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de Jager E, Levine AA, Sidey-Gibbons CJ, Udyavar NR, Liu C, Lamaina M, Maggard Gibbons MA, Ko CY, Burstin HR, Haider AH, Hoyt DB, Schoenfeld AJ, Weissman JS, Britt LD. Development and Validation of a Novel Literature-Based Method to Identify Disparity-Sensitive Surgical Quality Metrics. J Am Coll Surg 2023; 237:856-861. [PMID: 37703495 DOI: 10.1097/xcs.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Disparity in surgical care impedes the delivery of uniformly high-quality care. Metrics that quantify disparity in care can help identify areas for needed intervention. A literature-based Disparity-Sensitive Score (DSS) system for surgical care was adapted by the Metrics for Equitable Access and Care in Surgery (MEASUR) group. The alignment between the MEASUR DSS and Delphi ratings of an expert advisory panel (EAP) regarding the disparity sensitivity of surgical quality metrics was assessed. STUDY DESIGN Using DSS criteria MEASUR co-investigators scored 534 surgical metrics which were subsequently rated by the EAP. All scores were converted to a 9-point scale. Agreement between the new measurement technique (ie DSS) and an established subjective technique (ie importance and validity ratings) were assessed using the Bland-Altman method, adjusting for the linear relationship between the paired difference and the paired average. The limit of agreement (LOA) was set at 1.96 SD (95%). RESULTS The percentage of DSS scores inside the LOA was 96.8% (LOA, 0.02 points) for the importance rating and 94.6% (LOA, 1.5 points) for the validity rating. In comparison, 94.4% of the 2 subjective EAP ratings were inside the LOA (0.7 points). CONCLUSIONS Applying the MEASUR DSS criteria using available literature allowed for identification of disparity-sensitive surgical metrics. The results suggest that this literature-based method of selecting quality metrics may be comparable to more complex consensus-based Delphi methods. In fields with robust literature, literature-based composite scores may be used to select quality metrics rather than assembling consensus panels.
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Affiliation(s)
- Elzerie de Jager
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Adele A Levine
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Chris J Sidey-Gibbons
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - N Rhea Udyavar
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Charles Liu
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Margherita Lamaina
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Melinda A Maggard Gibbons
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Clifford Y Ko
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Helen R Burstin
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Adil H Haider
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - David B Hoyt
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Andrew J Schoenfeld
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Joel S Weissman
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - L D Britt
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
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de Jager E, Osman SY, Levine AA, Liu C, Maggard Gibbons MA, Ko CY, Burstin HR, Haider AH, Hoyt DB, Schoenfeld AJ, Britt LD, Weissman JS. Disparity-Sensitive Measures in Surgical Care: A Delphi Panel Consensus. J Am Coll Surg 2023; 236:135-143. [PMID: 36111798 PMCID: PMC9771907 DOI: 10.1097/xcs.0000000000000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the US, disparities in surgical care impede the delivery of uniformly high-quality care to all patients. There is a lack of disparity-sensitive measures related to surgical care. The American College of Surgeons Metrics for Equitable Access and Care in Surgery group, through research and expert consensus, aimed to identify disparity-sensitive measures in surgical care. STUDY DESIGN An environmental scan, systematic literature review, and subspecialty society surveys were conducted to identify potential disparity-sensitive surgical measures. A modified Delphi process was conducted where panelists rated measures on both importance and validity. In addition, a novel literature-based disparity-sensitive scoring process was used. RESULTS We identified 841 potential disparity-sensitive surgical measures. From these, our Delphi and literature-based approaches yielded a consensus list of 125 candidate disparity-sensitive measures. These measures were rated as both valid and important and were supported by the existing literature. CONCLUSION There are profound disparities in surgical care within the US healthcare system. A multidisciplinary Delphi panel identified 125 potential disparity-sensitive surgical measures that could be used to track health disparities, evaluate the impact of focused interventions, and reduce healthcare inequity.
