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Totonchilar S, Aarabi A, Eftekhari N, Mohammadi M. Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study. Perioper Med (Lond) 2024; 13:1. [PMID: 38167373 PMCID: PMC10763043 DOI: 10.1186/s13741-023-00356-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals. METHODS This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale. RESULTS A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons. CONCLUSIONS The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.
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Affiliation(s)
| | - Akram Aarabi
- Ardabil University of Medical Science, Ardabil, Iran.
- Isfahan University of Medical Sciences, Isfahan, Iran.
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Niu A, Ma H, Chen Z, Zhu X, Luo Y. Exploring the competencies of operating room nurses in mobile surgical teams based on the Onion Model: a qualitative study. BMC Nurs 2023; 22:254. [PMID: 37528375 PMCID: PMC10394863 DOI: 10.1186/s12912-023-01417-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND With the frequent occurrence of public health emergencies, conflicts and natural disasters around the world, mobile surgical teams are becoming more crucial. The competency of the operating room (OR) nurse has a substantial impact on the effectiveness and quality of the surgical team's treatment, still there is limited knowledge about OR nurse competencies in mobile surgical teams. This study aimed to explore the competencies of OR nurses in mobile surgical teams based on the Onion Model. METHODS We conducted a qualitative descriptive study of participants from 10 mobile surgical teams in 2022. Twenty-one surgical team members were interviewed, including 15 OR nurses, four surgeons, and two anesthesiologists. Data were collected through semi-structured interviews. The data were analyzed using Mayring's content analysis. RESULTS Twenty-eight competencies were found in the data analysis, which were grouped into four major domains using the Onion Model. From the outer layer to the inner layer were knowledge and skills, professional abilities, professional quality, and personal traits. The qualitative data revealed several novel competencies, including triage knowledge, self and mutual medical aid, outdoor survival skills, and sense of discipline. CONCLUSIONS The application of the Onion Model promotes the understanding of competency and strengthens the theoretical foundations of this study. New competencies can enrich the content of the competencies of OR nurses. The results of this study can be used for clinical recruitment, evaluation and training of OR nurses in mobile surgical teams. This study encourages further research to develop competency assessment tools and training programs for OR nurses.
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Affiliation(s)
- Aifang Niu
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Huijuan Ma
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Zhe Chen
- Army Health Service Training Base, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China
| | - Xiaoli Zhu
- Emergency department, General hospital of xinjiang military command, No. 754 Beijing Street, Urumqi, Xin Jiang, P.R. China
| | - Yu Luo
- School of Nursing, Third Military University / Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, P.R. China.
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Amare EM, Siebeck M, Yigzaw T, Fischer MR, Tadesse M, Berndt M. Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members in executing EPAs in Ethiopian medical education. Heliyon 2023; 9:e14316. [PMID: 36942250 PMCID: PMC10023974 DOI: 10.1016/j.heliyon.2023.e14316] [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: 07/26/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Background Entrustable Professional Activities (EPAs) are units of professional practice that are defined as tasks or responsibilities that are entrusted to an unsupervised execution by a trainee. In 2021, a framework of 29 EPAs was developed for surgical residency training programs in Ethiopia, with the goal of residents being able to perform independently by the time they graduate. However, studies show that surgical residents lack confidence and are unable to execute EPAs autonomously upon graduation, and concerns have been raised about graduate competencies in EPA execution. The goal of this research is to assess how surgical team members judge/perceive residents' performance in executing these EPAs autonomously at the time of graduation and how residents rate their own capability and autonomy in executing EPAs in order to systematically introduce and implement EPAs in Ethiopian medical education. Methods A survey was conducted in the Departments of Surgery at four residency training institutions in Ethiopia. All eligible surgical team members and final-year general surgery residents were invited to participate. Surgical team members were asked to rate the observed performance of a group of graduating surgical residents in each of the 29 EPAs, and residents were asked to rate their own capability in executing EPAs. The analysis focused on variations in performance ratings between surgical team members and residents, as well as across surgical team members. Results A total of 125 surgical team members and 49 residents participated in this study. Residents rate their competence in performing these EPAs higher than surgical team members, mean 4.2 (SD = 0.63) vs. 3.7 (SD = 0.9). A statistically significant difference in perceptions of capability, autonomy, and expectations in executing EPAs was observed between the two groups of study (p = 0.03, CI: 0.51-0.95), as well as within surgical team members (p < 0.001). Conclusions Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members, as well as within faculty members, were seen in executing EPAs. There were concerns about graduate surgical residents' competence to execute EPAs autonomously at the time of graduation. Surgical team members perceived that a set of graduating surgical residents are not yet safe to perform these EPAs independently (without supervision) and still requires distant supervision.
