1
|
Manzella A, Kravchenko T, Kheng M, Chao J, Laird AM, Pitt HA, Beninato T. Effects of the COVID-19 pandemic on endocrine operations in the United States. Am J Surg 2024; 228:22-29. [PMID: 37659868 DOI: 10.1016/j.amjsurg.2023.08.004] [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: 05/30/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the United States (US) healthcare system. Endocrine operations are predominantly elective and were likely affected. Therefore, our aim was to determine the effect of the pandemic on endocrine operations. STUDY DESIGN The Vizient Clinical Data Base® was examined for cases from 1/2019-12/2022 using ICD10 and CPT codes for thyroid, parathyroid, and adrenal operations. Control chart analysis identified trends in operative volume. Negative binomial regression was utilized to analyze demographic trends. RESULTS Monthly volumes for all operations from 515 hospitals decreased at the beginning of 2020, except for operations for adrenal malignancy. Inpatient operations (Thyroid -17.1%, Parathyroid -20.9%, p < 0.001 for both) experienced more significant and longer lasting disruptions than outpatient operations (Thyroid -2.6%, p = 0.883, Parathyroid -9.1%, p = 0.098). CONCLUSIONS The COVID-19 pandemic disrupted endocrine operations across the US. While all adrenal operations and outpatient thyroid and parathyroid operations have returned to pre-pandemic levels, inpatient operations for thyroid and parathyroid remain decreased.
Collapse
Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Timothy Kravchenko
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Marin Kheng
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joshua Chao
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| |
Collapse
|
2
|
He LD, Duggan JL, Lans J, Harper CM, Rozental TD. Trends in Orthopedic Management of Distal Radius Fractures Among Medicare Beneficiaries From 2019 to 2020: A Claims Analysis. J Hand Surg Glob Online 2023; 5:717-721. [PMID: 38106940 PMCID: PMC10721538 DOI: 10.1016/j.jhsg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Radius and ulna fractures are among the most common fractures. These fractures are managed through operative or nonsurgical treatment, with varying implications in terms of cost and functional outcome. There are few studies that robustly characterize the management of distal radius fractures (DRFs) in the United States during the COVID-19 pandemic. Furthermore, this has not been studied among the Medicare patient population, who are particularly vulnerable to fragility fractures and COVID-19. The purpose of this study is to analyze the services provided to Medicare beneficiaries both before and during the COVID-19 pandemic to determine how procedure volume was affected in this patient population. Methods We retrospectively analyzed services using the physician or supplier procedure summary data from the Centers for Medicare and Medicaid Services. All services provided by physicians between January 1, 2019, and December 31, 2020, were included. The data were stratified by US census region using insurance carrier number and pricing locality codes. We also compared data between states that maintained governors affiliated with the Democratic or Republican parties for the duration of the study. Results There was an overall decrease in claims regarding DRFs management from 2019 to 2020. There was a dramatic decline in procedure volume (-6.3% vs -12.9%). Of all distal radius related claims there was a relative increase in the proportion of operatively managed DRFs in 2020, from 50.2% to 52.0%. The Midwest saw the greatest decline in operatively managed DRFs, whereas the West experienced the smallest per-capita decline across all procedures. After separating the data by party affiliation, it was also found that operative and nonsurgical procedure volumes fell more sharply in states with Democratic governors. Conclusions This study shows a decrease in DRF procedural volume among Medicare beneficiaries. This data suggests that the operative and nonsurgical management of DRFs may have been affected by pandemic factors such as quarantine guidelines and supply chain or resource limitations. This may assist surgeons and health care systems in predicting how similar crises may affect operative volume. Type of study/level of evidence Therapeutic IV.
