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Study Design: Retrospective Study. Objective: At the North American Spine Society (NASS) conference, participants may influence spine surgery practices and patient care through their contributions. Therefore, their financial conflicts of interest are of notable interest. This study aims to compare the demographics and payments made to participating surgeons. Methods: A list of 151 spine surgeons was created based on those who participated in the 2022 NASS conference. Demographic information was obtained from public physician profiles. General payments, research payments, associated research funding, and ownership interest were collected for each physician. Descriptive statistics and two-tailed t-tests were used. Results: In 2021, 151 spine surgeon participants received industry payments, totaling USD 48 294 115. The top 10% of orthopedic surgeons receiving payments accounted for 58.7% of total orthopedic general value, while the top 10% of neurosurgeons accounted for 70.1%. There was no significant difference between these groups' general payment amounts. Surgeons with 21-30 years of experience received the most general funding. There was no difference in funding between surgeons in academic or private settings. For all surgeons, royalties accounted for the largest percentage of the general value exchanged, while food/beverage accounted for the largest percentage of transactions. Conclusion: Our study found that only years of experience had a positive association with general payments, and most monetary value belonged to a small handful of surgeons. These participants receiving significant money may promote techniques requiring products of companies providing their compensation. Future conferences may require disclosure policy changes so attendees understand the degree of funding participants receive. [ABSTRACT FROM AUTHOR]

Introduction: The role of robotic surgery in the nonelective setting remains poorly defined. Accessibility, patient acuity, and high turn-over may limit its applicability and utilization. The goal is to characterize the role of robotic cholecystectomy (CCY) in a busy acute care surgery (ACS) practice at a quaternary medical center, and compare surgical outcomes and resource utilization between robotic and laparoscopic CCY. Methods: Adult patients who underwent robotic (Da Vinci Xi) or laparoscopic CCY between 01/2021-12/2022 by an ACS attending within 1 week of admission were included. Primary outcomes included time from admission to surgery, off hour (weekend and 6p-6a) cases, operation time, and hospital costs, to reflect "feasibility" of robotic compared to laparoscopic CCY. Secondary outcomes encompassed surgery-related outcomes and complications. Results: The proportion of robotic CCY increased from 5% to 32% within 2 years. In total 361 laparoscopic and 89 robotic CCY were performed. Demographics and gallbladder disease severity were similar. Feasibility measures--operation time, case start time, time from admission to surgery, proportion of off-hour cases, and cost--were comparable between robotic and laparoscopic CCY. There were no differences in surgical complications, common bile duct injury, readmission, or mortality. Conversion to open surgery occurred more often in laparoscopic cases (5% vs 0%, P = .02, OR = 1.05). Discussion: Robotic CCY is associated with fewer open conversions and otherwise similar outcomes compared to laparoscopic CCY in the non-elective setting. Incorporation of robotic CCY in a busy ACS practice model is feasible with available resources. [ABSTRACT FROM AUTHOR]

Estimating thresholds when a threshold effect exists has important applications in biomedical research. However, models/methods commonly used in the biomedical literature may lead to a biased estimate. For patients undergoing coronary artery bypass grafting (CABG), it is thought that exposure to low oxygen delivery (DO2) contributes to an increased risk of avoidable acute kidney injury. This research is motivated by estimating the threshold of nadir DO2 for CABG patients to help develop an evidence-based guideline for improving cardiac surgery practices. We review several models (sudden-jump model, broken-stick model, and the constrained broken-stick model) that can be adopted to estimate the threshold and discuss modeling assumptions, scientific plausibility, and implications in estimating the threshold. Under each model, various estimation methods are studied and compared. In particular, under a constrained broken-stick model, a modified two-step Newton–Raphson algorithm is introduced. Through comprehensive simulation studies and an application to data on CABG patients from the University of Michigan, we show that the constrained broken-stick model is flexible, more robust, and able to incorporate scientific knowledge to improve efficiency. The two-step Newton–Raphson algorithm has good computational performances relative to existing methods. [ABSTRACT FROM AUTHOR]

There are few data on current trends in pain management for thoracic surgery in Australia and New Zealand. Several new regional analgesia techniques have been introduced for these operations in the past few years. Our survey aimed to assess current practice and perceptions towards various modalities of pain management for thoracic surgery among anaesthetists in Australia and New Zealand. A 22-question electronic survey was developed and distributed in 2020 with the assistance of the Australian and New Zealand College of Anaesthetists Cardiac Thoracic Vascular and Perfusion Special Interest Group. The survey focused on four key domains—demographics, general pain management, operative technique, and postoperative approach. Of the 696 invitations, 165 complete responses were obtained, for a response rate of 24%. Most respondents reported a trend away from the historical standard of thoracic epidural analgesia, with a preference towards non-neuraxial regional analgesia techniques. If representative of anaesthetists in Australia and New Zealand more widely, this trend may result in less exposure of junior anaesthetists to the insertion and management of thoracic epidurals, potentially resulting in reduced familiarity and confidence in the technique. Furthermore, it demonstrates a notable reliance on surgically or intraoperatively placed paravertebral catheters as the primary analgesic modality, and suggests the need for future studies assessing the optimal method of catheter insertion and perioperative management. It also gives some insight into the current opinion and practice of the respondents with regard to formalised enhanced recovery after surgery pathways, acute pain services, opioid-free anaesthesia, and current medication selection. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional observational. Background: The use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization's market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians' credentials and licensure. Physicians' use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms. Objective: To document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence. Methods: Cross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic and Pearson's correlation were used to investigate the relationships between the variables. Results: Out of the 325 surgeons, 96% were male with an average age of 51.5 ± 10.7 years and 14.1 ± 9.6 years of experience. The frequency of social media use included 57.2% of surgeons had professional LinkedIn, 17.8% had professional Facebook, and less than 16% had other social media platforms. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4% and 10.9% were active once and twice a month, respectively. Surgeon age (P = 0.004), years in practice (P < 0.001), and practice type (P < 0.001) were strongly correlated with social media activity. Conclusions: Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be utilized at a low level by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern among medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly, and provide access to high-quality education and information will be of considerable benefit to our field well into the future. [ABSTRACT FROM AUTHOR]

Over the past 5 years, The University of Alabama at Birmingham (UAB) Department of Surgery has taken a keen interest in the practice of surgery in rural Alabama and has established the UAB surgery community network. Our goal is to improve the delivery of surgical care in rural areas through active recruitment of rural surgeons, the development of research around rural surgery practice, and the expansion of a surgery network throughout the state. Here, we will present the challenges faced by rural surgery, our early work to address these challenges, and offer a plan for moving forward. [ABSTRACT FROM AUTHOR]

