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PubMed1996

Transmission of hepatitis B virus to multiple patients from a surgeon without evidence of inadequate infection control.

BACKGROUND: Although about 1 percent of surgeons are infected with hepatitis B virus (HBV), transmission from surgeons to patients is thought to be uncommon. In July 1992, a 47-year-old woman became ill with acute hepatitis B after undergoing a thymectomy in which a thoracic-surgery resident who had had acute hepatitis B six months earlier assisted. METHODS: To determine whether the surgeon transmitted HBV to this patient and others, we conducted chart reviews, interviews, and serologic testing of thoracic-surgery patients at the two hospitals where the surgeon worked from July 1991 to July 1992. Hepatitis B surface antigen (HBsAg) subtypes and DNA sequences from the surgeon and from infected patients were determined. RESULTS: Of 144 susceptible patients in whose surgery the infected surgeon participated, 19 had evidence of recent HBV infection (13 percent). One of the hospitals was selected for additional study, and none of the 124 susceptible patients of the other thoracic surgeons at this hospital had evidence of recent HBV infection (relative risk, infinity; 95 percent confidence interval, 4.7 to infinity). No evidence was found for any common source of HBV other than the infected surgeon. The HBsAg subtype and the partial HBV DNA sequences from the surgeon were identical to those in the infected patients. Transmission of the infection was associated with cardiac transplantation (relative risk, 4.9; 95 percent confidence interval, 1.5 to 15.5) but not with other surgical procedures. The surgeon was positive for hepatitis B e antigen and had a high serum HBV DNA concentration (15 ng per milliliter). Our investigations identified no deficiencies in the surgeon's infection-control practices. CONCLUSIONS: In this outbreak there was surgeon-to-patient HBV transmission despite apparent compliance with recommended infection-control practices. We could not identify any specific events that led to transmission.

Adolescent↗
PubMed1998

Surgeons' concern and practices of protection against bloodborne pathogens.

OBJECTIVE: To evaluate surgeons' concern regarding risk awareness and behavioral methods of protection against bloodborne pathogen transmission during surgery. METHODS: A 29-item questionnaire was sent to 914 surgeons from two universities and two surgical societies. RESULTS: The questionnaire was returned by 768 active surgeons. Slight or moderate concern about contracting human immunodeficiency virus (HIV) was reported by most surgeons; 8% reported extreme concern and 4% reported no concern. In total, 605 surgeons reported having been vaccinated against hepatitis B; surgeons in practice <7 years were most likely to be vaccinated. Most surgeons did not routinely use double gloves: 92 of 768 surgeons reported that they always use double gloves when performing surgery, and 83 reported that they usually use double gloves. There was a statistically significantly higher proportion of surgeons who always or usually use double gloves who also had hepatitis B vaccinations. Most surgeons incorrectly estimated the seroconversion rates with exposure to a patient with HIV (66% incorrect), hepatitis B (88% incorrect), or hepatitis C (84% incorrect). Most surgeons never or rarely report needle-stick injuries, and only 17% always report needle-stick injuries. CONCLUSIONS: Most surgeons underestimate the risk of bloodborne pathogens and do not routinely use double gloves.

Attitude of Health Personnel↗
PubMed2003

Does volume matter? The effect of trauma surgeons' caseload on mortality.

BACKGROUND: Evidence suggests that trauma centers treating high volumes of severely injured patients produce lower mortality rates than those with low volumes. However, the effect of individual surgeons' trauma caseload on outcomes has not been studied. This study compares outcomes between high-volume (HV) trauma surgeons admitting many patients with high injury severity, and low-volume (LV) surgeons treating fewer critical patients per year. METHODS: All trauma patients admitted to a large Level I trauma center over a 12-year period were assigned to either the HV or LV group, depending on the yearly volume of their admitting surgeon. Surgeons treating > 35 severely injured (Injury Severity Score > 15) patients per year were considered HV. Student's t test and chi2 analysis were used to test comparability of LV and HV patient groups and to compare mortality rates. Mortality rates of HV and LV surgeons' patients were compared in six injury patterns selected to represent moderate to severe injury. TRISS methodology (z score) was also used to assess outcomes in the two groups. The inherent bias of the TRISS method in comparing trauma outcomes was minimized by the homogeneity of the studied patient population. RESULTS: A total of 16,481 patients were admitted to HV surgeons, and 4,214 patients were admitted to LV surgeons. In all subgroups, HV and LV patients were similar regarding age, sex, physiologic status at admission, injury pattern, and injury severity. Mortality rates for HV and LV surgeons were not significantly different between the two groups in any injury pattern. The z score was 1.88 in the HV patient group versus 0.47 in the LV group. CONCLUSION: Within a single institution, mortality rates for patients treated by surgeons admitting many severely injured patients were not significantly different from low-volume surgeons' patients, although there was a trend toward higher mortality in the less active surgeons' patients in some subgroups.