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Affiliation(s)
- Equlinet Misganaw Amare
- CIH LMU, Center for International Health, University Hospital, LMU Munich, Germany
- Corresponding author. Wollo Sefer (near Mina Building), P. O. Box 2881, Code, 1250, Addis Ababa, Ethiopia.
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Tegbar Yigzaw
- Jhpiego – Ethiopia (an Affiliate of Johns Hopkins University), Addis Ababa, Ethiopia
| | - Martin R. Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Mekdim Tadesse
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Markus Berndt
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
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McNamara C, Markey K, O'Donnell C, Murphy J, O'Brien B. Factors that enhance compliance with the Surgical Safety Checklist. Br J Nurs 2022; 31:1080-1086. [PMID: 36416625 DOI: 10.12968/bjon.2022.31.21.1080] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has reported that its Surgical Safety Checklist (SSC) has resulted in significant reductions in morbidity and mortality. Despite its proven success, meaningful compliance with the Surgical Safety Checklist initiative has been low. AIMS The authors sought to identify and explore published research on factors that enhance compliance with the SSC within surgical team members. METHODS A review of the literature published between January 2017 and January 2021 was undertaken. Six databases were searched, and 1340 studies were screened for eligibility. The 17 studies included were critically appraised using the Crowe Critical Appraisal Tool. FINDINGS Three main themes were identified: training and innovations; process adaptations and team leadership. CONCLUSION This review of the literature draws attention to the complexities of checklist compliance and identifies the need for training, leadership and adaptation to new safety processes.
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Affiliation(s)
- Claire McNamara
- University Teacher, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Kathleen Markey
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Claire O'Donnell
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Jill Murphy
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Brid O'Brien
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
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Abstract
Aim: This study examines how OR nurses experience intraoperative prevention of SSIs. Introduction: Infections related to surgical procedures create both great patient suffering and high costs for society. Therefore, prevention of Surgical Site Infections (SSIs) should be a high priority for all surgical settings. All details of intraoperative care need to be investigated and evaluated to ensure best practices are evidence-based. Methods: This study uses the Reflective Lifeworld Research (RLR) approach, which is grounded in phenomenology. Participants were OR nurses with at least one year of clinical experience. In total, 15 participants from seven hospitals made contact and were included in this interview study. Results: Prevention of SSIs takes both head and hand. It requires long-term, continuous, and systematic work in several parallel processes, both intellectually and organisationally. The hierarchical tradition of the operating room is often ambiguous, shielded by its safe structures but still restricted by traditional patterns. Confident relations and resolute communication within the team generate favorable conditions for preventing SSIs. Conclusions: By setting up mutual platforms and forums for quality development, increasing legitimacy for OR nurses and establishing fixed teams, prevention of SSIs will continue to improve, ensuring the patients’ safety during intraoperative care.
