be surgeon volume, while specialization provided a limited additional value. However, specialization emerges as an independent factor with a greater contribution to long-term survival than the impact attributed to high-volume.
Collapse
Affiliation(s)
- Murat Emre Reis
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Mehmet Ulusahin
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Arif Burak Cekic
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Mehmet Arif Usta
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Ali Guner
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey; Karadeniz Technical University, Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey.
| |
Collapse
|
7
|
Badrek-Amoudi AH. Colorectal travelling fellowships: Exploring current perspective and future direction. Surg Open Sci 2023; 14:87-95. [PMID: 37528918 PMCID: PMC10388199 DOI: 10.1016/j.sopen.2023.07.005] [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: 05/10/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023] Open
Abstract
Travelling Surgical fellowships (TSF) have a longstanding tradition in promoting out-of-programme surgical training, fostering collegiality and collaboration among surgeons. In this retrospective review we explore its historical context and examine existing practices and likely future trends. More specifically, we focus on colorectal travelling fellowships (CTF) and provide additional quantitative and qualitative analyses, highlighting the most valued theme-based surgical experiences and examine their merits and impacts. The TSF time-series analysis was based on a total of 350 awarded fellowships from 2000 to 2019. CTF analysis was based on 98 fellowships. The accelerated utilization of internet-based virtual interaction during the COVID-19 Pandemic has offered an opportunity to examine its possible intermediate and long-term disruptive effects.
Collapse
Affiliation(s)
- Ahmed H. Badrek-Amoudi
- Department Of Surgery, Faculty Of Medicine, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia
| |
Collapse
|
8
|
The State of Cancer Care in the United Arab Emirates in 2022. Clin Pract 2022; 12:955-985. [PMID: 36547109 PMCID: PMC9777273 DOI: 10.3390/clinpract12060101] [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: 09/02/2022] [Revised: 10/25/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Cancer is the third-leading cause of death in the United Arab Emirates (UAE); cancer care in the UAE has evolved dramatically over the last 40 years, from a single center in Al Ain in 1981 to more than 30 cancer centers and clinics across the UAE, with at least four comprehensive cancer centers in the UAE nowadays. Despite the significant progress in medical care, cancer quality control across the UAE is still lacking, with significant variations in cancer care across the cancer centers. Access to clinical trials is still hampered by a lack of expertise and research infrastructure and a small population, which renders patient accrual for trials a major challenge. Education and training are other areas for improvement that require immediate attention, and, in this review, we try to address these critical aspects for stakeholders to consider better cancer care in the UAE. Early cancer detection and screening are still evolving in the UAE, and a national screening program is lacking. There is also a need to address barriers to screening and to consider less invasive screening methods such as approved blood-based screening, which is likely to be more acceptable to the UAE population. In this review, we also address new topics that have not been addressed previously, including oncology medical tourism, psycho-oncology, onco-fertility, precision oncology, survivorship, oncology nursing, cancer support programs, and the oncology sector's response to the COVID-19 pandemic, all in the context of the UAE cancer landscape. Finally, we provide recommendations for policymakers, regulators, payers, patient advocacy groups, and the UAE oncology community regarding the delivery and future planning of high-quality cancer care. These recommendations are aligned with the UAE government's vision to reduce cancer mortality and provide high-quality healthcare for its citizens and residents.
Collapse
|
9
|
Shum JW, Dierks EJ. Fellowship Training in Oral and Maxillofacial Surgery: Opportunities and Outcomes. Oral Maxillofac Surg Clin North Am 2022; 34:545-554. [PMID: 36224071 DOI: 10.1016/j.coms.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pursuit of fellowship training stems from one's desire to master a focused area of surgery. Successful applicants tend to have published articles and participated in other scholarly activities. They commonly have a mentor within the subspecialty of their interest. Selection of the program is generally based on the breadth of experience available followed by faculty reputation and location. Advantages to the successful fellowship graduate include the experience and confidence to provide specialized and efficient care to patients. Enhancements to an academic department with a fellowship program include mentorship for residents and guidance toward fellowship, as well as an increased level of scholarly activity.
Collapse
Affiliation(s)
- Jonathan W Shum
- Oral, Head and Neck Oncologic and Reconstructive Surgery Fellowship, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, 6560 Fannin Street Suite 1900#, Houston, TX 77054, USA.
| | - Eric J Dierks
- Department of Oral and Maxillofacial Surgery, Oregon and Health Sciences University, Head and Neck Surgical Associates, 1849 NW Kearney, Suite 300, Portland, OR 97209, USA
| |
Collapse
|
10
|
Ashton M, Lee M. Cosmetic surgery—why training matters. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n2.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
11
|
Vogel JFA, Barkhausen M, Pross CM, Geissler A. Defining minimum volume thresholds to increase quality of care: a new patient-oriented approach using mixed integer programming. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1085-1104. [PMID: 35089456 PMCID: PMC9395474 DOI: 10.1007/s10198-021-01406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
A positive relationship between treatment volume and outcome quality has been demonstrated in the literature and is thus evident for a variety of procedures. Consequently, policy makers have tried to translate this so-called volume-outcome relationship into minimum volume regulation (MVR) to increase the quality of care-yet with limited success. Until today, the effect of strict MVR application remains unclear as outcome quality gains cannot be estimated adequately and restrictions to application such as patient travel time and utilization of remaining hospital capacity are not considered sufficiently. Accordingly, when defining MVR, its effectiveness cannot be assessed. Thus, we developed a mixed integer programming model to define minimum volume thresholds balancing utility in terms of outcome quality gain and feasibility in terms of restricted patient travel time and utilization of hospital capacity. We applied our model to the German hospital sector and to four surgical procedures. Results showed that effective MVR needs a minimum volume threshold of 125 treatments for cholecystectomy, of 45 and 25 treatments for colon and rectum resection, respectively, of 32 treatments for radical prostatectomy and of 60 treatments for total knee arthroplasty. Depending on procedure type and incidence as well as the procedure's complication rate, outcome quality gain ranged between 287 (radical prostatectomy) and 977 (colon resection) avoidable complications (11.7% and 11.9% of all complications). Ultimately, policy makers can use our model to leverage MVR's intended benefit: concentrating treatment delivery to improve the quality of care.
Collapse
Affiliation(s)
- Justus F. A. Vogel
- School of Medicine, Chair of Health Care Management, University of St. Gallen, St. Jakob-Strasse 21, 9000 St. Gallen, Switzerland
| | | | - Christoph M. Pross
- Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Alexander Geissler
- School of Medicine, Chair of Health Care Management, University of St. Gallen, St. Jakob-Strasse 21, 9000 St. Gallen, Switzerland
| |
Collapse
|
12
|
Kingsnorth's modified score as predictor of complications in open inguinal hernia repair. Updates Surg 2022; 74:1985-1993. [PMID: 35943664 PMCID: PMC9361253 DOI: 10.1007/s13304-022-01341-2] [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: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Purpose This study aims to analyse the postoperative complications (30 days) on unilateral primary inguinal hernia repair and prove their correlation with the preoperative modified scoring system of Kingsnorth (KN). Methods Prospective study design collecting data from patients who underwent surgery for unilateral primary inguinal hernia in a University Hospital. The data were collected in the National Inguinal Hernia Registry (EVEREG). A statistical analysis to assess the association between the presence of postoperative complications and the preoperative and intraoperative variables was performed. The patients were classified depending on their KN score. Surgical complications and their relationship with the classification were specifically analysed. Study design was performed following STROBE statements. Results The sample included 403 patients who met the inclusion criteria from which 62 (15.3%) subjects presented postoperative complications. The variables that presented a statistically significant relationship with the appearance of complications were a KN score of 5–8 (OR 2.7; 95% CI 1.07–4.82; P = 0.03) and the involvement of a member of the abdominal wall surgery unit in the procedure (OR 0.28; 95% CI 0.08–0.92; P = 0.03). The KN score correlated with a longer duration of surgery (Pearson's correlation 0.291; P < 0.0001). Conclusion The KN classification can predict the onset of surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5–8 has a higher probability of wound complications. When surgery is performed by the abdominal wall surgery unit, the chances of postoperative complications decrease.