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Affiliation(s)
- Elzerie de Jager
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, AUS
| | - Samia Y Osman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Adele A Levine
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Charles Liu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | | | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA
- American College of Surgeons, Chicago, IL
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Andrew J Schoenfeld
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - LD Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
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Barpujari A, Singh R, Hoyt DB. The Importance of Physicians Voting in the US-Reply. JAMA Surg 2022; 157:1067. [PMID: 36001307 DOI: 10.1001/jamasurg.2022.3699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
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Barpujari A, Mehra M, Singh R, Wang K, Sherman B, Gopali R, Deme P, Reddy VP, Hoyt DB. Political Campaign Contributions of Surgeons in the United States Throughout the 2020 Election Cycle. JAMA Surg 2022; 157:515-522. [PMID: 35416934 PMCID: PMC9008566 DOI: 10.1001/jamasurg.2022.0798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Political engagement by the physician workforce is necessary to ensure continued representation of their interests in health care legislation. Limited data are available pertaining to the political involvement of US surgeons. Objective To analyze the magnitude and distribution of political donations made by all US surgeons throughout the 2020 election cycle. Design, Setting, and Participants Partisan and geographical differences in surgeon contributions by aggregating data (January 1 through December 31, 2020) from the US Federal Election Commission database were analyzed. Contributions were labeled as Republican, Democrat, or independent depending on the committee they were designated to. Main Outcomes and Measures Differences in contributions to Republicans, Democrats, and independent candidates for all US surgeons and for subgroups. Results For the 2020 election year, a total of 53 944 donations were made by surgeons in the United States, amounting to $9 223 350.68. Among all surgical specialties, the top 5 highest number of contributions were made from orthopedic surgeons (n = 15 081), ophthalmic surgeons (n = 14 836), neurological surgeons (n = 7481), urologists (n = 4544), and plastic surgeons (n = 4060). Of these donations, 59.46% (n = 32 107) were made to the Republican party ($5 420 326), 30.83% (n = 16 644) were made to the Democratic party ($1 612 775), and 9.71% (n = 5243) were made to nonpartisan (ie, independent) organizations ($2 190 250). Overall, pediatric surgeons reported the lowest mean contribution amount of $59.43, whereas thoracic surgeons reported the highest mean contribution amount of $225.19. Conclusions and Relevance Health care legislation has an immense impact on how medicine is practiced and utilized. This analysis reveals a high degree of political activity of surgeons across different specialties and geographic regions.
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Affiliation(s)
| | | | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
| | - Kendra Wang
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Benjamin Sherman
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Palvasha Deme
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Vamsi P. Reddy
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
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Hoyt DB. Operating room resuscitation. J Trauma Acute Care Surg 2022; 92:800. [PMID: 35195093 DOI: 10.1097/ta.0000000000003587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heiderscheit EA, Schlick CJR, Ellis RJ, Cheung EO, Irizarry D, Amortegui D, Eng J, Sosa JA, Hoyt DB, Buyske J, Nasca TJ, Bilimoria KY, Hu YY. Experiences of LGBTQ+ Residents in US General Surgery Training Programs. JAMA Surg 2021; 157:23-32. [PMID: 34668969 DOI: 10.1001/jamasurg.2021.5246] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored. Objective To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers. Design, Setting, and Participants A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination. Main Outcomes and Measures Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity. Results A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39). Conclusions and Relevance Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.