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Affiliation(s)
- Maria Qvistgaard
- a Department of Health and Caring sciences , Linneus University , Växjö , Sweden
| | - Jenny Lovebo
- a Department of Health and Caring sciences , Linneus University , Växjö , Sweden
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Corsini EM, Luc JGY, Mitchell KG, Turner NS, Vaporciyan AA, Antonoff MB. Predictors of the response of operating room personnel to surgeon behaviors. Surg Today 2019; 49:927-35. [PMID: 31144105 DOI: 10.1007/s00595-019-01829-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Several studies have assessed the physician-nurse relationship, particularly between females working together. While the surgeon workforce is increasingly represented by females, gendered relationships and biases in the operating room remain largely unstudied. METHODS We performed a prospective randomized study in which operative support staff, including nurses, surgical technologists, and surgical assistants, assessed scenarios describing questionable surgeon behaviors. Respondents were randomized to a survey that either discussed a female or male surgeon. For each scenario, one of the four standardized responses was selected. The respondents' assessments of surgeon behaviors were analyzed. RESULTS The response rate was 4.4% (3128/71143). Females were more likely than males to deem the surgeon's behavior inappropriate regardless of surgeon sex (p = 0.001). The likelihood of writing up the surgeon was predicted by role, with technologists, nurses, and assistants reporting surgeons at frequencies of 65.5%, 53.2%, and 48.8%, respectively (p = 0.008). While the overall respondents did not show a propensity to write-up either sex differentially (p = 0.070), technologists were significantly more likely to report female surgeons than male surgeons (p = 0.006). CONCLUSION Characteristics of operative personnel were correlated with varying tolerance of surgeon behaviors, with specific subgroups more critical of female surgeons than males. Further exploration of these perceptions will serve to improve interactions in a diverse workplace.
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Vermeulen CFW, Keijzers PJ, Fredriks EHWM, van der Hee P, Van Waes OJF, Hoencamp R. Dutch combat operation experiences in Iraq and Afghanistan: The conundrum of low surgical workload deployments. Injury 2019; 50:215-9. [PMID: 30458983 DOI: 10.1016/j.injury.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Combined Joined Task Force - Operation Inherent Resolve is the military intervention of Iraq and Coalition Forces in the battle against Islamic State of Iraq and Syria (ISIS). Al Assad Airbase (AAAB) is one of the key airbases. It contains a Role 2 Medical Treatment Facility, primarily to perform Damage Control Surgery in Coalition Forces, Iraqi National Security Forces and Local Nationals. We present a six month medical exposure in order to provide insight into the treatment of casualties and to optimize medical planning of combat operations and (pre-/post-) deployment training. PATIENTS AND METHODS This is a cohort study of casualties that were admitted to the Role 2 Medical Treatment Facility AAAB from November 2017 to April 2018. Their mechanisms and types of injury are described and compared to those sustained in Uruzgan, Afghanistan between 2006-2010. Additionally, they are compared to the caseload in the Dutch civilian medical centers of the medical specialist team at AAAB. RESULTS There were significant differences in both mechanism and type of injury between Coalition Forces and Iraqi Security Forces (p = 0.0001). Coalition Forces had 100% disease and non-battle injuries, where Iraqi Security Forces had 86% battle injuries and 14% non-battle casualties. The most common surgical procedures performed were debridement of wounds (38%), (exploratory) laparotomy (10%) and genital procedures (7%). The surgical caseload in Uruzgan, Afghanistan was significantly different in aspect and quantity, being 4.1 times higher. When compared to the workload at home all team members had at least a tenfold lower workload than in their civilian hospitals. DISCUSSION The deployed surgical teams were scarcely exposed to casualties at AAAB, Iraq. These low workload deployments could cause a decline in surgical skills. Military medical planning should be tailormade and should include adjusting length of stay, (pre-/post-)deployment refresher training and early consultation of military medical specialists. Future research should focus on optimizing this process by investigating fellowships in combat matching trauma centers, regional and international collaboration and refresher training possibilities to maintain the expertise of the acute military care provider.
