82 results on '"Thoracic Surgery standards"'
Search Results
2. The American Association for Thoracic Surgery and The Society of Thoracic Surgeons Reasoning for Not Endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines.
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Sabik JF 3rd, Bakaeen FG, Ruel M, Moon MR, Malaisrie SC, Calhoon JH, Girardi LN, and Guyton R
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- American Heart Association, Humans, Myocardial Revascularization, United States, Surgeons, Thoracic Surgery standards
- Published
- 2022
- Full Text
- View/download PDF
3. Wisdom From Past Presidents of The Society of Thoracic Surgeons.
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Han JJ, Mays JC, Iyengar A, Luc JGY, Patrick WL, Helmers MR, Smood B, Kelly JJ, Williams ML, Szeto WY, and Cevasco M
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- Societies, Medical, Thoracic Surgery standards
- Abstract
The Society of Thoracic Surgeons is a highly impactful professional organization in cardiothoracic surgery and an important network of mentors for trainees. Annually, presidents of The Society of Thoracic Surgeons deliver an address encapsulating their professional experiences, lessons learned, and future vision for the field. We sought to summarize these lessons into salient points for trainees. Transcriptions from 1964 to 2018 were reviewed by residents and expounded into categories of importance for readers. Six overarching themes were identified: (1) leadership, (2) education, (3) clinical excellence and innovation, (4) humanism and professionalism, (5) diversity and inclusion, and (6) the future of cardiothoracic surgery., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
- Full Text
- View/download PDF
4. An Update From The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery: Improving the Implementation of Clinical Practice Guidelines.
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Firestone S, Wyler von Ballmoos M, Kissoon K, Goldberg J, Worrell S, and Lawton J
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- Humans, Evidence-Based Medicine, Guideline Adherence, Thoracic Surgery standards, Thoracic Surgical Procedures standards
- Published
- 2021
- Full Text
- View/download PDF
5. 2019 Presidential Address of The Southern Thoracic Surgical Association: "WHY".
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Jacobs JP
- Subjects
- Philosophy, Medical, United States, Societies, Medical, Thoracic Surgery standards
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- 2021
- Full Text
- View/download PDF
6. Early vascular surgery response to the COVID-19 pandemic: Results of a nationwide survey.
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Latz CA, Boitano LT, Png CYM, Tanious A, Kibrik P, Conrad M, Eagleton M, and Dua A
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- COVID-19 diagnosis, Elective Surgical Procedures standards, Elective Surgical Procedures statistics & numerical data, Health Care Surveys, Humans, Internet, Patient Care standards, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' statistics & numerical data, Professional Practice standards, SARS-CoV-2, Thoracic Surgery standards, Thoracic Surgery statistics & numerical data, United States epidemiology, Vascular Surgical Procedures standards, COVID-19 epidemiology, Pandemics statistics & numerical data, Patient Care statistics & numerical data, Personal Protective Equipment statistics & numerical data, Professional Practice statistics & numerical data, Vascular Surgical Procedures statistics & numerical data
- Abstract
Objective: The COVID-19 pandemic has had major implications for the United States health care system. This survey study sought to identify practice changes, to understand current personal protective equipment (PPE) use, and to determine how caring for patients with COVID-19 differs for vascular surgeons practicing in states with high COVID-19 case numbers vs in states with low case numbers., Methods: A 14-question online survey regarding the effect of the COVID-19 pandemic on vascular surgeons' current practice was sent to 365 vascular surgeons across the country through REDCap from April 14 to April 21, 2020, with responses closed on April 23, 2020. The survey response was analyzed with descriptive statistics. Further analyses were performed to evaluate whether responses from states with the highest number of COVID-19 cases (New York, New Jersey, Massachusetts, Pennsylvania, and California) differed from those with lower case numbers (all other states)., Results: A total of 121 vascular surgeons responded (30.6%) to the survey. All high-volume states were represented. The majority of vascular surgeons are reusing PPE. The majority of respondents worked in an academic setting (81.5%) and were performing only urgent and emergent cases (80.5%) during preparation for the surge. This did not differ between states with high and low COVID-19 case volumes (P = .285). States with high case volume were less likely to perform a lower extremity intervention for critical limb ischemia (60.8% vs 77.5%; P = .046), but otherwise case types did not differ. Most attending vascular surgeons worked with residents (90.8%) and limited their exposure to procedures on suspected or confirmed COVID-19 cases (56.0%). Thirty-eight percent of attending vascular surgeons have been redeployed within the hospital to a vascular access service or other service outside of vascular surgery. This was more frequent in states with high case volume compared with low case volume (P = .039). The majority of vascular surgeons are reusing PPE (71.4%) and N95 masks (86.4%), and 21% of vascular surgeons think that they do not have adequate PPE to perform their clinical duties., Conclusions: The initial response to the COVID-19 pandemic has resulted in reduced elective cases, with primarily only urgent and emergent cases being performed. A minority of vascular surgeons have been redeployed outside of their specialty; however, this is more common among states with high case numbers. Adequate PPE remains an issue for almost a quarter of vascular surgeons who responded to this survey., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
7. Digital Health Primer for Cardiothoracic Surgeons.
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Baxter RD, Fann JI, DiMaio JM, and Lobdell K
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- Artificial Intelligence, Computer Simulation, Humans, Telemedicine, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgical Procedures methods, Thoracic Surgical Procedures standards
- Abstract
The burgeoning demands for quality, safety, and value in cardiothoracic surgery, in combination with the advancement and acceleration of digital health solutions and information technology, provide a unique opportunity to improve efficiency and effectiveness simultaneously in cardiothoracic surgery. This primer on digital health explores and reviews data integration, data processing, complex modeling, telehealth with remote monitoring, and cybersecurity as they shape the future of cardiothoracic surgery., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2020
- Full Text
- View/download PDF
8. The Society of Thoracic Surgeons National Database at 30: Honoring Our Heritage, Celebrating the Present, Evolving for the Future.
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Shahian DM, Fernandez FG, and Badhwar V
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- Databases, Factual trends, Forecasting, Humans, Societies, Medical, Thoracic Surgery trends, Total Quality Management, United States, Databases, Factual standards, Practice Guidelines as Topic, Thoracic Surgery standards
- Published
- 2019
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9. Current Practices in the Management of Pulmonary Ground-Glass Opacities: A Survey of SICT Members.