Collapse
|
13
|
Hadaya J, Handa R, Mabeza RM, Dobaria V, Sanaiha Y, Benharash P. Surgeon specialty does not influence outcomes of hiatal hernia repair. Surgery 2022; 172:734-740. [PMID: 35595565 DOI: 10.1016/j.surg.2022.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/12/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hiatal hernia repair is commonly performed by both general and thoracic surgeons. The present study examined differences in approach, setting, and outcomes by specialty for hiatal hernia repair. METHODS Adults undergoing hiatal hernia repair were identified in the 2012-2019 American College of Surgeons National Surgical Quality Improvement Program. Patients were grouped by specialty of the operating surgeon (thoracic surgery vs general surgery). Generalized linear models were used to evaluate the effect of specialty on mortality, major morbidity, and 30-day readmission. RESULTS Among 46,739 patients, 5.0% were operated on by thoracic surgery. General surgery operated on younger patients (44.7 years vs 47.0, P < .001) with lesser systemic illness (American Society of Anesthesiologists class ≥3 50.4% vs 54.8%, P < .001) compared to thoracic surgery. General surgery more commonly used laparoscopy (95.0% vs 82.6%) and less commonly used thoracic approaches than thoracic surgery (0.6% vs 8.5%, P < .001). From 2012 to 2019, the proportion of cases performed as an outpatient by general surgery increased (28.1% to 46.4%, P < .001), but it remained stable for thoracic surgery (0.1% to 0.7%, P = .10). After risk adjustment, thoracic surgery specialty was not associated with mortality (odds ratio 0.9, 95% confidence interval 0.5-1.5), major morbidity (0.9, 95% confidence interval 0.7-1.1), or readmission (0.9, 95% confidence interval 0.8-1.1). Rather, factors including surgical approach (laparotomy 1.6, 95% confidence interval 1.4-1.9; thoracoscopy/thoracotomy 2.0, 95% confidence interval 1.5-2.7), inpatient case status (2.4, 95% confidence interval 2.2-2.7), increasing ASA class, and functional status more strongly influenced major morbidity. CONCLUSION Operative factors, surgical approach, and patient comorbidities more strongly influence outcomes of hiatal hernia repair than does surgeon specialty, suggesting continued safety of hiatal hernia repair by both thoracic and general surgeons.
Collapse
Affiliation(s)
- Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA. https://twitter.com/CoreLabUCLA
| | - Rahul Handa
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA
| | - Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, University of California, Los Angeles, CA.
| |
Collapse
|
14
|
Complications of ovarian cancer surgery in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta: A cross-sectional study. Ann Med Surg (Lond) 2022; 77:103581. [PMID: 35444800 PMCID: PMC9014352 DOI: 10.1016/j.amsu.2022.103581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
Background Ovarian cancer remains as one of the deadliest gynecologic problems globally. Often appears in advanced state, its surgery proves to be a challenge for clinicians. This study aim to present complications surrounding ovarian cancer surgery. Materials and methods This study was a cross-sectional study to analyze reports of intraoperative and postoperative complications in ovarian cancer patients undergoing laparotomy in Dr. Cipto Mangunkusumo National General Hospital, Jakarta from January 2018 to December 2019. Ovarian cancer patients undergoing laparotomy surgery were included in the study. Patients with a history of other cancers or having incomplete data were excluded from the study. Intraoperative complications included intestinal, ureter, bladder injury, and postoperative complications included paralytic ileus, surgical wound infection and sepsis were documented. Results A total of 78 subjects were included in the study. The total proportion of complications was 19.2%. The most prevalent intraoperative complications were intestinal injury (12.8%), bladder injury (2.6%), and ureter injury (1.3%). Most prevalent postoperative complications reported were surgical wound infection (5.2%), sepsis (3.9%), while none of the patients had paralytic ileus. Conclusion The proportion of intraoperative and postoperative complications in ovarian cancer surgery was still at alarming level (19.2%). Further steps are needed to ameliorate the rate of complications surrounding ovarian cancer surgery. Ovarian cancer remains as one of the deadliest gynecologic problems globally. The proportion of intraoperative and postoperative complications in ovarian cancer. Reducing the incidence of surgical complications would improve outcome quality and reduce the cost of hospitalization.
Collapse
|
15
|
Tyler D. 2022 SSO Presidential Address: What is a Surgical Oncologist? Evolution of Surgical Oncology and the Society of Surgical Oncology in an Era of Hyperspecialization. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11770-3. [PMID: 35430661 PMCID: PMC9013271 DOI: 10.1245/s10434-022-11770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Douglas Tyler
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
16
|
Baloche P, Szabla N, Freton L, Hutin M, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Patard PM, Brichart N, Sabourin L, Dariane C, Baboudjian M, Gondran-Tellier B, Lebacle C, Madec FX, Nouhaud FX, Rod X, Fiard G, Pradere B, Peyronnet B. Impact of Hospital Volume on the Outcomes of Renal Trauma Management. EUR UROL SUPPL 2022; 37:99-105. [PMID: 35243394 PMCID: PMC8883196 DOI: 10.1016/j.euros.2022.01.004] [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] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Some health care systems have set up referral trauma centers to centralize expertise to improve trauma management. There is scant and controversial evidence regarding the impact of provider’s volume on the outcomes of trauma management. Objective To evaluate the impact of hospital volume on the outcomes of renal trauma management in a European health care system. Design, setting, and participants A retrospective multicenter study, including all patients admitted for renal trauma in 17 French hospitals between 2005 and 2015, was conducted. Intervention Nephrectomy, angioembolization, or nonoperative management. Outcome measurements and statistical analysis Four quartiles according to the caseload per year: low volume (eight or fewer per year), moderate volume (nine to 13 per year), high volume (14–25/yr), and very high volume (≥26/yr). The primary endpoint was failure of nonoperative management defined as any interventional radiology or surgical procedure needed within the first 30 d after admission. Results and limitations Of 1771 patients with renal trauma, 1704 were included. Nonoperative management was more prevalent in the very-high- and low-volume centers (p = 0.02). In a univariate analysis, very high hospital volume was associated with a lower risk of nonoperative management failure than low (odds ratio [OR] = 0.54; p = 0.05) and moderate (OR = 0.48; p = 0.02) hospital volume. There were fewer nephrectomies in the high- and very-high-volume groups (p = 0.003). In a multivariate analysis, very high volume remained associated with a lower risk of nonoperative management failure than low (OR = 0.48; p = 0.04) and moderate (OR = 0.42; p = 0.01) volume. Study limitations include all the shortcomings inherent to its retrospective multicenter design. Conclusions In this multicenter study, management of renal trauma varied according to hospital volume. There were lower rates of nephrectomy and failure of nonoperative management in very-high-volume centers. These results raise the question of centralizing the management of renal trauma, which is currently not the case in our health care system. Patient summary In this study, management of renal trauma varied according to hospital volume. Very-high-volume centers had lower rates of nephrectomy and failure of nonoperative management.
Collapse
|
17
|
Yeh J, Palamuthusingam P, Cameron D, Avramovic J. Impact of establishing a specialized hepatobiliary unit on liver resections in a non-specialized tertiary centre in regional Australia. ANZ J Surg 2021; 92:769-773. [PMID: 34820998 DOI: 10.1111/ans.17383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In April 2018, a dedicated hepatobiliary unit was established in a tertiary hospital in North Queensland. Changes included the employment of a hepatobiliary-trained surgeon, centralized referrals, and formalized multidisciplinary team meetings. This study aimed to evaluate the impact of establishing a hepatobiliary unit on outcomes after liver resection, in a regional centre where such procedures were previously performed by non-specialist general surgeons. METHODS Adult patients who underwent elective liver resection in Townsville from 2013 to 2020 were included in the study. Outcomes after liver resection were collected across two study periods - before and after the hepatobiliary unit was established. The primary end points were a before and after comparison of the 90-day morbidity and mortality and the R1 margin rates. RESULTS Across the two study periods, 76 and 77 patients, respectively, underwent liver resection. Rates of R1 resection, 90-day mortality and major complications were not significantly different between the two study periods. Primary tumours (14.5% before versus 50.6% after) and cirrhosis (1.3% before versus 14.3% after) were significantly higher in the latter period, as was the median length of stay (4 days before versus 6 days after). Annual surgical volume increased by 75% in the period after 2018 compared to the 5 years preceding it. CONCLUSION Establishing a centralized hepatobiliary unit in a tertiary regional centre resulted in increased surgical volume and case complexity, with no change in early outcomes after liver resection. Overall, this dedicated unit improved the accessibility of a subspecialty surgical service in regional Australia.
