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Alzumaili BA, Krumeich LN, Collins R, Kravchenko T, Ababneh EI, Fisch AS, Faquin WC, Nosé V, Martinez-Lage M, Randolph GW, Gartland RM, Lubitz CC, Sadow PM. A Comprehensive Study on the Diagnosis and Management of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid 2023; 33:566-577. [PMID: 36960710 PMCID: PMC10171954 DOI: 10.1089/thy.2023.0035] [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] [Indexed: 03/25/2023]
Abstract
Background: Since the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) was introduced in 2016, most retrospective studies have included cases diagnosed as encapsulated follicular variant of papillary thyroid carcinoma. We investigate a cohort diagnosed with NIFTP at resection. Methods: Retrospective institutional cohort of NIFTP from 2016 to 2022, including clinical, cytological, and molecular data for 319 cases (6.6% of thyroid surgeries, 183 cases as NIFTP-only). Results: The patient cohort had unifocal or multifocal thyroid nodules. Female:male ratio was 2.7:1, mean age was 52 years and median NIFTP size was 2.1 cm. NIFTP was associated with multiple nodules in 23% patients (n = 73) and 12% of NIFTP were multifocal (n = 39). Fine needle aspiration (FNA) of NIFTP (n = 255) were designated as nondiagnostic = 5%, benign = 13%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) = 49%, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) = 17%, suspicious for malignancy = 12%, or malignant = 4%. Molecular alterations were identified in 93% (n = 114), RAS or RAS-like. Thyroid Imaging Reporting and Data System (TI-RADS) score 4 was recorded in 50% of NIFTP, followed by scores 3 and 5 (26% and 20%, respectively). We also investigated the factors associated with extent of surgery. In our NIFTP-only group (n = 183), 66% were identified after hemithyroidectomy (HT) and 34% after total thyroidectomy (TT). On univariate analysis, TT patients demonstrated higher Bethesda category by FNA, more often had aberrant preoperative thyroid function, and/or underwent an FNA of additional nodule(s). With multivariable regression, Bethesda V NIFTP, in the presence of other nodules being evaluated by FNA and aberrant preoperative thyroid function, independently predicts TT. Bethesda II NIFTP correlated significantly with HT. Fifty-two patients (28%) with NIFTP-only had at least one postoperative surveillance ultrasound. In the NIFTP-only cohort, no HT patients had completion thyroidectomy or received postoperative radioactive iodine. No recurrence or metastases were recorded with median follow-up of 35 months (6-76 months; n = 120). Conclusions: Given this large cohort of NIFTP, including a large subset of isolated NIFTP-only, some with >6 years of follow-up and no tumor recurrences, consensus practical guidelines are needed for adequate postoperative management. Given the American Thyroid Association (ATA) provides guidelines for management of low-risk malignancies, guidance regarding that for borderline/biologically uncertain tumors, including NIFTP, is a reasonable next step.