Collapse
Affiliation(s)
| | | | - Jonathan Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Carl M. Harper
- Division of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara D. Rozental
- Division of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Sisak S, Salyer CE, Cortez AR, Vaysburg DM, Quillin RC, Van Haren RM. Experience of surgical subspecialty residents on general surgery rotations. Am J Surg 2023; 225:673-678. [PMID: 36336482 DOI: 10.1016/j.amjsurg.2022.10.044] [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: 05/20/2022] [Revised: 07/21/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical subspecialty residents complete 5-6 years of training which includes general surgery rotations. A lack of data exists evaluating these rotations. This study aims to identify discrepancies in subspecialty training and improve the quality of surgical education. METHODS Case logs for surgical subspecialty residents and general surgery residents at our institution were analyzed and queried for cases performed on general surgery rotations. A survey was distributed to subspecialty residents regarding their perceptions of these rotations. RESULTS 50 residents were included in the study and the majority were male (n = 27, 54%). Subspecialty residents perform fewer cases per month compared to general surgery residents (13 vs 21, p < 0.001). 75% of subspecialty residents were satisfied with their experience on general surgery rotations. CONCLUSIONS Subspecialty residents perform fewer operations on general surgery rotations. Despite this, most are satisfied with off-service rotations and believe they are an important part of their education.
Collapse
Affiliation(s)
- Stephanie Sisak
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Christen E Salyer
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Dennis M Vaysburg
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - R Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA
| | - Robert M Van Haren
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| |
Collapse
|
4
|
Mehrabian D, Liu IZ, Pakhchanian HH, Tarawneh OH, Raiker R, Boyd CJ. Nationwide analysis of plastic and reconstructive procedural volume in the United States during the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2021; 75:1483-1496. [PMID: 34955397 PMCID: PMC8639288 DOI: 10.1016/j.bjps.2021.11.100] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022]
Abstract
Introduction This study aims to define the impact of the novel Coronavirus Disease 2019 (COVID-19) pandemic on the volume of common plastic and reconstructive procedures in the United States. Methods TrinetX is a national, federated database that was utilized in surveying plastic and reconstructive procedural volumes among 53 Healthcare organizations (HCO) between March 2018 and May 2021. This timeframe was divided into pre-pandemic (March 2018 to February 2020) and pandemic periods (March 2020 to May 2021). Each period was then sub-divided into four seasons of the year and the mean monthly procedural volume per HCO was compared. A student's t-tests comparing pre-pandemic and pandemic seasonal mean procedural volumes were used for statistical analysis. Results A total of 366,032 patient encounters among 53 HCO were included. The average seasonal volume per HCO of all procedures reduced from 872.11 procedures during pre-pandemic seasons to 827.36 during pandemic seasons. Spring 2020 vol declined for most procedures as 15 of 24 (63%) assessed procedure categories experienced statistically significant decreases. Spring 2021 experienced rebounds with 15 of 24 (63%) assessed procedures showing statistically significant increases. Conclusion During the pandemic period, the average procedural volume per HCO of 14 procedure categories was significantly less than the pre-pandemic average procedural volume. Overall, an inverse relationship was observed between novel COVID-19 cases and plastic and reconstructive surgery procedure volumes in the United States.
Collapse
Affiliation(s)
- Daniel Mehrabian
- Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Ivan Z Liu
- Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Haig H Pakhchanian
- George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA
| | - Omar H Tarawneh
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA
| | - Rahul Raiker
- West Virginia University School of Medicine, 1 Medical Center Dr, Morgantown, WV 26506, USA
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 222 East 41st Street, New York, NY 10017-6739, USA.