Collapse
Affiliation(s)
- John Yeh
- Institute of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Pranavan Palamuthusingam
- Institute of Surgery, Townsville University Hospital, Townsville, Queensland, Australia.,North Queensland Minimally Invasive Surgery, Mater Private Hospital Townsville, Townsville, Queensland, Australia
| | - Donald Cameron
- Institute of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - John Avramovic
- Institute of Surgery, Townsville University Hospital, Townsville, Queensland, Australia.,North Queensland Minimally Invasive Surgery, Mater Private Hospital Townsville, Townsville, Queensland, Australia
| |
Collapse
|
18
|
Tu IWH, Wong JSM, Tan QX, Ng G, Ong CAJ, Chia CS. Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT): A subspecialty surgical oncological care model for advanced malignancies requiring complex procedures. Asian J Surg 2021; 45:546-548. [PMID: 34654606 DOI: 10.1016/j.asjsur.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Irene Wen-Hui Tu
- Duke-NUS Medical School, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Qiu Xuan Tan
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Center Singapore, Singapore
| | - Gillian Ng
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Center Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Center Singapore, Singapore; SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School, Singapore; Institute of Molecular and Cell Biology, A∗STAR Research Entities, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School, Singapore.
| |
Collapse
|
19
|
Brockmeyer DL. Editorial. The walls come tumbling down: a proposed two-specialty approach to complex pediatric spinal deformity surgery. J Neurosurg Pediatr 2021; 28:247-248. [PMID: 34214983 DOI: 10.3171/2021.1.peds20955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
20
|
Saager L, Ruetzler K, Turan A, Maheshwari K, Cohen B, You J, Mascha EJ, Qiu Y, Ince I, Sessler DI. Do It Often, Do It Better: Association Between Pairs of Experienced Subspecialty Anesthesia Caregivers and Postoperative Outcomes. A Retrospective Observational Study. Anesth Analg 2021; 132:866-877. [PMID: 33433116 DOI: 10.1213/ane.0000000000005318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiologists typically care for patients having a broad range of procedures. Outcomes might be improved when care is provided by caregivers experienced in particular types of surgery. We tested the hypothesis that intraoperative care provided by pairs of anesthesia caregivers having significant experience with a particular type of surgery reduces a composite of in-hospital death and 6 serious complications, including bleeding, cardiac, gastrointestinal, infectious, respiratory, and urinary complications, compared to care provided by pairs of anesthesia caregivers with less experience. METHODS We included patients having surgery lasting at least 30 minutes. Using cluster analysis, attending anesthesiologists, and Certified Registered Nurse Anesthetists (CRNAs) were identified as experienced or inexperienced caregivers for each type of surgery at the case level. We then compared surgeries for which anesthesia was provided by a pair of experienced caregivers versus a pair of inexperienced caregivers on our composite outcome. We estimated the average relative effect (ie, the exponentiated average log odds ratio) of receiving anesthesia from an experienced versus inexperienced caregiver pair across the 7 components of the composite outcome using a generalized estimating equation (GEE) model to adjust for between-component correlation and with inverse propensity score weighing to adjust for potential confounding from a host of variables. RESULTS A total of 8968 patients who received anesthesia care by an experienced pair were compared with 25,361 patients who received care from an inexperienced pair, adjusting for potential confounding. The incidence of composite complications (ie, any component event) was 7.6% (677/8968) for experienced pairs and 12% (2976/25,361) for inexperienced pairs (P < .001). Care by experienced pairs of caregivers was associated with lower odds of the composite outcome with an estimated average relative effect odds ratio across the individual components of 0.61 (95% confidence interval [CI], 0.54-0.71), P < .001. Among the 7 components of the primary outcome, experienced pairs of providers had significantly lower estimated odds of bleeding, infection, and mortality. CONCLUSIONS Anesthesia care by experienced pairs was associated with fewer bleeding complications, fewer infections, shorter hospitalization, and reduced in-hospital mortality.
Collapse
Affiliation(s)
- Leif Saager
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Kurt Ruetzler
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alparslan Turan
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kamal Maheshwari
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Barak Cohen
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Division of Anesthesia, Critical Care and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jing You
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Edward J Mascha
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Yuwei Qiu
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ilker Ince
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Daniel I Sessler
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
21
|
Singh V, Simcox T, Aggarwal VK, Schwarzkopf R, Long WJ. Comparative Analysis of Total Knee Arthroplasty Outcomes Between Arthroplasty and Nonarthroplasty Fellowship Trained Surgeons. Arthroplast Today 2021; 8:40-45. [PMID: 33718554 PMCID: PMC7921708 DOI: 10.1016/j.artd.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 01/22/2023] Open
Abstract
Background An adult reconstruction (AR) fellowship is designed to provide advanced training for a broad range of primary reconstructive and complex knee revision surgeries. This study aims to identify outcome differences between primary total knee arthroplasty (TKA) performed by AR fellowship-trained surgeons and non-AR (NAR) fellowship-trained surgeons. Material and Methods We retrospectively reviewed 7415 patients who underwent primary TKA from 2016 to 2020. Two cohorts were established based on whether the operation was performed by an AR or NAR fellowship-trained surgeon. Demographic, clinical data, and patient-reported outcome measures were collected at various time-points (preoperatively, 3 months, 1 year). Demographic differences were assessed with chi-square and independent sample t-tests. Primary outcomes were compared using multilinear regressions, controlling for demographic differences. Results AR surgeons performed 5194 (70%) cases while NAR surgeons performed 2221 (30%) cases. Surgical time (minutes) significantly differed between the 2 groups (101.26 vs 111.56; P < .001). Length of stay, 90-day all-cause readmissions, revisions, and all-cause emergency department visits did not statistically differ (P = .079, P = .978, P = .094, and P = .241, respectively). AR surgeons were more likely to discharge their patients home than NAR surgeons (P = .001). NAR group reported lower KOOS, JR scores at 3 months and 1 year (preop: 45.30 vs 45.79, P = .728; 3 months: 64.73 vs 59.47, P < .001; 1 year: 71.66 vs 69.56, P = .234); however, only 3-month scores statistically differed. Veterans RAND-12 Physical and Mental components scores (VR-12 PCS and MCS) were not statistically significant at any time-point between the cohorts. Delta-improvements preoperatively to 1 year in KOOS, JR (26.36 vs 23.77; P < .001) and VR-12 PCS (11.98 vs 10.62; P < .001) scores were significantly higher for the AR cohort but did not exceed the minimal clinically important difference. Conclusion This study demonstrates significantly shorter surgical times and greater improvements in KOOS, JR and VR-12 PCS scores associated with TKAs performed by AR fellowship-trained surgeons. Level III Evidence Retrospective Cohort Study.
Collapse
Affiliation(s)
- Vivek Singh
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Trevor Simcox
- NYU Winthrop Hospital, Department of Orthopedic Surgery, Mineola, NY, USA
| | - Vinay K Aggarwal
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - William J Long
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| |
Collapse
|
22
|
Campbell RJ, El-Defrawy SR, Gill SS, Whitehead M, Campbell EDLP, Hooper PL, Bell CM, Ten Hove MW. Surgical Outcomes among Focused versus Diversified Cataract Surgeons. Ophthalmology 2021; 128:827-834. [PMID: 33637327 DOI: 10.1016/j.ophtha.2021.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/09/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Narrowly focused surgical practice has become increasingly common in ophthalmology and may have an effect on surgical outcomes. Previous research evaluating the influence of surgical focus on cataract surgical outcomes has been lacking. This study aimed to evaluate whether surgeons' exclusive surgical focus on cataract surgery influences the risk of cataract surgical adverse events. DESIGN Population-based cohort study. PARTICIPANTS All patients 66 years of age or older undergoing cataract surgery in Ontario, Canada, between January 1, 2002, and December 31, 2013. METHODS Outcomes of isolated cataract surgery performed by exclusive cataract surgeons (no other types of surgery performed), moderately diversified cataract surgeons (1%-50% noncataract procedures), and highly diversified cataract surgeons (>50% noncataract procedures) were evaluated using linked healthcare databases and controlling for patient-, surgeon-, and institution-level covariates. Surgeon-level covariates included both surgeon experience and surgical volume. MAIN OUTCOME MEASURES Composite outcome incorporating 4 adverse events: posterior capsule rupture, dropped lens fragments, retinal detachment, and suspected endophthalmitis. RESULTS The study included 1 101 864 cataract operations. Patients had a median age of 76 years, and 60.2% were female. Patients treated by the 3 groups of surgeons were similar at baseline. Adverse events occurred in 0.73%, 0.78%, and 2.31% of cases performed by exclusive cataract surgeons, moderately diversified surgeons, and highly diversified surgeons, respectively. The risk of cataract surgical adverse events for patients operated on by moderately diversified surgeons was not different than for patients operated on by exclusive cataract surgeons (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.18). Patients operated on by highly diversified surgeons had a higher risk of adverse events than patients operated on by exclusive cataract surgeons (OR, 1.52; 95% CI, 1.09-2.14). This resulted in an absolute risk difference of 0.016 (95% CI, 0.012-0.020) and a number needed to harm of 64 (95% CI, 50-87). CONCLUSIONS Exclusive surgical focus did not affect the safety of cataract surgery when compared with moderate levels of surgical diversification. The risk of cataract surgical adverse events was higher among surgeons whose practice was dedicated mainly to noncataract surgery.
