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Weaver ML, Drudi LM, Adams AM, Faria I, Feldman HA, Gudmundsdottir H, Marmor H, Miles MVP, Ochoa B, Ruff SM, Sundland R, Tonelli C, Altieri MS, Cannada LK, Dewan K, Etkin Y, Marmor R, Plichta JK, Reyna C, Tatebe LC, Hicks CW. Implementation of a novel peer review academy by Surgery and the Association of Women Surgeons. Surgery 2024; 175:323-330. [PMID: 37953152 PMCID: PMC10842028 DOI: 10.1016/j.surg.2023.09.050] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND A novel Peer Review Academy was developed as a collaborative effort between the Association of Women Surgeons and the journal Surgery to provide formal training in peer review. We aimed to describe the outcomes of this initiative using a mixed methods approach. METHODS We developed a year-long curriculum with monthly online didactic sessions. Women surgical trainee mentees were paired 1:1 with rotating women surgical faculty mentors for 3 formal peer review opportunities. We analyzed pre-course and post-course surveys to evaluate mentee perceptions of the academy and assessed changes in mentee review quality over time with blinded scoring of unedited reviews. Semi-structured interviews were conducted upon course completion. RESULTS Ten women surgical faculty mentors and 10 women surgical trainees from across the United States and Canada successfully completed the Peer Review Academy. There were improvements in the mentees' confidence for all domains of peer review evaluated, including overall confidence in peer review, study novelty, study design, analytic approach, and review formatting (all, P ≤ .02). The mean score of peer review quality increased over time (59.2 ± 10.8 vs 76.5 ± 9.4; P = .02). In semi-structured interviews, important elements were emphasized across the Innovation, Implementation Process, and Individuals Domains, including the values of (1) a comprehensive approach to formal peer review education; (2) mentoring relationships between women faculty and resident surgeons; and (3) increasing diversity in the scientific peer review process. CONCLUSION Our novel Peer Review Academy was feasible on a national scale, resulting in significant qualitative and quantitative improvements in women surgical trainee skillsets, and has the potential to grow and diversify the existing peer review pool.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Hope A Feldman
- Department of General Surgery, Geisinger Medical Center, Danville, PA
| | | | - Hannah Marmor
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY
| | - M Victoria P Miles
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brielle Ochoa
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samantha M Ruff
- Division of Surgical Oncology, The Ohio State University, Columbus, OH
| | | | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Lisa K Cannada
- Novant Health Fracture Clinic, University of North Carolina-Charlotte School of Medicine, Charlotte, NC
| | - Karuna Dewan
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University, New Orleans, LA
| | - Yana Etkin
- Division of Vascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Rebecca Marmor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chantal Reyna
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Leah C Tatebe
- Department of Surgery, Northwestern University, Chicago, IL
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Gershuni V, Wall-Wieler E, Liu Y, Zheng F, Altieri MS. Observational cohort investigating health outcomes and healthcare costs after metabolic and bariatric surgery: a study protocol. BMJ Open 2024; 14:e077143. [PMID: 38272560 PMCID: PMC10824029 DOI: 10.1136/bmjopen-2023-077143] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION As the rate of obesity increases, so does the incidence of obesity-related comorbidities. Metabolic and bariatric surgery (MBS) is the most effective treatment for obesity, yet this treatment is severely underused. MBS can improve, resolve, and prevent the development of obesity-related comorbidities; this improvement in health also results in lower healthcare costs. The studies that have examined these outcomes are often limited by small sample sizes, reliance on outdated data, inconsistent definitions of outcomes, and the use of simulated data. Using recent real-world data, we will identify characteristics of individuals who qualify for MBS but have not had MBS and address the gaps in knowledge around the impact of MBS on health outcomes and healthcare costs. METHODS AND ANALYSIS Using a large US employer-based retrospective claims database (Merative), we will identify all obese adults (21+) who have had a primary MBS from 2016 to 2021 and compare their characteristics and outcomes with obese adults who did not have an MBS from 2016 to 2021. Baseline demographics, health outcomes, and costs will be examined in the year before the index date, remission and new-onset comorbidities, and healthcare costs will be examined at 1 and 3 years after the index date. ETHICS AND DISSEMINATION As this was an observational study of deidentified patients in the Merative database, Institutional Review Board approval and consent were exempt (in accordance with the Health Insurance Portability and Accountability Act Privacy Rule). An IRB exemption was approved by the wcg IRB (#13931684). Knowledge dissemination will include presenting results at national and international conferences, sharing findings with specialty societies, and publishing results in peer-reviewed journals. All data management and analytic code will be made available publicly to enable others to leverage our methods to verify and extend our findings.
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Affiliation(s)
- Victoria Gershuni
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Yuki Liu
- Intuitive Surgical, Sunnyvale, California, USA
| | - Feibi Zheng
- Intuitive Surgical, Sunnyvale, California, USA
- DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gershuni V, Wall-Wieler E, Liu Y, Zheng F, Altieri MS. Equity in bariatric surgery use: a cohort study. Surg Obes Relat Dis 2024:S1550-7289(24)00022-4. [PMID: 38336582 DOI: 10.1016/j.soard.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 07/17/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the most effective and durable treatment for obesity; however, access to MBS is not equitable. OBJECTIVE To determine the rate of MBS among eligible adults with obesity by demographics, health characteristics, and geography to better define populations that would benefit from resources to reduce barriers to access for this treatment. SETTING Adults with obesity were identified in the US employer-based retrospective claims database (Merative™). METHODS Rates of MBS were examined across demographics (age, sex, region, year, health plan type) health characteristics (obesity-related comorbidities, healthcare costs, inpatient admissions), and by state. Given differences in coverage requirements, rates are examined for 2 populations: Class 2 (BMI 35-39.9 kg/m2) and Class 3 (BMI 40+ kg/m2) obesity. RESULTS Of the 777,565 eligible adults, 49,371 (6.4%) had MBS; 3.2% of those with Class 2 and 8.3% of those with Class 3 obesity had MBS. MBS rates varied substantially by demographic and health characteristics, ranging from 1% to 14%, and from 2% to 41% among those with Class 2 and Class 3 obesity, respectively. Geographically, rates ranged from 0% (Hawaii) to 7.4% (New Mexico) for those with Class 2 Obesity and from 4.2% (Hawaii) to 15.3% (Mississippi) among those with Class 3 Obesity. CONCLUSIONS Use of MBS among eligible adults with obesity varies substantially across characteristics, indicating inequity in access to this treatment. To ensure greater access to the most effective treatment for obesity, policies should be implemented to reduce or eliminate barriers to care.
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Affiliation(s)
- Victoria Gershuni
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Elizabeth Wall-Wieler
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yuki Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California
| | - Feibi Zheng
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California; DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Maria S Altieri
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Alimi Y, Bevilacqua LA, Snyder RA, Walsh DS, Jackson PG, Betsy JE, Altieri MS. The Elephant in the Room: Racial Microaggressions and Implicit Bias in Surgical Training. Ann Surg 2024; 279:167-171. [PMID: 37565351 DOI: 10.1097/sla.0000000000006074] [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: 08/12/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between race, experience of microaggressions, and implicit bias in surgical training. BACKGROUND There is persistent underrepresentation of specific racial and ethnic groups in the field of surgery. Prior research has demonstrated significant sex differences among those who experience microaggressions during training. However, little research has been conducted on the association between race and experiences of microaggressions and implicit bias among surgical trainees. METHODS A 46-item survey was distributed to general surgery residents and residents of surgical subspecialties through the Association of Program Directors in Surgery listserv and social media platforms. The questions included general information/demographic data and information about experiencing, witnessing, and responding to microaggressions during surgical training. The primary outcome was the prevalence of microaggressions during surgical training by self-disclosed race. Secondary outcomes were predictors of and adverse effects of microaggressions. RESULTS A total of 1624 resident responses were obtained. General surgery residents comprised 825 (50.8%) responses. The female-to-male ratio was nearly equal (815:809). The majority of respondents identified as non-Hispanic White (63.4%), of which 5.3% of residents identified as non-Hispanic Black, and 9.5% identified as Hispanic. Notably, 91.9% of non-Hispanic Black residents (n=79) experienced microaggressions. After adjustment for other demographics, non-Hispanic Black residents were more likely than non-Hispanic White residents to experience microaggressions [odds ratio (OR): 8.81, P <0.001]. Similar findings were observed among Asian/Pacific Islanders (OR: 5.77, P <0.001) and Hispanic residents (OR: 3.35, P <0.001). CONCLUSIONS Race plays an important role in experiencing microaggressions and implicit bias. As the future of our specialty relies on the well-being of the pipeline, it is crucial that training programs and institutions are proactive in developing formal methods to address the bias experienced by residents.
