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Aref Y, Engel PV, Miao X, Givant M, Seify H. An Analysis of the Characteristics and Trends in Practicing Plastic Surgeons in California. Ann Plast Surg 2024; 92:S336-S339. [PMID: 38689415 DOI: 10.1097/sap.0000000000003846] [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: 05/02/2024]
Abstract
BACKGROUND Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons. METHODS Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17. RESULTS Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts. CONCLUSIONS Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.
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Affiliation(s)
- Youssef Aref
- From the California University of Science and Medicine School of Medicine, Colton
| | - Priya Vedula Engel
- From the California University of Science and Medicine School of Medicine, Colton
| | - Xinfei Miao
- From the California University of Science and Medicine School of Medicine, Colton
| | - Madeleine Givant
- From the California University of Science and Medicine School of Medicine, Colton
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Castillo N, Betterbed D, Martin S, Acosta E, Ortiz AC, Petrera P, Koizumi N, Ortiz J. Abdominal Transplant Surgeons: The Lack of Female Surgeons and People From Underrepresented Racial and Ethnic Minority Groups in Academic and Clinical Leadership. EXP CLIN TRANSPLANT 2024; 22:258-266. [PMID: 38742315 DOI: 10.6002/ect.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES The demographic disparities among surgeons in academic leadership positions is well documented. We aimed to characterize the present demographic details of abdominal transplant surgeons who have achieved academic and clinical leadership positions. MATERIALS AND METHODS We reviewed the 2022-2023 American Society of Transplant Surgeons membership registry to identify 1007 active abdominal transplant surgeons. Demographic details (academic and clinical titles) were collected and analyzed using the chi-square test, the Fisher exact test, and t tests. Multinomial logistic regressions were conducted. RESULTS Female surgeons (P < .001) and surgeons from racial-ethnic minorities (P = .027) were more likely to be assistants or associates rather than full professors. White male surgeons were more likely to be full professors than were White female (P < .001), Asian female (P = .008), and Asian male surgeons (P = .005). There were no Black female surgeons who were full professors. The frequency of full professorship increased with surgeon age (P < .001). Male surgeons were more likely to hold no academic titles (P < .001). Female surgeons were less likely to be chief of transplant(P = .025), chief of livertransplant (P = .001), chief of pancreas transplant (P = .037), or chair of surgery (P = .087, significance at 10%). Chief of kidney transplant was the most common clinical position held by a surgeon from a racial or ethnic minority group. Female surgeons were more likely to hold no clinical titles (P = .001). CONCLUSIONS The underrepresentation of women and people from racial and ethnic minority groups in academic and clinical leadership positions in the field of abdominal transplant surgery remains evident. White male physicians are more likely to obtain full professorship, and they comprise most of the clinical leadership positions overall. A continued push for representative leadership is needed.
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Mitchell JM, DeLeire T. Vertical Integration Versus Physician Owners: Trends in Practice Structure Among Breast Cancer Surgeons. Med Care 2022; 60:206-211. [PMID: 35157620 PMCID: PMC8869847 DOI: 10.1097/mlr.0000000000001687] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to document changes in physician practice structure among surgeons who treat women with breast cancer. DESIGN We merged cancer registry records from 5 large states with Medicare Part B claims to identify each surgeon who treated women with breast cancer. We added information from SK&A surveys and extensive internet searches. We analyzed changes in breast surgeons' practice structure over time. MEASURES We assigned each surgeon-year a practice structure type: (1) small single-specialty practice; (2) single-specialty surgery or multispecialty practice with ownership in an ambulatory surgery center (ASC); (3) physician-owned hospital; (4) multispecialty; (5) employed. RESULTS In 2003, nearly 74% of breast cancer surgeons belonged to small single-specialty practices. By 2014, this percentage fell to 51%. A shift to being employed (vertical integration) accounted for only a portion of this decline; between 2003 and 2014, the percentage of surgeons who were employed increased from 10% to 20%. The remainder of this decline is due to surgeons opting to acquire ownership in an ASC or a specialty hospital. Between 2003 and 2014, the percentage of surgeons with ownership in an ASC or specialty hospital increased from 4% to 17%. CONCLUSIONS Dramatic changes in surgeon practice structure occurred between 2003 and 2014 across the 5 states we examined. The most notable was the sharp decline in the prevalence of the small single-specialty practice and large increases in the proportion of surgeons either employed or with ownership in ACSs or hospitals.
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Affiliation(s)
- Jean M Mitchell
- McCourt School of Public Policy, Georgetown University, Old North 314, 37 & “O” Streets, NW, Washington DC 20007
| | - Thomas DeLeire
- McCourt School of Public Policy, Georgetown University, Old North 308, 37 & “O” Streets, NW, Washington DC 20007
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Wheeler DR, Oldani S, Montagna L, Vinci V. Space Medicine: A Spot for Future Plastic Surgeons? Plast Reconstr Surg 2022; 149:180e-181e. [PMID: 34878417 DOI: 10.1097/prs.0000000000008637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
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Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
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MESH Headings
- Adult
- Biomedical Research/organization & administration
- COVID-19/diagnosis
- COVID-19/economics
- COVID-19/epidemiology
- COVID-19/prevention & control
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/trends
- Female
- Global Health
- Health Resources/supply & distribution
- Health Services Accessibility/trends
- Humans
- Infection Control/economics
- Infection Control/methods
- Infection Control/standards
- International Cooperation
- Male
- Middle Aged
- Pandemics
- Perioperative Care/education
- Perioperative Care/methods
- Perioperative Care/standards
- Perioperative Care/trends
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/trends
- Surgeons/education
- Surgeons/psychology
- Surgeons/trends
- Surgical Procedures, Operative/education
- Surgical Procedures, Operative/methods
- Surgical Procedures, Operative/standards
- Surgical Procedures, Operative/trends
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Mahenthiran AK, Natarajan JP, Bertges DJ, Huffman KM, Eldrup-Jorgensen J, Lemmon GW. Impact of COVID-19 on the Society for Vascular Surgery Vascular Quality Initiative Venous Procedure Registries (varicose vein and inferior vena cava filter). J Vasc Surg Venous Lymphat Disord 2021; 9:1093-1098. [PMID: 33482377 PMCID: PMC7816572 DOI: 10.1016/j.jvsv.2021.01.002] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/10/2021] [Indexed: 11/09/2022]
Abstract
In response to the pandemic, an abrupt pivot of Vascular Quality Initiative physician members away from standard clinical practice to a restrictive phase of emergent and urgent vascular procedures occurred. The Society for Vascular Surgery Patient Safety Organization queried both data managers and physicians in May 2020. Approximately three-fourths (74%) of physicians adopted restrictive operating policies for urgent and emergent cases only, whereas one-half proceeded with "time sensitive" elective cases as urgent. Data manager case entry was negatively affected by both low case volumes and staffing due to reassignment or furlough. Venous registry volumes were reduced fivefold in the first quarter of 2020 compared with a similar period in 2019. The consequences of delaying vascular procedures for ambulatory venous practice remain unknown with increased morbidity likely. Challenges to determine venous thromboembolism mortality impact exist given difficulty in verifying "in home and extended care facility" deaths. Further ramifications of a pandemic shutdown will likely be amplified if postponement of elective vascular care extends beyond a short window of time. It will be important to monitor disease progression and case severity as a result of policy shifts adopted locally in response to pandemic surges.
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Affiliation(s)
| | - Jay P Natarajan
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Center, Burlington, Vt
| | | | | | - Gary W Lemmon
- Division of Vascular Surgery, Indiana University, Indianapolis, Ind.
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Joji N, Nugent N, Vadodaria S, Sankar TK. Impact of COVID-19 on Aesthetic Plastic Surgery Practice in the United Kingdom. J Plast Reconstr Aesthet Surg 2021; 74:2311-2318. [PMID: 34257034 PMCID: PMC8179720 DOI: 10.1016/j.bjps.2021.05.020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/07/2021] [Accepted: 05/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has transformed the delivery of medical and surgical services globally. Subsequently, all elective and aesthetic procedures have been cancelled or deferred in accordance with government-mandated quarantine measures. The Cosmetic Surgery Governance Forum (CSGF) is a network of aesthetic plastic surgery consultants which has enabled a sharing of expertise during challenging times. We conducted a cross-sectional survey to assess the impact of the COVID-19 pandemic on aesthetic plastic surgeons and their practice in the UK. METHODS On 15 June 2020, 131 respondents from the CSGF and wider aesthetic plastic surgeons in the UK were invited to respond to an online survey. An anonymised questionnaire was created using SmartSurveyTM and distributed at the end of the quarantine period. Questions regarding their current scope of practice, willingness to recommence face-to-face consultations, financial loss and psychological impact were asked. RESULTS A total of 101 Consultant Plastic surgeons (76%) completed the questionnaire. If strict protocols and adequate personal protective equipment were available, 50-55% of respondents would consider offering non-surgical treatments as soon as the private clinic was open. Furthermore, 51% would consider procedures under general anaesthetic, whilst 89% of respondents would offer local anaesthetic only in the initial phase. Moreover, 66% reported experiencing a psychological impact and 100% of respondents reported a significant financial impact. CONCLUSIONS This survey aims to give an account of the current state (May-July 2020) of aesthetic plastic surgery in the UK. There is ongoing uncertainty and deliberation regarding the timing and organisational changes required for aesthetic practice to restart.