District of Columbia↗
PubMed2005

The vascular surgeon's role in risk factor modification: results of a survey.

PURPOSE: Comprehensive care of vascular patients includes attention to atherosclerotic risk factor management. We surveyed members of the Midwestern Vascular Surgical Society (MVSS) with the following objectives: (1) to determine the usual practice pattern with respect to risk factor inquiry, screening, and intervention, (2) to determine which risk factors vascular surgeons believe are important for patients with peripheral arterial disease, and (3) to determine the vascular surgeon's confidence for management of each risk factor. METHODS: A survey was mailed to all MVSS members and two additional notifications were sent for initial nonresponders. Data regarding practice environment and local resources available to each surgeon were recorded. Questions were designed to determine the prevalence of risk factor inquiry and screening, grading of the importance of each risk factor, and the vascular surgeon's confidence in the management of each risk factor. RESULTS: The survey was completed by 219 (56%) of 391 of MVSS members. The average age of the responders was 53.1 +/- 9.3 years, and 94.1% were men. Seventy-four percent of the surgeons dedicate 90% to 100% of their time to vascular surgery, and 89% dedicate more than 50%. Seventy-seven percent of responders work in a private institution and 23% in a public hospital. The surgeon's practice had a full- or part-time affiliation with a medical school in 62% and was entirely community-based in 38%. A high proportion of surgeons inquire about each risk factor, but only a minority performs the actual screening of the risk factors, with the exception of hypertension. Diabetes mellitus and smoking were believed to be very important risk factors, hypertension and lipids of moderate importance, and exercise and activity, nutrition, and homocysteine level of low importance. The surgeons' confidence in risk factor management was low to moderate for most risk factors, but high for smoking and exercise. Despite these responses, only 10% of vascular surgeons thought that they should be primarily responsible for risk factor management. CONCLUSIONS: Vascular surgeons must provide a comprehensive approach to risk factor management for their patients. This can be conducted through the establishment of multidisciplinary risk factor programs or by the surgeon in certain cases when outside resources are not available. Risk factor management must be emphasized in vascular continuing medical education programs to enable surgeons to be confident with management.

Arteriosclerosis↗
PubMed2005

HIV/AIDS: occupational risk, attitude and behaviour of surgeons in southeast Nigeria.

Our objective was to evaluate the level of occupational risk, attitude and behaviour of surgeons towards HIV-infected patients. A questionnaire survey of 264 randomly selected surgeons in training or in practice in five different health institutions in southeast Nigeria within a five-month period was carried out. A 94% response rate was obtained with completed questionnaires from 264 surgeons. The respondents included obstetricians and gynaecologists (n = 78), general surgeons (n = 121), orthopaedic surgeons (n = 40), dental surgeons (n = 10), ophthalmologists (n = 6), urologists (n = 5), and ear, nose and throat surgeons (n = 4). Of them, 31% (n = 82) were qualified surgeons in practice, while the remaining 69% (n = 182) were resident surgeons in training. In the past five years, 40.2% (n = 106) and 26% (n = 70) of the respondents reported needle-stick injuries and blood splash, respectively, during surgery. The majority of the victims were resident surgeons, obstetricians and gynaecologists, and orthopaedic surgeons. Level of clinical experience and high patient blood loss are likely to contribute to this observation. In all, 89% (n = 236) were engaged in the risky practice of operating on patients with open wounds in their hand and the wounds were contaminated with blood in 5% of cases. During surgical procedures, all (100%) respondents wore protective apron, 65.2% (n = 172) wore double gloves and 30.3% (n = 80) used protective goggles. The use of double gloves and protective eye wear increased remarkably over the past decade, probably because the fear of occupational transmission of HIV was substantial. In total, 83% (n = 220) of the respondents had some reservations about treating patients infected with HIV, while 13.3% (n = 35) viewed them with fear. The remaining 3.4% (n = 9) had a more positive attitude towards HIV-infected patients. Further, 92% advocated preoperative screening, with special precaution during surgery, if the results are positive. In addition, 79.5% were of the view that infected patients should not be discriminated against in treatment, provided necessary protective materials are available. To ensure provision of these protective materials, 91% (n = 240) and 89.4% (n = 236) of the respondents favoured involvement of government and insurance agencies, respectively. In order to achieve a greater commitment from surgeons in developing countries towards caring for HIV-infected patients, there is a need for a comprehensive AIDS management package that would offer specific preventive and psychological training in care of HIV patients and provide requisite funds and resources.