Objective: To compare NIH funding in the field of Otolaryngology to other medical and surgical specialties between 2009 and 2019. Methods: Data was collected from the NIH RePORTER database on funding dollars received by each specialty from 2009 to 2019. Along with data on total active physicians per specialty using the Physician Specialty Data Book, comparisons were drawn between Otolaryngology and other medical and surgical specialties with regards to trends in total funding and NIH funding dollars per physician. The distributions of grant funding, within Otolaryngology from various NIH institutes among principal investigators, organizations, and subspecialties were further explored. Results: There were 3810 grants (1147 unique projects) for a total of $1 276 198 555 funded by the NIH to Otolaryngology departments from 2009 to 2019. Statistically insignificant funding increases (P >.05) caused otolaryngology to fall from first to fourth in funding among studied specialties. The National Institute on Deafness and Other Communication Disorders funded 57% of all unique projects, and 57.2% of all unique NIH projects were otology related. Most projects were basic science related. The top 10 principal investigators obtained 22.3% of the total NIH funding for Otolaryngology. The top 3 organizations over the studied period comprised 26.55% of the total funding, generating a combined 729 grants. Among principal investigators, 63.0% had a PhD degree, 25.3% had an MD, and 9.6% had an MD/PhD. Conclusion and Relevance: NIH funding in Otolaryngology has remained stable and is highly concentrated among a small number of organizations, geographic regions, and principal investigators. Recent initiatives by academic communities have sought to address funding disparities by incorporating diversity and inclusion into clinician-scientist pipelines. We urge our colleagues to strive toward identification of the factors that contribute to successful acquisition of funding and implementation of a more conducive institutional infrastructure to produce research. [ABSTRACT FROM AUTHOR]

Symptoms are determined in large part by mindsets. Feelings of distress and unhelpful thoughts (misinterpretations) of symptoms account for much of the variability in comfort and capability with the severity of the underlying pathophysiology making a more limited contribution. Incorporating this experimental evidence into the daily practice of hand surgery will help us find ways to develop healthy mindsets, to prioritize the alleviation of distress and the gentle redirection of unhelpful thoughts, to avoid unnecessary surgery, and to provide better psychological and social support for people recovering from injury and surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine provider and patient attitudes toward telemedicine in Otolaryngology—Head and Neck Surgery (OHNS). Methods: Otolaryngology practitioners conducting outpatient clinics at an academic tertiary referral center were provided with a pre-Study Provider Perception Questionnaire (pre-PPQ) designed to evaluate pre-study perception of telemedicine in otolaryngology. A post-study Provider Perception Questionnaire (post-PPQ) designed to evaluate elements similar to those constituting the PrePPQ was completed at 6 weeks. Additionally, following each visit, providers and patients completed Individual Encounter Survey Questionnaires (IESQ) to evaluate the virtual clinical encounter experience. Results: The pre-PPQ was completed by 29 providers, while the post-PPQ was completed by 12 providers. A total of 236 post-visit provider IESQs were completed, of which 208 were deemed successful. Audio/visual (AV) difficulties and limited server connectivity for the patient were most common causes for unsuccessful encounters. Providers reported that the most appropriate use of telemedicine, on both pre-PPQ and post-PPQ, was triaging patients to determine the need for in-person visits. The inability to perform a physical exam was rated as the primary barrier to telemedicine in OHNS on both pre-PPQ and post-PPQ. Patients strongly agreed with the statements, "My healthcare provider was able to understand my healthcare condition" and, "I felt comfortable communicating with my healthcare provider" 92.0% and 95.4% of the time, respectively. Conclusion: Both providers and patients demonstrated an overall positive attitude toward the use of telemedicine in the provision of otolaryngologic care. [ABSTRACT FROM AUTHOR]

Objective(s): To compare otolaryngology program director, house-staff, and medical student perspectives on the score reporting change of USMLE Step 1 to pass/fail. Methods: Separate electronic surveys were sent to program directors of ACGME-accredited otolaryngology programs (Cronbach's alpha =.87), otolaryngology house-staff (Cronbach's alpha =.91), and medical students interested in otolaryngology (Cronbach's alpha =.76). Results: Among the 51 otolaryngology program directors that completed the survey (response rate of 46.8%), 17.6% favored reporting USMLE Step 1 as pass/fail. A majority believed the reporting change would make it more difficult to screen (74.5%) and objectively compare applicants (82.4%). Step 2 CK scores will be more important to most program directors due to the reporting change (83.7%). Of the 93 house-staff that completed surveys, most did not favor the reporting change (61.3%). Over half (54.0%) of the 87 medical students that completed surveys did not support the scoring change, and most (65.5%) did not feel that it would decrease anxiety around residency applications (65.5%). Most house-staff and medical students felt that the scoring change would put non-U.S. MD students at a disadvantage (65.6% of house-staff, 69.8% of medical students). Conclusion: Most survey respondents do not agree with the decision to report Step 1 as pass/fail. Despite its intended goals, most do not believe pass/fail Step 1 reporting will improve medical student well-being and believe it will put certain student populations at a greater disadvantage. [ABSTRACT FROM AUTHOR]

Single-shot spinal diamorphine is becoming common practice in urological surgery to aid post-operative pain; however, its safety and efficacy require investigation. This study is a retrospective analysis of 113 laparoscopic or robotic-assisted nephrectomies over 4 years under one consultant urologist. Data were collected on demographic, pre-operative scores, anaesthesia, surgical information, post-operative outcomes and opioid consumption. Two main groups were established: no spinal diamorphine (NSD) and spinal diamorphine (SD). Four subgroups were then created, separating those who received patient-controlled anaesthesia (PCA) or not: Group 1 [general anaesthetic (GA)]; Group 2 [GA and PCA]; Group 3 [GA and spinal diamorphine] and Group 4 [GA, spinal diamorphine and PCA]. Ninety-eight eligible patients were identified. At 6 hours, pain scores were significantly higher for all non-spinal groups (p < 0.05); at 9 h, pain scores were significantly higher in NSD patients compared to SD (p = 0.026); at 12 h, pain scores were significantly higher for NSD patients compared to SD (p = 0.024), and Group 1 compared to Group 3 (p = 0.023). Total opioid consumption in the first 24 h post-surgery was higher in Group 1 compared to Group 3 (p = 0.024). There was no higher incidence of urinary retention, or any neurological complications reported within the SD patients. The study found a reduction in post-operative pain scores with the use of spinal diamorphine prior to laparoscopic and robotic-assisted nephrectomies. The findings may also suggest that pre-operative spinal diamorphine use can reduce the total volume of opioids administered via other routes in the first 24 h post-operatively. It recommends its routine administration but encourages prospective investigation. [ABSTRACT FROM AUTHOR]

Objective: To determine in-hospital costs associated with performing an EEA to anterior skull base pathology and to identify drivers of cost variability for patients undergoing endoscopic anterior skull base surgery. Methods: All endoscopic anterior skull base surgeries performed over a period from January 1st, 2015 to October 24th, 2017 were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and univariate analysis was performed using Stata software. Results: An EEA was associated with an average total in-hospital cost of $44 545. Compared to patients undergoing a transsphenoidal approach to pituitary tumor resection, EEA patients incurred higher in-hospital costs across all variables including a total cost increase of $15 921 (95% confidence interval $5720-26 122, P =.002). Univariate analysis of all endoscopic anterior skull base surgery patients showed a cost increase of $30 616 associated with post-operative cerebrospinal fluid (CSF) leak ($10 420-50 811, P =.004), $14 610 with post-operative diabetes insipidus (DI) ($4610-24 609, P =.004), and $11 522 with African-American patients relative to Caucasian patients ($3049-19 995, P =.008). Conclusions: Patients who undergo endoscopic EEA for resection of anterior skull base tumors typically incur greater in-hospital costs than patients undergoing a standard TSA. Post-operative complications such as CSF leak and DI, as well as ethnicity, are significant drivers of cost-variability. [ABSTRACT FROM AUTHOR]