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Craig-Schapiro R, DiBrito SR, Overton HN, Taylor JP, Fransman RB, Haut ER, Sacks BC. Meet your surgical team: The impact of a resident-led quality improvement project on patient satisfaction. Am J Surg 2018; 216:793-799. [PMID: 30177240 DOI: 10.1016/j.amjsurg.2018.07.056] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients often have an incomplete understanding of the levels of training and roles of the various surgical providers in teaching hospitals, leading to patient confusion and dissatisfaction. METHODS Pre-intervention discharge surveys were administered to gastrointestinal surgery inpatients (10/2016-02/2017) to evaluate sentiments regarding their surgical team. During the intervention period (02/2017-05/2017), patients at admission received "facesheets" containing team member profiles, photos, training level, and roles. These patients were evaluated using the survey, and pre- and post-intervention scores compared. RESULTS 153 pre- and 100 post-intervention surveys were collected. There was a significant increase in patients reporting it was important to know the surgical team members and that they knew team member roles (p ≤ 0.05). Scores in every domain of the satisfaction survey improved in the post-intervention period, although not reaching statistical significance. CONCLUSIONS Improving how patients perceive their interactions with their surgical team has implications on patient satisfaction and hospital quality metrics.
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Affiliation(s)
| | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Heidi N Overton
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - James P Taylor
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Ryan B Fransman
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Bethany C Sacks
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Bennett L, Ryan S, Walker L. Building an effective and efficient theatre team and harnessing its power. J Perioper Pract 2018; 28:123-127. [PMID: 29734932 DOI: 10.1177/1750458918767567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Laura Bennett
- 1 Senior Clinical Sister, CEPOD Theatre, Medway Maritime Hospital
| | - Shouphyna Ryan
- 2 Clinical Sister, CEPOD Theatre, Medway Maritime Hospital
| | - Lisa Walker
- 3 Senior Operating Department Practitioner, CEPOD Theatre, Medway Maritime Hospital
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Erestam S, Erichsen A, Derwinger K, Kodeda K. A survey of surgeons' perception and awareness of intraoperative time utilization. Patient Saf Surg 2014; 8:30. [PMID: 25006350 PMCID: PMC4086263 DOI: 10.1186/1754-9493-8-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/24/2014] [Accepted: 06/19/2014] [Indexed: 12/14/2022] Open
Abstract
Background Surgical teams’ awareness of the time needed to perform specific phases of a surgical procedure is likely to improve communication in the operating theatre and benefit patient safety. The aim of this study was to assess surgeons’ awareness of time utilization and the actual time needed to perform specific phases of an operation. Methods A survey was conducted to examine the method and design for a larger study. Interviews were conducted with 18 surgeons, and surgical time was measured during 21 colon cancer resections. Correlation analyses were performed to explore the factors that might affect operating time. Results The surgical phase with the greatest variation in time was dissection/resection (43–308 minutes). On a group level, no statistically significant differences were found between estimated and measured surgical procedural times for partial or full resections (160.4 versus 173.0 minutes, p = 0.539). However, interindividual variation was substantial. There was a positive significant correlation between long duration of dissection/resection and longer time to close the abdomen (r = 0.464, p = 0.039), as well as between long duration of a hand-sewn anastomosis and time needed to close the abdomen (r = 0.536, p = 0.018). Conclusions It can be difficult for a single surgeon to estimate the time required for a partial or full surgical procedure. A larger study might provide additional time estimates and identify variables that affect surgical time. The data could be of interest in the planning and scheduling of surgical resources, thus improving theatre team communication and patient safety.