Collapse
Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada.
| | - Sherif R El-Defrawy
- Department of Ophthalmology, University of Toronto, Toronto, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Division of Geriatric Medicine, Queen's University, Kingston, Canada; Division of Geriatric Medicine, Providence Care Hospital, Kingston, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Queen's University, Kingston, Canada
| | - Erica de L P Campbell
- Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Canada
| | - Philip L Hooper
- Department of Ophthalmology, University of Western Ontario, London, Canada; Department of Ophthalmology, St. Joseph's Hospital, London, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, Sinai Health System, Toronto, Canada
| | - Martin W Ten Hove
- Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Canada
| |
Collapse
|
23
|
Letter to the editor regarding the article "Selection of a high-level physician may help improve outcomes of nasopharyngeal carcinoma" by Fei et al. Radiother Oncol 2020; 154:e18-e19. [PMID: 32673780 DOI: 10.1016/j.radonc.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 11/21/2022]
|
24
|
Padilla JA, Gabor JA, Ryan SP, Long WJ, Seyler TM, Schwarzkopf RM. Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training. J Arthroplasty 2020; 35:S101-S106. [PMID: 32067895 DOI: 10.1016/j.arth.2020.01.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip fractures have significant economic implications as a result of their associated direct and indirect medical costs. Under alternative payment models, it has become increasingly important for institutions to find avenues by which costs could be reduced while maintaining outcomes in these cases. METHODS A multi-institutional retrospective analysis of Medicare patients who underwent total hip arthroplasty (THA) for femoral neck fracture was conducted to assess the impact of fellowship training in adult reconstruction (AR) on the total costs of the 90-day episode of care. Patients were divided into 2 cohorts according to fellowship training status of the operating surgeon: (1) AR-trained and (2) other fellowship training (non-AR). The primary outcome was the total cost of the 90-day episode of care converted to a percentage of the bundled payment target price. RESULTS A total of 291 patients who underwent THA for the treatment of a femoral neck fracture were included. The average total cost percentage of the 90-day episode of care was significantly lower for the AR cohort 70.9% (±36.6%) than the non-AR cohort 82.6% (±36.1%) (P < .01). After controlling for baseline demographics in the multivariable logistic regression, the care episodes in which the operating surgeons were AR fellowship-trained were still found to be significantly lower, at a rate of 0.87 times the costs of the non-AR surgeons (95% confidence interval 0.78-0.97, P = .011). In addition, the non-AR cohort exceeded the bundle target price more frequently than the AR cohort, 49 (28.7%) vs 16 (13.3%) (P = .02). CONCLUSION In an era of bundled payments, ascertaining factors that may increase the value of care while decreasing the cost is paramount for institutions and policymakers alike. The results presented in this study suggest that in the femoral neck fracture population, surgeons trained in AR achieve lower total costs for the THA episode of care. Furthermore, non-AR fellowship-trained surgeons exceeded the bundled payment target more frequently than the AR surgeons.
Collapse
Affiliation(s)
- Jorge A Padilla
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York
| | - Jonathan A Gabor
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William J Long
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ran M Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| |
Collapse
|
25
|
Fei Z, Qiu X, Li Y, Huang Y, Li M, Chen T, Li L, Huang C, Liu J, Lin X, Wang B, Chen Y, Chen C. Selection of a high-level physician may help improve outcomes of nasopharyngeal carcinoma. Radiother Oncol 2020; 147:130-135. [PMID: 32294606 DOI: 10.1016/j.radonc.2020.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/10/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To assess the relationship between the level of clinical radiation oncologist and the prognosis of patients with nasopharyngeal carcinoma (NPC). To our knowledge, no previous study has explicitly assessed the relationship with cancer prognosis and clinical radiation oncologists level. The effect of physicians on the prognosis has been entirely ignored. METHODS Clinical data were collected for 1140 patients with newly diagnosed NPC. Based on the 3-year overall survival, the treating physicians were classified into 3 grades: high-level group, medium-level group, and low-level group. Cox proportional hazards regression analysis was used to assess the independent significance of different prognostic factors. Propensity score matching (PSM) was used to minimize the influence of confounders so that difference in outcomes provides an unbiased estimate of the influence of physician. Interactive Risk Attributable Program (IRAP) was used to calculate the attribution risk of individual risk factors or a combination of multiple factors. RESULTS The 3-year OS in the high-level, medium-level, and low-level groups was 92.9%, 87.7%, and 83.5%, respectively (p = 0.003). After propensity score matching, the 3-year OS was 92.4%, 87.4%, and 82.9%, respectively (p = 0.004). IRAP was used to calculate the attribution risk of mortality risk. After multivariable adjustment, patient-related factors including tumor accounted for 90.02% [95% confidence interval (CI), 73.43-96.84%) and physician factors accounted for 17.66% (95% CI, 5.39-44.65%) of the mortalityrisk. All related factors, including patient-related factors and physician factors accounted for 92.02% (95% CI, 77.83-97.43%). CONCLUSION Our study demonstrated obvious differences in the prognosis of patients treated by various clinical radiation oncologists. The largest share of prognosis risk was found to be at the patient level, while variation in prognosis was, in part, attributable to differences among physicians.
Collapse
Affiliation(s)
- Zhaodong Fei
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiufang Qiu
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yi Li
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yingying Huang
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Mengying Li
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Taojun Chen
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Li Li
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Chaoxiong Huang
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jing Liu
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiang Lin
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Bingyi Wang
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yu Chen
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Chuanben Chen
- Department of Radiotherapy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
| |
Collapse
|
26
|
Cacicedo J, Navarro-Martin A, Gonzalez-Larragan S, De Bari B, Salem A, Dahele M. Systematic review of educational interventions to improve contouring in radiotherapy. Radiother Oncol 2019; 144:86-92. [PMID: 31786422 DOI: 10.1016/j.radonc.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Contouring is a critical step in the radiotherapy process, but there is limited research on how to teach it and no consensus about the best method. We summarize the current evidence regarding improvement of contouring skills. METHODS AND MATERIALS Comprehensive literature search of the Pubmed-MEDLINE database, EMBASE database and Cochrane Library to identify relevant studies (independently examined by two investigators) that included baseline contouring followed by a re-contouring assessment after an educational intervention. RESULTS 598 papers were identified. 16 studies met the inclusion criteria representing 370 participants (average number of participants per study of 23; range (4-141). Regarding the teaching methodology, 5/16 used onsite courses, 8/16 online courses, and 2/16 used blended learning. Study quality was heterogenous. There were only 3 randomized studies and only 3 analyzed the dosimetric impact of improving contouring homogeneity. Dice similarity coefficient was the most common evaluation metric (7/16), and in all these studies at least some contours improved significantly post-intervention. The time frame for evaluating the learning effect of the teaching intervention was almost exclusively short-time, with only one study evaluating the long-term utility of the educational program beyond 6 months. CONCLUSION The literature on educational interventions designed to improve contouring performance is limited and heterogenous. Onsite, online and blended learning courses have all been shown to be helpful, however, sample sizes are small and impact assessment is almost exclusively short-term and typically does not take into account the effect on treatment planning. The most effective teaching methodology/format is unknown and impact on daily clinical practice is uncertain.
Collapse
Affiliation(s)
- Jon Cacicedo
- Radiation Oncology Department, Cruces University Hospital, Osakidetza/Biocruces Health Research Institute/Department of Surgery, Radiology and Physical Medicine of the University of the Basque Country (UPV/EHU), Barakaldo, Spain.