Introduction: Senior medical students learn trauma principles in a 90-min interactive teaching session based on the trauma evaluation and management module designed by the American College of Surgeons. However, the number of surgical faculty available to conduct these interactive small group sessions is limited. The goal of this study is to compare the effectiveness of surgical residents to that of surgical faculty in teaching trauma principles. Methods: 53 senior medical students received trauma teaching from trauma faculty (n = 22), trauma residents (n = 21), or no teaching (n = 10). Students were tested on cognitive trauma knowledge (20 multiple choice questions) and clinical trauma simulation (using objective structured clinical performance score). All students completed a 5-point subjective questionnaire. Results: Students receiving trauma teaching outperformed students receiving no teaching in the knowledge test (mean 13.0 ± 3.6 standard deviation (SD) vs. 8.4 ± 2.4 SD, p < 0.05), while faculty and resident teaching outcomes were similar (mean 12.6 ± 3.0 SD vs. 13.4 ± 4.1, p = 0.45). Similarly, in the clinical trauma simulation, students receiving trauma teaching scored better (objective score mean 78% vs. 56%, p < 0.05), while there was no difference between faculty and resident teaching outcomes (objective score mean 77% vs. 80%, p = 0.52). In the subjective questionnaire, students who received trauma teaching rated themselves higher on a scale of 10 in trauma knowledge and skills than those who did not have formal teaching (mean 5.2 vs. 2.1, p < 0.05) as resident and attending teaching group ratings were similar. Conclusions: Although small group discussions and increased simulation enhance undergraduate surgical trauma education, the number of faculty surgeons needed to fully incorporate these activities is limited. Objective and perceived effectiveness of teaching trauma management by surgical residents compared to trauma attendings is equivalent. This highlights the opportunity to incorporate residents into teaching roles to bridge the gap in undergraduate trauma education. [ABSTRACT FROM AUTHOR]

Objectives: Despite the growth of social media in healthcare, the appropriateness of online friendships between otolaryngological residents and attendings is poorly defined in the current literature. This issue is of growing importance, particularly as residency programs increasingly utilize social media as a means of connecting with and evaluating applicants due to limited in-person experiences during the COVID-19 pandemic. Our objective was to better understand the prevalence of and concerns surrounding social media use between residents and faculty. Methods: This study sent out 2 surveys in 2017 to all United States Otolaryngology residency program directors to disperse to their residents and attendings, respectively. Results: We received a response from 72 residents and 98 attendings. Our findings show that social media is commonly used by both residents and attendings, and most residents have at least 1 online friendship with an attending. Resident and attending opinions diverge on topics such as appropriateness of use, privacy settings, and professionalism. Conclusions: We call on residency programs to delineate a transparent social media policy so applicant expectations on social media are clear. [ABSTRACT FROM AUTHOR]

Background: Resident involvement in patient care in the general surgery setting is most often encountered in an academic setting. Many community hospitals have residents involved in patient care as well. There are no studies that gauge patients' perceptions in the involvement of residents in their general surgery care in the community setting.Methods: Patients were given a Northeast Georgia Health System Graduate Medical Education Department Institutional review Board approved 26-question questionnaire during their office visit gauging their wiliness to allow a resident be involved in their care, and their understanding of what a resident is.Results: A total of 196 patients completed the survey with answers that could be analyzed. Overall, 67.3% would allow residents be involved in their care. The main reasons for this were to educate future surgeons, they enjoy a teaching environment, and that they have had residents involved in their care and it was a good experience. Of the 27 % that did not want a resident involved in their care, the main reason was they only wanted their doctor involved in their care. Of the respondents, 58 % were comfortable having a resident involved in their surgery or procedure. Only 14% noted that they would prefer not to have a resident involved in their procedure or surgery.Conclusions: Patents appear receptive to general surgery residents' involvement in their care in the community setting. This is reassuring as community practices may be more receptive to including residents in their practices, based upon these findings. [ABSTRACT FROM AUTHOR]

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes. [ABSTRACT FROM AUTHOR]

Antiseizure Medication Use and Medical Resource Utilization After Resective Epilepsy Surgery in Children in the United States: A Contemporary Nationwide Cross Sectional Cohort Analysis Parker JJ, Zhang Y, Fatemi P, Halpern CH, Porter BE, Grant GA. Epilepsia. 2022;63(4):824-835. doi:10.1111/epi.17180 Objective: Antiseizure drug (ASD) therapy can significantly impact quality of life for pediatric patients whose epilepsy remains refractory to medications and who experience neuropsychological side effects manifested by impaired cognitive and social development. Contemporary patterns of ASD reduction after pediatric epilepsy surgery across practice settings in the United States are sparsely reported outside of small series. We assessed timing and durability of ASD reduction after pediatric epilepsy surgery and associated effects on health care utilization. Methods: We performed a retrospective analysis of 376 pediatric patients who underwent resective epilepsy surgery between 2007 and 2016 in the United States using the Truven MarketScan database. Filled ASD prescriptions during the pre- and postoperative periods were compared. Univariate and multivariate analyses identified factors associated with achieving a stable discontinuation of or reduction in number of ASDs. Health care utilization and costs were systematically compared. Results: One hundred seventy-one patients (45.5%) achieved a >90-day ASD-free period after surgery, and 84 (22.3%) additional patients achieved a stable reduction in number of ASDs. Achieving ASD freedom was more common in patients undergoing total hemispherectomy (n = 21, p =.002), and less common in patients with tuberous sclerosis (p =.003). A higher number of preoperative ASDs was associated with a greater likelihood of achieving ASD reduction post-operatively (hazard ratio [HR]: 1.85, 95% confidence interval [CI]: 1.50–2.28) but was not associated with a significant difference in the likelihood of achieving ASD freedom (0.83, 95% CI: 0.49–1.39). Achieving an ASD-free period was associated with fewer hospital readmissions within the first year after surgery. Significance: Patterns of ASD use and discontinuation after pediatric epilepsy surgery provide an unbiased surgical outcome endpoint extractable from administrative databases, where changes in seizure frequency are not captured. This quantitative measure can augment traditional surgical outcome scales, incorporating a significant clinical parameter associated with improved quality of life. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the recent Otolaryngology-Head and Neck Surgery (OTO-HNS) applicant characteristics, to identify which applicant characteristics are associated with successful match into OTO-HNS, and to compare OTO-HNS applicant trends and characteristics to that of peer surgical specialties (PS). Materials and Methods: Data were obtained from official reports by the National Residency Matching Program (NRMP) for OTO-HNS, plastic and reconstructive surgery, orthopedic surgery, neurosurgery, and dermatology from 2006 to 2019. Alpha Omega Alpha (AOA) membership, United States Medical Licensing Examination (USMLE) scores, research productivity, graduation from a top-40 NIH-funded U.S. medical school, and additional graduate degree were recorded. Odds ratios (OR) were calculated to evaluate the relationship between applicant qualifications and match success. Results: From 2014 to 2018, the OTO-HNS applicant pool shrunk from 443 to 333, representing the largest drop of all PS. Furthermore, OTO-HNS reported the most unfilled positions and highest match rates in 2017 (n = 14; 92.1%) and 2018 (n = 12; 94.6%) among any PS. Despite recent trends, 2019 NRMP data revealed a 38.74% increase in OTO-HNS applicant numbers compared to 2018. AOA membership (OR, 7.3; P =.030), USMLE Step 2 scores between 241 and 260 (OR, 6.5; P =.009), and research productivity (OR, 5.6; P =.005) significantly increased the odds of matching into OTO-HNS. Conclusions: Despite recent fluctuations in application trends, OTO-HNS continues to successfully match highly qualified applicants, including applicants with AOA membership, high Step 2 scores, and high research productivity. An understanding of the qualifications used to evaluate residency applicants may be helpful to both applicants and residency programs of OTO-HNS. [ABSTRACT FROM AUTHOR]