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Affiliation(s)
- Bayan A. Alzumaili
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren N. Krumeich
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Reagan Collins
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy Kravchenko
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emad I. Ababneh
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S. Fisch
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William C. Faquin
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Vania Nosé
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W. Randolph
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology—Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Rajshri M. Gartland
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie C. Lubitz
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M. Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Gartland RM, Landino SM, Liang NE, Day CJ, Berger DL. Obstructive Jaundice Secondary to Peribiliary Cyst Within the Common Hepatic Duct. Am Surg 2023; 89:478-480. [PMID: 33283523 DOI: 10.1177/0003134820973359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rajshri M Gartland
- Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha M Landino
- Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Norah E Liang
- Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Celeste J Day
- Department of Anesthesiology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Naureckas Li C, Leya GA, Mort E, Aaronson E, Gartland RM. Development and Implementation of a Practical Onboarding Curriculum for Physician Quality and Safety Leaders. Am J Med Qual 2023; 38:81-86. [PMID: 36735496 DOI: 10.1097/jmq.0000000000000106] [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: 02/04/2023]
Abstract
Physicians are increasingly asked to assume quality and safety (Q&S) leadership roles; prior experience varies, and onboarding training is limited. Semistructured interviews were completed with physician Q&S leaders; interview responses were analyzed using 2-step rapid analysis. Interview learnings informed development of a 2-day onboarding training and complementary digital resource repository. Attendees were surveyed to evaluate the training. Thirteen semistructured interviews with physician leaders from 6 academic medical centers demonstrated 61.5% had no formal Q&S training before assuming their role. Respondents identified a range of knowledge gaps. A 2-day virtual onboarding training and complementary digital repository were created. Attendee surveys demonstrated 96% (73/76) believed the training would be "extremely" or "moderately" helpful to others. Subject-matter familiarity across all content areas improved after the training. Using front-line stakeholder input, a pilot onboarding curriculum for Q&S leaders was created. Future work includes ongoing implementation and iterative improvement.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
| | - Gregory A Leya
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth Mort
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, and Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Emily Aaronson
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rajshri M Gartland
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Collins RA, DiGennaro C, Beninato T, Gartland RM, Chaves N, Broekhuis JM, Reddy L, Lee J, Deimiller A, Alterio MM, Campbell MJ, Lee YJ, Khilnani TK, Stewart LA, O’Brien MA, Alvarado MVY, Zheng F, McAneny D, Liou R, McManus C, Dream SY, Wang TS, Yen TW, Alhefdhi A, Finnerty BM, Fahey TJ, Graves CE, Laird AM, Nehs MA, Drake FT, Lee JA, McHenry CR, James BC, Pasieka JL, Kuo JH, Lubitz CC. Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19. Surgery 2023; 173:93-100. [PMID: 36210185 PMCID: PMC9420726 DOI: 10.1016/j.surg.2022.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/28/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans. METHODS American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon. RESULTS Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ2 = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66). CONCLUSION Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.
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Affiliation(s)
- Reagan A. Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Catherine DiGennaro
- Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Natalia Chaves
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jordan M. Broekhuis
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Lekha Reddy
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jenna Lee
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Maeve M. Alterio
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Yeon Joo Lee
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Latoya A. Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Mollie A. O’Brien
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | | | - Feibi Zheng
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - David McAneny
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | - Rachel Liou
- Section of Endocrine Surgery, Columbia University, New York, NY
| | | | - Sophie Y. Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tracy S. Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W. Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Amal Alhefdhi
- Department of General Surgery, Breast and Endocrine Section, King Faisal Specialist Hospital and Research Centre, Al Mathar Ash Shamali, Riyadh, Saudi Arabia
| | - Brendan M. Finnerty
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Thomas J. Fahey
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Amanda M. Laird
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Matthew A. Nehs
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | | | - James A. Lee
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Christopher R. McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Benjamin C. James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Janice L. Pasieka
- Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jennifer H. Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Carrie Cunningham Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA,Reprint requests: Carrie Cunningham Lubitz, MD, MPH, 55 Fruit Street, Boston, MA 02114
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Gebran A, El Moheb M, Argandykov D, Mashbari H, Gartland RM, Hwabejire JO, Velmahos GC, Kaafarani HM. Mesenteric Ischemia in Patients with Coronavirus 2019: A Scoping Review. Surg Infect (Larchmt) 2022; 23:781-786. [DOI: 10.1089/sur.2022.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Anthony Gebran