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Affiliation(s)
- Evan A Heiderscheit
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cary Jo R Schlick
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elaine O Cheung
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dre Irizarry
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Palo Alto, California
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, Pennsylvania
| | - Thomas J Nasca
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Hewitt DB, Ellis RJ, Chung JW, Cheung EO, Moskowitz JT, Huang R, Merkow RP, Yang AD, Hu YY, Cohen ME, Ko CY, Hoyt DB, Bilimoria KY. Association of Surgical Resident Wellness With Medical Errors and Patient Outcomes. Ann Surg 2021; 274:396-402. [PMID: 32282379 DOI: 10.1097/sla.0000000000003909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to: (1) measure the prevalence of self-reported medical error among general surgery trainees, (2) assess the association between general surgery resident wellness (ie, burnout and poor psychiatric well-being) and self-reported medical error, and (3) examine the association between program-level wellness and objectively measured patient outcomes. SUMMARY OF BACKGROUND DATA Poor wellness is prevalent among surgical trainees but the impact on medical error and objective patient outcomes (eg, morbidity or mortality) is unclear as existing studies are limited to physician and patient self-report of events and errors, small cohorts, or examine few outcomes. METHODS A cross-sectional survey was administered immediately following the January 2017 American Board of Surgery In-training Examination to clinically active general surgery residents to assess resident wellness and self-reported error. Postoperative patient outcomes were ascertained using a validated national clinical data registry. Associations were examined using multivariable logistic regression models. RESULTS Over a 6-month period, 22.5% of residents reported committing a near miss medical error, and 6.9% reported committing a harmful medical error. Residents were more likely to report a harmful medical error if they reported frequent burnout symptoms [odds ratio 2.71 (95% confidence interval 2.16-3.41)] or poor psychiatric well-being [odds ratio 2.36 (95% confidence interval 1.92-2.90)]. However, there were no significant associations between program-level resident wellness and any of the independently, objectively measured postoperative American College of Surgeons National Surgical Quality improvement Program outcomes examined. CONCLUSIONS Although surgical residents with poor wellness were more likely to self-report a harmful medical error, there was not a higher rate of objectively reported outcomes for surgical patients treated at hospitals with higher rates of burnout or poor psychiatric well-being.
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Affiliation(s)
- Daniel Brock Hewitt
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| | - Jeanette W Chung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Reiping Huang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
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Schlick CJR, Ellis RJ, Etkin CD, Greenberg CC, Greenberg JA, Turner PL, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY, Hu YY. Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US. JAMA Surg 2021; 156:942-952. [PMID: 34319377 DOI: 10.1001/jamasurg.2021.3195] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions. Objective To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. Design, Setting, and Participants This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. Exposures Specific types, sources, and factors associated with gender-based discrimination and sexual harassment. Main Outcomes and Measures Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models. Results The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents). Conclusions and Relevance In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.
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Affiliation(s)
- Cary Jo R Schlick
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Caryn D Etkin
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine, Madison
| | - Jacob A Greenberg
- Department of Surgery, University of Wisconsin School of Medicine, Madison
| | - Patricia L Turner
- American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago, Chicago, Illinois
| | - Jo Buyske
- American Board of Surgery, Philadelphia, Pennsylvania
| | | | - Thomas J Nasca
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Richardson JD, Sachdeva AK, Hoyt DB. Importance of Practice Continuity. J Am Coll Surg 2021; 233:554-556. [PMID: 34329748 DOI: 10.1016/j.jamcollsurg.2021.07.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
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Fischer CP, Hu QL, Wescott AB, Maggard-Gibbons M, Hoyt DB, Ko CY. Evidence Review for the American College of Surgeons Quality Verification Part II: Processes for Reliable Quality Improvement. J Am Coll Surg 2021; 233:294-311.e1. [PMID: 33940183 DOI: 10.1016/j.jamcollsurg.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/21/2022]
Abstract
After decades of experience supporting surgical quality and safety by the American College of Surgeons, the American College of Surgeons Quality Verification Program was developed to help hospitals improve surgical quality, safety, and reliability. This review is the second of a 3-part review aiming to synthesize the evidence supporting the main principles of the American College of Surgeons Quality Verification Program. Evidence was systematically reviewed for 5 principles: case review, peer review, credentialing and privileging, data for surveillance, and continuous quality improvement using data. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical fashion, extracted data, and summarized results in a narrative fashion. A total of 9,098 studies across the 5 principles were identified. After exclusion criteria, a total of 184 studies in systematic reviews and primary studies were included for assessment. The identified literature supports the importance of standardized processes and systems to identify problems and improve quality of care.