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Affiliation(s)
- Yewande Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC
| | - Lisa A Bevilacqua
- Department of General Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | | | - Patrick G Jackson
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC
| | - J E Betsy
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Jog A, Baldwin D, Wernsing D, Gershuni V, Hashimoto DA, Williams N, Dumon K, Altieri MS. Trends in bariatric surgery training: bariatric operations performed by Fellowship Council trainees from 2012 to 2019. Surg Obes Relat Dis 2023:S1550-7289(23)00845-6. [PMID: 38413321 DOI: 10.1016/j.soard.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/25/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND The American Society for Metabolic and Bariatric Surgery (ASMBS) Fellowship Certificate was created to ensure satisfactory training and requires a minimum number of anastomotic cases. With laparoscopic sleeve gastrectomy becoming the most common bariatric procedure in the United States, this may present a challenge for fellows to obtain adequate numbers for ASMBS certification. OBJECTIVES To investigate bariatric fellowship trends from 2012 to 2019, the types, numbers, and approaches of surgical procedures performed by fellows were examined. SETTING Academic training centers in the United States. METHODS Data were obtained from Fellowship Council records of all cases performed by fellows in ASMBS-accredited bariatric surgery training programs between 2012 and 2019. A retrospective analysis using standard descriptive statistical methods was performed to investigate trends in total case volume and cases per fellow for common bariatric procedures. RESULTS From 2012 to 2019, sleeve gastrectomy cases performed by all Fellowship Council fellows nearly doubled from 6,514 to 12,398, compared with a slight increase for gastric bypass, from 8,486 to 9,204. Looking specifically at bariatric fellowships, the mean number of gastric bypass cases per fellow dropped over time, from 91.1 cases (SD = 46.8) in 2012-2013 to 52.6 (SD = 62.1) in 2018-2019. Mean sleeve gastrectomy cases per fellow increased from 54.7 (SD = 31.5) in 2012-2013 to a peak of 98.6 (SD = 64.3) in 2015-2016. Robotic gastric bypasses also increased from 4% of all cases performed in 2012-2013 to 13.3% in 2018-2019. CONCLUSIONS Bariatric fellowship training has seen a decrease in gastric bypasses, an increase in sleeve gastrectomies, and an increase in robotic surgery completed by each fellow from 2012 to 2019.
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Affiliation(s)
- Aditya Jog
- Department of Surgery, University of Pennsylvania, Philadelphia
| | - Dustin Baldwin
- Department of Surgery, Division of General and Bariatric Surgery, East Carolina University, Greenville, North Carolina
| | - David Wernsing
- Department of Surgery, University of Pennsylvania, Philadelphia
| | | | | | - Noel Williams
- Department of Surgery, University of Pennsylvania, Philadelphia
| | | | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia.
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Nimeri A, Oviedo R, Vosburg WR, Fam J, Blalock CA, Altieri MS, Augustin T, Hallowell P, Carter JT. ASMBS statement on metabolic and bariatric surgery for beneficiaries of Centers for Medicare and Medicaid Services with a review of the literature. Surg Obes Relat Dis 2023; 19:1331-1338. [PMID: 37891102 DOI: 10.1016/j.soard.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023]
Abstract
This position statement is issued by the American Society for Metabolic and Bariatric. Surgery in response to inquiries made to the Society by patients, physicians, Society members, hospitals, health insurance payors, the media, and others regarding the access and outcomes of metabolic and bariatric surgery for beneficiaries of Centers for Medicare and Medicaid Services. This position statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement is not intended to be and should not be construed as stating or establishing a local, regional, or national standard of care. This statement will be revised in the future as additional evidence becomes available.
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Affiliation(s)
- Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts.
| | - Rodolfo Oviedo
- Department of Surgery, Nacogdoches Medical Center, University of Houston Tilman J. Fertitta Family College of Medicine, Nacogdoches, Texas
| | - Wesley R Vosburg
- Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - John Fam
- Department of Surgery, Drexel University College of Medicine, Reading, Pennsylvania
| | - Cynthia A Blalock
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Maria S Altieri
- Department of Surgery. University of Pennsylvania, Philadelphia, Pennsylvania
| | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter Hallowell
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, California
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Docimo S, Aylward L, Albaugh VL, Afaneh C, El Djouzi S, Ali M, Altieri MS, Carter J. Endoscopic sleeve gastroplasty and its role in the treatment of obesity: a systematic review. Surg Obes Relat Dis 2023; 19:1205-1218. [PMID: 37813705 DOI: 10.1016/j.soard.2023.08.020] [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] [Received: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Salvatore Docimo
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida, Tampa, Florida.
| | - Laura Aylward
- Rockefeller Neuroscience Institute, West Virginia University of Medicine, Morgantown, West Virginia
| | - Vance L Albaugh
- Department of Metabolic Surgery, Pennington Biomedical Research Center, Metamor Institute, Baton Rouge, Louisiana
| | - Cheguevara Afaneh
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | | | - Mohamed Ali
- Department of Surgery, UC Davis Health, University of California, Davis, Davis, California
| | | | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, San Francisco, California
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Jog A, Altieri MS. Routine labs following appendectomy for uncomplicated appendicitis: Is it really necessary? Am J Surg 2023; 226:569-570. [PMID: 37574335 DOI: 10.1016/j.amjsurg.2023.07.034] [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] [Received: 07/20/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Aditya Jog
- University of Pennsylvania, Department of Surgery, United States
| | - Maria S Altieri
- University of Pennsylvania, Department of Surgery, United States.