Attitude of Health Personnel↗
PubMed2005

Comparison of the volume of scoliosis surgery between spine and pediatric orthopaedic fellowship-trained surgeons in New York and California.

BACKGROUND: Controversy exists regarding the optimal fellowship training experience for surgeons who perform scoliosis surgery in pediatric patients. While many studies have demonstrated that higher surgical volumes are associated with superior outcomes, the volume of scoliosis procedures performed by pediatric orthopaedic-trained surgeons as opposed to spine surgery-trained surgeons has not been reported. METHODS: Validated, statewide hospital discharge databases from the states of New York and California were utilized to examine the volume of spinal fusion procedures performed for the treatment of scoliosis in patients who were eighteen years of age or less. Fellowship training of surgeons in New York who had performed more than fifty procedures from 1992 to 2001 (that is, more than five procedures per year) was determined, and the operative volumes of surgeons who had received pediatric orthopaedic as opposed to spine fellowship training were compared. Hospitals in California with either type of fellowship program were identified, and the operative volumes of hospitals and fellows with pediatric orthopaedic or spine fellowship training from 1995 to 1999 were compared. RESULTS: Among the 228 surgeons in New York who had performed one or more spinal fusion procedures in patients eighteen years of age or less from 1992 to 2001, only 13% (thirty) had performed more than five procedures per year. However, these thirty surgeons accounted for 75% (3858) of all 5136 procedures in this age-group. Surgeons who had completed a pediatric orthopaedic fellowship had performed a mean of 14.5 procedures per physician per year, whereas those who had completed a spine fellowship had performed a mean of 10.5 procedures per physician per year. Surgeons who had not completed either type of fellowship had performed a mean of 14.4 procedures per physician per year. In California, the mean annual volume of scoliosis procedures from 1995 to 1999 was 59.0 procedures per year at hospitals with pediatric orthopaedic fellowship programs and 15.7 procedures per year at those with spine surgery programs. The mean number of procedures per fellow at hospitals with pediatric orthopaedic fellowship programs was 31.6 procedures per fellow per year, and the mean number at hospitals with spine surgery programs was 12.7 procedures per fellow per year. Over time, there was a significant increase in the number of procedures per year at hospitals with both types of fellowship programs, but the percentage increase was greater for hospitals with pediatric orthopaedic fellowship programs than for hospitals with spine surgery fellowship programs (45.2% compared with 13.5%). CONCLUSIONS: These data indicate that, on the average, a large number of surgeons in New York performed five scoliosis procedures per year or fewer. Among higher-volume surgeons in New York, those with pediatric orthopaedic fellowship training performed more scoliosis procedures on children and adolescents than those with orthopaedic spine training did. In California, the volume of scoliosis procedures at hospitals with pediatric orthopaedic fellowship programs was nearly four times greater than that at hospitals with spine fellowship programs and the volume of procedures per fellow was more than two times greater, and this disparity is widening over time. These data are an important element in establishing what type of fellowship best prepares surgeons for scoliosis surgery.

Adolescent↗
PubMed1979

Oral surgeons in full-time private practice.