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Affiliation(s)
- Nikita Joji
- Plastic Surgery Registrar, Cosmetic Surgery Governance forum (CSGF), UK
| | - Nora Nugent
- Consultant Plastic Surgeon, Cosmetic Surgery Governance forum (CSGF), UK
| | - Shailesh Vadodaria
- Consultant Plastic Surgeon, Cosmetic Surgery Governance forum (CSGF), UK; Consortium of Aesthetic Plastic Surgery Clinic Owners (CAPSCO) UK
| | - Thangasamy K Sankar
- Consultant Plastic Surgeon, Cosmetic Surgery Governance forum (CSGF), UK; Consortium of Aesthetic Plastic Surgery Clinic Owners (CAPSCO) UK.
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Canturk NZ, Guler SA, Kocdor MA, Simsek T. The new normal for breast cancer surgery during COVID-19 pandemic: An international survey conducted by SENATURK. J BUON 2021; 26:1405-1414. [PMID: 34564998] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The COVID-19 pandemic has changed the way many health institutions approach their workload. Physicians managing patients with cancer now have to deal not only with the disease but also the restrictions and limitations imposed because of the global pandemic. We aimed to determine how surgical preferences in breast cancer management were affected globally using a questionnaire-based survey. METHODS Under the auspices of the Turkish Senology Society (SENATURK) we asked 122 surgeons from 27 countries to reply to a 26-question survey designed to measure the impact of COVID-19 on their surgical practice when treating patients with breast cancer. RESULTS The characteristics of participant surgeons were statistically similar when comparing the participants' answers from Turkey and other countries. From the responses given to our questionnaire, it was understood that breast cancer surgery decreased by 25% (p<0.05) in institutions all over the world, including Turkey, but there was no change in the approach technique to the axilla. CONCLUSIONS Globally breast surgeons have adapted to the new normal due to the COVID-19 pandemic. Many surgical approaches and some follow up protocols have been changed, although the degree of change has varied from country to country. In addition, the availability of multidisciplinary case conferences has been reduced in some centers which may affect the quality of services provided to patients.
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Affiliation(s)
- Nuh Zafer Canturk
- Kocaeli University Medical Faculty, Dept.of General Surgery, Kocaeli, Turkey
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Magouliotis D, Fergadi M, Koukousaki D, Symeonidis D, Diamantis A, Tatsios E, Christodoulidis G, Zacharoulis D. Differences in surgical oncology practice in Greece and Cyprus between the first and second COVID-19 pandemic waves: Lessons from a paradigm shift. J BUON 2021; 26:1679-1682. [PMID: 34565036] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has led to the implementation of certain restrictions and rearrangements regarding the surgical oncology operations, thus affecting the surgical lists, the availability of surgical time, along with the consultations of oncologic patients. The purpose of the present study was to identify the differences in surgical oncology practices in Greece and Cyprus between the first and second pandemic waves. We designed a questionnaire for surgeons treating surgical oncology patients. A total of 104 surgeons participated in the present study by answering our questionnaire. According to our outcomes, there was a significant shift between the two waves in patients' willingness to undergo surgery and to present to consultations. Nonetheless, the availability of surgical services remained limited. The consequent mismatch in patients' needs and the availability of healthcare services, we demonstrate herein, is alarming and should be taken into consideration by the policymakers.
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Affiliation(s)
- Dimitrios Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London; Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
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11
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Scali ST, Martin AJ, Neal D, Berceli SA, Beach J, Suckow BD, Goodney PP, Powell RJ, Huber TS, Stone DH. Surgeon experience versus volume differentially affects lower extremity bypass outcomes in contemporary practice. J Vasc Surg 2021; 74:1978-1986.e2. [PMID: 34082002 DOI: 10.1016/j.jvs.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Calls for minimum case thresholds to guide surgeon credentialing paradigms are increasing in contemporary practice. To date, the volume-outcome relationship and the role of surgeon experience as a proxy for quality have remained primarily focused on nonvascular extirpative surgery and aneurysm repair. However, it is unclear whether these data can be rightly extrapolated to predict lower extremity bypass (LEB) outcomes. Thus, the purpose of the present study was to examine whether the annualized case volume vs surgeon experience is more consequential in predicting for successful LEB reconstruction. METHODS A total of 25,852 procedures with sufficient 1-year follow-up data from the Society for Vascular Surgery Vascular Quality Initiative infrainguinal bypass registry (2003-2019) were reviewed for chronic limb threatening ischemia among patients undergoing infrageniculate reconstruction. The procedures were categorized according to surgeon years of practice experience at surgery (ie, 0-5, 6-10, 11-15, >15 years) and the number of LEB procedures performed by the surgeon during the year of surgery (volume quartiles: 1-8, 9-14, 15-21, and >21). Mixed effects logistic and Cox regression models were used to assess the effects of experience, volume, and their interaction on outcomes. RESULTS Increasing practice experience was more significantly associated with a reduction of in-hospital complications (odds ratio, 0.97; 95% confidence interval [CI], 0.96-0.99; P = .002) and the risk of major adverse limb events (odds ratio, 0.94; 95% CI, 0.92-0.97; P < .0001) compared with the volume. Increasing experience and volume were both associated with increased freedom from thrombosis (hazard ratio, 0.95; 95% CI, 0.93-0.98; P = .001). In contrast, neither experience nor volume had any significant association with early mortality. However, a higher volume was associated with diminished long-term survival (hazard ratio, 1.04; 95% CI, 1.0-1.1; P = .01). The most experienced surgeons (>15 years' experience) were significantly more likely to perform LEB for rest pain (P < .0001). No significant differences were found in the bypass rates among patients with tissue loss. The most experienced and highest volume surgeons were more likely to use an autogenous and/or composite conduit, in situ reconstruction, and/or pedal targets (P < .05). Similarly, more experienced and higher volume surgeons had less blood loss and shorter procedure times (P < .0001). Overall, the most experienced surgeons (>15 years' experience) were significantly more likely to have a higher volume with a diminished risk for all LEB outcomes. CONCLUSIONS Surgeon experience appears to have the most important role in predicting for overall LEB performance with improved in-hospital outcomes and major adverse limb events. The more experienced surgeons performed more complex reconstructions with fewer complications. These findings have significant clinical and educational implications as our most experienced surgeons approach retirement. Mentorship strategies to facilitate ongoing technical development among less experienced surgeons are imperative to sustain optimal limb salvage outcomes and have significant ramifications regarding expectations for regulatory and credentialing paradigms.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla; Malcolm Randall Veterans Affairs Hospital, Gainesville, FL.
| | - Andrew J Martin
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Dan Neal
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla; Malcolm Randall Veterans Affairs Hospital, Gainesville, FL
| | - Jocelyn Beach
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard J Powell
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Hemingway JF, Desikan S, Dasari M, Tran C, Hoffman R, Gobble A, Spurlock A, Singh N, Quiroga E, Tran N, Starnes BW. Intraoperative consultation of vascular surgeons is increasing at a major American trauma center. J Vasc Surg 2021; 74:1581-1587. [PMID: 34022381 DOI: 10.1016/j.jvs.2021.04.065] [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: 12/29/2020] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Vascular surgeons are often called to aid other surgical specialties for complex exposure, hemorrhage control, or revascularization. The evolving role of the vascular surgeon in the management of intraoperative emergencies involving trauma patients remains undefined. The primary aims of this study included determining the prevalence of intraoperative vascular consultation in trauma, describing how these interactions have changed over time, and characterizing the outcomes achieved by vascular surgeons in these settings. We hypothesized that growing endovascular capabilities of vascular surgeons have resulted in an increased involvement of vascular surgery faculty in the management of the trauma patient over time. METHODS A retrospective review of all operative cases at a single level I trauma center where a vascular surgeon was involved, but not listed as the primary surgeon, between 2002 and 2017 was performed. Cases were abstracted using Horizon Surgical Manager, a documentation system used in our operating room to track staff present, the type of case, and use. All elective cases were excluded. RESULTS Of the 256 patients initially identified, 22 were excluded owing to the elective or joint nature of the procedure, leaving 234 emergent operative vascular consultations. Over the 15-year study period, a 529% increase in the number of vascular surgery consultations was seen, with 65% (n = 152) being intraoperative consultations requiring an immediate response. Trauma surgery (n = 103 [44%]) and orthopedic surgery (n = 94 [40%]) were the most common consulting specialties, with both demonstrating a trend of increasing consultations over time (general surgery, 1400%; orthopedic surgery, 220%). Indications for consultation were extremity malperfusion, hemorrhage, and concern for arterial injury. The average operative time for the vascular component of the procedures was 2.4 hours. Of patients presenting with ischemia, revascularization was successful in 94% (n = 116). Hemorrhage was controlled in 99% (n = 122). In-hospital mortality was relatively low at 7% (n = 17). Overall, despite the increase in intraoperative vascular consultations over time, a concomitant increase in the proportion of procedures done using endovascular techniques was not seen. CONCLUSIONS Vascular surgeons are essential team members at a level I trauma center. Vascular consultation in this setting is often unplanned and often requires immediate intervention. The number of intraoperative vascular consultations is increasing and cannot be attributed solely to an increase in endovascular hemorrhage control, and instead may reflect the declining experience of trauma surgeons with vascular trauma. When consulted, vascular surgeons are effective in quickly gaining control of the situation to provide exposure, hemorrhage control, or revascularization.