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Reyna C, Altieri MS. Abortion Is Essential to Fully Supporting Healthy Surgical Family Building-Reply. JAMA Surg 2023; 158:1228-1229. [PMID: 37405789 DOI: 10.1001/jamasurg.2023.2518] [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: 07/06/2023]
Affiliation(s)
- Chantal Reyna
- Department of Surgery, Crozer Health, Upland, Pennsylvania
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia
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Eckhoff JA, Rosman G, Altieri MS, Speidel S, Stoyanov D, Anvari M, Meier-Hein L, März K, Jannin P, Pugh C, Wagner M, Witkowski E, Shaw P, Madani A, Ban Y, Ward T, Filicori F, Padoy N, Talamini M, Meireles OR. SAGES consensus recommendations on surgical video data use, structure, and exploration (for research in artificial intelligence, clinical quality improvement, and surgical education). Surg Endosc 2023; 37:8690-8707. [PMID: 37516693 PMCID: PMC10616217 DOI: 10.1007/s00464-023-10288-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Surgery generates a vast amount of data from each procedure. Particularly video data provides significant value for surgical research, clinical outcome assessment, quality control, and education. The data lifecycle is influenced by various factors, including data structure, acquisition, storage, and sharing; data use and exploration, and finally data governance, which encompasses all ethical and legal regulations associated with the data. There is a universal need among stakeholders in surgical data science to establish standardized frameworks that address all aspects of this lifecycle to ensure data quality and purpose. METHODS Working groups were formed, among 48 representatives from academia and industry, including clinicians, computer scientists and industry representatives. These working groups focused on: Data Use, Data Structure, Data Exploration, and Data Governance. After working group and panel discussions, a modified Delphi process was conducted. RESULTS The resulting Delphi consensus provides conceptualized and structured recommendations for each domain related to surgical video data. We identified the key stakeholders within the data lifecycle and formulated comprehensive, easily understandable, and widely applicable guidelines for data utilization. Standardization of data structure should encompass format and quality, data sources, documentation, metadata, and account for biases within the data. To foster scientific data exploration, datasets should reflect diversity and remain adaptable to future applications. Data governance must be transparent to all stakeholders, addressing legal and ethical considerations surrounding the data. CONCLUSION This consensus presents essential recommendations around the generation of standardized and diverse surgical video databanks, accounting for multiple stakeholders involved in data generation and use throughout its lifecycle. Following the SAGES annotation framework, we lay the foundation for standardization of data use, structure, and exploration. A detailed exploration of requirements for adequate data governance will follow.
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Affiliation(s)
- Jennifer A Eckhoff
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC339, Boston, MA, 02114, USA.
- Department of General, Visceral, Tumor and Transplant Surgery, University Hospital Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany.
| | - Guy Rosman
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC339, Boston, MA, 02114, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar St, Cambridge, MA, 02139, USA
| | - Maria S Altieri
- Stony Brook University Hospital, Washington University in St. Louis, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Stefanie Speidel
- National Center for Tumor Diseases (NCT), Fiedlerstraße 23, 01307, Dresden, Germany
| | - Danail Stoyanov
- University College London, 43-45 Foley Street, London, W1W 7TY, UK
| | - Mehran Anvari
- Center for Surgical Invention and Innovation, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lena Meier-Hein
- German Cancer Research Center, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Keno März
- German Cancer Research Center, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Pierre Jannin
- MediCIS, University of Rennes - Campus Beaulieu, 2 Av. du Professeur Léon Bernard, 35043, Rennes, France
| | - Carla Pugh
- Department of Surgery, Stanford School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Martin Wagner
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Elan Witkowski
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC339, Boston, MA, 02114, USA
| | - Paresh Shaw
- New York University Langone, 530 1St Ave. Floor 12, New York, NY, 10016, USA
| | - Amin Madani
- Surgical Artifcial Intelligence Research Academy, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Yutong Ban
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC339, Boston, MA, 02114, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar St, Cambridge, MA, 02139, USA
| | - Thomas Ward
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC339, Boston, MA, 02114, USA
| | - Filippo Filicori
- Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Nicolas Padoy
- Ihu Strasbourg - Institute Surgery Guided Par L'image, 1 Pl. de L'Hôpital, 67000, Strasbourg, France
| | - Mark Talamini
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ozanan R Meireles
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC339, Boston, MA, 02114, USA
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Bader A, Altieri MS. Social media (some) models in resident education. Surgery 2023; 174:741-743. [PMID: 37438183 DOI: 10.1016/j.surg.2023.05.041] [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] [Received: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 07/14/2023]
Abstract
Social media has changed the way in which we communicate, as it has grown tremendously in the past decade. Social media platforms have even penetrated the area of surgery and surgical education. The COVID-19 pandemic has even further pushed for more innovative communication and surgical education methods, such as case and video discussions, asking for advice, and having journal clubs. In this article, we review several social media platforms, such as Twitter, Facebook, and others, and the ways that they have been integrated into surgical education.
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Affiliation(s)
- Amanda Bader
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. https://twitter.com/altierim1
| | - Maria S Altieri
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Loftus TJ, Altieri MS, Balch JA, Abbott KL, Choi J, Marwaha JS, Hashimoto DA, Brat GA, Raftopoulos Y, Evans HL, Jackson GP, Walsh DS, Tignanelli CJ. Artificial Intelligence-enabled Decision Support in Surgery: State-of-the-art and Future Directions. Ann Surg 2023; 278:51-58. [PMID: 36942574 DOI: 10.1097/sla.0000000000005853] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To summarize state-of-the-art artificial intelligence-enabled decision support in surgery and to quantify deficiencies in scientific rigor and reporting. BACKGROUND To positively affect surgical care, decision-support models must exceed current reporting guideline requirements by performing external and real-time validation, enrolling adequate sample sizes, reporting model precision, assessing performance across vulnerable populations, and achieving clinical implementation; the degree to which published models meet these criteria is unknown. METHODS Embase, PubMed, and MEDLINE databases were searched from their inception to September 21, 2022 for articles describing artificial intelligence-enabled decision support in surgery that uses preoperative or intraoperative data elements to predict complications within 90 days of surgery. Scientific rigor and reporting criteria were assessed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS Sample size ranged from 163-2,882,526, with 8/36 articles (22.2%) featuring sample sizes of less than 2000; 7 of these 8 articles (87.5%) had below-average (<0.83) area under the receiver operating characteristic or accuracy. Overall, 29 articles (80.6%) performed internal validation only, 5 (13.8%) performed external validation, and 2 (5.6%) performed real-time validation. Twenty-three articles (63.9%) reported precision. No articles reported performance across sociodemographic categories. Thirteen articles (36.1%) presented a framework that could be used for clinical implementation; none assessed clinical implementation efficacy. CONCLUSIONS Artificial intelligence-enabled decision support in surgery is limited by reliance on internal validation, small sample sizes that risk overfitting and sacrifice predictive performance, and failure to report confidence intervals, precision, equity analyses, and clinical implementation. Researchers should strive to improve scientific quality.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
| | - Maria S Altieri
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Jeremy A Balch
- Department of Surgery, University of Florida Health, Gainesville, FL
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
| | - Kenneth L Abbott
- Department of Surgery, University of Florida Health, Gainesville, FL
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
| | - Jeff Choi
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, Stanford University, Stanford, CA
| | - Jayson S Marwaha
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, Beth Israel Deaconess Medical Center
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Daniel A Hashimoto
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, University of Pennsylvania Perelman School of Medicine
- General Robotics, Automation, Sensing, and Perception Laboratory, University of Pennsylvania School of Engineering and Applied Science, Philadelphia, PA
| | - Gabriel A Brat
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, Beth Israel Deaconess Medical Center
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Yannis Raftopoulos
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Weight Management Program, Holyoke Medical Center, Holyoke, MA
| | - Heather L Evans
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Gretchen P Jackson
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Digital, Intuitive Surgical, Sunnyvale, CA; Departments of Pediatric Surgery, Pediatrics, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Danielle S Walsh
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery, University of Kentucky, Lexington, KY
| | - Christopher J Tignanelli
- American College of Surgeons Health Information Technology Committee and Artificial Intelligence Subcommittee, Chicago, IL
- Department of Surgery
- Institute for Health Informatics
- Program for Clinical Artificial Intelligence, Center for Learning Health Systems Science, University of Minnesota, Minneapolis, MN
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13
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Altieri MS, Carter J, Aminian A, Docimo S, Hinojosa MW, Cheguevara A, Campos GM, Eisenberg D. American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:763-771. [PMID: 37268518 DOI: 10.1016/j.soard.2023.03.019] [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] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jonathan Carter
- Department of General Surgery, University of California, San Francisco, California
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Salvatore Docimo
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Afaneh Cheguevara
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California
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14
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Rosen CB, Roberts SE, Sharpe J, Gershuni V, Altieri MS, Kelz RR. A study analyzing outcomes after bariatric surgery by primary language. Surg Endosc 2023:10.1007/s00464-023-10127-5. [PMID: 37266743 DOI: 10.1007/s00464-023-10127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication is key to success in bariatric surgery. This study aims to understand how outcomes after bariatric surgery differ between patients with a non-English primary language and those with English as their primary language. METHODS This retrospective, observational cohort study of bariatric surgery patients age ≥ 18 years utilized the Michigan, Maryland, and New Jersey State Inpatient Databases and State Ambulatory Surgery and Services Databases, 2016 to 2018. Patients were classified by primary spoken language: English and non-English. Primary outcome was complications. Secondary outcomes included length of stay (LOS) and cost, with cost calculated using cost-to-charge ratios provided by Healthcare Cost and Utilization Project and reported in 2019 United States dollars. Multivariable regression models (logistic, Poisson, and quantile) were used to examine associations between primary language and outcomes. Given the uneven distribution of race by primary language, interaction terms were used to examine conditional effects of race. RESULTS Among 69,749 bariatric surgery patients, 2811 (4.2%) spoke a non-English primary language. Covariates, notably race distribution, and unadjusted outcomes differed significantly by primary language. However, after adjustment, non-English primary language was not associated with significantly increased odds of complications (odds ratio 1.24, p = 0.389), significantly different LOS (- 0.02 days, p = 0.677), nor significantly different mean healthcare costs (- $265, p = 0.309). There were no significant conditional effects of race seen among outcomes. CONCLUSIONS Though non-English primary language was associated with a significantly different distribution of observable characteristics (including race, income quartile, and insurance type), after adjustment, non-English primary language was not associated with significant differential risk of adverse outcomes after bariatric surgery, and there were no significant conditional effects of race. As such, this study suggests that disparities in bariatric surgery by primary spoken language more likely related to access to care, or the pre- and post-hospital care continuum, rather than index hospitalization after surgery.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA.