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Lococo F, Cusumano G, De Filippis AF, Curcurù G, Quercia R, Marulli G, Monaco G, Granone P, Muriana G, Rea F, Crisci R, Di Rienzo G, Cardillo G, and Lococo A
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- Attitude of Health Personnel, Female, Health Care Surveys, Humans, Italy, Lung diagnostic imaging, Lung pathology, Lung Neoplasms pathology, Lung Neoplasms surgery, Male, Positron-Emission Tomography trends, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' trends, Risk Assessment, Societies, Medical, Surgeons, Thoracic Surgery standards, Thoracic Surgery trends, Tomography, X-Ray Computed trends, Lung Neoplasms diagnostic imaging, Outcome Assessment, Health Care, Positron-Emission Tomography standards, Surveys and Questionnaires, Tomography, X-Ray Computed standards
- Abstract
Background: Several gray areas and controversies exist concerning the management of pulmonary ground-glass opacities (GGOs), and there is a lack of consensus among clinicians on this topic. One of the main aims of the Italian Society of Thoracic Surgery is to promote education and research, so we decided to perform a survey on this topic to estimate current trends in practice in a large sample of thoracic surgeons., Methods: A total of 160 thoracic surgeons responded, namely, completed our questionnaire (response rate, 53%; 160 of 302). The survey was composed of 36 questions divided into six subsections: (1) demographic characteristics of the respondents; (2) terminology and taxonomy; (3) radiologic and radiometabolic evaluation; (4) diagnostic approach and indications for surgery; (5) surgical management; and (6) radiologic surveillance., Results: We observed some divergence of opinion regarding the definition of mixed GGOs, the role of 18F fluorodeoxyglucose positron emission tomography and computed tomography scans, indications for nonsurgical biopsy, intraoperative techniques for localizing GGOs, indications for surgery, extension of lung resection and lymph node dissection according to the radiologic scenario, use of intraoperative frozen section analysis, and radiologic surveillance of pure GGOs., Conclusions: This topic warrants more investigation in the future. An upcoming consensus conference of Italian Society of Thoracic Surgery experts (also open to experts in other specialties) could provide updated indications for GGO management based on the literature, expert opinions, and the results of the present survey., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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10. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2018 Update on Research.
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Crabtree TD, Gaissert HA, Jacobs JP, Habib RH, and Fernandez FG
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- Advisory Committees organization & administration, Databases, Factual, Female, Humans, Leadership, Male, Organizational Innovation, Quality Improvement, Thoracic Surgery trends, United States, Outcome Assessment, Health Care, Patient Safety, Research organization & administration, Societies, Medical organization & administration, Thoracic Surgery standards
- Published
- 2018
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11. Best Practices for Training, Educating and Introducing New Techniques and Technology into Practice.
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Sudarshan M and Blackmon SH
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- Humans, Practice Guidelines as Topic, Thoracic Surgical Procedures methods, Credentialing standards, Diffusion of Innovation, Thoracic Surgery education, Thoracic Surgery standards, Thoracic Surgical Procedures education, Thoracic Surgical Procedures standards
- Abstract
Adoption of new practices is challenging to the surgeon innovator given lack of standardized processes for implementation. Credentialed surgeons who want to apply new practices need to ensure adequate training depending on the procedure and underlying skills. A competent and motivated team needs to be identified and appropriate privileging sought for the procedure from the local institution. Planning for meticulous monitoring of outcomes ensures continuous safety and quality surveillance. Patients need complete transparency when being informed about a novel practice with information on comparison to standard of care treatments., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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12. Sharing the Airway: The Importance of Good Communication Between Anesthesiologist and Surgeon.
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Shamji FM and Deslauriers J
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- Airway Management history, Anesthesiologists standards, Anesthesiology history, Clinical Competence, Communication, History, 18th Century, History, 19th Century, History, 20th Century, History, 21st Century, Humans, Interprofessional Relations, Patient Care history, Surgeons standards, Thoracic Surgery history, Thoracic Surgical Procedures history, Airway Management standards, Anesthesiology standards, Patient Care standards, Respiratory System surgery, Thoracic Surgery standards, Thoracic Surgical Procedures standards
- Abstract
One of the most challenging tasks during airway surgery is ensuring adequate ventilation throughout the procedure. Because the airway is shared between surgeon and anesthesiologist, successful oxygenation and ventilation of the patient can only be accomplished through close collaboration during the various stages of the procedure. This includes periods in which surgical airway manipulation compromises adequate ventilation and periods in which ventilation interferes with the surgical environment. With continuous communication between surgeon and anesthesiologist, optimal outcomes can be achieved., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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13. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality.
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D'Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, McDonald D, Edwards FH, and Shahian DM
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- Benchmarking, Humans, United States, Cardiac Surgical Procedures standards, Quality Improvement, Registries, Societies, Medical, Surgeons standards, Thoracic Surgery standards
- Abstract
Established in 1989, The Society of Thoracic Surgeons Adult Cardiac Surgery Database is one of the most comprehensive clinical data registries in health care. It is widely regarded as the gold standard for benchmarking risk-adjusted outcomes in cardiac surgery and is the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This is the second in a series of annual reports that summarizes current aggregate national outcomes in cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement during the past year., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2017
- Full Text
- View/download PDF
14. What is a Cardiothoracic Surgical "Center of Excellence"?
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Kouchoukos NT
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- Humans, Quality Assurance, Health Care, Thoracic Surgery standards, Thoracic Surgical Procedures standards
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- 2016
- Full Text
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15. Regarding American College of Surgeons Commission on Cancer Non-Small Cell Lung Cancer Quality of Care Measure 10RLN.