| |
Collapse
|
5
|
Chen YW, Westfal ML, Cauley CE, Chang DC, Kelleher CM. Do surgeons adjust clinical productivity after maternity leave? Am J Surg 2021; 223:900-904. [PMID: 34615603 DOI: 10.1016/j.amjsurg.2021.09.032] [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: 07/02/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been speculated that women's productivity decreases after maternity leave. In this study, we measured if surgeon clinical productivity decreases after a maternity leave or other types of leave. METHODS Data from a large medical center was used to measure surgeon productivity before (pre) and after (post) a leave of absence. Post-to-pre productivity ratios were calculated for each leave based on operative volumes and Relative Value Units (RVUs). Multivariate linear regression analysis was performed for the post/pre productivity ratios, adjusting for surgeon characteristics. RESULTS Fifty leaves of absence, from 30 surgeons, were analyzed. There was no significant difference between post and pre leave productivity for maternity leave or other types of leave. There was also no significant difference when comparing post/pre productivity ratios between maternity leaves versus other types of leave (volume: 0.06, p = 0.52; RVU: 0.08, p = 0.58). CONCLUSION Surgeons do not significantly reduce clinical productivity after maternity or other types of leaves.
Collapse
Affiliation(s)
- Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Maggie L Westfal
- Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Cassandra M Kelleher
- Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
6
|
Purdy AC, Smith BR, Hohmann SF, Nguyen NT. The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States. Surg Endosc 2021. [PMID: 33871720 DOI: 10.1007/s00464-021-08477-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/28/2021] [Indexed: 02/06/2023]
Abstract
Background In March 2020, the Surgeon General recommended limiting elective procedures to prepare for the COVID-19 surge. We hypothesize a consequence of COVID-19 is reduced operative volume across the country. We aim to examine changes in volume of common gastrointestinal operations during COVID-19, including elective, urgent/emergent, and cancer operations. We also evaluate if hospitals with more COVID-19 admissions were most impacted. Methods The Vizient database was used to determine monthly operative volume from November 2019 to June 2020 for elective operations (hiatal hernia repairs, bariatric surgery), urgent operations (cholecystectomies, appendectomies, inguinal hernia repairs), and cancer operations (colectomies, gastrectomies, esophagectomies). COVID-19 admissions per hospital were also determined. November 2019–January 2020 was defined as “pre-COVID.” The monthly reduction in volume from pre-COVID was calculated for each operation. The top quartile (25%) of hospitals with the most COVID admissions were also evaluated separately from hospitals with fewer COVID cases. Data were analyzed using analysis of variance. Results Data from 559 hospitals were analyzed. The volumes of all operations evaluated were significantly reduced during the pandemic except gastrectomies and esophagectomies for cancer. The greatest reduction in all operations was in April. In April, the volume of bariatric surgery reduced by 98% (P < 0.001), hiatal hernia repairs by 96% (P < 0.001), urgent cholecystectomies by 42% (P < 0.001), urgent inguinal hernia repairs by 40% (P < 0.001), urgent appendectomies by 24% (P < 0.001), and colectomies for cancer by 39% (P < 0.001). Hospitals with the most COVID-19 admissions had greater reductions in all operations than hospitals with fewer COVID cases. Conclusions The coronavirus pandemic led to a significant reduction in volume of all gastrointestinal operations evaluated except gastrectomies and esophagectomies. While elective, non-cancer operations were most affected, urgent and some cancer operations also declined significantly. As COVID-19 continues to surge, Americans may suffer continued limited access to surgical care and a significant operative backlog may be forthcoming.