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - James Sharpe
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - Victoria Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Maria S Altieri
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
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15
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Rasic G, Parikh PP, Wang ML, Keric N, Jung HS, Ferguson BD, Altieri MS, Nahmias J. The silver lining of the pandemic in surgical education: virtual surgical education and recommendations for best practices. Global Surg Educ 2023; 2:59. [PMID: 38013862 PMCID: PMC10205563 DOI: 10.1007/s44186-023-00137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 11/29/2023]
Abstract
Virtual education is an evolving field within the realm of surgical training. Since the onset of the COVID-19 pandemic, the application of virtual technologies in surgical education has undergone significant exploration and advancement. While originally developed to supplement in-person curricula for the development of clinical decision-making, virtual surgical education has expanded into the realms of clinical decision-making, surgical, and non-surgical skills acquisition. This manuscript aims to discuss the various applications of virtual surgical education as well as the advantages and disadvantages associated with each education modality, while offering recommendations on best practices and future directions.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA USA
| | - Priti P. Parikh
- Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH USA
| | - Ming-Li Wang
- Department of Surgery, University of New Mexico, Albuquerque, NM USA
| | - Natasha Keric
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, AZ USA
| | - Hee Soo Jung
- Division of Acute Care and Regional General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Benjamin D. Ferguson
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM USA
| | - Maria S. Altieri
- Division of Gastrointestinal Surgery, Department of Surgery, Pennsylvania Hospital, Penn Medicine, Philadelphia, PA USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA USA
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16
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Weaver JL, Cannada L, Anand T, Dream S, Park PK, Altieri MS, Tasnim S, Reyna C. The importance of allyship in Academic Surgery. Am J Surg 2023; 225:805-807. [PMID: 36376112 DOI: 10.1016/j.amjsurg.2022.10.058] [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: 08/11/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Jessica L Weaver
- Department of Surgery, University of California San Diego School of Medicine, USA.
| | - Lisa Cannada
- Novant Health Department of Orthopedic Surgery, USA
| | - Tanya Anand
- University of Arizona Banner University Medical Center, USA
| | - Sophie Dream
- Medical College of Wisconsin Department of Surgery, USA
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17
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Johnson HM, Torres MB, Möller MG, Cannada L, Nosanov LB, Riner AN, Tatebe LC, Reyna C, Altieri MS. Association of Women Surgeons' Comprehensive Initiative for Healthy Surgical Families During Residency and Fellowship Training. JAMA Surg 2023; 158:310-315. [PMID: 36598769 DOI: 10.1001/jamasurg.2022.6334] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance The lack of family-friendly policies continues to contribute to the underrepresentation and attrition of surgical trainees. Women in surgery face unique challenges in balancing surgical education with personal and family needs. Observations The Association of Women Surgeons is committed to supporting surgical families and developing equitable family-friendly guidelines. Herein we detail recommendations for adequate paid parental leave, access to childcare, breastfeeding support, and insurance coverage of fertility preservation and assisted reproductive technology. Conclusions and Relevance The specific recommendations outlined in this document form the basis of a comprehensive initiative for supporting surgical families.
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Affiliation(s)
- Helen M Johnson
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Madeline B Torres
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Mecker G Möller
- DeWitt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Lisa Cannada
- University of North Carolina Department of Orthopaedics, Raleigh
| | - Lauren B Nosanov
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Leah C Tatebe
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Chantal Reyna
- Department of Surgery, Crozer Health, Upland, Pennsylvania
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia
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18
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Jog A, Altieri MS. Comment on: Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:250-251. [PMID: 36404227 DOI: 10.1016/j.soard.2022.10.013] [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: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Aditya Jog
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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19
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Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [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] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
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20
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Mitsakos AT, Irish W, DeMaria EJ, Pories WJ, Altieri MS. Body mass index and risk of mortality in patients undergoing bariatric surgery. Surg Endosc 2023; 37:1213-1221. [PMID: 36156736 DOI: 10.1007/s00464-022-09651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m2. METHODS A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m2) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. RESULTS A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m2; 1.5% of patients had BMI ≥ 70.0 kg/m2. On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m2, the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m2, although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB). CONCLUSIONS BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m2. In these patients, RYGB is associated with increased risk of mortality compared to SG.
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Affiliation(s)
- Anastasios T Mitsakos
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Department of Surgery, Vidant Medical Center, East Carolina University Brody School of Medicine, 2100 Stantonsburg Road, Greenville, NC, 27834, USA.
| | - William Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Eric J DeMaria
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Maria S Altieri
- Department of Surgery, Section of GI Surgery, Pennsylvania Hospital/University of Pennsylvania, Philadelphia, PA, USA
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21
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Rosen CB, Altieri MS. Comment on: How much narcotics are really needed after bariatric surgery: results of a prospective study. Surg Obes Relat Dis 2023; 19:546-547. [PMID: 36792451 DOI: 10.1016/j.soard.2022.12.036] [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: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Claire B Rosen
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Weaver ML, Sundland R, Adams AM, Faria I, Feldman HA, Gudmundsdottir H, Marmor H, Miles V, Ochoa B, Ruff SM, Tonelli C, Altieri MS, Cannada L, Dewan K, Etkin Y, Marmor R, Plichta JK, Reyna C, Tatebe L, Drudi LM, Hicks CW. The art of peer review: Guidelines to become a credible and constructive peer reviewer. Semin Vasc Surg 2022; 35:470-478. [PMID: 36414364 PMCID: PMC9833278 DOI: 10.1053/j.semvascsurg.2022.10.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
Peer review is a learned skill set that requires knowledge of study design, review construct, ethical considerations, and general expertise in a field of study. Participating in peer review is a rewarding and valuable experience in which all academic physicians are encouraged to partake. However, formal training opportunities in peer review are limited. In 2021, the Association of Women Surgeons and the journal Surgery collaborated to develop a Peer Review Academy. This academy is a 1-year longitudinal course that offers a select group of young women surgical trainees across all specialties a curriculum of monthly lectures and multiple formal mentored peer review opportunities to assist them in developing the foundation necessary to transition to independent peer review. The trainees and faculty mentors participating in the Association of Women Surgeons-Surgery Peer Review Academy compiled a summary of best peer review practices, which is intended to outline the elements of the skill set necessary to become a proficient peer reviewer.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, 1215 Lee Street, PO Box 800679, Charlottesville, VA, 22908-0679.
| | | | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Hope A Feldman
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Hannah Marmor
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Victoria Miles
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - Brielle Ochoa
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samantha M Ruff
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Lisa Cannada
- Department of Orthopaedics, University of North Carolina, Charlotte, NC
| | - Karuna Dewan
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University, New Orleans, LA
| | - Yana Etkin
- Division of Vascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Rebecca Marmor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chantal Reyna
- Department of Surgery, Crozer Health System, Upland, PA
| | - Leah Tatebe
- Department of Surgery, Northwestern University, Chicago, IL
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospital de L'Université de Montréal, Montreal, Quebec, Canada
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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23
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Altieri MS, Pryor A, Torres MB, Miller ME, Möller MG, Diego EJ, Reyna C. Support of pregnancy and parental leave for trainees and practicing surgeons. Am J Surg 2022; 224:1501-1503. [PMID: 35987658 DOI: 10.1016/j.amjsurg.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Aurora Pryor
- Department of General Surgery, SUNY Stony Brook, Stony Brook, NY, USA
| | - Madeline B Torres
- Department of General Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Mecker G Möller
- Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Emilia J Diego
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chantal Reyna
- Department of Surgery Crozer Health System, Drexel Hill, PA, USA
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24
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McKinley SK, Altieri MS, Sheppard O, Hendershot K, Williams K, Smith BK. Designing the "match of the future": challenges and proposed solutions in the interview and match phase of the UME-GME transition. Global Surg Educ 2022; 1:69. [PMID: 38013709 PMCID: PMC9670067 DOI: 10.1007/s44186-022-00073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2023]
Abstract
This review focuses on the interview and match process with the purpose of broadly reviewing challenges in the current surgical residency selection process, detailing potential solutions, and identifying future avenues of investigation.
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Affiliation(s)
- Sophia K. McKinley
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Maria S. Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Olabisi Sheppard
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | | | - Keneeshia Williams
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | | | - the ASE Graduate Surgical Education Committee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
- Department of Surgery, University of Alabama, Birmingham, AL USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
- Department of Surgery, University of Utah, Salt Lake City, UT USA
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25
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Mascagni P, Alapatt D, Sestini L, Altieri MS, Madani A, Watanabe Y, Alseidi A, Redan JA, Alfieri S, Costamagna G, Boškoski I, Padoy N, Hashimoto DA. Computer vision in surgery: from potential to clinical value. NPJ Digit Med 2022; 5:163. [PMID: 36307544 PMCID: PMC9616906 DOI: 10.1038/s41746-022-00707-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Hundreds of millions of operations are performed worldwide each year, and the rising uptake in minimally invasive surgery has enabled fiber optic cameras and robots to become both important tools to conduct surgery and sensors from which to capture information about surgery. Computer vision (CV), the application of algorithms to analyze and interpret visual data, has become a critical technology through which to study the intraoperative phase of care with the goals of augmenting surgeons' decision-making processes, supporting safer surgery, and expanding access to surgical care. While much work has been performed on potential use cases, there are currently no CV tools widely used for diagnostic or therapeutic applications in surgery. Using laparoscopic cholecystectomy as an example, we reviewed current CV techniques that have been applied to minimally invasive surgery and their clinical applications. Finally, we discuss the challenges and obstacles that remain to be overcome for broader implementation and adoption of CV in surgery.
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Affiliation(s)
- Pietro Mascagni
- Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy. .,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. .,Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.
| | - Deepak Alapatt
- ICube, University of Strasbourg, CNRS, IHU, Strasbourg, France
| | - Luca Sestini
- ICube, University of Strasbourg, CNRS, IHU, Strasbourg, France.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Maria S Altieri
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amin Madani
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Yusuke Watanabe
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of Hokkaido, Hokkaido, Japan
| | - Adnan Alseidi
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jay A Redan
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
| | - Sergio Alfieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolas Padoy
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,ICube, University of Strasbourg, CNRS, IHU, Strasbourg, France
| | - Daniel A Hashimoto
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Altieri MS, Irish W, Pories WJ, DeMaria EJ. The US Prevalence of Metabolic Surgery in Patients with Obesity and Type 2 Diabetes Has Not Increased Despite Recommendations from the American Diabetes Association. Obes Surg 2022; 32:1086-1092. [PMID: 35032312 DOI: 10.1007/s11695-021-05865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/02/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Metabolic surgery dramatically improves type 2 diabetes mellitus (T2DM). In 2017, the American Diabetes Association (ADA) recommended metabolic surgery as the optimal treatment for patients with T2DM and Body Mass Index (BMI) > 40. We sought to evaluate whether or not that recommendation is being implemented. The purpose of this study was to evaluate the trend of bariatric surgery 2 years prior and 2 years following the ADA statement. MATERIALS AND METHODS A retrospective analysis of primary bariatric procedures on patients with class III obesity (BMI > 40 kg/m2) and T2DM performed between 2015 and 2018, using the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. RESULTS From 2015 to 2018, 164,535 patients with T2DM underwent bariatric surgery. The majority had a BMI > 40 kg/m2 (n = 117,422, 71.4%) and most were not using insulin. Majority of the patients with T2D and class III obesity were female (72.1%), Caucasian (71.5%), and mean age (SD) 48.5 (11.5). Although the numbers of patients with T2DM and class III obesity increased during this time period, there was not a significant change in the overall percentage of patients who were treated with surgery: from 25.99% in 2015 to 24.96% in 2018. In addition, this group is associated with higher rates of complications and mortality compared to patients with BMI > 40 kg/m2 without T2DM. CONCLUSION Utilization of metabolic surgery in patients with obesity and T2DM has not improved following the updated 2017 ADA guidelines. There is a clear need for more awareness of these guidelines among providers, patients, and the public.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - William Irish
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Walter J Pories
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Eric J DeMaria
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
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Altieri MS, DeMaria E, Lensing C, Derecho J, Fallorina R, Mehrotra S, Pories W, Irish WD. Real-World Retrospective Analysis of Outcomes in Patients Undergoing Bariatric Surgery with Class 1 Obesity. Surg Obes Relat Dis 2022; 18:569-576. [DOI: 10.1016/j.soard.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/25/2021] [Accepted: 01/12/2022] [Indexed: 12/28/2022]
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Johnson HM, Torres MB, Tatebe LC, Altieri MS. Every ounce counts: A call for comprehensive support for breastfeeding surgeons by the Association of Women Surgeons. Am J Surg 2022; 223:1226-1227. [DOI: 10.1016/j.amjsurg.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022]
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Altieri MS. Comment on: Prior bariatric surgery in COVID-19 positive patients may be protective. Surg Obes Relat Dis 2021; 17:e55-e56. [PMID: 34583892 PMCID: PMC8416295 DOI: 10.1016/j.soard.2021.08.026] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
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30
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Altieri MS, DeMaria E, Lensing C, Derecho J, Fallorina R, Mehrotra S, Pories W, Irish WD. Retrospective comparative study of the effectiveness of bariatric surgery on 3-year outcomes in the real-world clinical setting. Surg Obes Relat Dis 2021; 18:196-204. [PMID: 34922843 DOI: 10.1016/j.soard.2021.11.013] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery has shown an improvement in obesity and obesity-related disease in many clinical trials and single center studies. However, real-world data, including data from non-centers of excellence, is sparse. OBJECTIVES To provide clinical outcomes of patients who underwent bariatric surgery in real-world clinical setting. SETTING Academic Institution. METHODS Adults with obesity undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and a control group (CG) between 2007 and 2019 were identified. The CG represented patients with a previous visit to a bariatric surgeon without a subsequent surgery. Cohorts were matched on age, gender, ethnicity, baseline body mass index (BMI), and presence of diabetes and hypertension. Groups were compared in terms of co-morbidities, weight loss, and chronic conditions for three years. RESULTS A total of 61 313 patients were identified. From these, 14 916 RYGB and 20 867 SG patients were matched to the CG (n = 16 562). The median BMI loss three years after surgery was 28.7% (interquartile range [IQR] 20.8%-36.2%) and 20.5% (IQR 13.5%-28.6%) for RYGB and SG groups, respectively. The CG had a median BMI loss of 6.7% with IQR of 20.4% decrease to 1.78% gain. At three years postoperatively, HbA1C decreased by 13% for RYGB and 5.9% for the SG group. The probabilities of remission from diabetes, hypertension, and low high-density lipoprotein cholesterol were significantly higher among patients who had surgery compared to the CG. For both RYGB and SG, the estimated probabilities of remission were similar. CONCLUSION This study shows that bariatric surgery performed in the real-world clinical setting is an effective therapy for various expressions of the metabolic syndrome with results that are comparable to randomized control trials.