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohamad El Moheb
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dias Argandykov
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hassan Mashbari
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Faculty of Medicine, Jazan University, Saudi Arabia
| | - Rajshri M. Gartland
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John O. Hwabejire
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George C. Velmahos
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Fazendin JM, Gartland RM, Stephen A, Porterfield JR, Hodin R, Lindeman B. Outpatient Adrenalectomy: A Framework for Assessment and Institutional Protocol. Ann Surg 2022; 275:e541-e542. [PMID: 34091505 DOI: 10.1097/sla.0000000000004977] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica M Fazendin
- The Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL
| | - Rajshri M Gartland
- The Department of Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Antonia Stephen
- The Department of Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John R Porterfield
- The Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL
| | - Richard Hodin
- The Department of Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brenessa Lindeman
- The Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL
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Gartland RM, Myers LC, Iorgulescu JB, Nguyen AT, Yu-Moe CW, Falcone B, Mitchell R, Kachalia A, Mort E. Body of Evidence: Do Autopsy Findings Impact Medical Malpractice Claim Outcomes? J Patient Saf 2021; 17:576-582. [PMID: 32209947 PMCID: PMC7508944 DOI: 10.1097/pts.0000000000000686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinicians may hesitate to advocate for autopsies out of concern for increased malpractice risk if the pathological findings at time of death differ from the clinical findings. We aimed to understand the impact of autopsy findings on malpractice claim outcomes. METHODS Closed malpractice claims with loss dates between 1995 and 2015 involving death related to inpatient care at 3 Harvard Medical School hospitals were extracted from a captive malpractice insurer's database. These claims were linked to patients' electronic health records and their autopsy reports. Using the Goldman classification system, 2 physician reviewers blinded to claim outcome determined whether there was major, minor, or no discordance between the final clinical diagnoses and pathologic diagnoses. Claims were compared depending on whether an autopsy was performed and whether there was major versus minor/no clinical-pathologic discordance. Primary outcomes included percentage of claims paid through settlement or plaintiff verdict and the amount of indemnity paid, inflation adjusted. RESULTS Of 293 malpractice claims related to an inpatient death that could be linked to patients' electronic health records, 89 claims (30%) had an autopsy performed by either the hospital or medical examiner. The most common claim allegation was an issue with clinician diagnosis, which was statistically less common in the autopsy group (18% versus 38%, P = 0.001). There was no difference in percentage of claims paid whether an autopsy was performed or not (42% versus 41%, P = 0.90) and no difference in median indemnity of paid claims after adjusting for number of defendants ($1,180,537 versus $906,518, P = 0.15). Thirty-one percent of claims with hospital autopsies performed demonstrated major discordance between autopsy and clinical findings. Claims with major clinical-pathologic discordance also did not have a statistically significant difference in percentage paid (44% versus 41%, P > 0.99) or amount paid ($895,954 versus $1,494,120, P = 0.10) compared with claims with minor or no discordance. CONCLUSIONS Although multiple factors determine malpractice claim outcome, in this cohort, claims in which an autopsy was performed did not result in more paid outcomes, even when there was major discordance between clinical and pathologic diagnoses.
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Affiliation(s)
| | | | - J Bryan Iorgulescu
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anthony T Nguyen
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - C Winnie Yu-Moe
- Controlled Risk Insurance Company, Risk Management Foundation of the Harvard Medical Institutions Inc, Boston, Massachusetts
| | - Bianca Falcone
- Controlled Risk Insurance Company, Risk Management Foundation of the Harvard Medical Institutions Inc, Boston, Massachusetts
| | - Richard Mitchell
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Hwabejire JO, Kaafarani HMA, Mashbari H, Misdraji J, Fagenholz PJ, Gartland RM, Abraczinskas DR, Mehta RS, Paranjape CN, Eng G, Saillant NN, Parks J, Fawley JA, Lee J, King DR, Mendoza AE, Velmahos GC. Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience. Am Surg 2021; 87:1893-1900. [PMID: 34772281 DOI: 10.1177/00031348211038571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution's surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period. METHODS All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included. Data from the medical records were analyzed. RESULTS Twenty patients were included. Eighty percent had a new or increasing vasopressor requirement, 70% had abdominal distension, and 50% had increased gastric residuals. Intra-operatively, ischemia affected the large bowel in 80% of cases, the small bowel in 60%, and both in 40%. Sixty five percent had an initial damage control laparotomy. Most of the resected bowel specimens had a characteristic appearance at the time of surgery, with a yellow discoloration, small areas of antimesenteric necrosis, and very sharp borders. Histologically, the bowel specimens frequently have fibrin thrombi in the small submucosal and mucosal blood vessels in areas of mucosal necrosis. Overall mortality in this cohort was 33%. Forty percent of patients had a thromboembolic complication overall with 88% of these developing a thromboembolic phenomenon despite being on prophylactic pre-operative anticoagulation. CONCLUSION Bowel ischemia is a potentially lethal complication of COVID-19 infection with typical gross and histologic characteristics. Suspicious clinical features that should trigger surgical evaluation include a new or increasing vasopressor requirement, abdominal distension, and intolerance of gastric feeds.