Background: The procedures that rural general surgeons perform may be changing. It is important to recognize the trends and practices of the current rural general surgeon in efforts to better prepare general surgeons who desire to enter a practice in a rural environment. The aim of this review is to detail the recent operative case volumes of 6 rural locations in the upper Midwest where general surgery is practiced.Methods: The Enterprise Data and Analytics department of Sanford Health compiled all surgical procedures performed within the Sanford Health System between January 1, 2013 and August 31, 2018. Procedures performed by a total of 58 general surgeons in locations of under 50 000 people are included in this review.Results: From January 1, 2013 to August 31, 2018, 38 958 surgical procedures were performed in rural locations. Endoscopic procedures made up 61.6% of a rural general surgeon's practice. Cholecystectomy (6.3%), hernia repair (6.3%), and appendectomy (3.7%) were the principle nonendoscopic procedures performed by rural surgeons, comprising 16.3% of the case volume. Added together, endoscopy, cholecystectomy, hernia repair, and appendectomy made up 77.9% of the rural general surgeon's caseload. Vascular procedures (2.5%), breast procedures (1.8%), obstetrics (0.4%), and urology procedures (0.2%) are also included in this review.Conclusions: Rural general surgeons are vital to the surgical workforce in the United States. Recognizing a trend that rural general surgeons perform less subspecialty procedures and more endoscopic procedures will provide direction for those interested in pursuing a career in rural general surgery. [ABSTRACT FROM AUTHOR]

Background: The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth.Methods: US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics).Results: Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce.Conclusion: GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward. [ABSTRACT FROM AUTHOR]

Modern global surgery, which aims to provide improved and equitable surgical care worldwide, is a product of centuries of international care initiatives, some borne out of religious traditions, dating back to the first millennium. The first hospitals (xenodochia) were established in the 4th and 5th centuries CE by the early Christian church. Early "missions," a term introduced by Jesuit Christians in the 16th century to refer to the institutionalized expansion of faith, included medical care. Formalized Muslim humanitarian medical care was marked by organizations like the Aga Khan Foundation and the Islamic Association of North America in the 20th century. Secular medical humanitarian programs developed in the 19th century, notably with the creation of the International Committee of the Red Cross (1863) and the League of Nations Health Organization (1920) (which later became the World Health Organization [1946]). World War II catalyzed another proliferation of nongovernmental organizations, epitomized by the quintessential humanitarian health provider, Médecins Sans Frontières (1971). "Global health" as an academic endeavor encompassing education, service, and research began as an outgrowth of departments of tropical medicine and international health. The American College of Surgeons brought a surgical focus to global health beginning in the 1980s. Providing medical care in distant countries has a long tradition that parallels broad themes in history: faith, imperialism, humanitarianism, education, and service. Surgery as a focus of academic global health is a recent development that continues to gain traction. [ABSTRACT FROM AUTHOR]

Objective: Usage of radiation among various surgical specialists has not been comprehensively evaluated. A systems-based analysis evaluating intraoperative radiation can help identify high use factors and dose reduction behaviors leading to quality improvement initiatives.Methods: A retrospective review of all operative fluoroscopic-guided procedures from 2010 to 2017 from 4 hospitals in a tertiary academic health care system was performed.Results: One thousand two hundred fifty-two cases were analyzed, and notable trends in metrics including type of equipment, procedures, surgical field, surgical specialty, and dose reduction techniques were demonstrated. Higher radiation exposures were correlated with fixed vs. mobile C-arm usage (1229 mGy vs. 331 mGy, P = .001), abdominal/pelvic procedures (429.2 mGy vs. 274.0 mGy, P = .002), and embolization (2450.6 mGy vs. 328.2 mGy, P = .019). Vascular surgery averaged 40 times higher radiation exposure per patient than other specialties (613.3 mGy vs. 15.6 mGy, P = .001). Notably, vascular surgeons utilized dose reduction techniques less frequently than urology (21.5% vs. 70%, P = .001) but more than neurosurgery and orthopedics (21.5% vs. 1.3% and 0%, P = .001, respectively).Conclusions: A system-wide health care analysis identified vascular surgery procedures, use of a fixed C-arm, abdominal/pelvic procedures, and embolization cases as having the highest radiation exposure. These data can serve as baseline information for future quality improvement initiatives regarding fluoroscopy usage by surgeons. [ABSTRACT FROM AUTHOR]

Background: Social media is increasingly used in surgery, facilitating the dissemination of knowledge. Social media can potentially aid networking, education, and information exchange. This study explored the impact of tweet components and tweeter characteristics during a large surgical congress to inform recommendations for optimizing social media use at future surgical conferences.Methods: Twitter activity was monitored during the American College of Surgeons Clinical Congress 2018 using NodeXL to extract tweets containing the conference hashtag #ACSCC18 (or #ACSCC2018). Multivariable logistic regression analysis was performed to identify independent predictors of retweet activity, also testing for multicollinearity and interactions among variables.Results: There were 4386 tweets that contained #ACSCC18 (or #ACSCC2018) posted from 1023 Twitter accounts. A larger group of Twitter accounts just retweeted. Other Twitter accounts with a stake in the conference neither tweeted nor retweeted. In a multivariable analysis of original tweets, the following were all independently associated with retweets, in decreasing order of effect size: mention of other tweeters, multimedia, inclusion of other hashtags, and the number of followers. In contrast with other conferences, the inclusion of a weblink (URL)-for example, link to paper or blog-was not associated with retweets.Discussion: This study helps understand social media impact at surgical conferences. Engage by tweeting and retweeting. Mention other tweeters, add multimedia, include congress hashtags and topic-specific hashtags, and build your followers. Although not associated with retweet activity in this study, the inclusion of URLs can still contribute in substantiating the disseminated content based on findings at other conferences. [ABSTRACT FROM AUTHOR]

Background: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures. Methods: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann–Whitney U testing. Results: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this cohort was 47.6 ± 20.2 years with the majority identifying as African–American (53.7%) and male (67.2%). Otolaryngologists were significantly more likely to assess pre-operative nasal obstruction (100%) compared to plastic surgeons (24.1%) (P <.001). Otolaryngology elected operative management (53.3%) at a significantly higher rate than plastic surgery (24.1%) (P =.005). Additionally, otolaryngology was significantly more likely to manage patients in an outpatient setting (91.2%), whereas plastic surgery more commonly performed inpatient management (57.1%) (P =.006). Plastic surgery averaged a significantly shorter amount of time from presentation to operative management (7.3 ± 10.7 days) compared to otolaryngology (20 ± 27.7) (P =.019). Consulting service was not associated with a need for revision surgery. Conclusions: Consultants across subspecialties differ in the management of nasal bone trauma. A more standardized approach is warranted by all individuals involved in the care of maxillofacial trauma patients. [ABSTRACT FROM AUTHOR]