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Handy JR Jr, Costas K, Nisco S, Schaerf R, Vallières E, Hussain SX, Konieczny K, Weerasinghe R, Betzer C, and Lothrop K
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- Carcinoma, Non-Small-Cell Lung surgery, Humans, Lung Neoplasms surgery, Lymph Node Excision methods, Lymph Node Excision statistics & numerical data, Lymph Nodes surgery, Neoplasm Invasiveness pathology, Neoplasm Staging, Societies, Medical standards, Treatment Outcome, United States, Carcinoma, Non-Small-Cell Lung pathology, Lung Neoplasms pathology, Lymph Nodes pathology, Practice Guidelines as Topic standards, Quality of Health Care standards, Thoracic Surgery standards
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- 2016
- Full Text
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16. Temporary extracorporeal bypass modalities during aortic surgery.
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Bassin L and Bell D
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- Cardiopulmonary Bypass, Humans, Hypothermia complications, Postoperative Complications, Thoracic Surgery standards, Aorta surgery, Extracorporeal Circulation, Thoracic Surgery instrumentation
- Abstract
The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable. The main techniques to mitigate ischemia include hypothermia and selective perfusion of the ischemic organ in question. This chapter will first briefly review bypass modalities and then describe how they can be used for various aortic scenarios., (Copyright © 2016. Published by Elsevier Ltd.)
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- 2016
- Full Text
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17. The Society of Thoracic Surgeons General Thoracic Surgery Database Update on Outcomes and Quality.
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Seder CW, Wright CD, Chang AC, Han JM, McDonald D, and Kozower BD
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- Databases, Factual, Humans, Societies, Medical, Esophageal Neoplasms surgery, Lung Neoplasms surgery, Outcome Assessment, Health Care, Quality of Health Care, Thoracic Surgery standards
- Abstract
The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) is a voluntary effort that provides participants with semiannual, risk-adjusted performance reports that facilitate quality improvement and comparison of institutional outcomes with national benchmarks. With improved participation in the STS GTSD, increasingly meaningful analyses are available. This year, risk models for lobectomy and esophagectomy for cancer were updated. In addition, we developed the first composite quality measure for general thoracic surgery, a composite measure for lobectomy for lung cancer. Furthermore, international collaboration with the European Society of Thoracic Surgery has facilitated our understanding of variation between American and European treatment patterns, providing a foundation for future quality improvement initiatives. This article summarizes current aggregate national outcomes in general thoracic surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency from the STS GTSD over the past 12 months., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2016
- Full Text
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18. Factors in the Selection and Management of Chest Tubes After Pulmonary Lobectomy: Results of a National Survey of Thoracic Surgeons.
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Kim SS, Khalpey Z, Daugherty SL, Torabi M, and Little AG
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- Attitude of Health Personnel, Cross-Sectional Studies, Device Removal, Disease Management, Equipment Design, Female, Humans, Male, Patient Selection, Pneumonectomy methods, Prognosis, Surgeons statistics & numerical data, Thoracic Surgery standards, Thoracic Surgery trends, Thoracic Surgery, Video-Assisted methods, Thoracotomy methods, Time Factors, Treatment Outcome, Chest Tubes, Pneumonectomy instrumentation, Surveys and Questionnaires, Thoracic Surgery, Video-Assisted instrumentation, Thoracotomy instrumentation
- Abstract
Background: This study determined patterns of chest tube (CT) selection and management after open lobectomy and minimally invasive lobectomy by thoracic surgeons., Methods: Surveys were sent electronically to 5,175 thoracic surgeons, and 475 were completed. Responses, blinded so individuals could not be identified, were analyzed and compared according to surgeon characteristics (academic/private practice, years in practice, lobectomy volume, and geographic region). All indicated differences were statistically significant (p < 0.05 by χ(2) tests)., Results: CT selection: Most surgeons prefer rigid tubes, and the size most commonly used was 28F. Most place 2 CTs after open lobectomy and 1 CT after minimally invasive lobectomy. Academic surgeons are more likely than private surgeons to use 1 tube after open lobectomy, but both prefer 1 tube after minimally invasive lobectomy. Younger surgeons and high-volume surgeons are more likely to use 1 CT than senior surgeons and low-volume surgeons after both open lobectomy and minimally invasive lobectomy. CT management: Academic and younger surgeons remove the CT sooner after open lobectomy. Younger and high-volume surgeons remove the CT with greater drainage amounts. All groups remove CTs sooner after minimally invasive lobectomy than after open lobectomy. Approximately half of surgeons get a daily chest roentgenogram. Younger and low-volume surgeons are most likely to discharge patients with Heimlich valves, although overall use was in less than 5% (49 of 475) of respondents. Most surgeons believe clinical experience rather than training or the literature determined their CT strategy., Conclusions: This survey determined the difference in CT management among various groups of surgeons. Clinical experience was the most important factor in determining their CT strategy., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
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19. Strategies to improve clinical research in surgery through international collaboration.
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Søreide K, Alderson D, Bergenfelz A, Beynon J, Connor S, Deckelbaum DL, Dejong CH, Earnshaw JJ, Kyamanywa P, Perez RO, Sakai Y, and Winter DC
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- Biomedical Research organization & administration, Clinical Trials as Topic, Consumer Product Safety, Data Collection, General Surgery organization & administration, Health Services Accessibility, Humans, Orthopedics organization & administration, Orthopedics standards, Technology Assessment, Biomedical, Thoracic Surgery organization & administration, Thoracic Surgery standards, Biomedical Research standards, General Surgery standards, International Cooperation
- Abstract
More than 235 million patients undergo surgery every year worldwide, but less than 1% are enrolled in surgical clinical trials--few of which are international collaborations. Several levels of action are needed to improve this situation. International research collaborations in surgery between developed and developing countries could encourage capacity building and quality improvement, and mutually enhance care for patients with surgical disorders. Low-income and middle-income countries increasingly report much the same range of surgical diseases as do high-income countries (eg, cancer, cardiovascular disease, and the surgical sequelae of metabolic syndrome); collaboration is therefore of mutual interest. Large multinational trials that cross cultures and levels of socioeconomic development might have faster results and wider applicability than do single-country trials. Surgeons educated in research methods, and aided by research networks and trial centres, are needed to foster these international collaborations. Barriers to collaboration could be overcome by adoption of global strategies for regulation, health insurance, ethical approval, and indemnity coverage for doctors., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2013
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20. Aortic valve and ascending aorta guidelines for management and quality measures: executive summary.