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Affiliation(s)
- John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hassan Mashbari
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joseph Misdraji
- Department of Pathology, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Peter J Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rajshri M Gartland
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Diane R Abraczinskas
- Division of Gastroenterology, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Raaj S Mehta
- Division of Gastroenterology, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Charudutt N Paranjape
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - George Eng
- Department of Pathology, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Noelle N Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jason A Fawley
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jarone Lee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David R King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - April E Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Wrenn SM, Gartland RM, Kuo LE, Cho NL. The glass podium: Gender representation within the American Association of Endocrine Surgeons (AAES) from 2010 to 2019. Surgery 2021; 171:252-258. [PMID: 34598776 DOI: 10.1016/j.surg.2021.07.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite increasing numbers of women in surgery, female underrepresentation in surgical societies remains an ongoing issue. We sought to determine the gender composition of presenters at the American Association of Endocrine Surgery annual meetings. METHODS Utilizing previous meeting data, we collected gender information for presenters from 2010 to 2019, including first/senior author combinations. Awards winners and invited lecturers were also reviewed. We performed binomial testing to analyze proportions of male to female presenters, with significance set at P < .05. Temporal trends were analyzed via linear regression. RESULTS Fifty-six percent of American Association of Endocrine Surgery fellows and 36% of members are female. Of 354 podium and 477 poster presentations, women were listed less often as first (42.7%, P = .007) and senior (30.6%, P < .0001) podium authors and less often as first (42.8%, P = .002) and senior (29.8%, P < .0001) poster authors. The most common combination of first/senior authors was male-male (43.1%), followed by female-male (26.8%), female-female (16.1%), and male-female (14.0%). Less than 15% of invited lecturers were women, and women represented a minority in nearly all award categories. We observed a positive trend in female first authorship over time (slope = 0.766, 95% confidence interval, 0.70%-2.23%, P = .26) but no change in female senior authorship over time (slope = 0.03348, 95% confidence interval, 1.086%-1.153%, P = .95). CONCLUSION Women are underrepresented as American Association of Endocrine Surgery presenters and less likely to receive awards or deliver invited lectures. Although female first authorship increased over time, women continued to lag behind men as senior authors and mentors to trainees and junior faculty. Opportunities to improve speaker and awardee representation should be explored.
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Affiliation(s)
- Sean M Wrenn
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Rajshri M Gartland
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Lindsay E Kuo
- Department of Surgery, Temple University Hospital, Philadelphia, PA
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
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Gartland RM, Hodin RA. Faster than Frozen: Promising Preliminary Data for Rapid Parathyroid Tissue Confirmation Via a Novel Point-of-Care Method. World J Surg 2021; 45:2146-2147. [PMID: 33835218 DOI: 10.1007/s00268-021-06101-8] [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] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rajshri M Gartland
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Richard A Hodin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
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Doherty GM, Gartland RM, Duh QY. Choosing Wisely in the Workup of Primary Hyperaldosteronism. JAMA Surg 2021; 156:171-172. [PMID: 33146686 DOI: 10.1001/jamasurg.2020.5025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rajshri M Gartland
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, San Francisco