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Affiliation(s)
- Chelsea P Fischer
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Q Lina Hu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Annie B Wescott
- Galter Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - David B Hoyt
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; THIS Institute, University of Cambridge, UK
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11
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Buchwald H, Buchwald JN, Pories WJ, Hoyt DB. Executive Summary: Collected Papers of the American College of Surgeons Metabolic Surgery Symposium. Obes Surg 2021; 30:1961-1970. [PMID: 32072370 DOI: 10.1007/s11695-020-04451-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
On August 9-10, 2017, the American College of Surgeons hosted a symposium on metabolic surgery, with 12 follow-on papers published serially in the Bulletin of the College. The current synopsis outlines the varied contents of these papers, often in the original words of their authors, who are cited within their topic sections. Topics covered include the following: history and definition of metabolic surgery, bariatric surgery, international bariatric surgery, mechanisms of metabolic surgery, diabetes and the metabolic syndrome, frontiers of metabolic surgery, institutional collaborations, accreditations and quality initiatives, professional training, the role of the National Institutes of Health, and advocacy. Based on these insights, an enthusiastic affirmation for the future of metabolic surgery is warranted.
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Affiliation(s)
- Henry Buchwald
- University of Minnesota Medical School, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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12
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Yuce TK, Turner PL, Glass C, Hoyt DB, Nasca T, Bilimoria KY, Hu YY. National Evaluation of Racial/Ethnic Discrimination in US Surgical Residency Programs. JAMA Surg 2021; 155:526-528. [PMID: 32293655 DOI: 10.1001/jamasurg.2020.0260] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tarik K Yuce
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patricia L Turner
- American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago, Chicago, Illinois
| | - Charity Glass
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Thomas Nasca
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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13
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Demblowski LA, Busse B, Santangelo G, Blakely AM, Turner PL, Hoyt DB, Zeiger MA. NIH Funding for Surgeon-Scientists in the US: What Is the Current Status? J Am Coll Surg 2021; 232:265-274.e2. [PMID: 33588041 DOI: 10.1016/j.jamcollsurg.2020.12.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent literature suggests that the future of surgeon-scientists in the US has been threatened for the past several decades. However, we documented an overall increase in NIH funding for surgeon-scientists, as well as the number of NIH-funded surgeons, from 2010 to 2020. STUDY DESIGN NIH-funded principal investigators (PIs) were identified for June 2010 and June 2020 using the NIH internal data platform iSearch Grants (version 2.4). Biographical sketches were searched for key terms to identify surgeon-scientists. Grant research types and total grant costs were collected. American Association of Medical Colleges data were used to determine total surgeon and physician populations. Bivariate chi-square analyses were performed using population totals and were corroborated using z-tests of population proportions using JMP (version 13.0.0). A 2-tailed p value <0.05 was considered significant. RESULTS In June of 2020, a total of 1,031 surgeon-scientists held $872,456,710 in NIH funding. The percentage of funded surgeons significantly increased from 2010 (0.5%) to 2020 (0.7%) (p < 0.05), and the percentage of funded other physicians significantly decreased from 2.2% in 2010 to 1.6% in 2020 (p < 0.05). All surgeons sustained R grant funding at both time points (58% in 2020 and 60% in 2010), and specifically maintained basic science-focused R grants (73% in 2020 and 78% in 2010). CONCLUSIONS Our study found surgeon-scientists are increasing in number and NIH funding and are becoming more diverse in their research efforts, while maintaining a focus on basic science.
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Affiliation(s)
| | - Brad Busse
- Office of Portfolio Analysis, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD
| | - George Santangelo
- Office of Portfolio Analysis, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD
| | - Andrew M Blakely
- Surgical Oncology Program, National Cancer Institute, NIH, Bethesda, MD
| | | | | | - Martha A Zeiger
- Surgical Oncology Program, National Cancer Institute, NIH, Bethesda, MD.