The most prevalent type of practice of oral surgeons is full-time private practice. Its characteristics as obtained from data of The Manpower Survey of Oral Surgery in 1974 are described in this article. The number of offices or type of practice (solo or group) was not correlated significantly with the age of oral surgeons. The factor of reason for practice location had no influence on the factors of size of population where the practice was located, size of the trade area where practice was located, or annual income. The factor of average annual income indicated that the greatest income was earned by oral surgeons who were between the ages of 40 and 50 and whose practice was located in a population area of between 250,000 and 500,000. Annual income was also influenced by number of years in a practice location up to about five years. After that, years in a location had little influence. The question of adding a partner influenced younger oral surgeons more than older ones. More oral surgeons in solo practice intended to add a partner than oral surgeons in group practice. Neither the population of the city where a practice was located nor the waiting period for admission to a hospital for patients who needed elective surgery influenced significantly the plans of oral surgeons in full-time private practice with regard to the addition of an associate. The opinion of oral surgeons in full-time private practice with regard to methods of increasing the effectiveness of practice also was reviewed. A large proportion of oral surgeons in full-time private practice believed that they needed more training in outpatient ambulatory general anesthesia and more time rotating in internal medicine and general surgery. They stated that, in general, their preparation in activities of a professional nature was adequate but that their preparation in activities of an administrative nature was inadequate. Attendance of oral surgeons at professional meetings was not influenced by age, population of the city where their practice was located, population of trade area where their practice was located, or professional income. The majority of oral surgeons thought that there was enough dental manpower to meet the demand for oral surgery service. Age had no significant influence on this opinion. Oral surgeons in population areas of less than 150,000 were less inclined to think there was excessive manpower in the dental specialties than those in population areas of more than 150,000.

Adult↗
PubMed2004

Early failures of total hip replacement: effect of surgeon volume.

OBJECTIVE: To determine whether provider volume is associated with early failures following total hip replacement (THR) requiring revision. METHODS: Claims data were analyzed to follow a cohort of 57,488 Medicare beneficiaries who underwent elective primary THR in 1995-1996 in 3,044 hospitals in the US. Patients were followed through the end of 1999. Failure of primary THR was defined as a subsequent revision THR, as determined by International Classification of Diseases, Ninth Revision codes in hospital claims. Hospitals were stratified into 4 volume groups: low (<25 THRs/year), medium (26-50, 51-100 THRs/year), and high (>100 THRs/year). Low-volume surgeons were defined as those surgeons performing <12 elective primary THRs annually in the Medicare population. Associations between the rates of revision and surgeon volume were determined by hazard ratios from a proportional hazard model, with adjustment for hospital volume, patient age, poverty status, sex, and comorbidities. We also examined whether the effect of surgeon volume on revision rates differed between the first 18 months postoperatively and later time periods. RESULTS: Among 57,488 patients who had elective primary THR in 1995-1996, 2,537 (4.4%) had at least 1 revision THR by the end of 1999, with 1,437 (56.6%) of these revisions occurring within the first 18 months after the index primary THR. Median followup time was 47 months (range 0-54). Patients of high-volume surgeons were less likely to have revision THRs than patients of low-volume surgeons, regardless of hospital volume stratum. Further analysis revealed that the effect of surgeon volume on revisions was striking in the first 18 months after surgery but was not evident in the subsequent years. CONCLUSION: Patients of low-volume surgeons have higher rates of revision THR than patients of high-volume surgeons, particularly within the first 18 months postoperatively. Referring clinicians should consider including surgeon volume among the factors influencing their choice of surgeon for elective THR.

Aged↗
PubMed2005

Tolerance of uncertainty, extroversion, neuroticism and attitudes to randomized controlled trials among surgeons and physicians.