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Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria J, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reece TB, Reiss GR, Roselli E, Smith CR, Thourani VH, Tuzcu EM, Webb J, and Williams MR
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- Humans, Aorta, Thoracic surgery, Aortic Valve surgery, Practice Guidelines as Topic, Quality Assurance, Health Care, Societies, Medical, Thoracic Surgery standards, Thoracic Surgical Procedures standards
- Abstract
The Society of Thoracic Surgeons Clinical Practice Guidelines are intended to assist physicians and other health care providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines should not be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the same results. Moreover, these guidelines are subject to change over time, without notice. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of the individual circumstances presented by the patient., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
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21. Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.
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Rocco G and Brunelli A
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- Humans, Personal Satisfaction, Patient Satisfaction, Quality Improvement, Thoracic Surgery standards, Thoracic Surgical Procedures standards
- Abstract
Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
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22. The American Board of Thoracic Surgery: update.
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Rusch VW, Calhoon JH, Allen MS, and Baumgartner W
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- Certification standards, Critical Care, Curriculum, Internship and Residency standards, Thoracic Surgery classification, Thoracic Surgery standards, United States, Specialty Boards standards, Thoracic Surgery education
- Published
- 2012
- Full Text
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23. Do new thoracic surgeons feel ready to operate? Self-reported comfort level of thoracic surgery trainees and junior thoracic surgeons with core thoracic surgery procedures.
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Edwards J, Kelly E, Schieman C, Gelfand G, and Grondin SC
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- Adult, Alberta, Cross-Sectional Studies, Education, Medical, Graduate methods, Female, Humans, Male, Surveys and Questionnaires, Thoracic Surgery education, Thoracic Surgery standards, Thoracic Surgical Procedures standards, Clinical Competence, Internship and Residency, Medical Staff, Hospital, Self Efficacy, Thoracic Surgical Procedures education
- Abstract
Objective: To evaluate and compare self-reported surgical experience and comfort levels of Canadian thoracic surgery trainees and junior thoracic surgeons (<5 years in practice) with respect to core thoracic surgery procedures., Methods: A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents and newly graduated thoracic surgeons. A descriptive summary, including calculation of frequencies, means, proportions, and standard deviations was conducted. Associations between reported experience and comfort level for residents and surgeons were explored separately using the Pearson product moment correlation. The differences between resident and junior surgeons' rating of experience and comfort for each procedure were explored using Fisher exact tests., Results: The response rates were 50% for residents and 85% for staff. Adequate or better experience was reported by residents for 9 of 18 core thoracic surgical procedures and by staff for 10 of 18 procedures. A significant difference in self-reported experience level was found between groups for only 1 of 18 procedures. Staff reported that they would confidently perform 7 of 18 procedures independently at the end of their training. The mean resident response did not reach this level of comfort for any of the 18 procedures. Eight of 16 staff had completed extra training, primarily for personal interest, whereas 4 of 6 residents were planning on further training because of job market factors., Discussion: The results of this study help to characterize the comfort levels of thoracic trainees and new attending thoracic surgeons with core thoracic procedures and might assist training programs in identifying and improving areas of weakness., (Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
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24. Assessing the status of thoracic surgical research and quality improvement programs: a survey of the members of the Canadian Association of Thoracic Surgeons.
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Ivanovic J, Maziak DE, Gilbert S, Shamji FM, Sundaresan RS, Ramsay T, and Seely AJ
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- Canada, Databases, Factual, Female, Health Care Surveys, Humans, Male, Needs Assessment, Pilot Projects, Program Evaluation, Quality Assurance, Health Care, Research trends, Societies, Medical, Surveys and Questionnaires, Thoracic Surgery trends, Professional Practice standards, Quality Improvement organization & administration, Research standards, Thoracic Surgery standards
- Abstract
Objectives: Assessing the degree of involvement and participation in thoracic surgical research as well as surgical quality improvement conducted across Canadian institutions is difficult as no common data collection system and no prior studies exist. As a pilot investigation, we designed and conducted a membership survey of the Canadian Association of Thoracic Surgeons (CATS) to evaluate the extent of participation in research and quality improvement processes among thoracic surgeons., Design, Setting, and Participants: A 45-item needs assessment survey was mailed to all national members of CATS (n = 86) in August 2009. Questions primarily focused on clinical research programs and research activity, research funding, database use and interest, and other methods of quality monitoring., Results: The 49 completed surveys represented a 57.0% response rate and 28 institutions across Canada. Research in basic and clinical science is conducted by 17.0% and 80.9% of the respondents, respectively. The annual budget of research funds is most commonly between $5000 and $50,000. A total of 72.0% (n = 18) of institutions do not have a formal surgery quality assessment program and 92.3% (n = 24) do not participate in a national or international thoracic surgery database. Ten institutions (38.6%) have a local thoracic surgery database for quality monitoring. Other systems of monitoring surgical quality include formal morbidity and mortality rounds (69.2%; n = 8 institutions), formal evaluation of surgical wait times (73.1%; n = 19 institutions), and patient satisfaction surveys (71.4%; n = 10 institutions). Overall, 97.8% of surgeons would be willing to share data on morbidity and mortality with other centers, and 73.1% have a high or very high level of interest in participating in a national thoracic surgery quality database., Conclusions: A high level of interest and participation exists in thoracic surgery research. However, more robust quality improvement processes are needed for thoracic surgical oncology services. A national thoracic surgery quality improvement database offers a potential means to improve practice effectiveness, standardize surgical outcomes, and promote thoracic research across Canada., (Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
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25. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines.
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Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, and Shann KG
- Subjects
- Blood Transfusion, Humans, Anesthesiology standards, Blood Preservation standards, Cardiovascular Diseases therapy, Practice Guidelines as Topic, Societies, Medical, Thoracic Surgery standards
- Abstract
Background: Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007., Methods: The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector., Results: In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management., Conclusions: Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
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26. Lessons learned from the European thoracic surgery database: the Composite Performance Score.