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14
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Nelson H, Ko CY, Hoyt DB. American College of Surgeons Efforts in Support of Value-Based Metrics. JAMA Oncol 2021; 7:307-308. [PMID: 33300947 DOI: 10.1001/jamaoncol.2020.6462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
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15
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Schlick CJR, Ellis RJ, Etkin CD, Greenberg CC, Greenberg JA, Buyske J, Hoyt DB, Nasca T, Bilimoria KY, Hu YY. Experiences of Gender Discrimination and Sexual Harassment among US General Surgery Residents. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hu QL, Fischer CP, Wescott AB, Maggard-Gibbons M, Hoyt DB, Ko CY. Evidence Review for the American College of Surgeons Quality Verification Part I: Building Quality and Safety Resources and Infrastructure. J Am Coll Surg 2020; 231:557-569.e1. [PMID: 33002588 DOI: 10.1016/j.jamcollsurg.2020.08.758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/27/2022]
Abstract
Decades of quality program development by the American College of Surgeons (ACS) have identified the key components of a successful program for optimal surgical care and quality improvement. These key principles have been developed into a verification program-the ACS Quality Verification Program-to guide hospitals to improve surgical quality, safety, and reliability across all surgical specialties. The aim of this review was to synthesize the evidence supporting the first 4 of 12 ACS Quality Verification Program core principles of building quality and safety resources and infrastructure. MEDLINE was searched for articles published from inception to January 2019 for studies describing principles of leadership commitment to surgical quality and safety, a surgical quality officer, a surgical quality committee, and a culture of safety and high reliability. Two reviewers independently screened studies for inclusion in a hierarchical fashion, extracted data, and summarized results in a narrative fashion. A total of 5,332 studies across the 4 principles were identified. After exclusion criteria, a total of 477 studies in systematic reviews and primary studies were included for assessment. Despite heterogeneous study design and lack of randomized controlled trials, the available literature supports the importance of committed top-level hospital leadership, mid-level leadership, and committee dedicated to surgical quality and culture of safety and high reliability. In conclusion, adequate resources and infrastructure integral to the ACS Quality Verification Program are critical to achieving safe and high-quality surgical outcomes.
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Affiliation(s)
- Q Lina Hu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Chelsea P Fischer
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Annie B Wescott
- Galter Library and Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - David B Hoyt
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
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17
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Ellis RJ, Hu YY, Jones AT, Kopp JP, Soper NJ, Hoyt DB, Buyske J. Association Between Resident Physician Training Experience and Program-Level Performance on Board Examinations. JAMA Surg 2020; 155:163-165. [PMID: 31693059 DOI: 10.1001/jamasurg.2019.4464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ryan J Ellis
- Feinberg School of Medicine, Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Feinberg School of Medicine, Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, Illinois
| | | | - Jason P Kopp
- American Board of Surgery, Philadelphia, Pennsylvania
| | - Nathaniel J Soper
- Feinberg School of Medicine, Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, Illinois
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, Pennsylvania
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Wexner SD, Hoyt DB, Cortés-Guiral D. The American College of Surgeons Response to the COVID-19 Pandemic (Part III): Leadership in a Time of Crisis. Am Surg 2020; 86:762-765. [PMID: 32916069 DOI: 10.1177/0003134820940772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The response of the American College of Surgeons (ACS) to the COVID-19 pandemic was vigorous and effective because it had mature programs in surgical quality and health policy and advocacy, the legacy of decades of work by its officers and leaders and its current executive director, David Hoyt. Hoyt had the foresight to institute a digital communications platform upon which the College collected data for its clinical programs and conducted many of its meetings. Through internet portals, online communities, and social media it broadcasted news and information to the membership. When the global COVID-19 pandemic struck, the College was able to quickly mobilize its leaders and scientific experts to disseminate credible information, recommend protocols to maintain patient and provider safety in operating room environments, provide a rational scheme of prioritization of urgent surgical operations, and a sensible means of resumption of normal surgical practice. As the financial impact of the outbreak on surgical practice became apparent, the ACS represented the interests of surgeons in the White House, Capitol, federal agencies, and governors' mansions and statehouses. In an interview by Steven Wexner, a member of the ACS Board of Regents, Hoyt described the response of the ACS to an unprecedented threat to the surgical care of patients in the country and the world. His story demonstrates the legacy of credibility and professionalism built by decades of principled leadership of generations of officers and Regents of the College, and his own example of effective leadership in crisis.