BACKGROUND: Surgeons have a reputation for decisiveness and self-confidence, which suggests that they may tolerate uncertainty poorly and therefore be less capable than other doctors of experiencing clinical equipoise. Their 'typical' behaviour is characteristic of the stable extrovert personality and so they may prefer spontaneous clinical judgement over randomized trials. The aim of this study was to compare personality dimensions and tolerance of uncertainty among surgeons and hospital physicians, to determine whether differences in either property might help to explain the apparently poor performance of surgeons in conducting randomized controlled trials. METHODS: This was a postal questionnaire study of 1000 consultant general surgeons and 1000 consultant physicians. Respondents completed a short self-assessment of Eysenck personality dimensions, Budner's Intolerance of Ambiguity scale and a short questionnaire about attitudes to randomized trials. Correlation and multiple regression analyses were performed. RESULTS: The response rate was 36.5 per cent. Physicians were more likely to be women (P < 0.001) and had spent 1 more year in academic posts than surgeons (P < 0.030). Surgeons were significantly more extrovert (P < 0.001) and less neurotic (P < 0.001) than physicians. Surgeons were significantly more intolerant of uncertainty than physicians (P = 0.007). Multivariate analysis identified age (P < 0.030) and sex (P = 0.015) as independent predictors of intolerance of uncertainty. The attitudes of surgeons and physicians to randomized trials were no different. CONCLUSION: Surgeons are not prejudiced against randomized trials, but their intolerance of uncertainty may inhibit them from deciding that an individual patient is suitable for trial entry. If more surgeons were female, this difference between surgeons and physicians might disappear.

Attitude of Health Personnel↗
PubMed2000

Clinimetric scale to measure surgeons' satisfaction with anesthesia services.

PURPOSE: Continuous quality improvement is of increasing interest to anesthesiologists. Since surgeons are coworkers and important clients of anesthesiologists, the level of satisfaction of surgeons with anesthesia services should be explored to optimize quality. The purpose of this study was, first, to introduce the concept of surgeons as clients of anesthesiologists and second, to develop and test an instrument to measure surgeons' satisfaction, the Surgeon Satisfaction with Anesthesia Services (SSAS) scale. METHODS: A conceptual model of surgeon satisfaction with anesthesia services was created before the development of the SSAS scale. The scale, composed of socio-demographic, Likert-type and open-ended questions was sent to a sample of 250 surgeons selected randomly by the Collège des Médecins du Québec. Exploratory factorial analysis were performed on the results. RESULTS: A Cronbach's alpha of 0.84 was obtained for internal consistency. Exploratory factorial analysis yielded two subscale factors: a) clinical expertise and b) attitudes and behaviour Global mean of surgeons'satisfaction was moderately high (3.11/4.0). Satisfaction was not related to sociodemographic variables. Very high scores were obtained for items related to clinical expertise. Items related to attitudes and behaviour obtained lower scores. A significant difference was obtained between both factors (t = -5.732, P = 0.0001). CONCLUSION: The SSAS scale is a new instrument to evaluate surgeon satisfaction. Overall, surgeons seem satisfied with anesthesia services, but many areas of dissatisfaction persist. Further discussions with surgeons should be encouraged, in view of improving the perceptions of the quality of anesthesia services and interprofessional relationships.

Anesthesiology↗
PubMed2006

The impact of laparoscopic bariatric workshops on the practice patterns of surgeons.

BACKGROUND: This study was designed to evaluate the impact of a 2-day laparoscopic bariatric workshop on the practice patterns of participating surgeons. METHODS: From October 1998 to June 2002, 18 laparoscopic bariatric workshops were attended by 300 surgeons. Questionnaires were mailed to all participants. RESULTS: Responses were received from 124 surgeons (41%), among whom were 56 bariatric surgeons (open) (45%), 30 advanced laparoscopic surgeons (24%), and 38 surgeons who performed neither bariatric nor advanced laparoscopic surgery (31%). The questionnaire responses showed that 46 surgeons (37%) currently are performing laparoscopic gastric bypass (LGB), 38 (31%) are performing open gastric bypass, and 39 (32%) are not performing bariatric surgery. Since completion of the course, 46 surgeons have performed 8,893 LGBs (mean, 193 cases/surgeon). Overall, 87 of the surgeons (70%) thought that a limited preceptorship was necessary before performance of LGB, yet only 25% underwent this additional training. According to a poll, the respondents thought that, on the average, 50 cases (range, 10-150 cases) are needed for a claim of proficiency. CONCLUSION: Laparoscopic bariatric workshops are effective educational tools for surgeons wishing to adopt bariatric surgery. Open bariatric surgeons have the highest rates of adopting laparoscopic techniques and tend to participate in more adjunctive training before performing LGB. There was consensus that the learning curve is steep, and that additional training often is necessary. The authors propose a mechanism for post-residency skill acquisition for advanced laparoscopic surgery.