Objectives: To elucidate the frequency and types of pre- and post-interview communication that applicants engage with programs, to garner the perceptions of both applicants and program directors (PDs), and determine if communication influences outcomes. Subjects and Methods: Electronic surveys were distributed to otolaryngology residency applicants, and to PDs of ACGME-accredited otolaryngology programs after the 2018 to 2019 application cycle. Results: 93 of 324 applicants (28.7%) and 33 of 106 PDs (31.3%) responded. In the pre-interview period, 58.1% of applicants sent emails of interest, and 41.9% had a mentor initiate communication. In the post-interview period, the majority of applicants (82.8%) sent notes of intent to their number one choice, and 32.3% had a faculty mentor communicate this on their behalf. The majority of PDs (84.8%) were undecided or did not believe that emails of interest influence decisions to offer an interview, whereas 81.8% believed that communication initiated by an applicant's mentor has an impact on interview offers. No PD agreed that declarations of intent from applicants have an impact on their rank lists, while only 33.3% of PDs believed that a mentor communicating this for an applicant has some impact. Our statistical findings are in agreement with these perceptions as neither applicant-initiated pre-interview (P =.54), mentor-initiated pre-interview (P =.62), applicant-initiated post-interview (P =.11) nor mentor-initiated post-interview (P =.78) communications influenced the number of interviews received or ultimate match outcome. Conclusion: Pre- and post-interview communication practices vary widely among otolaryngology applicants. Applicant-initiated communication has no impact on outcomes, while mentor-initiated communication is perceived to have more benefit, despite not impacting interview or match outcomes in this study. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic dramatically altered the delivery of surgical care.Methods: Members of the Southeastern Surgical Congress were surveyed regarding system adjustments, personal impact, and productivity losses. Subgroups were analyzed for disproportionate impact across practice models (academic/employed/private), practice communities (urban, suburban, rural), and practice case-mix categories (broad general surgery, narrow general surgery, specialty practice, hospital-based practice).Results: 135 respondents reported that 98.5% of surgeons and 97% of hospitals canceled elective cases. Practices and hospitals reduced staffing dramatically. Telemedicine was utilized by most respondents. Hospitals variably implemented system changes, developed tests, and set up diagnostic centers. Most surgeons anticipated resumption of practice and hospital activity by July 1, 2020. More than one-quarter reported worsened financial status and personal well-being. Interestingly, family/personal relationships were improved in more than one-third. Most surgeons anticipate reduced year-end case volumes, clinical productivity, and salary. In subgroup analyses, academic surgeons were more likely than employed and private-practice surgeons to use telemedicine and to work in hospitals with in-house COVID-19 testing. Private-practice surgeons expected decreased financial status, case volumes, relative value units (RVUs), and salary. More rural surgeons anticipate reduced salary than urban and suburban surgeons. Surgeons in narrow general surgery practice reported more furlough of employees than specialty surgeons, hospital-based surgeons, and broad-based general surgeons. Narrow-practice surgeons and specialists were more likely to report RVU reductions and improved family/personal relationships.Discussion: The COVID-19 slowdown affected surgeons throughout the southeastern United States. Variations between different practice models, communities, and case-mix categories may help inform surgeons in the future. [ABSTRACT FROM AUTHOR]

COVID-19 emerged as a viral pandemic in the year 2019. The practice and scope of surgery and medicine transformed radicially as the virus spread across the world. There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery. We present a comprehensive review of the current literature on the management of surgical patients who develop COVID-19.Findings: Poor outcomes were most frequent in general surgery or oncological surgery patients who were older with chronic comorbidities. In contrast, outcomes among transplant surgery and obstetric patients were not signficantly altered by COVID-19. Surgical societies have released specialty specific guidelines on the managment of patients who require surgical care during the pandemic.Conclusion: COVID-19 is associated with adverse outcomes and increased mortality in surgical patients. Data is currently limited, often restricted to single sites and smaller cohorts. As the sequelae of the virus is better understood, the revisions to the guidelines on managment of surgical patients may help improve outcomes. [ABSTRACT FROM AUTHOR]

Background: RAAPID (Referral, Access, Advice, Placement, Information, and Destination) is a 24-h call center in Alberta, Canada, facilitating urgent telephone consultations between physicians and specialists. We evaluated the extent to which RAAPID calls to Otolaryngology-Head and Neck Surgery (OHNS) reduced visits to the emergency department and specialty clinics. Methods: This was a cross-sectional study evaluating all telephone consultations to OHNS from physicians in northern Alberta between 2013 and 2014 (T1) (where consultations by residents occurred) and 2015 to 2017 (T2) (where consultations were done by consultants during office hours and residents during after hours). Outcomes of the calls included medical advice, specialty clinic referrals, and emergency department (ED) referrals. Differences in the reduction of ED visits and costs, overall as well as in T1 and T2, were assessed using multivariate logistic regression. Results: Overall, 62.3% (1064/1709) of telephone consultations reduced ED visits consisting of advice being provided (n = 884; 83.1%) and referral to specialty clinics (n = 180; 16.9%). The adjusted odds ratio of calls reducing emergency visits in T2 as compared to T1 was 2.47 (95% CI 1.99 to 3.08). The adjusted odds ratio of reducing ED visits during office hours compared to after-hours 2.54 (95% CI 1.77–3.64). The estimated direct costs avoided from ED visits in T1 and T2 were $42,224.22 and $114,393.86, respectively. Conclusion: RAAPID telephone consultations to OHNS were effective in reducing ED visits and healthcare costs. This model should be considered in other areas to improve efficiencies within the health system. [ABSTRACT FROM AUTHOR]

After elective sigmoidectomy for diverticulitis, patients may experience persistent abdominal symptoms. This study aimed to determine the incidence and characteristics of persistent symptoms (PSs) and their risk factors in patients who had no reported recurrence after elective sigmoidectomy. Patients who underwent elective sigmoidectomy for diverticulitis from 2002 to 2016 at a tertiary academic colorectal surgery practice were included. After retrospective review of medical records, patients were contacted with a questionnaire to inquire about recurrence of diverticulitis and persistent abdominal symptoms since resection. Outcomes examined were prevalence of and risk factors for PSs after elective sigmoidectomy. Of 662 included patients, 346 completed the questionnaire and had no recurrent diverticulitis. PSs were reported by 43.9 per cent of the patients. The mean follow-up was 87 months. Female gender and preoperative diagnosis of irritable bowel syndrome were independent risk factors for PSs (Relative Risk 1.65, P < 0.001 and Relative Risk 1.41, P = 0.014). Previous IV antibiotics treatment was associated with PSs (P = 0.034) but not with a significant risk factor. As the follow-up interval increased, prevalence of PSs decreased (P = 0.006). More than 40 per cent of patients experienced persistent abdominal symptoms after sigmoidectomy for diverticulitis. Female patients and those with irritable bowel syndrome were at significantly increased risk. [ABSTRACT FROM AUTHOR]