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Affiliation(s)
- Maria S Altieri
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
| | - Eric DeMaria
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Cody Lensing
- OptumLabs at UnitedHealth Group, Minnetonka, Minnesota
| | | | | | | | - Walter Pories
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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Aminian A, Vosburg RW, Altieri MS, Hinojosa MW, Khorgami Z. The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery. Surg Obes Relat Dis 2021; 18:165-174. [PMID: 34896011 DOI: 10.1016/j.soard.2021.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - R Wesley Vosburg
- Department of Surgery, Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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32
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Altieri MS, Irish W, DeMaria EJ, Pories WJ, Wong JH. Understanding Disparities in Surgical Access to Bariatric Surgery in North Carolina. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.266] [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: 11/17/2022]
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Altieri MS. Comment on: Impact of a severe complication 2 years after laparoscopic Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2021; 17:1882-1883. [PMID: 34481725 DOI: 10.1016/j.soard.2021.08.009] [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] [Received: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
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Slama EM, Johnson HM, Yu YR, Sumra H, Altieri MS. Paid parental leave for surgeons in the United States. Am J Surg 2021; 223:218-220. [PMID: 34419264 DOI: 10.1016/j.amjsurg.2021.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Eliza M Slama
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, Saint Agnes Hospital, Baltimore, MD, 21227, USA.
| | - Helen M Johnson
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, 27834, USA
| | - Yangyang R Yu
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, University of California, Irvine Medical Center, Orange, CA, 92868, USA
| | - Hibba Sumra
- Association of Women Surgeons Publication Committee, USA; University of Toledo, College of Medicine, Toledo, OH, 43614, USA
| | - Maria S Altieri
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, 27834, USA
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Altieri MS, Irish W, Pories WJ, Shah A, DeMaria EJ. Examining the Rates of Obesity and Bariatric Surgery in the United States. Obes Surg 2021; 31:4754-4760. [PMID: 34345959 DOI: 10.1007/s11695-021-05628-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study is to evaluate the change in rate of increase of bariatric surgery performed compared to the growth of obesity and severe obesity in the United States (US). MATERIALS AND METHODS The number of primary adult bariatric procedures performed in the US between 2015 and 2018 was obtained from the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. The US Census database was used to derive age-adjusted obesity and severe obesity prevalence among adults. Prevalence of bariatric surgery, by year, was estimated as the ratio of the number of patients undergoing surgery and the projected number of eligible individuals for that year. RESULTS There were 627,386 bariatric procedures performed for body mass index (BMI) ≥ 30 kg/m2, of which 73.3% (n = 459,800) were performed for BMI ≥ 40 kg/m2. Although the rate of obesity increased by 3.32% per year during this period (RR = 1.0332 per year increase; 95% CI = 1.0313, 1.0352), the rate of surgery per eligible population increased by only 2.47% (RR = 1.0247 per year increase; 95% CI = 1.0065, 1.0432). The prevalence of severe obesity increased from 7.70% (n = 17,494,910) in 2015 to 9.95% (n = 23,135,039) in 2018 while the prevalence of surgery decreased from 0.588 per 100 eligible population in 2015 to 0.566 per 100 eligible population in 2018. CONCLUSION The rate of utilization has not kept up with the rate of increase in this disease, our costliest illness. There is a strong need to educate the public, healthcare professionals, insurance carriers, and legislators.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - William Irish
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Walter J Pories
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Anish Shah
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Eric J DeMaria
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
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36
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Bevilacqua LA, Siena NM, Gardner CA, Tatarian T, Madani A, Altieri MS. Gender disparities among leadership in academic surgical publishing over the past decade. Am J Surg 2021; 223:47-52. [PMID: 34332745 DOI: 10.1016/j.amjsurg.2021.07.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women account for 19 % of practicing surgeons in the United States, with representation decreasing with higher academic rank. Less is known about the proportion of women in editorial leadership positions at surgical journals. The objective of this study was to examine gender representation among editorial leadership at high-impact surgical journals. METHODS The five journals with the highest impact factors in general, cardiothoracic, plastics, otolaryngology, orthopedics, urology, vascular, and neurosurgery were identified. Data were abstracted on the proportion of women editors-in-chief (EIC) and editorial board members between 2010 and 2020 to determine how these demographics changed over time. RESULTS Multiple fields had no women EIC over the past decade (orthopedics, urology, cardiothoracic, neurosurgery). In all other fields, women were a minority of EIC. In 2020, women made up 7.9 % of EIC and 11.1 % of editorial boards in surgical journals. CONCLUSIONS Women remain under-represented among leadership at high-impact surgical journals, with varying improvement over the past decade among different subspecialties.
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Affiliation(s)
- Lisa A Bevilacqua
- Thomas Jefferson University Hospital, Dept. of Surgery, Philadelphia, PA, USA
| | - Nicholas M Siena
- Thomas Jefferson University Hospital, Dept. of Surgery, Philadelphia, PA, USA; University of California Los Angeles, Dept. of Surgery, Los Angeles, CA, USA
| | | | - Talar Tatarian
- Thomas Jefferson University Hospital, Dept. of Surgery, Philadelphia, PA, USA
| | - Amin Madani
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Maria S Altieri
- East Carolina University, Dept. of Surgery, Greeneville, NC, USA.
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Meireles OR, Rosman G, Altieri MS, Carin L, Hager G, Madani A, Padoy N, Pugh CM, Sylla P, Ward TM, Hashimoto DA. SAGES consensus recommendations on an annotation framework for surgical video. Surg Endosc 2021; 35:4918-4929. [PMID: 34231065 DOI: 10.1007/s00464-021-08578-9] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The growing interest in analysis of surgical video through machine learning has led to increased research efforts; however, common methods of annotating video data are lacking. There is a need to establish recommendations on the annotation of surgical video data to enable assessment of algorithms and multi-institutional collaboration. METHODS Four working groups were formed from a pool of participants that included clinicians, engineers, and data scientists. The working groups were focused on four themes: (1) temporal models, (2) actions and tasks, (3) tissue characteristics and general anatomy, and (4) software and data structure. A modified Delphi process was utilized to create a consensus survey based on suggested recommendations from each of the working groups. RESULTS After three Delphi rounds, consensus was reached on recommendations for annotation within each of these domains. A hierarchy for annotation of temporal events in surgery was established. CONCLUSIONS While additional work remains to achieve accepted standards for video annotation in surgery, the consensus recommendations on a general framework for annotation presented here lay the foundation for standardization. This type of framework is critical to enabling diverse datasets, performance benchmarks, and collaboration.