Bariatric Surgery↗
PubMed2002

Surgeon specialty is associated with outcome in rectal cancer treatment.

PURPOSE: The aim of this study was to determine the effect of surgeon specialty on disease-free survival and local control in patients with adenocarcinoma of the rectum. Patients underwent curative treatment with neoadjuvant external beam radiotherapy and proctectomy by colorectal surgeons and noncolorectal surgeons. METHODS: The records of 384 consecutive patients treated by colorectal surgeons (n = 251) and noncolorectal surgeons (n = 133) from 1977 to 1995 were reviewed independently by physicians in the Division of Radiation Oncology. Local recurrence was defined as pelvic recurrence occurring in the presence or absence of distant metastatic disease. RESULTS: The study population comprised 213 males, mean age 64 (range, 19-97) years. Preoperative radiotherapy was delivered as 4,500 cGy in 25 fractions six to eight weeks before surgery (n = 293) or 2,000 cGy in 5 fractions immediately before surgery (n = 91). Concurrent preoperative chemotherapy was given to 14 patients, postoperative chemotherapy to 55. Overall actuarial disease-free survival and local control rates were 74 and 90 percent, respectively, at five years. Actuarial disease-free survival and local control rates at five years were 77 and 93 percent for colorectal surgeons vs. 68 and 84 percent for noncolorectal surgeons (P < or = 0.005 for both, Tarone-Ware). Multivariate analysis revealed that pathologic stage and background of the surgeon were the only independent predictors of disease-free survival (both P < or = 0.006, Cox proportional hazards) and that pathologic stage, background of the surgeon, and proximal location of the tumor were independent predictors of local control (all P < or = 0.02, Cox proportional hazards). Radiation dose and use of chemotherapy were not significant factors. Sphincter preservation was more common by colorectal surgeons (131/251, 52 percent) than noncolorectal surgeons (40/133, 30 percent; P = 0.00004, Fisher's exact test, two-tailed). CONCLUSION: Good outcome for patients with adenocarcinoma of the rectum who undergo neoadjuvant external beam radiotherapy and proctectomy is associated with subspecialty training in colon and rectal surgery.

Adenocarcinoma↗
PubMed2005

Attitudes regarding surgeons' attire.

BACKGROUND: No studies to date exist regarding the attire of physicians on a surgical service. The objective of this study was to determine patient, surgeon, and nonhospitalized public (NHP) attitudes and preferences regarding surgeons' attire and mannerisms. METHODS: A questionnaire was developed to survey each group. The Internet was used as a novel avenue to survey the NHP. Eight questions were presented to each group, and each question had three possible responses: agree, disagree, or no opinion. Total responses and percentages were determined for each group's answers, and statistical analysis was performed using chi-square test. RESULTS: Thirty-eight surgical inpatients, 38 surgeons, and 334 NHP participated in the study. All groups agreed that surgeons should wear nametags while they are seeing patients. Inpatients agreed with surgeons that surgeons should wear white coats while seeing patients (P > .05). Surgeons considered scrubs and clogs to be acceptable attire, which differed from all other groups (P < .05). Although 31% of the NHP considered blue jeans acceptable, only 10% of surgeons (P < .05) and 22% of patients (P > .05) considered them acceptable. All groups believed that a surgeon's appearance influences their perceptions and impressions regarding the quality of medical care they received (P < .05). CONCLUSIONS: Based on the agreement of all groups that a surgeon's appearance and mannerisms affects perceptions of the quality of medical care received, surgeons should respond to these perceptions and dress accordingly while seeing surgical patients.

Attitude of Health Personnel↗
PubMedDate not supplied

Left-handed surgeons: are they left out?