Modern orthopedic surgery arose from Hugh Owen Thomas (1834-1891) and Sir Robert Jones (1857-1933), uncle and nephew, two descendants of a family of bonesetters from North Wales and Liverpool, respectively. Thomas combined a formal medical education with his hereditary vocation into treatments that have endured for more than a century. The epitome is the Thomas splint, which was credited with a decrease in the mortality from open femur fractures to 20 from 80 per cent during World War I and is still in use for the emergency transport of lower extremity injuries. Jones was 15 when he became Thomas' apprentice. By the end of the century, he was a leading figure in orthopedic surgery, at the forefront of the treatment of childhood deformities and the clinical use of X-rays. Enlisting in the Royal Army Medical Corps with the onset of World War I, he saw the need for a system of orthopedic care to treat soldiers with injured limbs that threatened to flood the country with crippled, disabled men. The centerpiece was the military orthopedic center, where surgeons devised integrated programs of surgery, physical therapy, and "curative workshops" to return war-injured soldiers to productive lives. With British surgeons conscripted to work at the Western Front, hundreds of American surgeons with little prior experience in orthopedics volunteered to work in the centers and thus received intensive training under Jones. Orthopedic surgery, traditionally part of the broader practice of surgery, thus emerged from the war as a full-time endeavor and a distinct surgical specialty. [ABSTRACT FROM AUTHOR]

One of the iconic families in American surgery is the Ochsners. The youngest son of Swiss immigrants, Henry Ochsner (1877-1902) was the first to enter the medical profession. His promising internship at the Johns Hopkins Hospital ended when he died of cholera, a tragedy deeply felt by his mentor William Osler. On another branch of the family tree, Albert Ochsner (1858-1925) wrote authoritative textbooks on surgery and became president of the ACS and the American Surgical Association. His most significant achievement may have been his mentorship of his cousin's son Alton (1896-1981), guiding his medical education and training in surgery. The younger Ochsner succeeded Rudolph Matas as chair of surgery at Tulane University at the age of only 31 years. Under his leadership, Charity Hospital in New Orleans became a leading program for surgical training and Tulane earned a reputation for clinical excellence. Ochsner and four partners from the Tulane faculty created a multidisciplinary clinic to attract patients from a wider area, a facility that would become today's Ochsner Clinic. His son John (1927-2018) followed him in the profession and received specialty training in cardiovascular surgery under Michael DeBakey in Houston, a Tulane graduate and an Ochsner trainee. John Ochsner returned to the Ochsner Clinic to establish a major cardiothoracic and vascular surgery program. Further generations of the Ochsner family continued the family legacy in surgery and medicine, exemplified by M. Gage Ochsner (1954-2013), Alton's grandson and John's nephew, who became a leading traumatologist and surgical educator in Savannah. [ABSTRACT FROM AUTHOR]

The prevalence of otolaryngologic complaints in general practice is disproportionate to the extent of otolaryngology teaching in undergraduate medical education. This is the first multi-institutional validated study used to assess basic otolaryngology knowledge among medical students in order to understand their abilities to recognize and manage these cases. A 9-question, psychometrically validated, multiple-choice quiz was distributed in June 2017 to medical students of 9 US allopathic institutions as an assessment of basic otolaryngology knowledge. A total of 547 medical student responses were used to assess basic otolaryngology knowledge, comfort levels, amount of exposure to otolaryngology, and number of times the head and neck physical examination was taught formally. Comfort in managing otolaryngologic conditions correlated positively with knowledge (P < .001, R2 = 0.266), in addition to otolaryngology exposure correlating positively with knowledge (P < .001, R2 = 0.284). Students intending to enter otolaryngology had higher scores (P = .002), higher comfort levels in managing otolaryngologic cases (P < .001), and higher comfort levels performing the head and neck examination (χ2 = 21.324, P < .001), compared with students intending to enter primary care or another surgical specialty. Clinical students in third and fourth years entering any surgical specialty (including otolaryngology), more often than students entering primary care (P = .007), recognized the obturator as the instrument used to guide the insertion of the tracheotomy tube. Additionally, the number of times the head and neck examination was taught correlated positively with comfort in performing the examination (rs = 0.095, P = .022). Our findings support the need for increased otolaryngologic education and training among all medical students, not only those entering otolaryngology. [ABSTRACT FROM AUTHOR]

The pursuit of dedicated research time during surgical residency prolongs training and delays entry into practice. Currently, there is a lack of research quantifying the financial implication of this delay and trainees' understanding of its impact on career earnings. An opportunity cost analysis was performed regarding the impact of delay due to training within general surgery and selected subspecialties. An anonymous survey was distributed to general surgery categorical junior trainees in 2017 at a large academic hospital in the Northeast to determine understanding and beliefs regarding dedicated training on career earnings. For all specialties analyzed, dedicated research time was shown to negatively affect career earnings. The net cost was highest among those intending to pursue cardiothoracic surgery and lowest for those intending to pursue surgical oncology. A total of 26 of 35 (74%) present research residents and clinical residents intending to perform dedicated research time responded to an anonymous survey. On average, survey respondents underestimated the impact of dedicated research time on career earnings by $1.4 million. Dedicated research time during general surgery residency carries a substantial opportunity cost to overall career earnings. General surgery residents lack understanding of both the direction and the magnitude of this opportunity cost. [ABSTRACT FROM AUTHOR]

Abstract Purpose To analyze the utilization, indications, and outcomes of dual-energy computed tomography (DECT) gout imaging in clinical practice. Methods This retrospective study was ethics approved. Radiology reports of DECT gout scans between 2007 and 2016 were analyzed for trends of utilization, referral pattern, indication, and diagnosis. Results DECT gout referrals increased substantially (2007: 37; 2008: 72; 2016: 385; total: 1877). The largest number of referrals were from rheumatology (1160), emergency medicine (283), and family medicine (177). Most referrals (92%) were requested to aid an initial diagnosis of gout. Other reasons included estimating the disease burden (6%) or monitoring disease progression and effectiveness of treatment (2%). Rheumatology accounted for most referrals for the latter two reasons (81% and 97%). Imaging findings of urate presence were similar in referrals from rheumatology (62%), family medicine (62%), and other medical specialties (62%). The urate positive rates were slightly lower in referrals from emergency medicine (47%) and surgical specialties (41%). The most common differential diagnoses by referring specialties were calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and other inflammatory or erosive arthritides (rheumatology, family medicine), CPPD and infections (other medical specialties), infections and fractures (emergency medicine), neoplasm and infections (surgical specialties). Conclusions The increasing utilization of DECT for gout imaging validates its clinical value. Varying clinical presentation could explain differences of urate positive rates among specialties. Our results support a multispecialty collaborative approach to the diagnosis and management of gout, with direct access to DECT gout imaging provided to various physician specialties. [ABSTRACT FROM AUTHOR]