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran VIa de ĹHospitalet, Barcelona, Spain.
| | | | - Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire Jean Minjoz, INSERM U1098 EFS/BFC, Besançon, France.
| | - Ahmed Salem
- Division of Cancer Sciences, University of Manchester, United Kingdom; Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom.
| | - Max Dahele
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC (VUmc location), the Netherlands.
| |
Collapse
|
27
|
Saw KS, Robertson J, Walsh M, Hider P, Rodgers M, Booth M, Srinivasa S, Koea J. Treatment of gastric adenocarcinoma at a New Zealand centre: meeting the challenges of a low volume country. ANZ J Surg 2019; 90:81-85. [DOI: 10.1111/ans.15543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Kai Sheng Saw
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| | - Jason Robertson
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| | - Michael Walsh
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| | - Phillip Hider
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
- Department of Population HealthUniversity of Otago Christchurch New Zealand
| | - Michael Rodgers
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| | - Michael Booth
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| | - Sanket Srinivasa
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| | - Jonathan Koea
- Upper Gastrointestinal Unit, Department of SurgeryNorth Shore Hospital Auckland New Zealand
| |
Collapse
|
28
|
Changes in Surgical Volume and Outcomes Over Time for Women Undergoing Hysterectomy for Endometrial Cancer. Obstet Gynecol 2019; 132:59-69. [PMID: 29889759 DOI: 10.1097/aog.0000000000002691] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine changes over time in surgeon and hospital procedural volume for hysterectomy for endometrial cancer and explore the association between changes in volume and perioperative outcomes. METHODS We used the Statewide Planning and Research Cooperative System database to analyze women who underwent abdominal or minimally invasive hysterectomy from 2000 to 2014. Annualized surgeon and hospital volume was estimated. The association between surgeon and hospital volume and perioperative morbidity, mortality, and resource utilization (transfusion, length of stay, hospital charges) was estimated by modeling procedural volume as a continuous and categorical variable. RESULTS A total of 44,558 women treated at 218 hospitals were identified. The number of surgeons performing cases each year decreased from 845 surgeons with 2,595 patients (mean cases=3) in 2000 to 317 surgeons who operated on 3,119 patients (mean cases=10) (P<.001) in 2014, whereas the mean hospital volume rose from 14 to 32 cases over the same time period (P=.29). When stratified by surgeon volume quartiles, the morbidity rate was 14.6% among the lowest volume surgeons, 20.8% for medium-low, 15.7% for medium-high, and 14.1% for high-volume surgeons (P<.001). In multivariable models in which volume was modeled as a continuous variable, there was no association between surgeon volume and the rate of complications, whereas excessive total charges were lowest and perioperative mortality highest for the high-volume surgeons (P<.001 for both). CONCLUSION Care of women with endometrial cancer has been concentrated to a smaller number of surgeons and hospitals. The association between surgeon and hospital volume for endometrial cancer is complex with an increased risk of adverse outcomes among medium-volume hospitals and surgeons but the lowest complication rates for the highest volume surgeons and centers.
Collapse
|
29
|
Lee JK, Doumouras AG, Springer JE, Eskicioglu C, Amin N, Cadeddu M, Hong D. Examining the transferability of colon and rectal operative experience on outcomes following laparoscopic rectal surgery. Surg Endosc 2019; 34:1231-1236. [PMID: 31183793 DOI: 10.1007/s00464-019-06885-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic rectal surgery is technically challenging and often low volume. Alternatively, colon resections utilize similar advanced laparoscopic skills and are more common but it is unknown whether this experience affects laparoscopic rectal surgery outcomes. The purpose of this paper is to determine the volume-outcome relationship between several colorectal procedures and laparoscopic rectal surgery outcomes. METHODS This was a population-based retrospective cohort of all colorectal surgeries with primary anastomoses performed across Canada (excluding Quebec) between April 2008 and March 2015. Patient characteristics, comorbidities, procedures, and discharge details were collected from the Canadian Institute for Health Information. Volumes for common colorectal procedures were calculated for individual surgeons. All-cause morbidity, defined as complications arising during the index admission and contributing to an increased length of stay by more than 24 h, was the primary outcome examined. RESULTS A total of 5323 laparoscopic rectal surgery cases and 108,034 colorectal cases, between 180 hospitals and 620 surgeons, were identified. Data analysis demonstrated that high-volume laparoscopic rectal surgeons (OR 0.77, CI 0.61-0.96, p = 0.020) and high-volume open rectal surgeons (OR 0.76, CI 0.61-0.93, p = 0.009) significantly reduced all-cause morbidity. Conversely, surgeon volumes for laparoscopic and open colon cases had no effect on laparoscopic rectal outcomes. CONCLUSION High-volume surgeon status in laparoscopic and open rectal surgery are important predictors of all-cause morbidity after laparoscopic rectal surgery, while laparoscopic colon surgery volumes did not impact outcomes. This may reflect more dissimilarity between colon and rectal cases and less transferability of advanced laparoscopic skills than previously thought.
Collapse
Affiliation(s)
- Jennie K Lee
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Aristithes G Doumouras
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeremy E Springer
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Nalin Amin
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Margherita Cadeddu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Dennis Hong
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
30
|
Coventry CA, Holland AJA, Read DJ, Ivers RQ. Australasian general surgical training and emergency medical teams: a review. ANZ J Surg 2019; 89:815-820. [PMID: 31066168 DOI: 10.1111/ans.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
Emergency medical teams (EMTs) have provided surgical care in sudden-onset disasters in low- and middle-income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high-income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden-onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.
Collapse
Affiliation(s)
- Charles A Coventry
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
31
|
Yagi A, Ueda Y, Nakagawa S, Morimoto A, Matsuzaki S, Kobayashi E, Kimura T. Relation between the number of board-certified gynecologic oncologists per hospital and survival of cervical cancer. J Obstet Gynaecol Res 2019; 45:1160-1166. [PMID: 30843312 DOI: 10.1111/jog.13948] [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: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 11/29/2022]
Abstract
AIMS In cancer therapy, choice of treatment method has a tremendous influence on patient prognosis. We aimed to evaluate the impact of the number of Gynecologic Oncology (GO) Specialists on treatment outcomes of cervical cancer patients. METHODS We used data for 5-year treatment outcomes obtained from the annual treatment reports of the Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology (JSOG). We compared this to data posted on the Japanese Society of Gynecologic Oncology (JSGO) website regarding the enrollment of GO Specialists at each hospital. RESULTS The 5-year survival ratio of cervical cancer patients treated in hospitals with 2-or-more GO Specialists was 79.0% (2010/2543). This was significantly higher than 75.4% (974/1292) for facilities with 0 or 1 specialist (P = 0.011); however, the number of GO Specialists was not an independent prognostic factor (P = 0.77, adjusted HR: 1.13 [0.38-2.03]). The 5-year survival ratio significantly increased in medical facilities whose number of GO Specialists increased from 0 to 1 or more, or from 1 to 2 or more (P = 0.045). CONCLUSION This study demonstrates a causal relationship between the numbers of GO Specialists and treatment outcomes of cervical cancer patients for the first time. Our study suggests that although JSGO board-certified gynecologic oncologists do clearly contribute to improving treatment outcome, the number of specialists was not an independent factor for improving the prognosis of the patients. Thus, it was not clear whether simply increasing the number of GO Specialists, beyond two, will lead to any significant improvement in cervical cancer patient prognosis.
Collapse
Affiliation(s)
- Asami Yagi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akiko Morimoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
32
|
Kuwayama D. Authors’ Reply: Are American Surgical Residents Prepared for Humanitarian Deployment? A Comparative Analysis of Resident and Humanitarian Case Logs. World J Surg 2019; 43:295-296. [DOI: 10.1007/s00268-018-4713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Franco P, Arcadipane F, Trino E, Gallio E, Martini S, Iorio GC, Piva C, Moretto F, Ruo Redda MG, Verna R, Tseroni V, Bona C, Pozzi G, Fiandra C, Ragona R, Bertetto O, Ricardi U. Variability of clinical target volume delineation for rectal cancer patients planned for neoadjuvant radiotherapy with the aid of the platform Anatom-e. Clin Transl Radiat Oncol 2018; 11:33-39. [PMID: 29928706 PMCID: PMC6008279 DOI: 10.1016/j.ctro.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting. Materials and methods Two clinical cases of locally advanced rectal cancer were chosen. Participants were instructed to follow the 2009 Radiation Therapy Oncology Group consensus atlas and asked to manually segment clinical target volumes (CTVs), for both patient 1 and 2, on day 1 with and without the use of Anatom-e. After one week (day 2), the same radiation oncologist contoured again, with and without Anatom-e, the same CT series. Intraobserver (Intra-OV) and interobserver (Inter-OV) variability were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA). Results For clinical case 1, no significant difference was found for Intra-OV and Inter-OV. For clinical case 2, no significant difference was found for Intra-OV but a statistically significant difference was found for Inter-OV in DSC when using or not the platform. Mean DCS was 0.65 (SD: ±0.64; range: 0.58-0.79) for day 1 vs reference volume without Anatom-e and 0.72 (SD: ±0.39; range: 0.67-0.77) (p = 0.03) with it. Mean MDA was lower with Anatom-e (3.61; SD: ±1.33; range: 2.85-4.78) than without (4.14; SD: ±2.97; range: 2.18-5.21), with no statistical significance (p = 0.21) The use of Anatom-e decreased the SD from 2.97 to 1.33. Mean HD was lower with Anatom-e (26.06; SD: ±2.05; range: 24.08-32.62), with no statistical significance (p = 0.14) compared to that without (31.39; SD: ±1.31; range: 26.14-48.72). Conclusions The use of Anatom-e decreased the Inter-OV in the CTV delineation process for locally advanced rectal cancer with complex disease presentation planned for neoadjuvant RT. This system may be potentially helpful in increasing the compliance to follow shared guidelines and protocols.