BACKGROUND: Left-handedness has been considered a simple inconvenience by some or something as convoluted as "the sinister," the Latin word for the left, by others. One in ten medical personnel is left-handed. The perceptions of left-handed surgeons regarding their laterality related inconveniences are unknown. OBJECTIVES: To determine the perceptions of left-handed surgeons and the way it has affected their surgical training and career. DESIGN AND SETTING: Web-based survey of left-handed surgeons. PARTICIPANTS: Left-handed surgeons in 2 boroughs of New York City, Manhattan and Brooklyn. METHODS: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Career-oriented concerns of left-handed surgeons. RESULTS: Three percent of left-handed surgeons received laterality related mentoring during medical school. Ten percent of the programs mentored left-handed surgical residents, and 13% of the programs provided left-handed instruments during surgical residency. Laparoscopy and laparoscopic instruments did not eliminate the problems associated with instrument handling to left-handed surgeons. Ten percent of the left-handed surgeons expressed concerns when asked whether they would be comfortable being treated by another left-handed surgeon when they are the patients themselves. CONCLUSIONS: This study reveals the perceptions of left-handed surgeons in adapting to a right-handed world. Early laterality related mentoring in medical school and during surgical residency with provision of left-handed instruments might reduce the inconveniences of left-handed surgeons learning.

Attitude of Health Personnel↗
PubMed2004

Practice patterns of oral and maxillofacial surgeons in Australia: 1990 and 2000.

This study was undertaken to describe practice patterns of oral and maxillofacial surgeons in Australia and compare trends over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). In both 1990 and 2000 the majority of surgeons worked 80+% of the time in the private sector (64.1 and 71.4%), had 80+% referrals from dental versus medical sources (74.0 and 74.7%), and had 80+% of patients from dentoalveolar rather than major maxillofacial surgery (70.7 and 69.7%). The percentage of dual qualified (dental plus medical degree) surgeons increased from 2.5% in 1990 to 17.1% in 2000 (P < 0.05; chi2). In 2000, surgeons who worked less than 80% in the private sector were more likely to report being overworked (57.9%) and that more surgeons were required in the public sector (65.0%) than those who worked 80% or more private (17.0 and 24.0%, respectively). Multivariate linear regressions of annual non-dentoalveolar surgical procedures per surgeon showed (P < 0.05) higher provision of implant (beta = 0.362), TMJ (beta = 0.267) and bone graft surgery (beta = 0.208) in 2000 compared to 1990, and higher provision of orthognathic (beta = 0.199), implant (beta = 0.194) and bone graft surgery (beta = 0.289) by dual qualified surgeons compared to those with only dental qualifications. Despite the mix of cases remaining predominantly dentoalveolar there was some change over time for selected non-dentoalveolar surgical procedures, with growth in the percentage of medically qualified surgeons and differences in surgery rates by qualification.

Adult↗
PubMed2006

Surgeon volumes and selected patient outcomes in cataract surgery: a population-based analysis.

OBJECTIVE: To study the association of annual surgeon volume of cataract procedures with the risk of postoperative adverse events. DESIGN: We used population-based administrative health records to conduct a retrospective cohort study from 2001 through 2003. PARTICIPANTS: The number of surgeons who performed more than 50 cataract surgeries annually ranged from 231 to 243 over the 3 years. There were 284 797 cataract surgeries in patients older than 20 years performed at 70 hospitals or eye surgery centers in the province of Ontario, Canada. METHODS: We calculated cataract surgery volume for each surgeon and tested for the presence of a volume-outcome association. We used generalized estimating equations to account for the effect of clustering of patients according to individual surgeons and to adjust estimates for the potential confounding effects of patient age and gender. MAIN OUTCOME MEASURES: We used a composite outcome of postoperative adverse events from cataract surgery that included billing claims for vitrectomy, vitreous aspiration or injection of medication, vitreous air or fluid exchange, and dislocated lens extraction performed by any ophthalmologist between 1 and 14 days after cataract surgery. These procedures are surrogate markers for the outcomes of retinal detachment, lost lens or lens fragment, and suspected endophthalmitis. RESULTS: In each year, fewer than 1 in 200 patients experienced an adverse event (range, 0.33%-0.41%). Surgeons performing 50 to 250 cataract surgeries per year had an adverse event rate of 0.8%. Surgeons performing 251 to 500 cataract surgeries per year had an adverse event rate of 0.4% and an adjusted odds ratio of postoperative adverse events of 0.52 (95% confidence interval [CI], 0.39-0.69) compared with surgeons performing 50 to 250 procedures per year. Surgeons performing 501 to 1000 cataract surgeries per year had an adverse event rate of 0.2% and an adjusted odds ratio of 0.31 (95% CI, 0.22-0.43), and surgeons performing more than 1000 cataract surgeries per year had an adverse event rate of 0.1% and an adjusted odds ratio of 0.14 (95% CI, 0.09-0.23). CONCLUSIONS: Selected adverse event rates for surgeons performing more than 50 cataract surgeries per year are low. There is a volume-outcomes relationship for cataract surgery, and this relationship persists even for very high-volume surgeons.