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Affiliation(s)
- Jake F Hemingway
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Sarasijhaa Desikan
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Mohini Dasari
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Cuong Tran
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Rachel Hoffman
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Alexandra Gobble
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Aaron Spurlock
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Elina Quiroga
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Nam Tran
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
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Linhares D, Sousa-Pinto B, Ribeiro da Silva M, Fonseca JA, Neves N. Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures: A Survey of European and North American Experts. Spine (Phila Pa 1976) 2021; 46:E534-E541. [PMID: 33156282 DOI: 10.1097/brs.0000000000003769] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Survey study. OBJECTIVE Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices. SUMMARY OF BACKGROUND DATA Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes. METHODS A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure. RESULTS We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P < 0.05). Orthosis mean cost was $611.4 ± 716.0, significantly higher in North America compared with Europe and in high income, when compared with upper middle income countries (both P < 0.05). Although hospital costs were not evaluated, orthosis is costlier when it involves admission of the patient (P < 0.05). An increase in orthosis cost associated with higher gross domestic product (GDP) per capita and higher health expenditure was found. CONCLUSION More than 90% of spine specialists still use orthosis in conservative treatment of adult patients with acute TL fractures. Orthosis cost vary significantly between continents, and it is influenced by the country's economy.Level of Evidence: 4.
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Affiliation(s)
- Daniela Linhares
- Center for Health Technology and Services Research, CINTESIS, Porto, Portugal
- Health Information and Decision Sciences Department (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- Ortopedia e Traumatologia - Centro Hospitalar São João, Porto, Portugal
- RISE - Health Research from Lab to Community, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Center for Health Technology and Services Research, CINTESIS, Porto, Portugal
- Health Information and Decision Sciences Department (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- RISE - Health Research from Lab to Community, University of Porto, Porto, Portugal
| | - Mnuel Ribeiro da Silva
- Ortopedia e Traumatologia - Centro Hospitalar São João, Porto, Portugal
- Orthopedics Department, Hospital CUF Porto, Porto, Portugal
| | - João A Fonseca
- Health Information and Decision Sciences Department (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- Patient-centred Innovation and Technologies group (PaCeIT), Center for Health Technology and Services Research
- Medicina, Educação, I&D e Avaliação, Lda (MEDIDA), Porto, Portugal
- Imunoalergologia, CUF Porto, Portugal
- RISE - Health Research from Lab to Community, University of Porto, Porto, Portugal
| | - Nuno Neves
- Ortopedia e Traumatologia - Centro Hospitalar São João, Porto, Portugal
- Orthopedics Department, Hospital CUF Porto, Porto, Portugal
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Abstract
STUDY DESIGN Retrospective descriptive, multicenter study. OBJECTIVE The aim of this study was to predict the three-dimensional (3D) radiographic outcomes of the spinal surgery in a cohort of adolescent idiopathic scoliosis (AIS) as a function preoperative spinal parameters and surgeon modifiable factors. SUMMARY OF BACKGROUND DATA Current guidelines for posterior spinal fusion surgery (PSF) in AIS patients are based on two-dimensional classification of the spinal curves. Despite the high success rate, the prediction of the 3D spinal alignment at the follow-ups remains inconclusive. A data-driven surgical decision-making method that determines the combination of the surgical procedures and preoperative patient specific parameters that leads to a specific 3D global spinal alignment outcomes at the follow-ups can lessen the burden of surgical planning and improve patient satisfaction by setting expectations prior to surgery. METHODS A dataset of 371 AIS patients who underwent a PSF with two-year follow-up were included. Demographics, 2D radiographic spinal and pelvic measurements, clinical measurements of the trunk shape, and the surgical procedures were collected prospectively. A previously developed classification of the preoperative global 3D spinal alignment was used as an additional predictor. The 3D spinal alignment (vertebral positions and rotations) at two-year follow-up was used as the predicted outcome. An ensemble learner was used to predict the 3D spinal alignment at two-year follow-up as a function of the preoperative parameters with and without considering the surgeon modifiable factors. RESULTS The preoperative and surgical factors predicted three clusters of 3D surgical outcomes with an accuracy of 75%. The prediction accuracy decreased to 64% when only preoperative factors, without the surgical factors, were used in the model. Predictor importance analysis determined that preoperative distal junctional kyphosis, pelvic sagittal parameters, end-instrumented vertebra (EIV) angulation and translation, and the preoperative 3D clusters are the most important patient-specific predictors of the outcomes. Three surgical factors, upper and lower instrumented vertebrae, and the operating surgeon, were important surgical predictors. The role of surgeon in achieving a certain outcome clusters for specific ranges of preoperative T10-L2 kyphosis, EIV angulation and translation, thoracic and lumbar flexibilities, and patient's height was significant. CONCLUSION Both preoperative patient-specific and surgeon modifiable parameters predicted the 3D global spinal alignment at two-year post PSF. Surgeon was determined as a predictor of the outcomes despite including 20 factors in the analysis that described the surgical moves. Methods to quantify the differences between the implemented surgeon modifiable factors are essential to improve outcome prediction in AIS spinal surgery.Level of Evidence: 3.
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Affiliation(s)
- Saba Pasha
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Suken Shah
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Peter Newton
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, CA
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15
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Mahat N, Zubaidi SA, Soe HHK, Nah SA. Paediatric surgical response to an 'adult' COVID-19 pandemic. Med J Malaysia 2021; 76:284-290. [PMID: 34031324] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The Coronavirus Disease 2019 (COVID-19) has dramatically affected global healthcare systems. We aimed to determine the response of our paediatric surgical fraternity to a disease that overwhelmingly affects adults. MATERIALS AND METHODS We conducted a cross-sectional questionnaire-based study over 6 weeks during a federally mandated lockdown. Using snowball sampling, we recruited paediatric surgeons, trainees and medical officers from paediatric surgical units in Malaysia. The anonymous online questionnaire covered sociodemographic information, changes in patient care, redeployment, concerns regarding family members, and impact on training. Mental well-being was assessed using the Depression, Anxiety and Stress Scale (DASS-21). Kruskal-Wallis, ANOVA and multiple regression analysis was used, with significance level 0.05. RESULTS Of the 129 eligible participants, 100(77%) responded. Junior doctors had clinically higher levels of depression, anxiety, and stress. Age <30 years was significantly associated with anxiety. Junior doctors believed that redeployment led to loss of surgical skills (p<0.001) and trainees felt that clinical application of knowledge had reduced (p<0.020). CONCLUSION Specific to our paediatric surgical community, this study highlights areas of concern, particularly among junior doctors. It is likely that recurrent cycles of the pandemic will occur soon. These issues must be addressed to preserve the mental and emotional well-being of all health care workers.
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Affiliation(s)
- N Mahat
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia
| | - S A Zubaidi
- University of Malaya Medical Centre, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia
| | - H H K Soe
- Melaka Manipal Medical College, Department of Community Medicine, Melaka, Malaysia
| | - S A Nah
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia.
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16
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McKenzie DM, Westrup AM, O'Neal CM, Lee BJ, Shi HH, Dunn IF, Snyder LA, Smith ZA. Robotics in spine surgery: A systematic review. J Clin Neurosci 2021; 89:1-7. [PMID: 34119250 DOI: 10.1016/j.jocn.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/13/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022]
Abstract
Robotic systems to assist with pedicle screw placement have recently emerged in the field of spine surgery. Here, the authors systematically reviewed the literature for evidence of these robotic systems and their utility. Thirty-four studies that reported the use of spinal instrumentation with robotic assistance and met inclusion criteria were identified. The outcome measures gathered included: pedicle screw accuracy, indications for surgery, rates of conversion to an alternative surgical method, radiation exposure, and learning curve. In our search there were five different robotic systems identified. All studies reported accuracy and the most commonly used accuracy grading scale was the Gertzbein Robbins scale (GRS). Accuracy of clinically acceptable pedicle screws, defined as < 2 mm cortical breech, ranged from 80% to 100%. Many studies categorized indications for robotic surgery with the most common being degenerative entities. Some studies reported rates of conversion from robotic assistance to manual instrumentation due to many reasons, with robotic failure as the most common. Radiation exposure data revealed a majority of studies reported less radiation using robotic systems. Studies looking at a learning curve effect with surgeon use of robotic assistance were not consistent across the literature. Robotic systems for assistance in spine surgery have continued to improve and the accuracy of pedicle screw placement remains superior when compared to free-hand technique, however rates of manual conversion are significant. Currently, these systems are successfully employed in various pathological entities where trained spine surgeons can be safe and accurate regardless of robotic training.