Collapse
|
7
|
Kassam AF, Lynch CA, Cortez AR, Vaysburg D, Potts JR, Quillin RC. Where Has All the Complexity Gone? An Analysis of the Modern Surgical Resident Operative Experience. J Surg Educ 2021; 78:9-16. [PMID: 32616451 DOI: 10.1016/j.jsurg.2020.06.016] [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] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The operative experience of today's general surgery (GS) residents are changing. The Surgical Council on Resident Education (SCORE) was founded to provide a standardized, competency-based curriculum. We set out to evaluate resident operative experience in core and advanced operations. DESIGN Accreditation Council for Graduate Medical Education (ACGME) national operative log reports from 2010 to 2018 were reviewed. Operative volume data for 344 operations were extracted and analyzed. Operations were designated as core, advanced, or undefined as listed by SCORE, and stratified as GS or subspecialty. SETTING National analysis utilizing ACGME operative log reports. PARTICIPANTS All graduating general surgery residents between 2010 and 2018. RESULTS A total of 10,118 residents completed GS training with an average of 1121.5 ± 29.3 total cases. Core operations comprised 80.5% of total volume while advanced comprised only 8.0%. The total core experience increased (+7.0 cases/year), while total advanced experience decreased (-1.4 cases/year) (p < 0.01 each). Compositional analysis among core operations revealed an increase in 9/13 GS domains and a decrease in 8/10 subspecialty domains (all p < 0.05). CONCLUSIONS There has been an increase in core operative experience with a concurrent decrease in advanced operative experience of graduating GS residents. These findings highlight the continued narrowing of the operative experience for trainees, with increasing focus on GS and less on subspecialty domains. Ongoing efforts to look beyond operative volume to ensure competency of graduates will prove beneficial.
Collapse
Affiliation(s)
- Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio.
| | - Caroline A Lynch
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Dennis Vaysburg
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - John R Potts
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - R Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| |
Collapse
|
8
|
Wali AR, Ryba BE, Kang K, Santiago-Dieppa DR, Steinberg J, Diaz-Aguilar LD, Stone LE, Brandel MG, Longhurst CA, Taylor W, Khalessi AA. Impact of COVID-19 on a Neurosurgical Service: Lessons from the University of California San Diego. World Neurosurg 2020; 148:e172-e181. [PMID: 33385598 PMCID: PMC7772085 DOI: 10.1016/j.wneu.2020.12.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/25/2022]
Abstract
Background The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. Methods We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. Results The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre–versus post–OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. Conclusions During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.
Collapse
Affiliation(s)
- Arvin R Wali
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Bryan E Ryba
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA.
| | - Keiko Kang
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | | | - Jeffrey Steinberg
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | | | - Lauren E Stone
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Michael G Brandel
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Christopher A Longhurst
- Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - William Taylor
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
9
|
Baumgarten HD, Bauer AJ, Isaza A, Mostoufi-Moab S, Kazahaya K, Adzick NS. Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center. J Pediatr Surg 2019; 54:1969-1975. [PMID: 30902456 DOI: 10.1016/j.jpedsurg.2019.02.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/29/2018] [Accepted: 02/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent studies suggest improved outcomes for children undergoing thyroidectomy at high-volume pediatric surgery centers. We present outcomes after thyroid surgery at a single center and advocate for referral to high-volume centers for multidisciplinary management of these children. METHODS Medical records were reviewed for all pediatric patients undergoing thyroid surgery at a single institution from 2009 through 2017. Routine recurrent laryngeal nerve and parathyroid hormone monitoring was used. Lymph node dissections were performed in appropriately selected cancer patients. Data collection focused on pathologic diagnosis, surgical technique, and surgical complications, including postoperative hematoma, neurapraxia, permanent nerve damage, hypocalcemia, and transient and permanent hypoparathyroidism. RESULTS From 2009 through 2017, 464 patients underwent thyroid surgery. Median age of the cohort was 15 years (range 2-24). Thirty-three percent were diagnosed with benign nodules (n=151), 36% with papillary or follicular thyroid cancer (n=168), 27% with Graves' disease (n=124), 3% with medullary thyroid cancer (n=14), and 1.5% underwent prophylactic thyroidectomy for MEN2a (n=7). Six patients required return to the OR for hematoma evacuation including 5 patients after surgery for Graves' disease (RR 8.7, 95% CI 1.06-71.85). In sixteen cases, concern about neurapraxia resulted