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Brunelli A, Rocco G, Van Raemdonck D, Varela G, and Dahan M
- Subjects
- Databases, Factual, Europe, Humans, Logistic Models, Pneumonectomy mortality, Quality Indicators, Health Care, Reference Values, Registries, Thoracic Surgery statistics & numerical data, Benchmarking, Lung Diseases surgery, Pneumonectomy statistics & numerical data, Quality of Health Care, Thoracic Surgery standards
- Abstract
Background: This study reports the methods used to review the Composite Performance Score (CPS) along with a reference table, which will be used in the upcoming ESTS Quality Certification Program., Methods: Data from 4303 patients who underwent pulmonary resection (July 2007-January 2010) were captured in the ESTS database and used for the present analysis. Only patients submitted from units contributing at least 100 consecutive lung resections were used for developing the score. According to the best available evidence the following measures were selected for each surgical domain: preoperative care (1. % of DLCO measurement in patients submitted to major anatomic resections; 2. % of preoperative invasive mediastinal staging in patients with clinically suspicious N2 disease), operative care (% of systematic lymph node dissection), outcomes (risk-adjusted cardiopulmonary morbidity and mortality rates). Morbidity and mortality risk-models were developed by logistic regression and validated by bootstrap analyses. Individual processes and outcomes scores were rescaled according to their standard deviations and summed to generate the CPS. Units were rated accordingly and a percentile reference table was produced., Results: Risk-adjusted survival and absence of morbidity rates varied from 91.5% to 100%, and from 50.2% to 97.5%, respectively. CPS ranged from -4.038 to 1.24. The 50% percentile of CPS corresponded to 0.404., Conclusions: A revised Composite Performance Score was developed and a reference table presented to be used as a benchmark for the ESTS Quality Certification program., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)
- Published
- 2010
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27. Surgeon specialty is associated with better outcomes: the facts speak for themselves.
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Wood DE and Farjah F
- Subjects
- Cohort Studies, Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Retrospective Studies, Thoracic Surgical Procedures adverse effects, Outcome Assessment, Health Care, Thoracic Surgery standards, Thoracic Surgical Procedures standards
- Published
- 2009
- Full Text
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28. The safe transition from open to thoracoscopic lobectomy: a 5-year experience.
- Author
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Seder CW, Hanna K, Lucia V, Boura J, Kim SW, Welsh RJ, and Chmielewski GW
- Subjects
- Age Factors, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Kaplan-Meier Estimate, Laparoscopy methods, Laparoscopy mortality, Length of Stay, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Minimally Invasive Surgical Procedures methods, Minimally Invasive Surgical Procedures mortality, Pneumonectomy mortality, Probability, Prognosis, Registries, Retrospective Studies, Risk Assessment, Sensitivity and Specificity, Statistics, Nonparametric, Survival Analysis, Thoracic Surgery standards, Thoracic Surgery trends, Thoracic Surgery, Video-Assisted mortality, Thoracoscopy methods, Thoracoscopy mortality, Thoracotomy mortality, Treatment Outcome, Intraoperative Complications surgery, Lung Neoplasms surgery, Pneumonectomy methods, Thoracic Surgery, Video-Assisted methods, Thoracotomy methods
- Abstract
Background: We hypothesized that established thoracic surgeons without formal minimally invasive training can learn thoracoscopic lobectomy without compromising patient safety or outcome., Methods: Data were retrospectively collected on patients who underwent pulmonary lobectomy at a single health system between August 1, 2003, and April 1, 2008. Age, sex, pulmonary function tests, preoperative and postoperative stages, pathologic diagnosis, anatomic resection, extent of lymph node sampling, surgical technique and duration, complications, blood loss, transfusion requirement, chest tube duration, length of hospital stay, 30-day readmission, and mortality rate were examined. The percentage of patients who underwent thoracoscopic lobectomy and their outcomes were then compared among three chronologic cohorts., Results: Three hundred sixty-four patients underwent pulmonary lobectomy (239 open; 99 thoracoscopic; 26 thoracoscopic converted to open). Baseline characteristics, staging, pathologic diagnosis, and anatomic resections were similar in the early, middle, and late cohorts. The percentage of thoracoscopic lobectomies increased from 16% to 49%, whereas open lobectomy decreased from 81% to 42% (p < 0.0001). The complication rate remained constant with the exception of air leaks lasting more than 7 days (9% versus 10% versus 2%; p = 0.02). Hospital length of stay (6 versus 5 versus 4 days; p < 0.0001) and chest tube duration (4 versus 3 versus 3 days; p < 0.0001) decreased and operative duration increased as more thoracoscopic lobectomies were performed. Blood loss, transfusion requirement, 30-day readmission, and 1-year survival were not significantly different among chronologic cohorts., Conclusions: Established thoracic surgeons can safely incorporate thoracoscopic lobectomy with no increase in morbidity or mortality.
- Published
- 2009
- Full Text
- View/download PDF
29. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3--valve plus coronary artery bypass grafting surgery.