Collapse
Key Words
- AJCC/UICC, American Joint Committee on Cancer/Union Internationale Contre le Cancer
- CHT, chemotherapy
- CT, computed tomography
- CTV, clinical target volume
- Contouring
- DSC, Dice similarity coefficient
- GTV, gross tumor volume
- HD, Hausdorff distance
- Inter-OV, inter-observer variability
- Interobserver variability
- Intra-OV, intra-observer variability
- MDA, mean distance to agreement
- MR, magnetic resonance imaging
- Neoadjuvant radiotherapy
- OARs, organs at risk
- RT, radiotherapy
- RTOG, Radiation Therapy Oncology Group
- Rectal cancer
- Ros, radiation oncologists
- SD, standard deviation
- SWOG, Radiation Committee of the Southwest Oncology Group
- Target volume delineation
- VMAT, volumetric modulated arc therapy
Collapse
Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Elisabetta Trino
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Elena Gallio
- Department of Medical Physics, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Giuseppe Carlo Iorio
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Cristina Piva
- Department of Radiation Oncology, Ivrea Community Hospital, Ivrea, Italy
| | - Francesco Moretto
- Department of Radiation Oncology, 'Cardinal Massaia' Community Hospital, Asti, Italy
| | - Maria Grazia Ruo Redda
- Department of Oncology, Radiation Oncology, University of Turin, AO Ordine Mauriziano, Turin, Italy
| | - Roberta Verna
- Department of Radiation Oncology, AOU San Luigi Gonzaga, Orbassano (TO), Italy
| | - Vassiliki Tseroni
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Presidio San Giovanni Antica Sede, Turin, Italy
| | - Cristina Bona
- Department of Radiation Oncology, ASL Verbano Cusio Ossola, Verbania, Italy
| | - Gabriele Pozzi
- Department of Radiation Oncology, AO 'SS Antonio e Biagio e Cesare Arrigo', Alessandria, Italy
| | - Christian Fiandra
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | | | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| |
Collapse
|
34
|
Zhu R, Liu F, Grisotti G, Perez-Irizarry J, Salem RR, Cha CH, Johung KL, Boffa DJ, Zhang Y, Khan SA. Clinical impact of underutilization of adjuvant therapy in node positive gastric adenocarcinoma. J Gastrointest Oncol 2018; 9:517-526. [PMID: 29998017 DOI: 10.21037/jgo.2018.03.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Adjuvant therapy for gastric adenocarcinoma has shown a survival advantage, though it may be underutilized. The purpose of this study is to examine how infrequently adjuvant therapy is administered with curative intent gastrectomy for node positive gastric cancer and the long-term effects to patients. Methods The National Cancer Database was queried from 2006-2013 for patients with node positive gastric adenocarcinoma undergoing a potentially curative gastrectomy. Overall survival was compared between patients who received adjuvant chemotherapy or chemoradiation and those who did not. Results Of 2,565 patients, 793 (30.9%) patients did not receive any adjuvant chemotherapy or radiation therapy, while 147 (5.7%) received peri-operative chemotherapy and 723 (28.2%) received post-operative chemoradiation. From 2006-2013, the percentage of patients receiving peri-operative chemotherapy rose from 1.1% to 9.9%, while those receiving post-operative chemoradiation decreased from 39.7% to 21.6%. The adjusted restricted mean survival time over 5 years for no adjuvant therapy was 27.7 months, peri-operative chemotherapy was 39.6 months, and post-operative chemoradiation was 37.7 months (P<0.0001). Conclusions Approximately one third of patients treated for node positive gastric cancer undergo surgical resection without adjuvant therapy. This is associated with poorer survival, highlighting the need for improvement in multimodality care and cancer outcomes.
Collapse
Affiliation(s)
- Rebecca Zhu
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Fangfang Liu
- Department of Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China
| | - Gabriella Grisotti
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - Ronald R Salem
- Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Charles H Cha
- Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Kimberly L Johung
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel J Boffa
- Department of Surgery, Section of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Yawei Zhang
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.,Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Sajid A Khan
- Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
35
|
Tsugawa Y, Jena AB, Orav EJ, Blumenthal DM, Tsai TC, Mehtsun WT, Jha AK. Age and sex of surgeons and mortality of older surgical patients: observational study. BMJ 2018; 361:k1343. [PMID: 29695473 PMCID: PMC5915700 DOI: 10.1136/bmj.k1343] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate whether patients' mortality differs according to the age and sex of surgeons. DESIGN Observational study. SETTING US acute care hospitals. PARTICIPANTS 100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014. MAIN OUTCOME MEASURE Operative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients' and surgeons' characteristics and indicator variables for hospitals. RESULTS 892 187 patients who were treated by 45 826 surgeons were included. Patients' mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). After stratification by sex of surgeon, patients' mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50s had the lowest operative mortality. CONCLUSION Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons.
Collapse
Affiliation(s)
- Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Thomas C Tsai
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Winta T Mehtsun
- Division of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ashish K Jha
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The VA Healthcare System, Boston, MA 02138, USA
| |
Collapse
|
36
|
Venigalla S, Nead KT, Sebro R, Guttmann DM, Sharma S, Simone CB, Levin WP, Wilson RJ, Weber KL, Shabason JE. Association Between Treatment at High-Volume Facilities and Improved Overall Survival in Soft Tissue Sarcomas. Int J Radiat Oncol Biol Phys 2018; 100:1004-1015. [PMID: 29485042 PMCID: PMC5830163 DOI: 10.1016/j.ijrobp.2017.12.262] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Soft tissue sarcomas (STS) are rare malignancies that require complex multidisciplinary management. Therefore, facilities with high sarcoma case volume may demonstrate superior outcomes. We hypothesized that STS treatment at high-volume (HV) facilities would be associated with improved overall survival (OS). METHODS AND MATERIALS Patients aged ≥18 years with nonmetastatic STS treated with surgery and radiation therapy at a single facility from 2004 through 2013 were identified from the National Cancer Database. Facilities were dichotomized into HV and low-volume (LV) cohorts based on total case volume over the study period. OS was assessed using multivariable Cox regression with propensity score-matching. Patterns of care were assessed using multivariable logistic regression analysis. RESULTS Of 9025 total patients, 1578 (17%) and 7447 (83%) were treated at HV and LV facilities, respectively. On multivariable analysis, high educational attainment, larger tumor size, higher grade, and negative surgical margins were statistically significantly associated with treatment at HV facilities; conversely, black race and non-metropolitan residence were negative predictors of treatment at HV facilities. On propensity score-matched multivariable analysis, treatment at HV facilities versus LV facilities was associated with improved OS (hazard ratio, 0.87, 95% confidence interval, 0.80-0.95; P = .001). Older age, lack of insurance, greater comorbidity, larger tumor size, higher tumor grade, and positive surgical margins were associated with statistically significantly worse OS. CONCLUSIONS In this observational cohort study using the National Cancer Database, receipt of surgery and radiation therapy at HV facilities was associated with improved OS in patients with STS. Potential sociodemographic disparities limit access to care at HV facilities for certain populations. Our findings highlight the importance of receipt of care at HV facilities for patients with STS and warrant further study into improving access to care at HV facilities.
Collapse
Affiliation(s)
- Sriram Venigalla
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Kevin T Nead
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ronnie Sebro
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David M Guttmann
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sonam Sharma
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - William P Levin
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert J Wilson
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacob E Shabason
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
37
|
Shared Decision-Making in Acute Surgical Illness: The Surgeon's Perspective. J Am Coll Surg 2018; 226:784-795. [PMID: 29382560 DOI: 10.1016/j.jamcollsurg.2018.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical patients increasingly have more comorbidities and are of an older age, complicating surgical decision-making in emergent situations. Little is known about surgeons' perceptions of shared decision-making in these settings. STUDY DESIGN Twenty semi-structured interviews were conducted with practicing surgeons at 2 large academic medical centers. Thirteen questions and 2 case vignettes were used to assess perceptions of decision-making, considerations when deciding whether to offer to operate, and communication patterns with patients and families. RESULTS Thematic analysis revealed 6 major themes: responsibility for the decision to operate, perceived futility, surgeon judgment, surgeon introspection, pressure to operate, and costs of the operation. Perceived futility was universally considered a contraindication to surgical intervention. However, the challenge of defining futility led participants to emphasize the importance of patients' self-determined risk-to-benefit analysis when considering surgical intervention. More experienced surgeons reported greater comfort with communicating to patients that a condition was not amenable to an operation and reserved the right to refuse to operate. CONCLUSIONS Due to external pressures and uncertainty, some providers err on the side of operative intervention, despite suspected futility. Greater experience allows surgeons to withstand external pressures, be confident in their assessments of perceived futility, and guide patients and their families away from additional interventions.