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Affiliation(s)
- Sofia Erestam
- Institute of Health and Care Sciences, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden ; Department of Anaesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Annette Erichsen
- Institute of Health and Care Sciences, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden ; Department of Anaesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Kristoffer Derwinger
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Campus Östra, Gothenburg, Sweden ; Department of Colorectal Surgery, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Karl Kodeda
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Campus Östra, Gothenburg, Sweden ; Department of Colorectal Surgery, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
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McCahill LE, May M, Morrow JB, Khandavalli S, Shabahang B, Kemmeter P, Pimiento JM. Esophagectomy outcomes at a mid-volume cancer center utilizing prospective multidisciplinary care and a 2-surgeon team approach. Am J Surg 2013; 207:380-6; discussion 385-6. [PMID: 24581762 DOI: 10.1016/j.amjsurg.2013.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 09/30/2022]
Abstract
BACKGROUND Esophagectomy is associated with high morbidity and mortality, leading to calls for restricted performance at high-volume centers. METHODS Patients with esophageal cancer were evaluated prospectively in a multidisciplinary tumor board from January 2012 - December 2012. A 2-surgeon team was utilized and detailed outcomes were assessed prospectively. RESULTS Thirty-one patients underwent esophagectomy, 20 patients underwent laparoscopic transhiatal (65%) approach, and 11 patients underwent laparoscopically assisted Ivor-Lewis (35%) approach. Eighty-one percent of the patients were male, with a median age of 64 years (range: 35 to 83 years) and 73% of the patients had adenocarcinoma. Neoadjuvant chemoradiation was performed in 79% of the patients. R0 resection was achieved in 29 (94%) patients, median nodes identified were 15. Major complications (grade III to V) occurred in 13 (42%) patients and did not correlate with surgical techniques, anastomotic leak occurred in 5 (16%) patients, and significant pulmonary complications occurred in 11 (35%) patients. The length of stay at the hospital was 10 days, readmission rate 23%, and 30-day mortality rate 6%. CONCLUSIONS High-quality esophagectomy can be performed safely at a mid-volume cancer center. Our outcomes question the reliance on volume alone as an indicator of cancer surgical quality.
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Affiliation(s)
- Laurence E McCahill
- Metro Cancer Center, Metro Health Hospital, 5950 Metro Way, Wyoming, MI 49519, USA; College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Mary May
- Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA
| | | | - Sharif Khandavalli
- Metro Cancer Center, Metro Health Hospital, 5950 Metro Way, Wyoming, MI 49519, USA; Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA
| | - Behooz Shabahang
- Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA
| | | | - Jose M Pimiento
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA; Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA
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Seth AK, Hirsch EM, Kim JY, Bethke KP, Hansen NM, Fine NA. Two surgeons, one patient: the impact of surgeon-surgeon familiarity on patient outcomes following mastectomy with immediate reconstruction. Breast 2013; 22:914-8. [PMID: 23673077 DOI: 10.1016/j.breast.2013.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 02/07/2013] [Accepted: 04/17/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mastectomy with immediate reconstruction requires the coordination and expertise of two distinct surgeons. This often results in several different combinations of mastectomy and reconstructive surgeons, but with an unknown impact on patient outcomes. We evaluate the effect of different surgical teams on complication rates following mastectomy and immediate reconstruction. METHODS Retrospective review of consecutive patients that underwent mastectomy with immediate prosthetic reconstruction from 4/1998 to 10/2008 at one institution was performed. Patients of the three highest-volume mastectomy and reconstructive surgeons were stratified by their individual combination of surgeons, resulting in nine different surgical teams. Complications were categorized by end-outcome. Appropriate statistics, including multiple linear regression, were performed. RESULTS Clinical characteristics were similar among patients (n = 511 patients, 699 breasts) with the same mastectomy surgeon but different reconstructive surgeon. Mean follow-up was 38.4 ± 25.7 months. For each mastectomy surgeon, the choice of reconstructive surgeon did not affect complication rates. Furthermore, the combined complication rates of the three highest-volume teams (n = 384 breasts) were similar to the remaining lower-volume teams (n = 315 breasts). Patient factors, but not the individual surgeon or surgical team, were independent risk factors for complications. DISCUSSION Our study suggests that among high-volume surgeons, complication rates following mastectomy with immediate reconstruction are not affected by the surgeon-surgeon familiarity. The individual surgeon's expertise, and patient risk factors, may have a greater impact on outcomes than the team's experience with each other. These results validate the efficacy and safety of the surgeon distribution model currently used by many breast surgery practices.
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