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Affiliation(s)
- Daniel M McKenzie
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alison M Westrup
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin J Lee
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Laura A Snyder
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Saricilar EC, Iliopoulos J, Ahmad M. A systematic review of the effect of surgeon and hospital volume on survival in aortic, thoracic and fenestrated endovascular aneurysm repair. J Vasc Surg 2021; 74:287-295. [PMID: 33548427 DOI: 10.1016/j.jvs.2020.12.104] [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: 08/31/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is becoming a mainstay in vascular surgery, both in metropolitan and regional hospitals. This review aims to assess the impact of hospital and surgeon volume on perioperative mortality specific to this surgery type to support the use of this treatment modality extensively. METHODS A literature search was performed on multiple dedicated medical databases using a detailed search strategy with terms focusing on hospital volume and EVARs. Inclusion and exclusion criteria were used to screen and evaluate suitable sources, focusing on operators and hospitals performing EVARs and the morbidity/mortality as outcomes. The results were then appraised using a PRISMA framework. RESULTS We reviewed 45 articles. Twelve articles met inclusion criteria for complete review. There was no level 1 evidence, and only a single systematic review and meta-analysis. EVAR and thoracic EVAR perioperative mortality had no correlation with hospital volume. Limited evidence was presented for fenestrated EVAR, where a mortality risk based on hospital volume remains unanswered. Open procedures for aneurysm repair had perioperative mortality outcomes that grossly correlated with hospital volume, supporting their use in high-volume centers. CONCLUSIONS With open aneurysm repairs having an increased mortality risk in low-volume centers, and endovascular treatment options gaining momentum, there is considerable support for the use of EVAR and thoracic EVAR in smaller regional centers safely and effectively. There is very limited evidence in the use of fenestrated EVAR, which remains unanswered, but presents a significant opportunity for research.
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Affiliation(s)
- Erin Cihat Saricilar
- Department of Surgery, Liverpool Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia.
| | - Jim Iliopoulos
- Department of Surgery, Liverpool Hospital, Sydney, Australia
| | - Mehtab Ahmad
- Department of Surgery, Liverpool Hospital, Sydney, Australia
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18
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Khan HA, Rabah NM, Winkelman RD, Levin JM, Mroz TE, Steinmetz MP. The Impact of Preoperative Depression on Patient Satisfaction With Spine Surgeons in the Outpatient Setting. Spine (Phila Pa 1976) 2021; 46:184-190. [PMID: 33399438 DOI: 10.1097/brs.0000000000003763] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The aim of this study was to examine the association between preoperative depression and patient satisfaction in the outpatient spine clinic after lumbar surgery. SUMMARY OF BACKGROUND DATA The Clinician and Group Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is used to measure patient experience in the outpatient setting. CG-CAHPS scores may be used by health systems in physician incentive programs and quality improvement initiatives or by prospective patients when selecting spine surgeons. Although preoperative depression has been shown to predict poor patient-reported outcomes and less satisfaction with the inpatient experience following lumbar surgery, its impact on patient experience with spine surgeons in the outpatient setting remains unclear. METHODS Patients who underwent lumbar surgery and completed the CG-CAHPS survey at postoperative follow-up with their spine surgeon between 2009 and 2017 were included. Data were collected on patient demographics, Patient Health Questionnaire 9 (PHQ-9) scores, and Patient-Reported Outcome Measurement Information System Global Health Physical Health (PROMIS-GPH) subscores. Patients with preoperative PHQ-9 scores ≥10 (moderate-to-severe depression) were included in the depressed cohort. The association between preoperative depression and top-box satisfaction ratings on several dimensions of the CG-CAHPS survey was examined. RESULTS Of the 419 patients included in this study, 72 met criteria for preoperative depression. Depressed patients were less likely to provide top-box satisfaction ratings on CG-CAHPS metrics pertaining to physician communication and overall provider rating (OPR). Even after controlling for patient-level covariates, our multivariate analysis revealed that depressed patients had lower odds of reporting top-box OPR (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.06-0.63, P = 0.007), feeling that their spine surgeon provided understandable explanations (OR: 0.32, 95% CI: 0.11-0.91, P = 0.032), and feeling that their spine surgeon provided understandable responses to their questions or concerns (OR: 0.19, 95% CI: 0.06-0.63, P = 0.007). CONCLUSION Preoperative depression is independently associated with lower OPR and satisfaction with spine surgeon communication in the outpatient setting after lumbar surgery.Level of Evidence: 3.
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Affiliation(s)
- Hammad A Khan
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH
| | - Nicholas M Rabah
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH
| | - Robert D Winkelman
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH
| | - Jay M Levin
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - Thomas E Mroz
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
- Department of Orthopedic Surgery, Cleveland Clinic, OH
| | - Michael P Steinmetz
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH
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Fang Z, Judelson D, Simons J, Steppacher R, Arous E, Sideman M, Schanzer A, Aiello FA. Vascular Surgeons Are Not Adequately Valued by Traditional Productivity Metrics. Ann Vasc Surg 2020; 73:446-453. [PMID: 33359694 DOI: 10.1016/j.avsg.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reimbursements for professional services performed by clinicians are under constant scrutiny. The value of a vascular surgeon's services as measured by work relative value units (wRVUs) and professional reimbursement has decreased for some of the most common procedures performed. Hospital reimbursements, however, often remain stable or increases. We sought to evaluate fistulagrams as a case study and hypothesized that while wRVUs and professional reimbursements decrease, hospital reimbursements for these services increased over the same time period. METHODS Medicare 5% claims data were reviewed to identify all fistulagrams with or without angioplasty or stenting performed between 2015 and 2018 using current procedural terminology codes. Reimbursements were classified into 3 categories: medical center (reimbursements made to a hospital for a fistulagram performed as an outpatient procedure), professional (reimbursement for fistulagrams based on compensation for procedures: work RVUs, practice expense RVU, malpractice expense RVU), and office-based laboratory (OBL, reimbursement for fistulagrams performed in an OBL setting). Medicare's Physician Fee Schedule was used to calculate wRVU and professional reimbursement. Medicare's Hospital Outpatient Prospective Payment System-Ambulatory Payment Classification was used to calculate hospital outpatient reimbursement. RESULTS From 2015 to 2018, we identified 1,326,993 fistulagrams. During this study period, vascular surgeons experienced a 25% increase in market share for diagnostic fistulagrams. Compared with 2015, total professional reimbursements from 2017 to 2018 for all fistulagram procedures decreased by 41% (-$10.3 million) while OBL reimbursement decreased 29% (-$42.5 million) and wRVU decreased 36%. During the same period, medical center reimbursement increased by 6.6% (+$14.1 million). CONCLUSIONS Vascular surgeons' contribution to a hospital may not be accurately reflected through traditional RVU metrics alone. Vascular surgeons performed an increasing volume of fistulagram procedures while experiencing marked reductions in wRVU and reimbursement. Medical centers, on the other hand, experienced an overall increase in reimbursement during the same time period. This study highlights that professional reimbursements, taken in isolation and without consideration of medical center reimbursement, undervalues the services and contributions provided by vascular surgeons.
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Affiliation(s)
- Zachary Fang
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Dejah Judelson
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Jessica Simons
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Robert Steppacher
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Edward Arous
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Matthew Sideman
- Division of Vascular Surgery, University of Texas at San Antonio, San Antonio, TX
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Francesco A Aiello
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA.
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20
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Affiliation(s)
- Martin Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - Sebastian E Debus
- Department for Vascular Medicine (Vascular Surgery, Angiology and Endovascular Therapy) University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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21
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Burm S, Sebok-Syer SS, Van Koughnett JA, Watling CJ. Are we generating more assessments without added value? Surgical trainees' perceptions of and receptiveness to cross-specialty assessment. Perspect Med Educ 2020; 9:201-209. [PMID: 32504448 PMCID: PMC7459015 DOI: 10.1007/s40037-020-00594-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Competency-based medical education (CBME) hinges on robust assessment. However, integrating regular workplace-based assessment within demanding and sometimes chaotic clinical environments remains challenging. Many faculty lack assessment expertise, and some programs lack the infrastructure and faculty numbers to fulfill CBME's mandate. Recognizing this, we designed and implemented an assessment innovation that trains and deploys a cadre of faculty to assess in specialties outside their own. Specifically, we explored trainees' perceptions of and receptiveness to this novel assessment approach. METHODS Within Western University's Surgical Foundations program, 27 PGY‑1 trainees were formatively assessed by trained non-surgeons on a basic laparoscopic surgical skill. These assessments did not impact trainees' progression. Four focus groups were conducted to gauge residents' sentiments about the experience of cross-specialty assessment. Data were then analyzed using a thematic analysis approach. RESULTS While a few trainees found the experience motivating, more often trainees questioned the feedback they received and the practicality of this assessment approach to advance their procedural skill acquisition. What trainees wanted were strategies for improvement, not merely an assessment of performance. DISCUSSION Trainees' trepidation at the idea of using outside assessors to meet increased assessment demands appeared grounded in their expectations for assessment. What trainees appeared to desire was a coach-someone who could break their performance into its critical individual components-as opposed to an assessor whose role was limited to scoring their performance. Understanding trainees' receptivity to new assessment approaches is crucial; otherwise training programs run the risk of generating more assessments without added value.