Collapse
|
38
|
Grąt M, Lewandowski Z, Patkowski W, Grąt K, Wronka KM, Krasnodębski M, Wróblewski T, Nyckowski P, Krawczyk M. Individual Surgeon Experience Yields Bimodal Effects on Patient Outcomes After Deceased-Donor Liver Transplant: Results of a Quantile Regression for Survival Data. EXP CLIN TRANSPLANT 2017; 16:425-433. [PMID: 29108512 DOI: 10.6002/ect.2017.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Data on the relevance of surgeon experience in liver transplant procedures are scarce. In this study, we evaluated the effects of individual surgeon experience on survival outcomes after deceased-donor liver transplant. MATERIALS AND METHODS In this retrospective analysis of 1193 liver transplant procedures, quantile regression for survival data was performed to assess the effects of surgeon experience. Conditional quantiles of mortality and graft loss were set as primary and secondary outcome measures, respectively, which were categorized as early, midterm, and late. RESULTS Greater experience of a surgeon performing hepatectomy increased the risk of early mortality (P = .005) and graft loss (P = .025) when the recipient Model for End-Stage Liver Disease was ≤ 25 and the donor Model for End-Stage Liver Disease was ≤ 1600. In conventional transplant procedures, greater experience of surgeon performing hepatectomy additionally increased the risk of midterm mortality (P = .027) and graft loss (P = .046). Conversely, a graft implant procedure performed by a more experienced surgeon was associated with better early, midterm, and late outcomes after conventional transplants (all P < .037) and reduced the risk of early graft loss when the donor Model for End-Stage Liver Disease score was > 1600 (P = .027). CONCLUSIONS Unexpectedly, individual surgeon experience yields bimodal effects on posttransplant outcomes, dependent on the stage of operation, operative technique, severity of recipient status, and transplant risk profile.
Collapse
Affiliation(s)
- Michał Grąt
- From the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Zacharia BE, Youngerman BE, Bruce SS, Hershman DL, Neugut AI, Bruce JN, Wright JD. Quality of Postoperative Venous Thromboembolism Prophylaxis in Neuro-oncologic Surgery. Neurosurgery 2017; 80:73-81. [PMID: 27258769 DOI: 10.1227/neu.0000000000001270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Given the vagaries of published guidelines and the lack of high-quality evidence on the method, timing, and dose of venous thromboembolism (VTE) prophylaxis in neurological surgery, little is known about practice patterns regarding VTE prophylaxis in the United States. OBJECTIVE To estimate the use of VTE prophylaxis in patients who underwent surgery for a cerebral neoplasm and to identify patient, physician, and hospital characteristics associated with prophylaxis. METHODS Using the Premier Perspective database, we classified patients undergoing surgery for intracranial neoplasm between 2006 and 2012 on the basis of the type of VTE prophylaxis they received (mechanical, pharmacological, or combination). Generalized estimating equations were used to analyze the effects of pretreatment patient and system variables, including hospital and surgeon volume, on prophylaxis while controlling for hospital clustering. RESULTS A total of 43 327 patients were identified. Venous thromboembolism prophylaxis was given to 70.2% of patients. Overall, 16 957 (39.2%) had only mechanical prophylaxis, 5628 (13%) received only pharmacological prophylaxis, and 7826 (18.1%) received combination prophylaxis. Patients with high-volume providers (odds ratio, 2.22; 95% confidence interval, 1.33-3.69) were more likely to receive prophylaxis. CONCLUSION Nearly one-third of patients who underwent surgery for an intracranial tumor did not receive any VTE prophylaxis. We noted that the rate of overall VTE prophylaxis did not significantly change over the course of the 7 years analyzed despite an increasing focus on complication prevention. High-volume surgeons were more likely to provide VTE prophylaxis.
Collapse
Affiliation(s)
- Brad E Zacharia
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Brett E Youngerman
- Department of Neurological Surgery, Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Samuel S Bruce
- Department of Neurological Surgery, Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | | | | | - Jeffrey N Bruce
- Department of Neurological Surgery, Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| |
Collapse
|
40
|
Breast cancer liver metastases in a UK tertiary centre: Outcomes following referral to tumour board meeting. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.06.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
41
|
Jue JS, Spector SA, Spector SA. Telemedicine broadening access to care for complex cases. J Surg Res 2017; 220:164-170. [PMID: 29180178 DOI: 10.1016/j.jss.2017.06.085] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Surgical and nonsurgical specialists are highly centralized, making access to high-quality care difficult for many Americans. We explored the feasibility, benefits, preliminary outcomes, and patient satisfaction with a new type of health visit, in which a surgical oncologist used video telecommunication to manage and treat complex cancer diseases, including patients with severe comorbidities. MATERIALS AND METHODS Patients visited local VA medical centers throughout Florida to engage in video telecommunication visits with a centralized surgical oncologist in Miami, who directed their oncology treatment. The average length of stay and rate of unplanned readmission were calculated within each organ. The total mileage saved was calculated by subtracting the distance between the patient's home address and the local VA from the distance between the patient's home address and the Miami VA. Travel costs were determined by the VA's reimbursement of $0.415/mile for health-related travel and reimbursement of $150.00 for an overnight hotel stay. A Likert scale with both positively and negatively keyed questions was used to assess patient satisfaction. RESULTS In 24 mo, seven unplanned readmissions occurred among 195 operations. Patients experienced an 80.7% reduction in travel distance and saved a total of 213,007.58 miles by visiting their local VA instead of the Miami VA. Survey results indicate that 86% of patients believed that the telemedicine program made medical care more accessible. CONCLUSIONS The Specialist-Directed Telemedicine Model can save patients substantial time and money by not traveling to centralized areas, while delivering greater continuity of care and patient satisfaction.
Collapse
Affiliation(s)
- Joshua S Jue
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sydney A Spector
- Surgical Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Seth A Spector
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Surgical Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida.
| |
Collapse
|
42
|
Patterns of Specialty-Based Referral and Perioperative Outcomes for Women With Endometrial Cancer Undergoing Hysterectomy. Obstet Gynecol 2017; 130:81-90. [PMID: 28594765 DOI: 10.1097/aog.0000000000002100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine patterns of referral to gynecologic oncologists and perioperative outcomes based on surgeon specialty for women with endometrial cancer and hyperplasia. METHODS The National Surgical Quality Improvement Program database was used to perform a retrospective cohort study of women with endometrial cancer and hyperplasia who underwent hysterectomy from 2014 to 2015. Patients were stratified based on treatment by a gynecologic oncologist or other health care provider. Patterns of referral to a gynecologic oncologist was the primary outcome, and mode of hysterectomy and complications were secondary outcomes. RESULTS A total of 6,510 women were identified. Gynecologic oncologists performed 90.9% (95% confidence interval [CI] 90.1-91.7) of the hysterectomies for endometrial cancer, 66.8% (95% CI 63.1-70.4) for complex atypical endometrial hyperplasia, and 49.3% (95% CI 44.7-53.8) for endometrial hyperplasia without atypia. Older women and those with a higher American Society of Anesthesiology score were more likely to be treated by an oncologist. Minimally invasive hysterectomy was performed in 73.6% (95% CI 72.1-75.1) of women with endometrial cancer operated on by gynecologic oncologists compared with 73.8% (95% CI 68.8-78.2) of those treated by other physicians (odds ratio [OR] 0.99, 95% CI 0.80-1.23); lymphadenectomy was performed in 56.3% of women treated by gynecologic oncologists compared with 34.8% of those treated by other specialists (OR 2.42, 95% CI 1.99-2.94). Severe complications were uncommon and there was no difference in complication rates based on specialty, 2.6% (95% CI 2.2-3.1) compared with 2.0% (95% CI 0.8-3.3). CONCLUSION Gynecologic oncologists provide care for the majority of women with endometrial cancer who undergo hysterectomy in the United States and are also involved in the care of a large percentage of women with endometrial hyperplasia.