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Myers LC, Gartland RM, Skillings J, Heard L, Bittner EA, Einbinder J, Metlay JP, Mort E. An Examination of Medical Malpractice Claims Involving Physician Trainees. Acad Med 2020; 95:1215-1222. [PMID: 31833853 DOI: 10.1097/acm.0000000000003117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events. METHOD The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events. They classified claims as controls if they were from the same facilities, but trainees were not directly involved in the harm events. They performed multivariable regression with predictor variables being patient and provider characteristics. The outcome was physician trainee involvement in harm events. RESULTS From the original pool of 30,973 claims, there were 581 cases and 2,610 controls. The majority of cases involved residents (471, 81%). Cases had a statistically significant higher rate of having a trainee named as defendants than controls (184, 32% vs 233, 9%; P < .001). The most common final diagnosis for cases was puncture or laceration during surgery (62, 11%). Inadequate supervision was a contributing factor in 140 (24%) cases overall, with the majority (104, 74%) of these claims being procedure related. Multivariable regression analysis revealed that trainees were most likely to be involved in harm events in specialties such as oral surgery/dentistry and obstetrics-gynecology (OR = 7.99, 95% CI 2.93, 21.83 and OR = 1.85, 95% CI 1.24, 2.66, respectively), when performing procedures (OR = 1.58, 95% CI 1.27, 1.96), or when delivering care in the emergency room (OR = 1.65, 95% CI 1.43, 1.91). CONCLUSIONS Among claims involving physician trainees, procedures were common and often associated with inadequate supervision. Training directors of surgical specialties can use this information to improve resident supervision policies. The goal is to reduce the likelihood of future harm events.
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Affiliation(s)
- Laura C Myers
- L.C. Myers is a research fellow, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-2872-3388
| | - Rajshri M Gartland
- R.M. Gartland is a surgical resident, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jillian Skillings
- J. Skillings is data analyst, Controlled Risk Insurance Company, Boston, Massachusetts
| | - Lisa Heard
- L. Heard is senior program director, Patient Safety and Education, Controlled Risk Insurance Company, Boston, Massachusetts
| | - Edward A Bittner
- E.A. Bittner is associate professor of anesthesia, Harvard Medical School, and program director, Critical Care Anesthesiology Fellowship, Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan Einbinder
- J. Einbinder is instructor of medicine, Harvard Medical School, member, Division of General Internal Medicine, Brigham and Women's Hospital, and assistant vice president, Advanced Data Analytics and Coding, Controlled Risk Insurance Company, Boston, Massachusetts
| | - Joshua P Metlay
- J.P. Metlay is professor, Department of Medicine, Harvard Medical School, professor of health policy and management, Harvard School of Public Health, and chief, General Internal Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Mort
- E. Mort is assistant professor in health care policy, Harvard Medical School, member, Division of General Internal Medicine, and chief quality officer, Massachusetts General Hospital, Boston, Massachusetts
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Gartland RM, Bloom JP, Parangi S, Hodin R, DeRoo C, Stephen AE, Narra V, Lubitz CC, Mort E. A Long, Unnerving Road: Malpractice Claims Involving the Surgical Management of Thyroid and Parathyroid Disease. World J Surg 2020; 43:2850-2855. [PMID: 31384995 DOI: 10.1007/s00268-019-05102-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
BACKGROUND Given their profound emotional, physical, and financial toll on patients and surgeons, we studied the characteristics, costs, and contributing factors of thyroid and parathyroid surgical malpractice claims. METHODS Using the Controlled Risk Insurance Company Strategies' Comparative Benchmarking System database, representing ~30% of all US paid and unpaid malpractice claims, 5384 claims filed against general surgeons and otolaryngologists from 1995-2015 were reviewed to isolate claims involving the surgical management of thyroid and parathyroid disease. These claims were studied, and multivariable regression analysis was performed to identify factors associated with plaintiff payout. RESULTS One hundred twenty-eight thyroid and parathyroid surgical malpractice claims were isolated. The median time from alleged harm event to closure of a malpractice case was 39 months. The most common associated complications were bilateral recurrent laryngeal nerve (RLN) injury (n = 23) and hematoma (n = 18). Complications led to death in 18 cases. Patient payout occurred in 33% of claims (n = 42), and the median cost per claim was $277,913 (IQR $87,343-$783,663). On multivariable analysis, bilateral RLN injury was predictive of patient payout (OR 3.58, p = 0.03), while procedure, death, and surgeon specialty were not. CONCLUSION Though rare, malpractice claims related to thyroid and parathyroid surgery are costly, time-consuming, and reveal opportunities for early surgeon-patient resolution after poor outcomes.