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Abstract
This survey study describes surgical trainees’ self-reported experiences of bullying and symptoms of burnout and suicidality assessed at the time of their board certification examination.
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Affiliation(s)
- Lindsey M. Zhang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Ryan J. Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Meixi Ma
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Elaine O. Cheung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | | | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
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20
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Liu JY, Ellis RJ, Hu QL, Cohen ME, Hoyt DB, Yang AD, Bentrem DJ, Ko CY, Pawlik TM, Bilimoria KY, Merkow RP. Post Hepatectomy Liver Failure Risk Calculator for Preoperative and Early Postoperative Period Following Major Hepatectomy. Ann Surg Oncol 2020; 27:2868-2876. [DOI: 10.1245/s10434-020-08239-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Indexed: 12/13/2022]
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21
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de Jager E, Levine AA, Udyavar NR, Burstin HR, Bhulani N, Hoyt DB, Ko CY, Weissman JS, Britt LD, Haider AH, Maggard-Gibbons MA. Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map. J Am Coll Surg 2020; 228:276-298. [PMID: 30803548 DOI: 10.1016/j.jamcollsurg.2018.12.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Elzerie de Jager
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Adele A Levine
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - N Rhea Udyavar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Nizar Bhulani
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - L D Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - Melinda A Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
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22
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Hu YY, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, Potts JR, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med 2019; 381:1741-1752. [PMID: 31657887 PMCID: PMC6907686 DOI: 10.1056/nejmsa1903759] [Citation(s) in RCA: 486] [Impact Index Per Article: 97.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.
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Affiliation(s)
- Yue-Yung Hu
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Ryan J Ellis
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - D Brock Hewitt
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Anthony D Yang
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Elaine Ooi Cheung
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Judith T Moskowitz
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - John R Potts
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Jo Buyske
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - David B Hoyt
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Thomas J Nasca
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Karl Y Bilimoria
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
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Khorfan R, Yuce T, Love R, Yang A, Chung JW, Hoyt DB, Lewis F, Bilimoria KY. Cumulative Effect of Flexible Duty Hour Policies on Resident Outcomes: Long-Term Follow-Up Results from the FIRST Trial. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yang AD, Quinn CM, Hewitt DB, Chung JW, Zembower TR, Jones A, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY. National Evaluation of Needlestick Events and Reporting Among Surgical Residents. J Am Coll Surg 2019; 229:609-620. [PMID: 31541698 DOI: 10.1016/j.jamcollsurg.2019.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Needlestick injuries pose significant health hazards; however, the nationwide frequency of needlesticks and reporting practices among surgical residents are unknown. The objectives of this study were to examine the rate and circumstances of self-reported needlestick events in US surgery residents, assess factors associated with needlestick injuries, evaluate reporting practices, and identify reporting barriers. STUDY DESIGN A survey administered after the American Board of Surgery In-Training Examination (January 2017) asked surgical residents how many times they experienced a needlestick during the last 6 months, circumstances of the most recent event, and reporting practices and barriers. Factors associated with needlestick events were examined using multivariable hierarchical regression models. RESULTS Among 7,395 resident survey respondents from all 260 US general surgery residency programs (99.3% response rate), 27.7% (n = 2,051) noted experiencing a needlestick event in the last 6 months. Most events occurred in the operating room (77.5%) and involved residents sticking themselves (76.2%), mostly with solid needles (84.7%). Self-reported factors underlying needlestick events included residents' own carelessness (48.8%) and feeling rushed (31.3%). Resident-level factors associated with self-reported needlestick events included senior residents (PGY5 29.9% vs PGY1 22.4%; odds ratio 1.66; 95% CI 1.41 to 1.96), female sex (31.9% vs male 25.2%; odds ratio 1.31; 95% CI 1.18 to 1.46), or frequently working more than 80 hours per week (odds ratio 1.42; 95% CI 1.20 to 1.68). More than one-fourth (28.7%) of residents did not report the needlestick event to employee health. CONCLUSIONS In this comprehensive national survey of surgical residents, needlesticks occurred frequently. Many needlestick events were not reported and numerous reporting barriers exist. These findings offer guidance in identifying opportunities to reduce needlesticks and encourage reporting of these potentially preventable injuries among trainees.