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Affiliation(s)
- Sarah Burm
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | - Julie Ann Van Koughnett
- Divisions of General Surgery and Surgical Oncology, Western University, London, Ontario, Canada
| | - Christopher J Watling
- Departments of Oncology and Clinical Neurological Sciences, Centre for Education Research and Innovation, Western University, London, Ontario, Canada
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22
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Ad N, Luc JGY, Nguyen TC. Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact. J Thorac Cardiovasc Surg 2020; 162:893-903.e4. [PMID: 32768300 PMCID: PMC7330597 DOI: 10.1016/j.jtcvs.2020.06.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. Methods A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. Results Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high –7.6% vs low –2.6%, P = .195). Conclusions The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.
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Affiliation(s)
- Niv Ad
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Adventist White Oak Medical Center, Silver Spring, Md.
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex
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Bingmer K, Ofshteyn A, Bliggenstorfer JT, Steinhagen E, Stein SL. Where is the leak in the surgeon pipeline? Am J Surg 2020; 220:1174-1178. [PMID: 32654766 DOI: 10.1016/j.amjsurg.2020.06.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 02/15/2020] [Revised: 04/10/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In order to care for an increasingly diverse population, the surgical workforce must improve in gender, racial, and ethnic diversity. We aim to identify deficiencies in the surgical pipeline. METHODS Data from the United States Census, Bureau of Labor Statistics, and Association of American Medical Colleges were collected from 2004 to 2018, and evaluated for changing population over time. RESULTS Women comprise 51% of the population, 32% of surgeons, and representation is increasing at a rate of 0.4% per year. 13% of the population and 6% of surgeons are black, and representation is decreasing at a rate of -0.1% per year. Hispanics represent 18% of the population, 6% of surgeons, and representation is increasing at a rate of 0.04% per year. CONCLUSIONS While the proportion of women and Hispanic surgeons is slowly increasing, the proportion of black surgeons is decreasing. Recruitment methods need to be focused to improve surgical workforce diversity.
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Affiliation(s)
- Katherine Bingmer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Asya Ofshteyn
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan T Bliggenstorfer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Narahari AK, Cook IO, Mehaffey JH, Chandrabhatla AS, Hawkins RB, Tyerman Z, Charles EJ, Tribble CG, Kron IL, Teman NR, Roeser ME, Ailawadi G. Comprehensive National Institutes of Health funding analysis of academic cardiac surgeons. J Thorac Cardiovasc Surg 2020; 159:2326-2335.e3. [PMID: 31604638 PMCID: PMC7546359 DOI: 10.1016/j.jtcvs.2019.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine trends in National Institutes of Health (NIH) funding for cardiac surgeons, hypothesizing they are at a disadvantage in obtaining funding owing to intensive clinical demands. METHODS Cardiac surgeons (adult/congenital) currently at the top 141 NIH-funded institutions were identified using institutional websites. The NIH funding history for each cardiac surgeon was queried using the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER). Total grant funding, publications, and type was collected. Academic rank, secondary degrees, and fellowship information was collected from faculty pages. Grant productivity was calculated using a validated grant impact metric. RESULTS A total of 818 academic cardiac surgeons were identified, of whom 144 obtained 293 NIH grants totaling $458 million and resulting in 6694 publications. We identified strong associations between an institution's overall NIH funding rank and the number of cardiac surgeons, NIH grants to cardiac surgeons, and amount of NIH funding to cardiac surgeons (P < .0001 for all). The majority of NIH funding to cardiac surgeons is concentrated in the top quartile of institutions. Cardiac surgeons had a high conversion rates from K awards (mentored development awards) to R01s (6 of 14; 42.9%). Finally, we demonstrate that the rate of all NIH grants awarded to cardiac surgeons has increased, driven primarily by P and U (collaborative project) grants. CONCLUSIONS NIH-funded cardiac surgical research has had a significant impact over the last 3 decades. Aspiring cardiac surgeon-scientists may be more successful at top quartile institutions owing to better infrastructure and mentorship.
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Affiliation(s)
- Adishesh K Narahari
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Ian O Cook
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Anirudha S Chandrabhatla
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Robert B Hawkins
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Zachary Tyerman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Eric J Charles
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Curtis G Tribble
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Irving L Kron
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Mark E Roeser
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va.
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Lopez Ramos C, Brandel MG, Rennert RC, Hirshman BR, Wali AR, Steinberg JA, Santiago-Dieppa DR, Flagg M, Olson SE, Pannell JS, Khalessi AA. The Potential Impact of "Take the Volume Pledge" on Outcomes After Carotid Artery Stenting. Neurosurgery 2020; 86:241-249. [PMID: 30873551 PMCID: PMC7308658 DOI: 10.1093/neuros/nyz053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/31/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The "Volume Pledge" aims to centralize carotid artery stenting (CAS) to hospitals and surgeons performing ≥10 and ≥5 procedures annually, respectively. OBJECTIVE To compare outcomes after CAS between hospitals and surgeons meeting or not meeting the Volume Pledge thresholds. METHODS We queried the Nationwide Inpatient Sample for CAS admissions. Hospitals and surgeons were categorized as low volume and high volume (HV) based on the Volume Pledge. Multivariable hierarchical regression models were used to examine the impact of hospital volume (2005-2011) and surgeon volume (2005-2009) on perioperative outcomes. RESULTS Between 2005 and 2011, 22 215 patients were identified. Most patients underwent CAS by HV hospitals (86.4%). No differences in poor outcome (composite endpoint of in-hospital mortality, postoperative neurological or cardiac complications) were observed by hospital volume but HV hospitals did decrease the likelihood of other complications, nonroutine discharge, and prolonged hospitalization. From 2005 to 2009, 9454 CAS admissions were associated with physician identifiers. Most patients received CAS by HV surgeons (79.2%). On multivariable analysis, hospital volume was not associated with improved outcomes but HV surgeons decreased odds of poor outcome (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.97; P = .028), complications (OR 0.56, 95% CI 0.46-0.71, P < .001), nonroutine discharge (OR 0.70, 95% CI 0.57-0.87; P = .001), and prolonged hospitalization (OR 0.52, 95% 0.44-0.61, P < .001). CONCLUSION Most patients receive CAS by hospitals and providers meeting the Volume Pledge threshold for CAS. Surgeons but not hospitals who met the policy's volume standards were associated with superior outcomes across all measured outcomes.
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Affiliation(s)
- Christian Lopez Ramos
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Jeffrey A Steinberg
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | | | - Mitchell Flagg
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Scott E Olson
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
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Shrestha BM. Women in Surgery: Changing Perspectives. JNMA J Nepal Med Assoc 2019. [PMID: 32335646 PMCID: PMC7580426 DOI: 10.31729/jnma.4124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Badri Man Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
- Correspondence: Dr. Badri Man Shrestha, Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, S5 7AU, UK. , Phone: +44-1142714604
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Affiliation(s)
- Domingo M Braile
- Faculdade de Medicina de São José do Rio Preto São José do Rio Preto SP Brazil Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
- Universidade de Campinas Campinas SP Brazil Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Meryt Zanini
- Universidade de São Paulo Faculdade de Saúde Pública Postgraduate degree in Health Law São Paulo SP Brazil Postgraduate degree in Health Law from Faculdade de Saúde Pública da Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Fundação Getúlio Vargas MBA in Health Managemen São Paulo SP Brazil MBA in Health Management from Fundação Getúlio Vargas (FGV), São Paulo, SP, Brazil
| | - Camila Sáfadi Alves Gonçalves
- Sociedade Brasileira de Cirurgia Cardiovascular São Paulo SP Brazil Sociedade Brasileira de Cirurgia Cardiovascular, São Paulo, SP, Brazil
| | - Paulo Roberto B Evora
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Ribeirão Preto SP Brazil Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Unsal SS, Yildirim T, Armangil M. Comparison of surgical trends in zone 2 flexor tendon repair between Turkish and international surgeons. Acta Orthop Traumatol Turc 2019; 53:474-477. [PMID: 31395430 PMCID: PMC6939005 DOI: 10.1016/j.aott.2019.07.003] [Citation(s) in RCA: 5] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/14/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to evaluate Turkish trends in zone 2 flexor repair with regards to surgical technique, suture materials, anesthesia and post-operative rehabilitation and compare this with international surgeons by modifying Gibson's survey. Methods A printed and online survey consisting of 19 questions modified from Gibson's survey was sent to 590 Turkish and international surgeons. The surgeon's years in practice, province of practice, residency type, number of zone 2 flexor tendon repairs done in a year, preferred surgical technique, suture material, complications and postoperative protocols were asked to the respondents. Results A total of 194 surgeons completed the survey (a 25% response rate). Of those who completed the survey, 91 were international (mostly from far eastern countries) and 103 were Turkish surgeons. Years in practice and educational background had influence on the decision-making. There were differences between the Turkish and international surgeons in the core and epitendinous suture thickness preference and flexor tendon sheath repair. There was a statistically significant relationship between the province of practice and the use of WALANT (Wide awake local anesthesia no tourniquet) (p < 0.05). While the majority of respondents who preferred postoperative early passive motion protocol were from Turkey (61.5%), the majority of respondents who preferred early active motion protocol were practicing abroad (73.9%). Conclusion Despite some variations the surgeons involved in this study follow to a large extent the current literature.