Adult↗
PubMed2003

Surgeon experience with laparoscopic-assisted colorectal surgery in Washington State.

PURPOSE: To describe the current practice and opinions held by surgeons performing colorectal surgery in Washington regarding laparoscopic colorectal surgery. METHODS: After attempting to identify all surgeons with hospital privileges in colorectal surgery in Washington, a survey was sent to 303 surgeons. The survey asked about the surgeon's practice, volume of colon surgery in the preceding year, the number of laparoscopic colon resections ever performed, the surgeon's opinion on the future practice of laparoscopic colorectal surgery, and whether faced with the personal need to undergo colon resection at the present time, would the surgeon elect to have laparoscopic or open colon resection. RESULTS: In all 170 surveys were returned; 154 returned surveys were from surgeons who had performed at least one colon resection in the preceding year; 53 (34%) respondents had experience with fewer than 20 laparoscopic resections and 83 (55%) have never performed laparoscopic-assisted colectomy (LAC). Only 4 (3%) surgeons had performed more than 50 laparoscopic colon resections. Forty-five percent of respondents indicated that they would currently seek a laparoscopic resection for themselves to treat either a benign condition or an incurable malignancy, and 84% of respondents indicated they would have an open colectomy for a curable malignancy. CONCLUSIONS: The majority of surgeons performing colorectal resections in Washington have limited experience with LAC. Surgeon opinion regarding the role of laparoscopic colorectal surgery in clinical practice is mixed. We suggest a model for proctoring of LAC for surgeons interested in implementing laparoscopic colorectal resection into their practice.

Attitude of Health Personnel↗
PubMed2005

Association of hospital and surgeon operation volume with the incidence of postoperative endophthalmitis: Taiwan experience.

PURPOSE: To determine the association between hospital and surgeon volume with the incidence of postoperative endophthalmitis. METHODS: A prospective cohort study was conducted to analyse the national health insurance claims data of those patients receiving cataract surgery in 2000 in Taiwan. A total of 108,705 patients who received cataract surgery by 1004 surgeons at 494 hospitals were followed to the end of 2002. Stepwise Cox regression was used to analyse the effects of hospital and surgeon volume of cataract surgery on postoperative endophthalmitis after adjustment for patient's age, gender, education, ophthalmic comorbidities, general comorbidities, and surgical factors including operative methods, different types of intraocular lenses, and surgeon's age. RESULTS: The 2-year incidence of postoperative endophthalmitis at high-volume hospitals (0.90%) was lower than low-volume hospitals (1.16%). The incidence of postoperative endophthalmitis by high-volume surgeons (0.59%) was lower than those by middle-high-volume (0.73%), middle-low-volume (0.80%), or low-volume surgeons (1.16%). After controlling for case mix, the risk of postoperative endophthalmitis of the low-volume hospitals (hazard ratio (HR) = 1.39) was higher than that of the high-volume hospitals. The risk of postoperative endophthalmitis of low-volume surgeons (HR = 1.67) was higher than that of the high-volume surgeons. CONCLUSIONS: The provider volume (hospital and surgeon volume) is associated with the risk of postoperative endophthalmitis. The patients who receive cataract surgery at low-volume hospitals or by low-volume surgeons have significantly higher risk of postoperative endophthalmitis than at high-volume hospitals or by high-volume surgeons. Provider volume can be considered in further postoperative endophthalmitis study as a risk factor.

Adolescent↗