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Affiliation(s)
- Anthony D Yang
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern Medicine, Chicago, IL.
| | - Christopher M Quinn
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern Medicine, Chicago, IL
| | - D Brock Hewitt
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern Medicine, Chicago, IL; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jeanette W Chung
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern Medicine, Chicago, IL
| | - Teresa R Zembower
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
| | | | - Thomas J Nasca
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern Medicine, Chicago, IL
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Hoyt DB. Reducing the impact of violence on the health status of African-Americans: Literature review and recommendations from the Society of Black Academic Surgeons. Am J Surg 2018; 216:831-832. [DOI: 10.1016/j.amjsurg.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Maier RV, Freischlag JA, Hoyt DB, Pellegrini CA, Torchiana DF, Zinner MJ. Is There Life After Surgery?: American Surgical Association Forum 138th Annual Meeting, April 20, 2018. Ann Surg 2018; 268:551-556. [PMID: 30048304 DOI: 10.1097/sla.0000000000002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ommaya AK, Cipriano PF, Hoyt DB, Horvath KA, Tang P, Paz HL, DeFrancesco MS, Hingle ST, Butler S, Sinsky CA. Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout. NAM Perspect 2018. [DOI: 10.31478/201801c] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bilimoria KY, Hoyt DB, Lewis F. Perspective of the FIRST Trial Investigators on Accreditation Council for Graduate Medical Education Changes in Resident Work Environment and Duty Hours. JAMA Surg 2017; 152:903-904. [DOI: 10.1001/jamasurg.2017.2218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2American College of Surgeons, Chicago, Illinois
| | | | - Frank Lewis
- American Board of Surgery, Philadelphia, Pennsylvania
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Liu JB, Ban KA, Berian JR, Hutter MM, Huffman KM, Liu Y, Hoyt DB, Hall BL, Ko CY. Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study. BMJ 2017; 358:j4244. [PMID: 28951446 PMCID: PMC5613750 DOI: 10.1136/bmj.j4244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
Objective To determine whether perioperative outcomes differ between patients undergoing concurrent compared with non-concurrent bariatric operations in the USA.Design Retrospective, propensity score matched cohort study.Setting Hospitals in the US accredited by the American College of Surgeons' metabolic and bariatric surgery accreditation and quality improvement program.Participants 513 167 patients undergoing bariatric operations between 1 January 2014 and 31 December 2016.Main outcome measures The primary outcome measure was a composite of 30 day death, morbidity, readmission, reoperation, anastomotic or staple line leak, and bleeding events. Operative duration and lengths of stay were also assessed. Operations were defined as concurrent if they overlapped by 60 or more minutes or in their entirety.Results In this study of 513 167 operations, 739 (29.5%) surgeons at 483 (57.8%) hospitals performed 6087 (1.2%) concurrent operations. The most frequently performed concurrent bariatric operations were sleeve gastrectomy (n=3250, 53.4%) and Roux-en-Y gastric bypass (n=1601, 26.3%). Concurrent operations were more often performed at large academic medical centers with higher operative volumes and numbers of trainees and by higher volume surgeons. Compared with non-concurrent operations, concurrent operations lasted a median of 34 minutes longer (P<0.001) and resulted in 0.3 days longer average length of stay (P<0.001). Perioperative adverse events were not observed to more likely occur in concurrent compared with non-concurrent operations (7.5% v 7.4%; relative risk 1.02, 95% confidence interval 0.90 to 1.15; P=0.84).Conclusions Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations. These results, however, do not argue against improved and more meaningful disclosure of concurrent surgery practices.