- Author
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Shahian DM, O'Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, and Anderson RP
- Subjects
- Advisory Committees, Age Factors, Aged, Aged, 80 and over, Aortic Valve surgery, Cause of Death, Combined Modality Therapy, Coronary Artery Bypass methods, Databases, Factual, Female, Heart Valve Diseases mortality, Heart Valve Prosthesis Implantation methods, Humans, Male, Middle Aged, Mitral Valve surgery, Predictive Value of Tests, Prognosis, Risk Adjustment, Sensitivity and Specificity, Sex Factors, Societies, Medical, Survival Analysis, Thoracic Surgery standards, Thoracic Surgery trends, Coronary Artery Bypass mortality, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation mortality, Models, Cardiovascular, Models, Statistical, Postoperative Complications mortality
- Abstract
Background: Since 1999, The Society of Thoracic Surgeons (STS) has published two risk models that can be used to adjust the results of valve surgery combined with coronary artery bypass graft surgery (CABG). The most recent was developed from data for patients who had surgery between 1994 and 1997 using operative mortality as the only endpoint. Furthermore, this model did not specifically consider mitral valve repair plus CABG, an increasingly common procedure. Consistent with STS policy of periodically updating and improving its risk models, new models for valve surgery combined with CABG have been developed. These models specifically address both perioperative morbidity and mitral valve repair, and they are based on contemporary data., Methods: The final study population consisted of 101,661 procedures, including aortic valve replacement (AVR) plus CABG, mitral valve replacement (MVR) plus CABG, or mitral valve repair (MVRepair) plus CABG between January 1, 2002, and December 31, 2006. Model outcomes included operative mortality, stroke, deep sternal wound infection, reoperation, prolonged ventilation, renal failure, composite major morbidity or mortality, prolonged postoperative length of stay, and short postoperative length of stay. Candidate variables were screened for frequency of missing data, and imputation techniques were used where appropriate. Stepwise variable selection was employed, supplemented by advice from an expert panel of cardiac surgeons and biostatisticians. Several variables were forced into models to insure face validity (eg, atrial fibrillation for the permanent stroke model, sex for all models). Based on preliminary analyses of the data, a single model was employed for valve plus CABG, with indicator variables for the specific type of procedure. Interaction terms were included to allow for differential impact of predictor variables depending on procedure type. After validating the model in the 40% validation sample, the development and validation samples were then combined, and the final model coefficients were estimated using the overall 100% combined sample. The final logistic regression model was estimated using generalized estimating equations to account for clustering of patients within institutions., Results: The c-index for mortality prediction for the overall valve plus CABG population was 0.75. Morbidity model c-indices for specific complications (permanent stroke, renal failure, prolonged ventilation > 24 hours, deep sternal wound infection, reoperation for any reason, major morbidity or mortality composite, and prolonged postoperative length of stay) for the overall group of valve plus CABG procedures ranged from 0.622 to 0.724, and calibration was excellent., Conclusions: New STS risk models have been developed for heart valve surgery combined with CABG. These are the first valve plus CABG models that also include risk prediction for individual major morbidities, composite major morbidity or mortality, and short and prolonged length of stay.
- Published
- 2009
- Full Text
- View/download PDF
30. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: introduction.
- Author
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Shahian DM and Edwards FH
- Subjects
- Adult, Advisory Committees, Algorithms, Databases, Factual, Female, Humans, Male, Models, Cardiovascular, Reproducibility of Results, Risk Adjustment, Sensitivity and Specificity, Societies, Medical, Survival Analysis, Thoracic Surgery standards, Thoracic Surgery trends, Cardiac Surgical Procedures methods, Cardiac Surgical Procedures mortality, Models, Statistical
- Published
- 2009
- Full Text
- View/download PDF
31. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery.
- Author
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O'Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, and Anderson RP
- Subjects
- Advisory Committees, Age Factors, Aged, Databases, Factual, Female, Heart Valve Diseases mortality, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation methods, Humans, Male, Middle Aged, Reproducibility of Results, Risk Adjustment, Sensitivity and Specificity, Sex Factors, Societies, Medical, Survival Analysis, Thoracic Surgery standards, Thoracic Surgery trends, Treatment Outcome, Cause of Death, Heart Valve Prosthesis Implantation mortality, Models, Cardiovascular, Models, Statistical, Postoperative Complications mortality
- Abstract
Background: Adjustment for case-mix is essential when using observational data to compare surgical techniques or providers. That is most often accomplished through the use of risk models that account for preoperative patient factors that may impact outcomes. The Society of Thoracic Surgeons (STS) uses such risk models to create risk-adjusted performance reports for participants in the STS National Adult Cardiac Surgery Database (NCD). Although risk models were initially developed for coronary artery bypass surgery, similar models have now been developed for use with heart valve surgery, particularly as the proportion of such procedures has increased. The last published STS model for isolated valve surgery was based on data from 1994 to 1997 and did not include patients undergoing mitral valve repair. STS has developed new valve surgery models using contemporary data that include both valve repair as well as replacement. Expanding upon existing valve models, the new STS models include several nonfatal complications in addition to mortality., Methods: Using STS data from 2002 to 2006, isolated valve surgery risk models were developed for operative mortality, permanent stroke, renal failure, prolonged ventilation (> 24 hours), deep sternal wound infection, reoperation for any reason, a major morbidity or mortality composite endpoint, prolonged postoperative length of stay, and short postoperative length of stay. The study population consisted of adult patients who underwent one of three types of valve surgery: isolated aortic valve replacement (n = 67,292), isolated mitral valve replacement (n = 21,229), or isolated mitral valve repair (n = 21,238). The population was divided into a 60% development sample and a 40% validation sample. After an initial empirical investigation, the three surgery groups were combined into a single logistic regression model with numerous interactions to allow the covariate effects to differ across these groups. Variables were selected based on a combination of automated stepwise selection and expert panel review., Results: Unadjusted operative mortality (in-hospital regardless of timing, and 30-day regardless of venue) for all isolated valve procedures was 3.4%, and unadjusted in-hospital morbidity rates ranged from 0.3% for deep sternal wound infection to 11.8% for prolonged ventilation. The number of predictors in each model ranged from 10 covariates in the sternal infection model to 24 covariates in the composite mortality plus morbidity model. Discrimination as measured by the c-index ranged from 0.639 for reoperation to 0.799 for mortality. When patients in the validation sample were grouped into 10 categories based on deciles of predicted risk, the average absolute difference between observed versus predicted events within these groups ranged from 0.06% for deep sternal wound infection to 1.06% for prolonged postoperative stay., Conclusions: The new STS risk models for valve surgery include mitral valve repair as well as multiple endpoints other than mortality. Model coefficients are provided and an online risk calculator is publicly available from The Society of Thoracic Surgeons website.