in laryngoscopy, revealing eleven patients with vocal cord paresis. Two of these patients demonstrated a persistent deficit at 6 months postoperatively (0.4%). Thirty-seven percent of patients had transient hypoparathyroidism (n=137), and two patients had persistent hypoparathyroidism 6 months after total thyroidectomy (0.6%). There was no significant difference in either hypocalcemia or hypoparathyroidism after total thyroidectomy based on age or diagnosis. CONCLUSIONS Characterizing outcomes for pediatric patients based on diagnosis will assist in preoperative counseling for patients and their families. This high-volume center reports low complication rates after pediatric thyroid surgery, highlighting that referral to high-volume centers should be considered for children and adolescents with thyroid disease requiring surgery. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Heron D Baumgarten
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Andrew J Bauer
- Department of Pediatrics, and the Pediatric Thyroid Center, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amber Isaza
- Department of Pediatrics, and the Pediatric Thyroid Center, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, and the Pediatric Thyroid Center, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ken Kazahaya
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - N Scott Adzick
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
10
|
Albutt K, Punchak M, Kayima P, Namanya DB, Shrime MG. Operative volume and surgical case distribution in Uganda's public sector: a stratified randomized evaluation of nationwide surgical capacity. BMC Health Serv Res 2019; 19:104. [PMID: 30728037 PMCID: PMC6366061 DOI: 10.1186/s12913-019-3920-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023] Open
Abstract
Background Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. Methods A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda’s population. Results A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R2 = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics. Conclusion An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
Collapse
Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Peter Kayima
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health, Kampala, Uganda.,Uganda Martyrs University, Nkozi, Uganda
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| |
Collapse
|
11
|
Cortez AR, Dhar VK, Sussman JJ, Pritts TA, Edwards MJ, Quillin RC. Not all operative experiences are created equal: a 19-year analysis of a single center's case logs. J Surg Res 2018; 229:127-133. [PMID: 29936979 DOI: 10.1016/j.jss.2018.03.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/21/2017] [Revised: 03/19/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although national operative volumes have remained stable, surgical educators should appreciate the changing experience of today's surgical residents. We set out to evaluate operative volume trends at our institution and study the impact of resident learning styles on operative experience. MATERIALS AND METHODS The Accreditation Council for Graduate Medical Education operative log data from 1999 to 2017 for a single general surgery residency program were examined. All residents completed the Kolb Learning Style Inventory. Statistical analyses were performed using linear regression analysis, Student's t-test, and Fischer's exact test. RESULTS Over the study period, 106 general surgery residents graduated from our program. There were 87% action learners and 13% observation learners. Although there was no change in total major, total chief, or total non-chief cases, a decrease in teaching assistant cases was observed. Subcategory analysis revealed that there was an increase in operative volume on graduation in the following categories: skin, soft tissue, and breast; alimentary tract; abdomen; pancreas; operative trauma; pediatric; basic laparoscopy; complex laparoscopy; and endoscopy with a concurrent decrease in liver, vascular, and endocrine. Learning style analysis found that action learners completed significantly more cases than observation learners in most domains in which operative volume increased. CONCLUSIONS While the operative volume at our center remained stable over the study period, the experience of general surgery residents has become narrowed toward a less subspecialized, general surgery experience. These shifts may disproportionally impact trainees as observation learners operate less than action learners. Residency programs should therefore incorporate methods such as learning style assessment to identify residents at risk of a suboptimal experience.
Collapse
Affiliation(s)
| | - Vikrom K Dhar
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - R Cutler Quillin
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, New York
| |
Collapse
|
12
|
Tso MK, Dakson A, Ahmed SU, Bigder M, Elliott C, Guha D, Iorio-Morin C, Kameda-Smith M, Lavergne P, Makarenko S, Taccone MS, Wang B, Winkler-Schwartz A, Sankar T, Christie SD. Operative Landscape at Canadian Neurosurgery Residency Programs. Can J Neurol Sci 2017; 44:415-9. [PMID: 28322180 DOI: 10.1017/cjn.2017.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. METHODS Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. RESULTS Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. CONCLUSIONS This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.
Collapse
|