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Affiliation(s)
- Jason B Liu
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kristen A Ban
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Julia R Berian
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Matthew M Hutter
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Yaoming Liu
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
| | - David B Hoyt
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
| | - Bruce L Hall
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
- Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Olin Business School, Washington University in St Louis, St Louis, MO, USA; BJC Healthcare, St Louis, MO, USA
| | - Clifford Y Ko
- American College of Surgeons, 633 N St Clair St, Chicago, IL, 60611, USA
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Affiliation(s)
- David B Hoyt
- University of California, Irvine, Irvine, CA, USA; American College of Surgeons, 633 North Saint Clair Street, Chicago, IL 60611-3211, USA.
| | - Peter Angelos
- Endocrine Surgery, Department of Surgery, MacLean Center for Clinical Medical Ethics, The University of Chicago Medicine, MC 4052, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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Hoyt DB. Looking forward. Bull Am Coll Surg 2017; 102:10-12. [PMID: 28885800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Affiliation(s)
- Dwight W. Burney
- Patient Safety Committee, American Academy of Orthopaedic Surgeons, Los Ranchos, New Mexico
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Hoyt DB. Looking forward. Bull Am Coll Surg 2017; 102:8-10. [PMID: 28885803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward. Bull Am Coll Surg 2017; 102:8-10. [PMID: 28892320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – April 2017. Bull Am Coll Surg 2017; 102:9-10. [PMID: 28920640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Bilimoria KY, Quinn CM, Dahlke AR, Kelz RR, Shea JA, Rajaram R, Love R, Kreutzer L, Biester T, Yang AD, Hoyt DB, Lewis FR. Use and Underlying Reasons for Duty Hour Flexibility in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. J Am Coll Surg 2017; 224:118-125. [DOI: 10.1016/j.jamcollsurg.2016.10.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 01/11/2023]
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Hoyt DB. Looking forward – February 2017. Bull Am Coll Surg 2017; 102:9-11. [PMID: 28925172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Stulberg JJ, Pavey ES, Cohen ME, Ko CY, Hoyt DB, Bilimoria KY. Effect of Flexible Duty Hour Policies on Length of Stay for Complex Intra-Abdominal Operations: A Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Analysis. J Am Coll Surg 2017; 224:143-148.e1. [DOI: 10.1016/j.jamcollsurg.2016.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
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Hoyt DB. Looking forward – January 2017. Bull Am Coll Surg 2017; 102:8-10. [PMID: 28925606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – December 2016. Bull Am Coll Surg 2016; 101:9-11. [PMID: 28936856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Executive Director’s annual report. Bull Am Coll Surg 2016; 101:46-62. [PMID: 28936864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – November 2016. Bull Am Coll Surg 2016; 101:9-11. [PMID: 28937186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – October 2016. Bull Am Coll Surg 2016; 101:8-9. [PMID: 28937708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – September 2016. Bull Am Coll Surg 2016; 101:8-10. [PMID: 28941365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – August 2016. Bull Am Coll Surg 2016; 101:9-10. [PMID: 28941424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Hoyt DB. Looking forward – July 2016. Bull Am Coll Surg 2016; 101:7-8. [PMID: 28941442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
Ultrasound is used worldwide to evaluate patients with blunt abdominal trauma. Sometimes referred to as an extension of the physical exam, ultrasound can rapidly help distinguish patients with injury requiring computerized tomography (CT) or surgery (typically 5%-10%) from those with no abdominal injury (> 90%). Ultrasound has several advantages in the setting of trauma. It is portable, integrates easily into the resuscitation of trauma victims without causing delay in therapy, is noninvasive, and has no associated morbidity. Limitations of ultrasound include its dependence on operator skill and technique, poor image quality in patients with morbid obesity or extensive subcutaneous gas, limited visualization of the retroperitoneum, and less reliable localization of visceral injury compared to CT. Successful use of abdominal ultrasound in the setting of trauma can be maximized with adequate sonographer training, appreciation of technical limitations, and adherence to an appropriate trauma ultrasound protocol.
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Affiliation(s)
- Michèle A Brown
- Department of Radiology, UCSD Medical Center, San Diego, CA 92103, USA.
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Hoyt DB. Looking forward. Bull Am Coll Surg 2016; 101:8-11. [PMID: 27405179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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