Dr. Orvar Swenson is best remembered for developing the Swenson pull-through, a technique he developed to treat Hirschsprung's disease. After graduating from Harvard Medical School and beginning his residency at Peter Bent Brigham Hospital, Dr. Swenson observed that patients with Hirschsprung's disease and toxic megacolon resumed normal bowel function after placement of transverse colostomies. His observation led to studying the patency of his patients' colons using barium enema contrast studies. At the collapsed portion of the colon, he performed rectal biopsies leading to the discovery that the cause of Hirschsprung's disease is that the collapsed portion of the colon lacks the Auerbach plexus. The Swenson pull-through removes this aganglionic portion of the colon and cures the patient. His career grew from there as he traveled to academic institutions teaching his technique. He is remembered fondly for his contributions to pediatric surgery through the restructuring of pediatric surgery departments, pediatric surgery research, and writing and editing multiple volumes of Pediatric Surgery, the standard textbook for pediatric surgeons. He died peacefully in 2012 at the age of 103 years. [ABSTRACT FROM AUTHOR]

Objective To identify organizational barriers to and facilitators for female surgeons' career progression. Design Systematic review of qualitative and quantitative studies relating to organizational barriers to and facilitators for female Surgeons' career progression. After the quality assessment of the peer-reviewed journal articles, twelve articles were selected for full review. Thematic analysis was used to identify key themes in these selected articles. Setting The studies solely focused on organizational factors linked to female physicians' career progression in surgical specialties. Partcipants Female surgeons. Main outcome measures Organizational barriers and facilitators Results Twelve peer-reviewed journal articles were included in the study which focused on barriers to female surgeons' career progression, ways of facilitating female surgeons' career progression, and female surgeons' job satisfaction. Conclusion The major organisational factors contributing to the lack of career progression for female surgeons are (1) organizational culture which promotes rigid career structure that is inclined to support male surgeons than female surgeons and also male domination in which male surgeons feel superior to female surgeons (2) work family conflict whereby women feel that they have to make a family sacrifice by being women; they experience the difficulty in securing a work-life balance in the masculine career structure in surgical specialties. This implies that policy makers and healthcare organizations need to pay significant attention to organizational facilitators for female surgeons' career progression such as flexible career pathways and work patterns, a variety of different viable career progressions, more family-friendly working conditions, and the promotion of female mentors and role models in surgical specialties to support female surgeons in dealing with the organizational barriers in the male-dominated organizational culture and the lifestyle issues as well. [ABSTRACT FROM AUTHOR]

Many spine surgeons enlist the aid of an "access surgeon" to provide anterior exposure of the lumbosacral spine. We proposed that a single, community hospital general surgery practice can successfully develop an anterior spine exposure program with acceptable clinical outcomes. One hundred and forty-three consecutive anterior exposures were performed between 2008 and 2014. Morbidity and 30-day mortality were recorded. The effects of American Society of Anesthesiologists Physical Status classification (ASA class) and number of levels exposed on length of stay (LOS) and estimated blood loss (EBL) was reported. The growth of the program during this period was also evaluated. During the six-year period, there were nine (6.3%) major complications and 17 (11.9%) minor complications with no 30-day mortality. The mean LOS was similar for one-level and two-level exposures (3.8 days). Mean LOS was higher in ASA III patients (4.4 days) than ASA I (2.9 days) or ASA II (3.2 days). Mean EBL for one-level exposures (336.3 mL) was not significantly different than EBL for two-level exposures (425.9 mL). EBLs in ASA class III patients were greater than in class I and class II patients. The program began in July of 2008 with a single spine surgeon and one operation that year. A high of 54 procedures, with seven different spine surgeons, was recorded in 2013. A single, community hospital general surgery practice can successfully develop an anterior approach to spine exposure program with acceptable clinical outcomes and with sustained growth of the program. [ABSTRACT FROM AUTHOR]

Tulane graduates have, over the past six years, chosen general surgical residency at a rate above the national average (mean 9.6% vs 6.6%). With much of the recent career choice research focusing on disincentives and declining general surgery applicants, we sought to identify factors that positively influenced our students' decision to pursue general surgery. A 50-question survey was developed and distributed to graduates who matched into a general surgery between the years 2006 and 2014. The survey evaluated demographics, exposure to surgery, and factors affecting interest in a surgical career. We achieved a 54 per cent (61/112) response rate. Only 43 per cent considered a surgical career before medical school matriculation. Fifty-nine per cent had strongly considered a career other than surgery. Sixty-two per cent chose to pursue surgery during or immediately after their surgery clerkship. The most important factors cited for choosing general surgery were perceived career enjoyment of residents and faculty, resident/faculty relationship, and mentorship. Surgery residents and faculty were viewed as role models by 72 and 77 per cent of responders, respectively. This study demonstrated almost half of those choosing a surgical career did so as a direct result of the core rotation experience. We believe that structuring the medical student education experience to optimize the interaction of students, residents, and faculty produces a positive environment encouraging students to choose a general surgery career. [ABSTRACT FROM AUTHOR]

The article discusses a report on the development and validation of an affordable non-perishable suturing simulator. Topics discussed include importance of suturing skills in surgeon training, a survey to establish content validity of the suture simulator which uses a five point Likert scale scoring system, and the effects of improper suturing which results in bleeding, dehiscence, infection.

Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system. [ABSTRACT FROM AUTHOR]

The Match was developed in response to a chaotic residency selection process. While the match has remained relatively unchanged since it was introduced, the number of medical school graduates has increased at a rate outpacing the number of residency positions leading to a more competitive process for applicants. In May 2014, an 18-question mixed-response questionnaire was distributed to fourth year allopathic medical students via an E-mail distribution list for student affairs representatives. The individual surveys were accessible via SurveyMonkey and available for completion over the course of a 4-week period. Approximately 65.1 per cent of students performed at least one audition rotation and documented average expenditures of $2494 on housing, food, and transportation. The average applicant applied to 32 programs and attended 12 interviews while spending $4420 on the interview trail. Applicants for surgical programs applied to approximately 42 programs and attended 13 interviews compared with primary care applicants who averaged 23 programs (P < 0.001) and attended 12 interviews (P = 0.002). Surgical applicants averaged 20 days on the interview trail while spending $5500 ($423/interview) on housing, food, and transportation compared with primary care applicants averaged 19 days away from home (P < 0.05) and spending $3400 ($283/interview) on these same items (P < 0.001). The findings in our study indicate that the "Match process" contributes to the financial burden of graduating medical students and it is more expensive and time consuming for the candidates interested in surgical specialties. [ABSTRACT FROM AUTHOR]

With changes in work hour limitations, there is an increasing need for objective determination of technical proficiency. Electromagnetic hand-motion analysis has previously shown only time to completion and number of movements to correlation with expertise. The present study was undertaken to evaluate the efficacy of hand-motion-tracking analysis in determining surgical skill proficiency. A nine-degree-of-freedom sensor was used and mounted on the superior aspect of a needle driver. A one-way analysis of variance and Welch's t test were performed to evaluate significance between subjects. Four Novices, four Trainees, and three Experts performed a large vessel patch anastomosis on a phantom tissue. Path length, total number of movements, absolute velocity, and total time were analyzed between groups. Compared to the Novices, Expert subjects exhibited significantly decreased total number of movements, decreased instrument path length, and decreased total time to complete tasks. There were no significant differences found in absolute velocity between groups. In this pilot study, we have identified significant differences in patterns of motion between Novice and Expert subjects. These data warrant further analysis for its predictive value in larger cohorts at different levels of training and may be a useful tool in competence-based training paradigms in the future. [ABSTRACT FROM AUTHOR]