- Published
- 2009
- Full Text
- View/download PDF
32. The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery.
- Author
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Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR, Bridges CR, Haan CK, Svedjeholm R, Taegtmeyer H, and Shemin RJ
- Subjects
- Adult, Aged, Cardiac Surgical Procedures mortality, Female, Humans, Male, Middle Aged, Perioperative Care, Sensitivity and Specificity, Societies, Medical, Survival Analysis, Thoracic Surgery standards, Treatment Outcome, Blood Glucose analysis, Cardiac Surgical Procedures methods, Monitoring, Intraoperative standards, Practice Guidelines as Topic
- Published
- 2009
- Full Text
- View/download PDF
33. Intravascular ultrasound imaging as applied to the aorta: a new tool for the cardiovascular surgeon.
- Author
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Kpodonu J, Ramaiah VG, and Diethrich EB
- Subjects
- Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic surgery, Female, Forecasting, Humans, Male, Sensitivity and Specificity, Thoracic Surgery standards, Thoracic Surgery trends, Vascular Surgical Procedures methods, Vascular Surgical Procedures trends, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Ultrasonography, Interventional methods
- Abstract
Intravascular ultrasound is a novel endovascular imaging technology that is useful as an imaging tool for diagnosis and treatment of arterial and venous pathologies. Intravascular ultrasound is particularly useful as a decision-making tool in the endovascular management of vascular pathologies. Recently the aorta has become increasingly amenable to endovascular technology, and with the advent of intravascular ultrasound detailed imaging, using intravascular ultrasound permits the diagnosis and endovascular management of various complex aortic pathologies affecting the abdominal and thoracic aorta. Various aortic pathologies including thoracic and abdominal aortic aneurysms, type B dissections, penetrating aortic ulcers, coarctation of the aorta, and many other aortic pathologies, which were once only amenable by open surgical repair are increasingly being managed with endoluminal technology. As experience develops with this technology, more complex aortic pathologies would become readily amenable to advanced endovascular interventions.
- Published
- 2008
- Full Text
- View/download PDF
34. Idealism versus reality: the modern surgeon-scientist.
- Author
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Gruber PJ
- Subjects
- Biomedical Research standards, Biomedical Research trends, Forecasting, Humans, Science trends, Thoracic Surgery trends, Total Quality Management, Interdisciplinary Communication, Science standards, Thoracic Surgery standards
- Published
- 2008
- Full Text
- View/download PDF
35. The challenge of "tending the bridge".
- Author
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Chiu RC
- Subjects
- Biomedical Research trends, Cardiac Surgical Procedures standards, Cardiac Surgical Procedures trends, Forecasting, Humans, Periodicals as Topic, Thoracic Surgery trends, United States, Biomedical Research standards, Interdisciplinary Communication, Thoracic Surgery standards
- Published
- 2008
- Full Text
- View/download PDF
36. The bright future of cardiothoracic surgery in the era of changing health care delivery: an update. 1996. Updated in 2007.
- Author
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Grover FL
- Subjects
- Academic Medical Centers trends, Forecasting, Health Care Reform, Humans, Thoracic Surgery standards, United States, Delivery of Health Care trends, Thoracic Surgery trends
- Published
- 2008
- Full Text
- View/download PDF
37. Towards establishing standards of practice in general thoracic surgery: the European perspective.
- Author
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Klepetko W
- Subjects
- Europe, Humans, Thoracic Surgical Procedures standards, Quality Assurance, Health Care organization & administration, Thoracic Surgery standards
- Abstract
The European situation makes it not easy to establish uniform conditions for quality assurance in GTS. However, by setting up the necessary tools in the form of the European Board, the European Cardiovascular and Thoracic Surgery Institute of Accreditation, and the European Registry, the two major scientific societies of Europe have prepared the necessary requirements for that quality assurance [6]. All these instruments and the application of the suggested mechanisms currently are still voluntary; nevertheless, it is important that regulations are defined within the concerned scientific societies and not imposed from an outside legal body. It lies in the interest and in the discretion the individual departments and surgeons to use and to comply with these existing possibilities to perform GTS at a uniform European quality level.
- Published
- 2007
- Full Text
- View/download PDF
38. Quality measurement in adult cardiac surgery: part 2--Statistical considerations in composite measure scoring and provider rating.
- Author
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O'Brien SM, Shahian DM, DeLong ER, Normand SL, Edwards FH, Ferraris VA, Haan CK, Rich JB, Shewan CM, Dokholyan RS, Anderson RP, and Peterson ED
- Subjects
- Adult, Health Status Indicators, Humans, Outcome Assessment, Health Care methods, Societies, Medical, United States, Guideline Adherence organization & administration, Models, Statistical, Practice Guidelines as Topic standards, Quality of Health Care classification, Quality of Health Care standards, Thoracic Surgery standards
- Published
- 2007
- Full Text
- View/download PDF
39. Quality measurement in adult cardiac surgery: part 1--Conceptual framework and measure selection.
- Author
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Shahian DM, Edwards FH, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, O'Brien SM, Shewan CM, Dokholyan RS, and Peterson ED
- Subjects
- Adult, Advisory Committees, Benchmarking, Evidence-Based Medicine methods, Humans, Outcome and Process Assessment, Health Care organization & administration, Outcome and Process Assessment, Health Care trends, Quality Assurance, Health Care organization & administration, Risk Assessment, Societies, Medical, Total Quality Management classification, Total Quality Management standards, United States, Quality Assurance, Health Care standards, Quality Indicators, Health Care classification, Quality of Health Care standards, Thoracic Surgery standards