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Affiliation(s)
- Seyyid Serif Unsal
- Ankara University Faculty of Medicine, Department of Orthopedics and Traumatology, Department of Hand Surgery, Ankara, Turkey
| | - Tugrul Yildirim
- Ankara University Faculty of Medicine, Department of Orthopedics and Traumatology, Department of Hand Surgery, Ankara, Turkey.
| | - Mehmet Armangil
- Ankara University Faculty of Medicine, Department of Orthopedics and Traumatology, Department of Hand Surgery, Ankara, Turkey
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Association Of Rural Surgeons Of India-Lancet Commission On Global Surgery Consensus Committee Arsi-LCoGS Consensus Committee. The Lancet Commission on Global Surgery - Association of Rural Surgeons of India Karad Consensus Statement on Surgical System Strengthening in Rural India. Healthc (Amst) 2019; 7:7-9. [PMID: 30709795 DOI: 10.1016/j.hjdsi.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
In India, 90% of the rural population is estimated to lack access to safe, affordable, and timely surgical care. Surgical care in these settings is often characterized by limited resources. Provision of rural surgical care often requires novel approaches as compared to those in higher income urban sectors, specifically in areas of infrastructure, workforce, and blood. This consensus statement draws upon the wealth of experience held by India's rural surgeons to identify key problems and lay forth actionable solutions in the areas of surgical infrastructure, workforce, and blood supply.
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Elkbuli A, Dowd B, Flores R, Boneva D, McKenney M. The impact of level of the American College of Surgeons Committee on Trauma verification and state designation status on trauma center outcomes. Medicine (Baltimore) 2019; 98:e16133. [PMID: 31232965 PMCID: PMC6636922 DOI: 10.1097/md.0000000000016133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The American College of Surgeons (ACS) Committee on Trauma (COT) verification and State designation of trauma centers (TCs) into Level 1 or 2 establishes a distinction based on resources, trauma volume, and educational commitment. The ACS COT and individual states each verify TCs to differentiate performance levels. We aim to determine the relationship between ACS and State Level 1 versus 2, and injury-adjusted, all-cause mortality in a national sampling.TCs were identified by review of the National Sample Program (NSP) from the National Trauma Data Bank (NTDB)-the largest validated trauma database in the nation-of the year 2013. TCs were categorized by ACS or State Level 1 or 2 status, all others were excluded. Adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived by trauma and injury severity score (TRISS) methodology. Chi-squared and t test analyses were used for categorical variables, with a statistical significance defined as P-value <.05.Of the 94 TCs in the NSP, 67 had ACS and 80 had State designations. There were 38 ACS Level 1 TCs and 29 ACS Level 2. For State designations, there were 45 as State Level 1 and 35 State Level 2. ACS Level 1 TCs had a similar O/E compared with ACS Level 2 verified centers (0.73 vs 0.75, chi-square, P = .36). Level 1 TCs designated by their state, had a similar O/E compared with State Level 2 centers (0.70 vs 0.74, chi-square, P = .08).Both ACS and State Level 1 and 2 trauma centers performed similarly on injury adjusted, all-cause mortality.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami
| | - Brianna Dowd
- Department of Surgery, Kendall Regional Medical Center, Miami
| | - Rudy Flores
- Health Corporation of America - South Atlantic Division, Charleston, South Carolina
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami
- University of South Florida, Tampa, Florida
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami
- University of South Florida, Tampa, Florida
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El-Arousy H, Lim S, Batagini NC, Azim AA, Bena J, Clair DG, Kirksey L. Open aortic surgery volume experience at a regionalized referral center and impact on Accreditation Council for Graduate Medical Education trainees. J Vasc Surg 2019; 70:921-926. [PMID: 31147113 DOI: 10.1016/j.jvs.2019.02.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/21/2016] [Accepted: 02/19/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to review our institute's open aortic surgery volume experience and its impact on Accreditation Council for Graduate Medical Education trainees. METHODS A review was conducted of the vascular surgery department's operative database for all cases that underwent aortic aneurysm repair, whether open aortic repair (OAR), endovascular aneurysm repair (EVAR), or fenestrated EVAR (FEVAR). We also reviewed our graduating trainees' case logs. In the setting of our regionalized referral center, all patients who underwent open or endovascular aortic intervention between 2010 and 2014 at our main campus were included. The total number of aortic procedures performed by our graduation trainees was determined. All aortic aneurysm interventions, both open and endovascular (both EVAR and FEVAR), were included. The main outcome measures were the total number of aortic interventions, any change in trends of intervention, and the total number of open aortic cases that our graduation trainees had. RESULTS During the 5-year period analyzed, a total of 1389 abdominal aortic aneurysm repair procedures were performed by OAR, EVAR, and FEVAR. Of those, 462 were OARs, representing 33.2% of the total; 440 were EVARs, representing 31.6%; and 487 were FEVARs, representing 35.2%. For all OAR procedures, there was a significant increase in the proportion of these cases over time (P = .014). The total number of EVAR and FEVAR cases performed annually during this time did not change, whereas the number of OAR cases has increased. Of the OARs, 59.3% were performed for juxtarenal aneurysms, whereas 22.9% involved type IV thoracoabdominal aortic aneurysms. On average, graduating vascular surgery trainees performed 23.1 OARs before graduation (range, 19-26). CONCLUSIONS In contrast to the documented national trend of decreased OAR, our institute continues to see increased OAR relative to EVAR and FEVAR. Moreover, we theorized that the preservation of OAR volume in our program and other similar institutions might offer a practical solution to the challenge of addressing vascular surgery training in aortic surgery by OAR, EVAR, and FEVAR. Inclusive discussions at the national and international levels are needed to reach consensus regarding the future of vascular surgery training and key issues, such as additional, mandatory, subspecialized training in OAR and FEVAR for both residents and fellows who wish to receive certification in OAR; creation of centers of excellence for open aortic surgery that would centralize OAR and direct trainees to those centers for their needed training; and possibly development of new training strategies whereby single cases can be shared among trainees with alternating roles as exposure and closure vs repair.
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Affiliation(s)
- Hazem El-Arousy
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sungho Lim
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Anas Abdel Azim
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Bena
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel G Clair
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lee Kirksey
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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Zilberstein B, Malafaia O, Czeczko NG. THE COST OF BEING A DOCTOR. Arq Bras Cir Dig 2019; 31:e1368. [PMID: 29972396 PMCID: PMC6044198 DOI: 10.1590/0102-672020180001e1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: Access to cardiac surgical care around the world. J Thorac Cardiovasc Surg 2019; 159:987-996.e6. [PMID: 31128897 DOI: 10.1016/j.jtcvs.2019.04.039] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [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: 11/11/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Cardiovascular disease is the leading cause of death worldwide, responsible for 17.5 million deaths every year, of which 80% occur in low- and middle-income countries. Some 75% of the world does not have access to cardiac surgery when needed because of lack of infrastructure, human resources, and financial coverage. This study aims to map access to cardiac surgery around the world. METHODS A scoping review was done on access to cardiac surgery for an undifferentiated population. Workforce data were collected from the Cardiothoracic Surgery Network database and used to calculate numbers and ratios of adult and pediatric cardiac surgeons to population. RESULTS A total of 12,180 adult cardiac surgeons and 3858 pediatric cardiac surgeons were listed in the Cardiothoracic Surgery Network in August 2017, equaling 1.64 (0-181.82) adult cardiac surgeons and 0.52 (0-25.97) pediatric cardiac surgeons per million population globally. Large disparities existed between regions, ranging from 0.12 adult cardiac surgeons and 0.08 pediatric cardiac surgeons per million population (sub-Saharan Africa) to 11.12 adult cardiac surgeons and 2.08 pediatric cardiac surgeons (North America). Low-income countries possessed 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries. CONCLUSIONS This study maps the current global state of access to cardiac surgery. Disparities exist between and within world regions, with a positive correlation between a nation's economic status and access to cardiac surgery. Low early mortality rates in low-resource settings suggest the possibility of high-quality cardiac surgery in low- and middle-income countries. There is the need to increase human and physical resources, while focusing on safety, quality, and efficiency to improve access to cardiac surgery for the 4.5 billion people without.