The benefits of enhanced recovery after surgery (ERAS) have been demonstrated for multiple surgical procedures in high-volume programs. However, resources required for its implementation may be daunting to individual surgeons. Patients undergoing elective abdominal procedures from June 2013 to April 2015 by a surgical oncologist before and after the implementation of an ERAS protocol were reviewed. A total of 179 patients were included. The mean age of the patients was 63 years, and a majority of them were females (53.6%), white (61.5%), had a Charlson score of 0 to 2 (45.8%), and a Clavien complication grade of 0 to I (60.1%). The univariate analysis revealed that the ERAS protocol was associated with shorter length of stay (LOS) (6.2 vs 9.6 days), lower cost ($21,674 vs $30,380), and lower mortality (0 vs 3.3%); P < 0.05. Differences were noted in LOS and costs for all procedures, the differences were the greatest for hepatic resection (3.8 vs 8.4 days and $16,770 vs $28,589), intestinal resection/stoma closure (4.8 vs 7.6 days and $18,391 vs $22,239), and other abdominal procedures (5.0 vs 10.8 and $17,713 vs $30,900); P < 0.05. The differences were less for patients undergoing procedures for which postoperative pathways were already in place such as pancreatic (9 vs 10.8 days and $30,524 vs $34,291) and colorectal (5.3 vs 6.5 days and $20,733 vs $25,150) surgeries. P > 0.05. An ERAS program can be instituted by an individual surgeon with the benefits of decreased LOS, cost, and mortality. [ABSTRACT FROM AUTHOR]

We assessed surgical team member perceptions of multiple dimensions of safe surgical practice in 38 South Carolina hospitals participating in a statewide initiative to implement surgical safety checklists. Primary data were collected using a novel 35-item survey. We calculated the percentage of 1,852 respondents with strongly positive, positive, and neutral/negative responses about the safety of surgical practice, compared results by hospital and professional discipline, and examined how readiness, teamwork, and adherence related to staff perception of care quality. Overall, 78% of responses were positive about surgical safety at respondent’s hospitals, but in each survey dimension, from 16% to 40% of responses were neutral/negative, suggesting significant opportunity to improve surgical safety. Respondents not reporting they would feel safe being treated in their operating rooms varied from 0% to 57% among hospitals. Surgeons responded more positively than nonsurgeons. Readiness, teamwork, and practice adherence related directly to staff perceptions of patient safety (p < .001). [ABSTRACT FROM AUTHOR]

Acute care surgery (ACS) programs have emerged mainly at academic medical centers to provide timely care for emergency general surgery and trauma patients. We hypothesized that the development of an ACS program in a multispecialty group practice would improve outcomes for patients with acute appendicitis. A retrospective analysis of patients with acute appendicitis was performed in two time periods: 18 months of private practice and the following 12 months with ACS coverage. Length of stay was the primary outcome measure. A total of 871 patients were studied (526 private practice, 345 ACS). The ACS group had a greater proportion of laparoscopic appendectomies (P < 0.001) and more transitions in care between surgeons (P < 0.001). Length of stay was shorter in the ACS group (1.6 ± 1.5 [mean ± standard deviation] vs 1.9 ± 2.4 days, P = 0.01) and a greater proportion of surgeries were performed during the daytime (44.9 vs 36.6%, P = 0.02). Multivariate analysis demonstrated length of stay was related to appendicitis grade (P < 0.001), American Society of Anesthesiologists class (P < 0.001), symptom duration (P = 0.001), and laparoscopic approach (P < 0.001). The initial transition from private practice to ACS resulted in decreased length of stay with no increase in morbidity related to transitions of surgical care in patients with appendicitis. [ABSTRACT FROM AUTHOR]

Inferior vena cava filters (IVCFs) for thromboprophylaxis in trauma patients are being increasingly used despite a lack of strong clinical data in support of their efficacy and conflicting clinical practice guidelines. This national survey elucidates practice patterns of IVCF use across U.S. trauma centers. A web-based survey was administered to members of the Eastern Association for the Surgery of Trauma between September 2011 and October 2011. The survey queried: 1) background and professional practice; 2) trauma patient population; 3) IVCF placement; 4) IVCF retrieval and follow-up; and 5) pharmacologic prophylaxis. Two hundred eighty-one of 1059 eligible providers completed the survey (27%). Respondents were from a wide spectrum of training backgrounds and clinical practice settings. IVCFs were used by 98.9 per cent of respondents. IVCFs in patients without known venous thromboembolism were considered by 93.2 per cent of respondents. Indications and timing of IVCF retrieval vary. Follow-up care of patients with IVCFs was not uniform. An IVCF registry was maintained by 38 per cent of trauma programs. Adjunctive pharmacologic prophylaxis was used by 96.8 per cent of respondents. This study elucidates the gaps and variations in contemporary practices of IVCF use in trauma patients. Identification of best practices in IVCF use and retrieval awaits well-designed comparative effectiveness studies. [ABSTRACT FROM AUTHOR]

The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of inter-hospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The health contingency due to COVID19 has represented an unprecedented state of health contingency with implications for the economy and public health. There is a concern in the medical community regarding the risk of contagion of COVID19. Recently, the occupational risk of contagion by COVID19 has been described in surgical specialties that involve proximity to the face and airway of the patient Ophthalmology and Otorhinolaryngology and head and neck surgery (ENT). A possibility has been raised that Foot and Ankle joint surgeons have some occupational protection due to the distance greater than 1m with respect to the patient's airway during surgical activities. The objective of this study is to compare COVID-19 infections referred by different surgical specialties and subspecialties. Methods: An observational, cross-sectional, and descriptive study will be carried out in which a survey will be applied to 134 surgical specialists divided into 3 groups (ophthalmology, ENT, and orthopedic surgeons performing foot and ankle surgery) during the months of August to September 2020.Percentage prevalences of each variable to be evaluated will be obtained, likewise, a Chisquare test will be applied to determine statistical differences between the proportions of referred positivity in the 3 groups. This research study was reviewed by our institution and hospital research ethics committee. All participants gave their informed consent at the time of conducting the survey, as well as allowing the use of their responses for the purposes of this project. Results: A total of 134 surveys pertaining to 30, 69, and 35 Mexican ophthalmology, ENT, and orthopedic surgeons who perform foot and ankle surgery respectively were evaluated. The geographical distribution of the surveys is identified in figure 1. After the statistical analysis, non-significant statistical differences (p> 0.32) were documented in the proportion of infections between ophthalmologists or ENTs, with respect to the proportion of infections referred by COVID-19 in the group of Orthopedic foot and ankle surgeons surveyed. Conclusion: When analyzing the results of this survey-type study, it is possible to establish that the statistically non-significant differences between the proportions of infections of the groups of specialists evaluated could suggest that the working distance with respect to the patient's airway is not a protective factor for contagion. by COVID-19. Preventive strategies, as well as the vaccination of health personnel involved in patient care, are essential. [ABSTRACT FROM AUTHOR]