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Affiliation(s)
- Rajshri M Gartland
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Lawrence Center for Quality and Safety, Massachusetts General Hospital, Massachusetts General Physicians Organization, Boston, MA, USA.
| | - Jordan P Bloom
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Hodin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Antonia E Stephen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vinod Narra
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie C Lubitz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Mort
- Lawrence Center for Quality and Safety, Massachusetts General Hospital, Massachusetts General Physicians Organization, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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14
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Affiliation(s)
- Rajshri M. Gartland
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - George C. Velmahos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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15
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Bloom JP, Moonsamy P, Gartland RM, O'Malley C, Tolis G, Villavicencio-Theoduloz MA, Burkhardt C, Dunn P, Sundt TM, D'Alessandro DA. Impact of staff turnover during cardiac surgical procedures. J Thorac Cardiovasc Surg 2019; 161:139-144. [PMID: 31928826 DOI: 10.1016/j.jtcvs.2019.11.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/16/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The impact of staff turnover during cardiac procedures is unknown. Accurate inventory of sharps (needles/blades) requires attention by surgical teams, and sharp count errors result in delays, can lead to retained foreign objects, and may signify communication breakdown. We hypothesized that increased team turnover raises the likelihood of sharp count errors and may negatively affect patient outcomes. METHODS All cardiac operations performed at our institution from May 2011 to March 2016 were reviewed for sharp count errors from a prospectively maintained database. Univariate and multivariable analyses were performed. RESULTS Among 7264 consecutive cardiac operations, sharp count errors occurred in 723 cases (10%). There were no retained sharps detected by x-ray in our series. Sharp count errors were lower on first start cases (7.7% vs 10.7%, P < .001). Cases with sharp count errors were longer than those without (7 vs 5.7 hours, P < .001). In multivariable analysis, factors associated with an increase in sharp count errors were non-first start cases (odds ratio [OR], 1.3; P = .006), weekend cases (OR, 1.6; P < .004), more than 2 scrub personnel (3 scrubs: OR, 1.3; P = .032; 4 scrubs: OR, 2; P < .001; 5 scrubs: OR, 2.4; P = .004), and more than 1 circulating nurse (2 nurses: OR, 1.9; P < .001; 3 nurses: OR, 2; P < .001; 4 nurses: OR, 2.4; P < .001; 5 nurses: OR, 3.1; P < .001). Sharp count errors were associated with higher rates of in-hospital mortality (OR, 1.9; P = .038). CONCLUSIONS Sharp count errors are more prevalent with increased team turnover and during non-first start cases or weekends. Sharp count errors may be a surrogate marker for other errors and thus increased mortality. Reducing intraoperative team turnover or optimizing hand-offs may reduce sharp count errors.
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Affiliation(s)
- Jordan P Bloom
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass.
