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Background Socioeconomic disparities have been associated with outcomes in many medical conditions. The association of socioeconomic status (SES) with readmissions after ventral and inguinal hernia repair has not been well studied on a national level. This study aims to evaluate the association of SES with readmission as a significant outcome in patients undergoing ventral and inguinal hernia repair. Methods A retrospective cohort study was performed evaluating patients undergoing ventral hernia and inguinal hernia repair with 1:1 propensity score matching using the Nationwide Readmissions Database (2016-2017). Both 30- and 90-day readmissions were examined. After matching, a multivariate logistic regression analysis was performed using confounding variables including hospital setting, comorbidities, urgency of repair, sociodemographic status, and payer. Likelihood of readmission was reported in odds ratio form. Results Readmission rates were 11.56% (24,323 out of 210,381) and 17.94% (30,893 out of 172,210) for 30- and 90-day readmissions, respectively. Patients with Medicaid and in the lower income quartile were more likely to present in an emergent fashion for hernia repair. After matching, a multivariate logistic regression analysis showed socioeconomic status (OR 1.250 and 1.229) was a statistically significant independent predictor of readmission at 30 and 90 days, respectively. Inversely, factors associated with the least likely chance of readmission were a laparoscopic approach (OR 0.646 and 0.641), elective admission (OR 0.824 and 0.779), and care in a teaching hospital (OR 0.784 and 0.798). Conclusion SES is an independent predictor of readmission at 30 and 90 days following open and laparoscopic ventral and inguinal hernia repair. Patients with a lower socioeconomic status were more likely to undergo hernia repair in the emergent setting. Efforts toward mitigating SES disparities by potentially promoting MIS techniques, enhancing access to elective cases, and systematic approaches to perioperative care for this disadvantaged population can potentially enhance overall hernia outcomes.

Readmission status is an important clinical component of healthcare outcomes. 90-day readmission following complex open ventral hernia repair has not been well studied with national level data. This study aims to compare readmission rates for patients undergoing standard vs. complex (myocutaneous flap-based) ventral hernia repair. We hypothesize that complexity of reconstruction will be an independent predictor of readmission after ventral hernia repair. A retrospective cohort study was performed with 1:1 matching of hernia repair type using the National Readmissions Database. Patients were selected using ICD-9 codes corresponding to ventral hernia repair with or without myocutaneous flap. 90-day readmissions were determined on patients within the first through third quarters of each year. After matching, a multivariable logistic regression analysis was performed using confounding variables including hospital setting, comorbidities, type of repair, urgency of repair, sociodemographic status, and payer. Likelihood of 90-day readmission was calculated from odds ratios. Readmission rates were 19.1% (38,313 out of 200,266) and 22.5% (692 out of 3075) at 90-day for standard ventral hernia repair and complex ventral hernia repair, respectively. 3116 standard ventral hernia repair patients were matched with 3074 complex ventral hernia repair patients. After matching there was a significantly increased readmission rate for repairs involving myocutaneous flaps, with odds ratio (OR) 1.30 (95% CI 1.22–1.60). Payer status (OR 1.82; 95% CI 1.21–2.74), teaching hospital status (OR 1.42; 95% CI 1.23–1.64) and income quartile (OR 1.35; CI 1.10–1.65) were independent predictors of readmission. Patients undergoing myocutaneous flap-based reconstruction have higher readmission rates than those undergoing less complex ventral hernia repair. Socioeconomic disparity as reflected in payer status is a particularly strong predictor of readmission. The data support the concept that focused efforts are needed to optimize patient outcomes for patients requiring more complex repair, including socioeconomically disadvantaged patient populations.

Objective The authors aimed to investigate faculty evaluation criteria for an effective oral surgical presentation in actual patient care contexts. Design We conducted a 2-step observation-based qualitative study. Residents audiotaped oral presentations of a surgical consult to an attending. Evaluation panels listened to the recordings and discussed to develop joint feedback for the resident. The panel discussions were recorded and served as the data source for this study. We analyzed the data following the grounded theory approach using open coding and axial coding. Setting The study setting was at Southern Illinois University School of Medicine, a 5-year general surgery residency program in Springfield, Illinois. Participants Thirteen residents out of 19 in the program participated by virtue of having submitted recordings of a patient care consult presentation via phone. Evaluation panels consisted of general surgery academic and community faculty, as well as senior residents. Results Several criteria for effective oral presentations emerged that have rarely been discussed in prior literature. Themes included: (1) The strategic opening is critical as it “sets the stage” and frames how the attending will listen. Situational factors, such as consideration of time of the day and urgency, should be accounted for in the opening. (2) A deductive structure defines the relevance of the presented information. Clinical judgement should precede supporting evidence. Attending physicians perceive important information as unnecessary if provided outside of this framework. (3) Established trust between a resident and a surgeon determines the level of detail expected of the presenting resident. With increasing trust, surgeons expect residents to present fewer details; if too much detail is included, the presentation may be assessed as ineffective. (4) Surgical descriptions are appreciated for their value in promoting the attending's visualization or mental picture of the patient condition. (5) Oral emphasis using voice tone and pace can be helpful for capturing attending attention. Conclusions These findings can be utilized to improve the current training program and assessment rubrics toward contextualized work-based assessment practices in surgery. Oral patient presentation skills are neither static nor universal, but fluid and reflexive, based on trust, and situational factors.

Although a rare malignancy, mortality from esophageal cancer remains high. Lymphadenectomy during esophagectomy is an essential part of the staging process for esophageal cancer and has been independently shown to affect overall survival. The optimal lymphadenectomy has been studied and will be reviewed below, including the total number of lymph nodes that need to be sampled to provide survival benefit, the lymph node ratio as a prognostic indicator, and the different anatomic dissections performed. It is recommended that a lymphadenectomy should at least include 15 lymph nodes sampled via at least a two-field approach and should have a standardized technique for submitting lymph nodes to pathology.

The Peterson et al[1][1] article in the Journal examines the declining volume of endoscopic procedures performed by family physicians (FPs) in both urban and rural settings. In a relatively short, 3-year time period, the percentage of colonoscopies, sigmoidoscopies, and upper endoscopies performed

Residents are critical educators in the current undergraduate and graduate medical education environment for a variety of reasons, both intrinsic and extrinsic to their own status as learners. Accordingly, focused development of resident educational skill is a key strategy linked to professional development and the framing of the learning environment. Understanding contemporary cognition science and theories surrounding learner development and progress can inform educational effort and structure. In addition, specific techniques can be modeled and taught to help residents become more proficient teachers, whether in the technical or nontechnical realm. Ultimately, helping residents develop educational skill promotes learning across the spectrum of experience and facilitates the progression toward entrustment and independent competence that is the goal of the educational process.