Collapse
|
43
|
Alotaibi NM, Ibrahim GM, Wang J, Guha D, Mamdani M, Schweizer TA, Macdonald RL. Neurosurgeon academic impact is associated with clinical outcomes after clipping of ruptured intracranial aneurysms. PLoS One 2017; 12:e0181521. [PMID: 28727832 PMCID: PMC5519166 DOI: 10.1371/journal.pone.0181521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Surgeon-dependent factors such as experience and volume are associated with patient outcomes. However, it is unknown whether a surgeon's research productivity could be related to outcomes. The main aim of this study is to investigate the association between the surgeon's academic productivity and clinical outcomes following neurosurgical clipping of ruptured aneurysms. METHODS We performed a post-hoc analysis of 3567 patients who underwent clipping of ruptured intracranial aneurysms in the randomized trials of tirilazad mesylate from 1990 to 1997. These trials included 162 centers and 156 surgeons from 21 countries. Primary and secondary outcomes were: Glasgow outcome scale score and mortality, respectively. Total publications, H-index, and graduate degrees were used as academic indicators for each surgeon. The association between outcomes and academic factors were assessed using a hierarchical logistic regression analysis, adjusting for patient covariates. RESULTS Academic profiles were available for 147 surgeons, treating a total of 3307 patients. Most surgeons were from the USA (62, 42%), Canada (18, 12%), and Germany (15, 10%). On univariate analysis, the H-index correlated with better functional outcomes and lower mortality rates. In the multivariate model, patients under the care of surgeons with higher H-indices demonstrated improved neurological outcomes (p = 0.01) compared to surgeons with lower H-indices, without any significant difference in mortality. None of the other academic indicators were significantly associated with outcomes. CONCLUSION Although prognostication following surgery for ruptured intracranial aneurysms primarily depends on clinical and radiological factors, the academic impact of the operating neurosurgeon may explain some heterogeneity in surgical outcomes.
Collapse
Affiliation(s)
- Naif M. Alotaibi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Wang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - R. Loch Macdonald
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- * E-mail:
| |
Collapse
|
44
|
Abstract
The quality of surgery is directly dependent on the quantity, more specifically, on the number of operations performed at a given hospital as well as on the designated surgeon. This fact is supported by numerous studies and meta-analyses that will be presented in the following text. Most of the convincing data for complex procedures can be obtained from visceral (upper and lower gastrointestinal) surgery studies. Mortality of large oncological procedures, such as esophageal or pancreatic surgery, can be reduced by 50% if a certain number of interventions are guaranteed per year. Centralizing these operations performed by specialized surgeons is the key to success. This also ensures that the minimum volume amounts within a given hospital are well above the required levels, thus enabling to teach the necessary expertise step by step. The obligatory 'learning curve' for complex interventions cannot be completed within the framework of reference figures during residency training. Together, surgeons and their respective societies have introduced a proposal for efficient case-oriented centralized surgery. Whether 'we are there yet' in surgery will depend in the end on how these efforts will be incorporated into administrative requirements and the guidelines that will then be implemented across the board.
Collapse
Affiliation(s)
| | - Kim C. Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Andrew L. Warshaw, MD Institute for Pancreatic Cancer Research, Thier 623, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
45
|
Vaidyanathan S, Samsudin A, Singh G, Hughes PL, Soni BM, Selmi F. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn. Int Med Case Rep J 2016; 9:253-9. [PMID: 27601933 PMCID: PMC5003592 DOI: 10.2147/imcrj.s99960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case. Case report A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure). Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT) of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30% to 17%. Follow-up CT revealed reduction in the size of subcapsular hematoma, no hydronephrosis, and several residual calculi. Conclusion Risk of subcapsular hematoma following ureteroscopic lithotripsy can be reduced by avoiding prolonged endoscopy and performing ureteroscopy under low pressure. When a paraplegic patient develops features of infection after ureteroscopy, renal imaging should be carried out promptly. Extended perioperative medical care is required for spinal cord injury patients because of their propensity to develop sepsis. Antibiotics should be prescribed on the basis of recent urine microbiology results. Spinal cord injury patients should be treated by senior, experienced doctors and cared for in a spinal injuries unit in order to minimize complications.
Collapse
Affiliation(s)
| | - Azi Samsudin
- Department of Urology, Whiston Hospital, Prescot, UK
| | | | - Peter L Hughes
- Department of Radiology, Southport and Formby District General Hospital, Southport, UK
| | - Bakul M Soni
- Regional Spinal Injuries Center, Southport and Formby District General Hospital, Southport, UK
| | - Fahed Selmi
- Regional Spinal Injuries Center, Southport and Formby District General Hospital, Southport, UK
| |
Collapse
|
46
|
Sahni NR, Dalton M, Cutler DM, Birkmeyer JD, Chandra A. Surgeon specialization and operative mortality in United States: retrospective analysis. BMJ 2016; 354:i3571. [PMID: 27444190 PMCID: PMC4957587 DOI: 10.1136/bmj.i3571] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To measure the association between a surgeon's degree of specialization in a specific procedure and patient mortality. DESIGN Retrospective analysis of Medicare data. SETTING US patients aged 66 or older enrolled in traditional fee for service Medicare. PARTICIPANTS 25 152 US surgeons who performed one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695 987 patients in 2008-13. MAIN OUTCOME MEASURE Relative risk reduction in risk adjusted and volume adjusted 30 day operative mortality between surgeons in the bottom quarter and top quarter of surgeon specialization (defined as the number of times the surgeon performed the specific procedure divided by his/her total operative volume across all procedures). RESULTS For all four cardiovascular procedures and two out of four cancer resections, a surgeon's degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure. CONCLUSION For several common procedures, surgeon specialization was an important predictor of operative mortality independent of volume in that specific procedure. When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon's procedure specific volume as well as the degree to which a surgeon specializes in that procedure.
Collapse
Affiliation(s)
- Nikhil R Sahni
- Department of Economics, Harvard University, Cambridge, MA, USA McKinsey and Company, Boston, MA, USA
| | - Maurice Dalton
- National Bureau of Economic Research, Cambridge, MA, USA
| | - David M Cutler
- Department of Economics, Harvard University, Cambridge, MA, USA National Bureau of Economic Research, Cambridge, MA, USA
| | - John D Birkmeyer
- Dartmouth-Hitchcock Health System, Lebanon, NH, USA Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Amitabh Chandra
- National Bureau of Economic Research, Cambridge, MA, USA Harvard Kennedy School, Cambridge, MA, USA
| |
Collapse
|
47
|
Albarrak J, Firouzbakht A, Peixoto RD, Ho MY, Cheung WY. Correlation between County-Level Surgeon Density and Mortality from Colorectal Cancer. J Gastrointest Cancer 2016; 47:389-395. [DOI: 10.1007/s12029-016-9834-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
48
|
Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 409] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
Collapse
Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
49
|
Are C, Wong S, Leon A. Global Cancer Surgery, or Lack Thereof: A Wake-Up Call. Ann Surg Oncol 2015; 23:1-3. [DOI: 10.1245/s10434-015-4964-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Indexed: 12/30/2022]
|
50
|
Conway RG, Bartlett EK, Hoffman RL, Czerniecki BJ, Karakousis GC, Kelz RR. Residents' Experience in Breast Cancer Care. JOURNAL OF SURGICAL EDUCATION 2015; 72:1233-1239. [PMID: 26119094 DOI: 10.1016/j.jsurg.2015.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE General surgeons commonly treat breast cancer (BC), hence necessitating adequate training during residency. We examined surgery residents' exposure to these conditions across postgraduate years (PGYs) to assess the proximity of involvement to commencement. STUDY DESIGN We examined the BC operative profile by PGY using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (ACS NSQIP PUF, 2008-2011). Operations were classified using the Surgical Council on Resident Education curriculum complexity categories. Univariate analysis was performed using chi-square, Fisher exact, analysis of variance, and Kruskal-Wallis tests, as appropriate. RESULTS Of 58,413 BC operations, 23,996 involved PGY1 to PGY5 residents. A Surgical Council on Resident Education complexity was assigned to 97.7% of operations studied (n = 23,432). PGY was inversely proportional to the number of operations performed. PGY1 to PGY3 residents covered most essential-common operations (PGY1-3, 72% vs PGY4-5, 28%; p < 0.001). PGY1 and PGY2 residents covered more than half of the complex operations (PGY1-2, 55% [n = 359] vs PGY3-5, 45% [n = 288]; p = 0.033). CONCLUSIONS Although junior residents perform most of the BC cases in surgical residency, residents do participate in operations for BC across the continuum of the training years. Program directors should consider trainees' career aspirations to ensure adequate exposure to the operative and nonoperative management of this common disease before the transition to independent practice.
Collapse
Affiliation(s)
- R Gregory Conway
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edmund K Bartlett
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca L Hoffman
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Czerniecki
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|