| | - Philicia Moonsamy
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Rajshri M Gartland
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Catherine O'Malley
- Perioperative Services Administration, Massachusetts General Hospital, Boston, Mass
| | - George Tolis
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | | | - Carolyn Burkhardt
- Perioperative Services Administration, Massachusetts General Hospital, Boston, Mass
| | - Peter Dunn
- Perioperative Services Administration, Massachusetts General Hospital, Boston, Mass
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
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McKinley SK, Wang LJ, Gartland RM, Westfal ML, Costantino CL, Schwartz D, Merrill AL, Petrusa E, Lillemoe K, Phitayakorn R. "Yes, I'm the Doctor": One Department's Approach to Assessing and Addressing Gender-Based Discrimination in the Modern Medical Training Era. Acad Med 2019; 94:1691-1698. [PMID: 31274522 DOI: 10.1097/acm.0000000000002845] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While gender-based bias and discrimination (GBD) is known to exist in medical training, there is limited guidance for training programs on how to understand and combat this issue locally. The Massachusetts General Hospital Department of Surgery established the Gender Equity Task Force (GETF) to address GBD in the local training environment. In 2017, members of the GETF surveyed residents in surgery, anesthesia, and internal medicine at 2 academic hospitals to better understand perceived sources, frequency, forms, and effects of GBD. Overall, 371 residents completed the survey (60% response rate, 197 women). Women trainees were more likely to endorse personal experience of GBD and sexual harassment than men (P < .0001), with no effect of specialty on rates of GBD or sexual harassment. Patients and nursing staff were the most frequently identified groups as sources of GBD. While an overwhelming majority of both men (86%) and women (96%) respondents either experienced or observed GBD in the training environment, less than 5% of respondents formally reported such experiences, most frequently citing a belief that nothing would happen. Survey results served as the basis for a variety of interventions addressing nursing staff and patients as sources of GBD, low confidence in formal reporting mechanisms, and the pervasiveness of GBD, including sexual harassment, across specialties. These results reproduce other studies' findings that GBD and sexual harassment disproportionately affect women trainees while demonstrating how individual training programs can incorporate local GBD data when planning interventions to address GBD.
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Affiliation(s)
- Sophia K McKinley
- S.K. McKinley is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. L.J. Wang is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. R.M. Gartland is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. M.L. Westfal is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. C.L. Costantino is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. D. Schwartz is resident physician, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. A.L. Merrill is a fellow, Department of Surgery, Ohio State University, Columbus, Ohio. E. Petrusa is associate professor, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. K. Lillemoe is professor and chair, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. R. Phitayakorn is associate professor, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Gartland RM, Di Marco A, Sywak M. Posterior retroperitoneoscopic approach is feasible in selected patients requiring revision adrenal surgery. ANZ J Surg 2019; 89:1175-1176. [PMID: 31522478 DOI: 10.1111/ans.15410] [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: 06/11/2019] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rajshri M Gartland
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aimee Di Marco
- Endocrine Surgery Unit, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
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18
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Gartland RM, Alves K, Brasil NC, Mossanen M, Mort E, Wright CD, Lubitz CC, May C. Does overlapping surgery result in worse surgical outcomes? A systematic review and meta-analysis. Am J Surg 2019; 218:181-191. [DOI: 10.1016/j.amjsurg.2018.11.039] [Citation(s) in RCA: 5] [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: 10/17/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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Gartland RM, Lubitz CC. Reply to "Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on the Outcomes of Lobectomy". Ann Surg Oncol 2018; 26:307-308. [PMID: 30362066 DOI: 10.1245/s10434-018-6953-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Rajshri M Gartland
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114-3117, USA
| | - Carrie C Lubitz
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114-3117, USA.
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Abstract
BACKGROUND The extent of surgery for low-risk papillary thyroid cancer (PTC) has been the subject of debate among experts for decades. OBJECTIVE In this paper, we aimed to systematically review whether thyroid lobectomy versus total thyroidectomy for PTC patients with tumors measuring 1.0-4.0 cm impacts tumor recurrence and survival. RESULTS A systematic review of the literature from January 1990 to February 2018 yielded 13 relevant studies, including eight national cancer registry database studies, one multi-institutional thyroid cancer-specific database, three large-scale institutional series, and one meta-analysis. Data from these studies demonstrate that total thyroidectomy for the treatment of PTC measuring 1.0-4.0 cm does not confer a clinically significant improvement in disease-specific survival compared with thyroid lobectomy. Four of six studies also reported that total thyroidectomy is associated with a small but statistically significant improvement in disease-free survival, although it is argued whether this difference is clinically significant. CONCLUSIONS While the quality of the data limit the strength of our conclusions, and while tumor characteristics, patient risk factors, and preferences should be considered, most data support that lobectomy and total thyroidectomy yield comparable oncologic outcomes for PTC measuring 1.0-4.0 cm.
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Affiliation(s)
- Rajshri M Gartland
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie C Lubitz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Institute for Technology Assessment, Boston, MA, USA.
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