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Affiliation(s)
- Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass.
| | - Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
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Esfahani DR, Shah H, Arnone GD, Scheer JK, Mehta AI. Lumbar Discectomy Outcomes by Specialty: A Propensity-Matched Analysis of 7464 Patients from the ACS-NSQIP Database. World Neurosurg 2018; 118:e865-e870. [PMID: 30031193 DOI: 10.1016/j.wneu.2018.07.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Darian R Esfahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harsh Shah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Abou El Ela Bourquin B, Gnanakumar S, Bath MF, Bashford T, Menon DK, Hutchinson PJ. The international health elective: a stepping stone for tomorrow's global surgeons and anaesthetists. Perspect Med Educ 2018; 7:228-231. [PMID: 30006869 PMCID: PMC6086820 DOI: 10.1007/s40037-018-0439-4] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael F Bath
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| | - Tom Bashford
- Division of Anaesthesia, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.
| | - David K Menon
- Division of Anaesthesia, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
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Jain M, Rajadhyaksha M, Nehal K. Implementation of fluorescence confocal mosaicking microscopy by "early adopter" Mohs surgeons and dermatologists: recent progress. J Biomed Opt 2017; 22:24002. [PMID: 28199474 PMCID: PMC5310648 DOI: 10.1117/1.jbo.22.2.024002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/20/2017] [Indexed: 05/06/2023]
Abstract
Confocal mosaicking microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed in fluorescence mode using acridine orange (nuclear specific dye), it enhances nuclei-to-dermis contrast that enables detection of all types of basal cell carcinomas (BCCs), including micronodular and thin strands of infiltrative types. So far, this technique has been mostly validated in research settings for the detection of residual BCC tumor margins with high sensitivity of 89% to 96% and specificity of 99% to 89%. Recently, CMM has advanced to implementation and testing in clinical settings by “early adopter” Mohs surgeons, as an adjunct to frozen section during Mohs surgery. We summarize the development of CMM guided imaging of ex vivo skin tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of residual BCC margins in the Mohs surgical setting but also for some melanocytic lesions and other skin conditions in clinical dermatology settings. Last, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.
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Affiliation(s)
- Manu Jain
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
- Address all correspondence to: Manu Jain, E-mail:
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
| | - Kishwer Nehal
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
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Keller EJ, Crowley-Matoka M, Collins JD, Chrisman HB, Milad MP, Vogelzang RL. Specialty-Specific Values Affecting the Management of Symptomatic Uterine Fibroids. J Vasc Interv Radiol 2017; 28:420-428. [PMID: 28082073 DOI: 10.1016/j.jvir.2016.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids. METHODS Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years. RESULTS Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests. CONCLUSIONS Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611; Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Megan Crowley-Matoka
- Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Jeremy D Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Howard B Chrisman
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Magdy P Milad
- Department of Obstetrics and Gynecology-Reproductive Endocrinology & Infertility, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Robert L Vogelzang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
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Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, Ansaloni L, Bala M, Balogh ZJ, Beltrán MA, Ben-Ishay O, Biffl WL, Birindelli A, Cainzos MA, Catalini G, Ceresoli M, Che Jusoh A, Chiara O, Coccolini F, Coimbra R, Cortese F, Demetrashvili Z, Di Saverio S, Diaz JJ, Egiev VN, Ferrada P, Fraga GP, Ghnnam WM, Lee JG, Gomes CA, Hecker A, Herzog T, Kim JI, Inaba K, Isik A, Karamarkovic A, Kashuk J, Khokha V, Kirkpatrick AW, Kluger Y, Koike K, Kong VY, Leppaniemi A, Machain GM, Maier RV, Marwah S, McFarlane ME, Montori G, Moore EE, Negoi I, Olaoye I, Omari AH, Ordonez CA, Pereira BM, Pereira Júnior GA, Pupelis G, Reis T, Sakakhushev B, Sato N, Segovia Lohse HA, Shelat VG, Søreide K, Uhl W, Ulrych J, Van Goor H, Velmahos GC, Yuan KC, Wani I, Weber DG, Zachariah SK, Catena F. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 2017; 12:29. [PMID: 28702076 PMCID: PMC5504840 DOI: 10.1186/s13017-017-0141-6] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023] Open
Abstract
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
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Affiliation(s)
| | - Alain Chichom-Mefire
- Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
| | - Francesco M. Labricciosa
- 0000 0001 1017 3210grid.7010.6Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Timothy Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Fikri M. Abu-Zidan
- 0000 0001 2193 6666grid.43519.3aDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Abdulrashid K. Adesunkanmi
- 0000 0001 2183 9444grid.10824.3fDepartment of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Luca Ansaloni
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Miklosh Bala
- 0000 0001 2221 2926grid.17788.31Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt J. Balogh
- 0000 0004 0577 6676grid.414724.0Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales Australia
| | - Marcelo A. Beltrán
- Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Offir Ben-Ishay
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L. Biffl
- 0000 0001 1482 1895grid.162346.4Acute Care Surgery at The Queen’s Medical Center, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, USA
| | - Arianna Birindelli
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - Miguel A. Cainzos
- 0000 0000 8816 6945grid.411048.8Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | - Marco Ceresoli
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Asri Che Jusoh
- Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
| | - Osvaldo Chiara
- grid.416200.1Emergency Department, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Federico Coccolini
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raul Coimbra
- 0000 0001 2107 4242grid.266100.3Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Zaza Demetrashvili
- 0000 0004 0428 8304grid.412274.6Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, T’bilisi, Georgia
| | - Salomone Di Saverio
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - Jose J. Diaz
- 0000 0001 2175 4264grid.411024.2Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - Valery N. Egiev
- 0000 0000 9559 0613grid.78028.35Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Paula Ferrada
- 0000 0004 0458 8737grid.224260.0Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Gustavo P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Wagih M. Ghnnam
- 0000000103426662grid.10251.37Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Jae Gil Lee
- 0000 0004 0470 5454grid.15444.30Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Carlos A. Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Andreas Hecker
- 0000 0000 8584 9230grid.411067.5Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Torsten Herzog
- 0000 0004 0490 981Xgrid.5570.7Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jae Il Kim
- 0000 0004 0470 5112grid.411612.1Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Kenji Inaba
- 0000 0001 2156 6853grid.42505.36Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA USA
| | - Arda Isik
- 0000 0001 1498 7262grid.412176.7Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Aleksandar Karamarkovic
- 0000 0001 2166 9385grid.7149.bClinic for Emergency Surgery, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Jeffry Kashuk
- 0000 0004 1937 0546grid.12136.37Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Vladimir Khokha
- Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus
| | - Andrew W. Kirkpatrick
- 0000 0004 0469 2139grid.414959.4Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, Foothills Medical Centre, Calgary, Alberta Canada
| | - Yoram Kluger
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Kaoru Koike
- 0000 0004 0372 2033grid.258799.8Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Victor Y. Kong
- 0000 0004 0576 7753grid.414386.cDepartment of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Gustavo M. Machain
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Ronald V. Maier
- 0000000122986657grid.34477.33Department of Surgery, University of Washington, Seattle, WA USA
| | - Sanjay Marwah
- 0000 0004 1771 1642grid.412572.7Department of Surgery, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael E. McFarlane
- 0000 0004 0500 5353grid.412963.bDepartment of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Giulia Montori
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Iyiade Olaoye
- 0000 0000 8878 5287grid.412975.cDepartment of Surgery, University of Ilorin, Teaching Hospital, Ilorin, Nigeria
| | - Abdelkarim H. Omari
- 0000 0004 0411 3985grid.460946.9Department of Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Carlos A. Ordonez
- 0000 0001 2295 7397grid.8271.cDepartment of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia
| | - Bruno M. Pereira
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Guntars Pupelis
- Department of General and Emergency Surgery, Riga East University Hospital ‘Gailezers’, Riga, Latvia
| | - Tarcisio Reis
- Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil
| | - Boris Sakakhushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Norio Sato
- 0000 0001 1011 3808grid.255464.4Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Helmut A. Segovia Lohse
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Vishal G. Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Kjetil Søreide
- 0000 0004 0627 2891grid.412835.9Department of Gastrointestinal Surgery, Stavanger University Hospital, Stravenger, Norway
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Waldemar Uhl
- 0000 0004 0490 981Xgrid.5570.7Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Ulrych
- 0000 0000 9100 9940grid.411798.2First Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - Harry Van Goor
- 0000 0004 0444 9382grid.10417.33Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - George C. Velmahos
- 0000 0004 0386 9924grid.32224.35Trauma, Emergency Surgery, and Surgical Critical Care Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Kuo-Ching Yuan
- 0000 0004 1756 1461grid.454210.6Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Imtiaz Wani
- 0000 0001 0174 2901grid.414739.cDepartment of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Dieter G. Weber
- 0000 0004 0453 3875grid.416195.eDepartment of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Sanoop K. Zachariah
- 0000 0004 1766 361Xgrid.464618.9Department of Surgery, Mosc Medical College, Kolenchery, Cochin, India
| | - Fausto Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
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Silberstein E, Shir-Az O, Reuveni H, Krieger Y, Shoham Y, Silberstein T, Bogdanov-Berezovsky A. Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel. Aesthet Surg J 2016; 36:NP299-NP304. [PMID: 27277272 DOI: 10.1093/asj/sjw094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Defensive medicine (DM) includes medical practices that are aimed at avoiding liability rather than benefitting the patient. DM has not been well characterized among plastic surgeons. OBJECTIVES The authors examined the extents of intended and unintended DM among members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS) and identified risk factors for DM. METHODS A total of 108 ISPAS members were asked to complete a questionnaire that addressed physician attitudes toward DM and intended or unintended DM practices. RESULTS Seventy-eight surgeons (72.2% response rate) returned the questionnaire, although some questionnaires were returned incomplete. Forty respondents acknowledged practicing DM (ie, DM group), and 33 respondents did not (ie, non-DM group). There were no between-group differences in gender, years of practice, or number of previous litigations. Thirty-one percent of respondents in the DM group indicated that they avoid certain surgical procedures, compared with 6% of respondents in the non-DM group (P = .008). In private practice, 66.2% of respondents stated that they obtain written informed consent twice before surgery, and 100% request preoperative blood-coagulation testing. In contrast, 40% and 74% of respondents in public practice, respectively, acknowledged these behaviors (for consent, P = .027; for testing, P = .0059). Sixty-three percent of respondents prescribe antibiotics for more than 24 hours postoperatively, and this practice was slightly more common in the DM group (34 prescribe antibiotics vs 21 in the non-DM group; P = .079). CONCLUSIONS DM is highly integrated into the daily medical practices of plastic surgeons in Israel.