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Affiliation(s)
- Ozanan R Meireles
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC460, Boston, MA, 02114, USA.
| | - Guy Rosman
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC460, Boston, MA, 02114, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, USA
| | - Maria S Altieri
- Department of Surgery, East Carolina University, Greenville, USA
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Duke University, Durham, USA
| | - Gregory Hager
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA
| | - Amin Madani
- Department of Surgery, University Health Network, Toronto, Canada
| | - Nicolas Padoy
- ICube, University of Strasbourg, Strasbourg, France
- IHU Strasbourg, Strasbourg, France
| | - Carla M Pugh
- Department of Surgery, Stanford University, Stanford, USA
| | - Patricia Sylla
- Department of Surgery, Mount Sinai Medical Center, New York, USA
| | - Thomas M Ward
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC460, Boston, MA, 02114, USA
| | - Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC460, Boston, MA, 02114, USA.
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Ieong K, Brown A, Yang J, Zhang X, Altieri MS, Spaniolas K, Pryor AD. The incidence of reintervention and reoperation following Heller myotomy across multiple indications. Surg Endosc 2021; 36:1619-1626. [PMID: 33733323 DOI: 10.1007/s00464-021-08357-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Achalasia is a debilitating primary esophageal motility disorder. Heller myotomy (HM) is a first-line therapy for the treatment of achalasia patients who have failed other modalities. Other indications for HM include diverticulum, diffuse esophageal spasm, and esophageal strictures. However, long-term outcomes of HM are unclear. This study aims to assess incidence of reintervention, either endoscopically or through minimally invasive or resectional procedures, in patients who underwent HM in New York State. METHODS The Statewide Planning and Research Cooperative System (SPARCS) administrative longitudinal database identified 1817 adult patients who underwent HM between 2000 and 2008 for achalasia, esophageal diverticulum, diffuse esophageal spasm, and esophageal strictures, based on ICD-9 and CPT codes. Through the use of unique identifiers, patients requiring reintervention were tracked up to 2016 (for at least 8 years follow-up). Primary outcome was incidence of subsequent procedures following HM. Secondary outcomes were time to reintervention and risk factors for reintervention. RESULTS Of the 1817 patients who underwent HM, 320 (17.6%) required subsequent intervention. Of the 320 patients, 234 (73.1%) underwent endoscopic reinterventions, 54 (16.9%) underwent minimally invasive procedures, and 32 (10%) underwent resectional procedures as their initial revisional intervention. Of the 234 patients who underwent endoscopic reintervention as their initial revisional procedure, only 40 (16.8%) required subsequent surgical procedures. Over a mean follow-up of 7.0 years, the mean time to a subsequent procedure was 4.3 ± 3.74 years. Reintervention rates after 10 years following HM for achalasia, diverticulum ,and other indication were 24.4%, 12.6%, and 37%, respectively. CONCLUSION The majority of HM reinterventions were managed solely by endoscopic procedures (60.6%). Heller myotomy remains an excellent procedure to prevent surgical reintervention for achalasia and diverticulum.
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Affiliation(s)
- Kelly Ieong
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA.
| | - Andrew Brown
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Jie Yang
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Xiaoyue Zhang
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Maria S Altieri
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Aurora D Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
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Wong JH, Irish WD, DeMaria EJ, Vohra NA, Pories WJ, Brownstein MR, Altieri MS, Akram W, Haisch CE, Leeser DB, Tuttle JE. Development and Assessment of a Systematic Approach for Detecting Disparities in Surgical Access. JAMA Surg 2021; 156:239-245. [PMID: 33326009 DOI: 10.1001/jamasurg.2020.5668] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 Although optimal access is accepted as the key to quality care, an accepted methodology to ascertain potential disparities in surgical access has not been defined. Objective To develop a systematic approach to detect surgical access disparities. Design, Setting, and Participants This cross-sectional study used publicly available data from the Health Cost and Utilization Project State Inpatient Database from 2016. Using the surgical rate observed in the 5 highest-ranked counties (HRCs), the expected surgical rate in the 5 lowest-ranked counties (LRCs) in North Carolina were calculated. Patients 18 years and older who underwent an inpatient general surgery procedure and patients who underwent emergency inpatient cholecystectomy, herniorrhaphy, or bariatric surgery in 2016 were included. Data were collected from January to December 2016, and data were analyzed from March to July 2020. Exposures Health outcome county rank as defined by the Robert Wood Johnson Foundation. Main Outcomes and Measures The primary outcome was the proportional surgical ratio (PSR), which was the disparity in surgical access defined as the observed number of surgical procedures in the 5 LRCs relative to the expected number of procedures using the 5 HRCs as the standardized reference population. Results In 2016, approximately 1.9 million adults lived in the 5 HRCs, while approximately 246 854 lived in the 5 LRCs. A total of 28 924 inpatient general surgical procedures were performed, with 4521 being performed in those living in the 5 LRCs and 24 403 in those living in the 5 HRCs. The rate of general surgery in the 5 HRCs was 13.09 procedures per 1000 population. Using the 5 HRCs as the reference, the PSR for the 5 LRCs was 1.40 (95% CI, 1.35-1.44). For emergent/urgent cholecystectomy, the PSR for the 5 LRCs was 2.26 (95% CI, 2.02-2.51), and the PSR for emergent/urgent herniorrhaphy was 1.83 (95% CI, 1.33-2.45). Age-adjusted rate of obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] greater than 30), on average, was 36.6% (SD, 3.4) in the 5 LRCs vs 25.4% (SD, 4.6) in the 5 HRCs (P = .002). The rate of bariatric surgery in the 5 HRCs was 33.07 per 10 000 population with obesity. For the 5 LRCs, the PSR was 0.60 (95% CI, 0.51-0.69). Conclusions and Relevance The PSR is a systematic approach to define potential disparities in surgical access and should be useful for identifying, investigating, and monitoring interventions intended to mitigate disparities in surgical access that effects the health of vulnerable populations.