- Published
- 2007
- Full Text
- View/download PDF
40. Sleep deprivation and results in cardiac surgery: dangerous study with very dangerous conclusions.
- Author
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Totaro P
- Subjects
- Humans, Sleep Deprivation, Thoracic Surgery standards, Work
- Published
- 2005
- Full Text
- View/download PDF
41. Sleep deprivation does not affect operative results in cardiac surgery.
- Author
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Ellman PI, Law MG, Tache-Leon C, Reece TB, Maxey TS, Peeler BB, Kern JA, Tribble CG, and Kron IL
- Subjects
- Adult, Cardiac Surgical Procedures standards, Hospital Mortality, Humans, Internship and Residency standards, Postoperative Complications epidemiology, Retrospective Studies, Survival Rate, Thoracic Surgery standards, Virginia, Cardiac Surgical Procedures statistics & numerical data, Coronary Artery Bypass mortality, Internship and Residency statistics & numerical data, Sleep Deprivation epidemiology, Sleep Disorders, Circadian Rhythm epidemiology, Thoracic Surgery statistics & numerical data, Work Schedule Tolerance
- Abstract
Background: There has been an increasing trend towards the mandatory reduction in work hours for physicians because of the fear that sleep-deprived (SD) surgeons are more prone to make mistakes. We hypothesized that sleep deprivation would not be associated with increased morbidity or mortality in cardiac operations., Methods: A retrospective review was done of all cases performed by all attending cardiac surgeons from January 1994 to April 2003. Complication rates of cases performed by SD surgeons were compared with cases done when the surgeons were not sleep-deprived (NSD). A surgeon was deemed sleep deprived if he or she performed a case the previous evening that started between 10:00 pm and 5:00 am, or ended between the hours of 11:00 pm and 7:30 am., Results: A total of 6,751 cases were recorded in the Society of Thoracic Surgeons database over the 9-year period examined. Of these, 339 cases (5%) were performed by SD surgeons, and 6,412 (95%) cases were performed by NSD surgeons. Mortality rates for coronary artery bypass operations showed no significant differences (1.7% [SD = 4/223] vs 3.1% [NSD = 133/4206)] p = 0.34). Operative (p = 0.47), pulmonary (p = 0.60), renal (p = 0.93), neurologic (p = 0.11), and infectious (p = 0.87) complications of all cases also failed to show any statistically significant differences in any group. Perfusion times, cross-clamp times, and the use of blood products were also similar between groups., Conclusions: Sleep deprivation does not affect operative morbidity or mortality in cardiac surgical operations. These data do not support a need for work hour restrictions on surgeons.
- Published
- 2004
- Full Text
- View/download PDF
42. Quo vadimus?
- Author
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Guyton RA
- Subjects
- Case Management standards, Clinical Competence, Computer Communication Networks organization & administration, Coronary Artery Bypass methods, Coronary Artery Bypass trends, Diffusion of Innovation, Guideline Adherence, Medical Errors, Medical Records Systems, Computerized, Medicare economics, Practice Guidelines as Topic, Quality Assurance, Health Care, Societies, Medical economics, Thoracic Surgery economics, Thoracic Surgery organization & administration, Thoracic Surgery standards, United States, Societies, Medical trends, Thoracic Surgery trends
- Published
- 2004
- Full Text
- View/download PDF
43. The complete cardiothoracic surgeon: qualities of excellence.
- Author
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Miller JI Jr
- Subjects
- Clinical Competence, Culture, Humanism, Humans, Leadership, Leisure Activities, Physician's Role, Thoracic Surgery education, Thoracic Surgery organization & administration, Thoracic Surgery standards
- Published
- 2004
- Full Text
- View/download PDF
44. The Society of Thoracic Surgeons Practice Guidelines.
- Author
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Edwards FH and Ferguson TB
- Subjects
- Evidence-Based Medicine, Humans, United States, Practice Guidelines as Topic, Societies, Medical, Thoracic Surgery standards
- Published
- 2004
- Full Text
- View/download PDF
45. Validity of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database.
- Author
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Welke KF, Ferguson TB Jr, Coombs LP, Dokholyan RS, Murray CJ, Schrader MA, and Peterson ED
- Subjects
- Adult, Humans, Iowa, Quality Assurance, Health Care, Quality Control, United States, Databases, Factual, Societies, Medical, Thoracic Surgery standards, Thoracic Surgery statistics & numerical data
- Published
- 2004
- Full Text
- View/download PDF
46. Competencies in pulmonary procedures.
- Author
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Alvarez F, Burger C, Grinton S, Johnson M, Keller C, Lyng P, Malik S, Parish J, and Pascual J
- Subjects
- Forecasting, Guideline Adherence, Humans, Outcome Assessment, Health Care, Thoracic Surgery trends, United States, Clinical Competence, Practice Guidelines as Topic, Thoracic Surgery standards
- Published
- 2004
- Full Text
- View/download PDF
47. Circulation of the spinal cord: an important consideration for thoracic surgeons.
- Author
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Shamji MF, Maziak DE, Shamji FM, Ginsberg RJ, and Pon R
- Subjects
- Adult, Aged, Angiography, Aorta, Thoracic pathology, Female, Humans, Intraoperative Complications diagnosis, Lung Neoplasms pathology, Male, Middle Aged, Prognosis, Regional Blood Flow, Risk Assessment, Sampling Studies, Spinal Cord blood supply, Spinal Cord Ischemia diagnosis, Spinal Cord Ischemia surgery, Thoracic Surgery standards, Thoracic Surgery trends, Thoracic Surgical Procedures adverse effects, Thoracic Surgical Procedures methods, Thoracotomy methods, Vascular Neoplasms secondary, Vascular Neoplasms surgery, Aorta, Thoracic surgery, Iatrogenic Disease, Lung Neoplasms surgery, Spinal Cord Ischemia etiology, Thoracotomy adverse effects
- Abstract
The spinal cord has significant thoracic arterial watershed areas rendering it vulnerable to intraoperative ischemic damage, clearly mandating a need for postoperative neurologic monitoring. Mechanisms of hypoperfusion include aortic cross-clamping, rib retraction, intercostal artery interruption, and costovertebral junction bleeding. We report cases of primary lung cancer resection, resection of pulmonary metastasis adherent to the thoracic aorta, resection of cartilaginous tumor with chest wall invasion, and esophagomyotomy for achalasia-all complicated by postoperative paraplegia. We review spinal cord circulation, describe mechanisms and patterns of neurologic dysfunction of susceptible watershed areas, and outline roles of preoperative spinal angiography and intraoperative evoked potentials.
- Published
- 2003
- Full Text
- View/download PDF
48. VHI report card gets a failing grade. Virginia Health Improvement.
- Author
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Higgins RS, DeAnda A, and Kasirajan V
- Subjects
- Databases, Factual, Information Services, Virginia, Quality Assurance, Health Care, Quality Indicators, Health Care, Thoracic Surgery standards
- Published
- 2002
- Full Text
- View/download PDF
49. Endoscopic thoracic sympathectomy.
- Author
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Cameron A
- Subjects
- Endoscopy, Humans, Thoracic Surgery standards, Sympathectomy, Thoracic Surgical Procedures
- Published
- 2002
- Full Text
- View/download PDF
50. Cardiac surgery report cards: making the grade.
- Author
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Grunkemeier GL, Zerr KJ, and Jin R
- Subjects
- Animals, Bias, Humans, Quality Assurance, Health Care statistics & numerical data, Quality Indicators, Health Care statistics & numerical data, Thoracic Surgery standards
- Published
- 2001
- Full Text
- View/download PDF
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