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Affiliation(s)
- Eldad Silberstein
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Ofir Shir-Az
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Haim Reuveni
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Yuval Krieger
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Yaron Shoham
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Tali Silberstein
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Alexander Bogdanov-Berezovsky
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
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Gani F, Thompson VM, Bentrem DJ, Hall BL, Pitt HA, Pawlik TM. Patterns of hepatic resections in North America: use of concurrent partial resections and ablations. HPB (Oxford) 2016; 18:813-820. [PMID: 27506995 PMCID: PMC5061025 DOI: 10.1016/j.hpb.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND National registries have not adequately captured concurrent partial hepatic resections or ablations. Therefore, the aim of this analysis was to describe the patterns of concurrent partial resections and ablations in North America. METHODS Patients undergoing a hepatic resection were identified using the American College of Surgeons-National Surgical Quality Improvement Program Targeted Hepatectomy database. Perioperative outcomes were compared for patients undergoing concurrent "wedge" resections and/or ablations and other subsets. RESULTS A total of 2714 patients were identified who met inclusion criteria. Major hepatectomy was performed in 1037 patients (38.2%) while partial lobectomy was performed in 1677 (61.8%) patients. Concurrent "wedge" hepatic resections and ablations were undertaken in 56.0% and 14.2% of patients, respectively, and were more frequently performed among patients undergoing a partial lobectomy and among patients undergoing surgery for colorectal liver metastasis (both p < 0.001). While associated with a decreased incidence of postoperative complications (p = 0.027) and liver failure (p = 0.031) among patients undergoing a major hepatectomy, concurrent therapies were associated with comparable 30-day outcomes for patients undergoing partial lobectomy. CONCLUSION Concurrent "wedge" hepatic resections and ablations are performed in 56.0% and 14.2%, respectively of patients undergoing hepatectomy. Concurrent procedures were not associated with worse clinical outcomes.
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Affiliation(s)
- Faiz Gani
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vanessa M Thompson
- National Surgical Quality Improvement Program, American College of Surgeons, Chicago, IL, USA
| | - David J Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce L Hall
- Department of Surgery, Washington University in St. Louis School of Medicine, Olin Business School, and BJC Healthcare, St. Louis, MO, USA
| | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Baciweicz FA. Surgeon volume and procedure selection. J Thorac Cardiovasc Surg 2016; 151:1218-9. [PMID: 26995629 DOI: 10.1016/j.jtcvs.2015.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Frank A Baciweicz
- Professor of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Wayne State University School of Medicine, Detroit, Mich
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Koike S, Shimizu A, Matsumoto M, Ide H, Atarashi H, Yasunaga H. Career pathways of board-certified surgeons in Japan. Surg Today 2015; 46:661-7. [PMID: 26144272 DOI: 10.1007/s00595-015-1212-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/31/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the career pathways of board-certified surgeons' and the factors associated with them maintaining their certification in Japan. METHODS We analyzed data from the surveys of physicians, dentists and pharmacists. A multivariate logistic regression model was used to investigate whether factors such as gender, year of registration, place of work, and subspecialty board certification were associated with maintaining board certification. RESULTS Most Japanese surgeons attain board certification within 5-10 years of initial medical registration. After adjusting for possible confounding factors, the odds of maintaining board certification were significantly lower for women, those who were beyond 20 years post-registration, those who worked in hospitals other than academic hospitals or clinics, and those who had board certification in surgery only. Of the total board-certified surgeons analyzed, 93.2 % continued to work in hospitals and 2.8 % moved to clinics within 2 years. Of those who moved from hospitals to clinics, half continued to practice surgery, while nearly 40 % changed their specialty to internal medicine. CONCLUSION It is necessary to establish a special training system for mature surgeons who move from surgery to general practice later in their careers. As the number of female surgeon increases, a support system is also required to secure the future supply of surgeons.
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Affiliation(s)
- Soichi Koike
- Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
- Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo Hospital, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
| | - Atsushi Shimizu
- Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masatoshi Matsumoto
- Department of Community Based Medical System, Faculty of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Hiroo Ide
- Department of Medical Community Network and Discharge, Chiba University Hospital, 1-8-1 Inohana, Chuo, Chiba, Chiba, 260-8677, Japan
| | - Hidenao Atarashi
- Department of Planning, Information and Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan
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Kilic A, Sultan IS, Arnaoutakis GJ, Black JH, Reifsnyder T. Significant differences between vascular and nonvascular surgeons in the perioperative management of antiplatelet therapies in patients with coronary stents. Ann Vasc Surg 2014; 29:526-33.e2. [PMID: 25476748 DOI: 10.1016/j.avsg.2014.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/22/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND An increasing number of patients undergoing noncardiac surgery have coronary stents. Although guidelines regarding perioperative management of antiplatelet therapies in this patient population exist, practice patterns remain incompletely understood. This study evaluated these practice patterns, with particular attention to differences in management between vascular and nonvascular surgeons. METHODS A link to a 16-question survey was displayed in the American College of Surgeons (ACS) electronic newsletter NewsScope, which is posted on the ACS Web site. Questions were focused on perioperative management of antiplatelets (aspirin, clopidogrel) for bare-metal (BMS; placed within 2 months) and drug-eluting stents (DES; placed within the past year) during low- and high-risk bleeding procedures, assuming a patient with no other confounding medical issues. Primary stratification was by surgeon specialty. RESULTS A total of 244 surgical providers responded to the survey, of which 40 (17%) were vascular surgeons. The majority of respondents were attending surgeons in practice for at least 10 years (79%, n = 190). A significantly higher percentage of vascular versus nonvascular surgeons would not stop aspirin preoperatively in low bleeding risk procedures (BMS: 90% vs. 54%, P = 0.001; DES: 88% vs. 58%, P = 0.009). A higher percentage of vascular surgeons would not stop aspirin preoperatively in high bleeding risk procedures as well (BMS: 70% vs. 28%, P < 0.001; DES: 78% vs. 32%, P < 0.001). Most vascular surgeons would not stop clopidogrel in a low-risk BMS patient (53% vs. 21% of nonvascular surgeons, P = 0.001). Similar findings with clopidogrel were observed in low- (would not stop: 65% vascular versus 30% nonvascular, P < 0.001) and high-risk DES patients (would not stop: 30% vascular versus 8% nonvascular, P = 0.001). The same trends were observed in resuming antiplatelets in the postoperative period. The majority of respondents were not familiar with professional guidelines regarding perioperative antiplatelet management (52%, n = 128), with no differences between vascular and nonvascular surgeons (45% vs. 54%, P = 0.30). CONCLUSIONS This national survey demonstrates significant variation in perioperative antiplatelet management in patients with coronary stents, with marked differences between vascular and nonvascular surgeons. More effective communication of existing guidelines or the development of new specialty-specific professional guidelines appears prudent in reducing this variability in practice.
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Affiliation(s)
- Arman Kilic
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | | | | | - James H Black
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Thomas Reifsnyder
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD.
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