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Affiliation(s)
- Jan H Wong
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.,Department of Public Health, East Carolina University, Greenville, North Carolina
| | - Eric J DeMaria
- Division of General Minimal Invasive and Bariatric Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Nasreen A Vohra
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Michelle R Brownstein
- Division of Trauma and Critical Care, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Maria S Altieri
- Division of General Minimal Invasive and Bariatric Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Warqaa Akram
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Carl E Haisch
- Division of Surgical Immunology and Transplantation, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - David B Leeser
- Division of Surgical Immunology and Transplantation, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Janet E Tuttle
- Division of Surgical Immunology and Transplantation, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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Altieri MS. Comment on: Outcomes of patients older than 55 years undergoing abdominoplasty after bariatric surgery. Surg Obes Relat Dis 2021; 17:908-909. [PMID: 33757702 DOI: 10.1016/j.soard.2021.02.016] [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: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
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Tatarian T, Nie L, McPartland C, Brown AM, Yang J, Altieri MS, Spaniolas K, Docimo S, Pryor AD. Comparative perioperative and 5-year outcomes of robotic and laparoscopic or open inguinal hernia repair: a study of 153,727 patients in the state of New York. Surg Endosc 2021; 35:7209-7218. [PMID: 33398566 DOI: 10.1007/s00464-020-08211-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to examine the perioperative outcomes of robotic inguinal hernia repair as compared to the open and laparoscopic approaches utilizing large-scale population-level data. METHODS This study was funded by the SAGES Robotic Surgery Research Grant (2019). The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was used to identify all adult patients undergoing initial open (O-IHR), laparoscopic (L-IHR), and robotic (R-IHR) inguinal hernia repair between 2010 and 2016. Perioperative outcome measures [complications, length of stay (LOS), 30-day emergency department (ED) visits, 30-day readmissions] and estimated 1/3/5-year recurrence incidences were compared. Propensity score (PS) analysis was used to estimate marginal differences between R-IHR and L-IHR or O-IHR, using a 1:1 matching algorithm. RESULTS During the study period, a total of 153,727 patients underwent inguinal hernia repair (117,603 [76.5%] O-IHR, 35,565 [23.1%] L-IHR; 559 [0.36%] R-IHR) in New York state. Initial univariate analysis found R-IHR to have longer LOS (1.74 days vs. 0.66 O-IHR vs 0.19 L-IHR) and higher rates of overall complications (9.3% vs. 3.6% O-IHR vs 1.1% L-IHR), 30-day ED visits (11.6% vs. 6.1% O-IHR vs. 4.9% L-IHR), and 30-day readmissions (5.6% vs. 2.4% O-IHR vs. 1.2% L-IHR) (p < 0.0001). R-IHR was associated with higher recurrence compared to L-IHR. Following PS analysis, there were no differences in perioperative outcomes between R-IHR and L-IHR, and the difference in recurrence was found to be sensitive to possible unobserved confounding factors. R-IHR had significantly lower risk of complications (Risk difference - 0.09, 95% CI [- 0.13, - 0.056]; p < 0.0001) and shorter LOS (Ratio 0.53, 95% CI [0.45, 0.62]; p < 0.0001) compared to O-IHR. CONCLUSION In adult patients, R-IHR may be associated with comparable to more favorable 30-day perioperative outcomes as compared with L-IHR and O-IHR, respectively.
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Affiliation(s)
- Talar Tatarian
- Department of Surgery, Thomas Jefferson University, 211 S 9th Street, Suite 402, Philadelphia, PA, 19107, USA.
| | - Lizhou Nie
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Connor McPartland
- Department of Surgery, Thomas Jefferson University, 211 S 9th Street, Suite 402, Philadelphia, PA, 19107, USA
| | - Andrew M Brown
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Maria S Altieri
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | | | - Salvatore Docimo
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Aurora D Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
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Bevilacqua LA, Obeid NR, Yang J, Zhu C, Altieri MS, Spaniolas K, Pryor AD. Incidence of GERD, esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma after bariatric surgery. Surg Obes Relat Dis 2020; 16:1828-1836. [DOI: 10.1016/j.soard.2020.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
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Altieri MS, Yang J, Zhang X, Zhu C, Madani A, Castillo J, Talamini M, Pryor A. Evaluating readmissions following laparoscopic cholecystectomy in the state of New York. Surg Endosc 2020; 35:4667-4672. [PMID: 32875412 DOI: 10.1007/s00464-020-07906-9] [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] [Received: 04/23/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hospital readmissions constitute an important component of associated costs of a disease and can contribute a significant burden to healthcare. The majority of studies evaluating readmissions following laparoscopic cholecystectomy (LC) comprise of single center studies and thus can underestimate the actual incidence of readmission. We sought to examine the rate and causes of readmissions following LC using a large longitudinal database. METHODS The New York SPARCS database was used to identify all adult patients undergoing laparoscopic cholecystectomy for benign biliary disease between 2000 and 2016. Due to the presence of a unique identifier, patients with readmission to any New York hospital were evaluated. Planned versus unplanned readmission rates were compared. Following univariate analysis, multivariable logistic regression model was used to identify risk factors for unplanned readmissions after accounting for baseline characteristics, comorbidities and complications. RESULTS There were 591,627 patients who underwent LC during the studied time period. Overall 30-day readmission rate was 4.94% (n = 29,245) and unplanned 30-days readmission rate was 4.58% (n = 27,084). Female patients were less likely to have 30-day unplanned readmissions. Patients with age older than 65 or younger than 29 were more likely to have 30-day unplanned readmissions compared to patients with age 30-44 or 45-64. Insurance status was also significant, as patients with Medicaid/Medicare were more likely to have unplanned readmissions compared to commercial insurance. In addition, variables such as Black race, presence of any comorbidity, postoperative complication, and prolonged initial hospital length of stay were associated with subsequent readmission. CONCLUSION This data show that readmissions rates following LC are relatively low; however, majority of readmissions are unplanned. Most common reason for unplanned readmissions was associated with complications of the procedure or medical care. By identifying certain risk groups, unplanned readmissions may be prevented.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Chencan Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Amin Madani
- Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Jed Castillo
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mark Talamini
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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Altieri MS, DeMaria EJ. Comment on: Standardized Reporting of Comorbidity Outcome After Bariatric Surgery: Low Compliance With the ASMBS Outcome Reporting Standards Despite Ease of Use. Surg Obes Relat Dis 2020; 16:1682-1683. [PMID: 32972864 DOI: 10.1016/j.soard.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Eric J DeMaria
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
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Altieri MS, Thompson H, Pryor A, Yang J, Zhu C, Talamini M, Genua J. Incidence of colon resections is increasing in the younger populations: should an early initiation of colon cancer screening be implemented? Surg Endosc 2020; 35:3636-3641. [DOI: 10.1007/s00464-020-07842-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/24/2020] [Indexed: 12/18/2022]
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Fong ZV, Qadan M, McKinney R, Griggs CL, Shah PC, Buyske J, Sachdeva AK, Callery MP, Altieri MS. Practical Implications of Novel Coronavirus COVID-19 on Hospital Operations, Board Certification, and Medical Education in Surgery in the USA. J Gastrointest Surg 2020; 24:1232-1236. [PMID: 32314235 PMCID: PMC7169641 DOI: 10.1007/s11605-020-04596-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ross McKinney
- Association of American Medical Colleges, Washington, DC, USA
| | - Cornelia L Griggs
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Paresh C Shah
- Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Jo Buyske
- American Board of Surgery, Philadelphia, PA, USA
| | | | - Mark P Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maria S Altieri
- Department of Surgery, East Carolina University Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA.
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Abstract
The Resident and Fellow Education Committee of the Society for Surgery of the Alimentary Tract (SSAT) is committed to the education of surgical trainees and has many initiatives to connect the candidate members with the leadership of the society. This month, the Mentor of the Month series features Dr. Timothy Pawlik MD, MPH, MTS, PhD. Dr. Pawlik received his medical degree from Tufts University School of Medicine and surgical training at the University of Michigan. He also spent 2 years at the Massachusetts General Hospital as a surgical oncology research fellow and went for an advanced training in surgical oncology at The University of Texas MD Anderson Cancer Center in Houston. Dr. Pawlik is currently the Chair of Surgery, Urban Meyer III and Shelley Meyer Chair for Cancer Research, and the Surgeon in Chief at The Ohio State University Wexner Medical Center. He is discussing his path to becoming co-editor in Chief of the Journal of Gastrointestinal Surgery, how to get involved as a reviewer for the journal, and how to critically review a manuscript.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
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Altieri MS. Comment on: Thrombophilia prevalence in patients seeking laparoscopic sleeve gastrectomy: extended chemoprophylaxis may decrease portal vein thrombosis rate. Surg Obes Relat Dis 2020; 16:e43-e44. [PMID: 32423832 DOI: 10.1016/j.soard.2020.04.005] [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: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Maria S Altieri
- Division of Bariatric and Minimally Invasive Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
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Altieri MS, Carmichael H, Jones E, Robinson T, Pryor A, Madani A. Educational value of telementoring for a simulation-based fundamental use of surgical energy™ (FUSE) curriculum: a randomized controlled trial in surgical trainees. Surg Endosc 2020; 34:3650-3655. [DOI: 10.1007/s00464-020-07609-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
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