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At least 325 records · Page 18Linked to original sources
PubMed2006

Inadequate hepatitis B vaccination and post-exposure evaluation among transplant surgeons: prevalence, correlates, and implications.

OBJECTIVES: To identify the proportion of U.S. transplant surgeons who are adequately vaccinated against hepatitis B virus (HBV), identify characteristics associated with inadequate vaccination, and assess the proportion who had been evaluated for immunization following potential HBV exposures. SUMMARY BACKGROUND DATA: It is unknown what proportion of transplant surgeons are appropriately vaccinated against HBV or evaluated for immunization following operative exposures. METHODS: We mailed questionnaires and to all active U.S. transplant surgeons. We compared demographic characteristics of responders and nonresponders to evaluate the potential for nonresponse bias. RESULTS: Of 619 eligible respondents, 347 (56.1%) returned completed questionnaires. Of the 311 surgeons for whom HBV vaccination was indicated (all surgeons with neither a prior history of HBV infection nor a prior adverse reaction to the vaccine itself), 70 (22.5%; 95% confidence interval [CI], 18.0-27.6%) received fewer than the recommended 3 injections. Surgeon characteristics associated with inadequate vaccination included length of clinical practice (odds ratio [OR], 1.5 per 10-year increment in duration of practice; 95% CI, 1.1-2.2), increased fear of infection (OR, 1.2 for each unit increase in fear out of 10; 95% CI, 1.1-1.4), and lack of recent testing for HBV infection (OR, 2.0; 95% CI, 1.1-3.8). Of the 94 surgeons (27.3%) reporting at least one needle-stick exposure while operating on an HBV-infected patient, 14 (14.9%) were inadequately vaccinated; of these 14, only 5 (35.7%) sought appropriate serologic testing and counseling for active immunization. Surgeons underestimated both the risks of percutaneous exposure while operating, and of becoming infected with HBV if exposed. CONCLUSIONS: Many transplant surgeons are inadequately vaccinated against HBV and fail to seek evaluation following possible exposures. Underestimation of the risks of HBV exposure and transmission may relate to these failures. Requiring documentation of HBV vaccination and immunity to maintain operating room privileges may protect surgeons, their patients, and operating room staff.

Attitude of Health Personnel↗
PubMed2004

A comparison of dermatologists', surgeons' and general practitioners' surgical management of cutaneous melanoma.

BACKGROUND: Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether different outcomes for melanoma are related to the specialist who treats the patient is unknown. OBJECTIVES: To examine the clinicopathological features and surgical management of patients with primary cutaneous malignant melanoma treated by dermatologists, general surgeons, plastic surgeons and general practitioners (GPs). We also examined if the category of specialist had an effect on the survival outcome for the patient. METHODS: A retrospective, observational study of patients registered on a specialist database that records the clinicopathological features, surgical treatment and follow-up information of patients with malignant melanoma in Scotland. The patients had invasive primary cutaneous malignant melanoma without evidence of metastasis at the time of surgery, diagnosed between 1979 and 1997, with follow-up to the end of December 1999. Clinicopathological characteristics and surgical treatment of patients were compared for the four groups of specialist, as were overall survival (OS), disease-free survival (DFS) and recurrence-free interval (RF). RESULTS: Of 1536 patients, 663 (43%) were treated initially by a dermatologist, 486 (32%) by a general surgeon, 257 (17%) by a plastic surgeon and 130 (8%) by a GP. The proportion of patients managed by dermatologists rose over the lifetime of the study. Compared with the other specialists, the patients treated by general and plastic surgeons were older; a higher proportion of female patients was managed by dermatologists; median tumour thickness, lesion diameter and frequency of ulceration were all greater in the general surgeon-treated group; plastic surgeons treated a higher proportion of lentigo maligna melanomas; and general surgeons and GPs saw a higher proportion of nodular melanomas. Over 90% of patients managed by a dermatologist or GP underwent wider local excision following initial excision, compared with 43% and 25%, respectively, in the general and plastic surgery groups. General surgeons used wider excision margins than the other specialists. OS, DFS and RF were significantly better in the dermatology group compared with the general and plastic surgery groups. CONCLUSIONS: This study showed that dermatologists manage an increasing majority of melanoma patients and that there were significant differences in the surgical treatment of melanoma between dermatologists and surgeons. Survival was significantly better in the dermatology-treated group, suggesting that dermatologists should have a central role in melanoma management.

Adult↗
PubMed1994

Pharmacological thromboprophylaxis in hip and knee surgery: a survey of New Zealand orthopaedic surgeons.

A survey was conducted of the attitudes and practices of New Zealand orthopaedic surgeons on the use of pharmacological thromboprophylaxis (PT) for patients undergoing major hip or knee surgery. A questionnaire was sent to all 106 consultant surgeons known to perform hip or knee surgery and a response rate of 89% was obtained. The results suggested that while almost all surgeons used PT at some time, only about one-third of elective surgery patients and just a few per cent of patients with neck of femur fracture (NOFF) receive PT. For about three-quarters of surgeons, heparin (usually low molecular weight) was the most frequently used PT. About half of the surgeons began prophylaxis pre-operatively and about half stopped it when the patients were mobile postoperatively. Previous venous thromboembolism was felt by almost all surgeons to be a very important indication for PT; gross obesity, prolonged pre-operative immobility and active malignancy were thought to be very important factors by approximately one-half of the surgeons. The presence of a major bleeding diathesis or active peptic ulcer was cited as a contraindication to PT by more than two-thirds of all surgeons. Fear of bleeding complications and the rarity of thromboembolic complications were cited as reasons for limited use of PT by about one-third of surgeons. The results suggest that most surgeons usually rely on non-pharmacological methods of thromboprophylaxis, particularly for NOFF patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroplasty↗
PubMed1998

Profile of a clinical practice: Thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons.

A 1991 NIH Consensus Development Conference statement provided recommendations for the management of patients with asymptomatic and minimally symptomatic primary hyperparathyroidism (primary HPT), but adherence to these guidelines has not been documented. We conducted a cross-sectional survey of North American members of the American Association of Endocrine Surgeons inquiring about surgeon and primary HPT patient characteristics, thresholds for surgery, and clinical outcomes. Multivariate regression was used to assess the relationship of physician characteristics to practice patterns and outcomes. Of 190 surgeons surveyed, 147 (77%) responded; 109 provided complete responses (57%). These surgeons spend 66% of their time in patient care and perform an average of 33 (range, 1-130) parathyroidectomies/yr. More than 72% of primary HPT patients who underwent surgery were asymptomatic or minimally symptomatic. High volume surgeons (>50 cases/yr) had significantly lower thresholds for surgery with respect to abnormalities in preoperative creatinine clearance, bone densitometry changes, and levels of intact PTH and urinary calcium compared to their low volume colleagues (1-15 cases/yr). Overall reported surgical cure rates were 95.2% after primary operation and 82.7% after reoperation. Compared to high volume surgeons, low volume endocrine surgeons had significantly higher complication rates after primary operation (1.9% vs. 1.0% respectively; P < 0.01) and reoperation (3.8% vs. 1.5%; P < 0.001) as well as higher in-hospital mortality rates (1.0% vs. 0.04%; P < 0.05). Endocrine surgeons operate on a large number of asymptomatic or minimally symptomatic primary HPT patients. Even among a group of highly experienced surgeons who typically see patients after referral from endocrinologists, clinical outcomes and criteria for surgery vary widely and appear to be associated with surgeon experience. Their criteria for surgery diverge from NIH guidelines. These results implore the endocrine community to examine the evidential basis for decisions made in the management of primary HPT.

Female↗
PubMed2006

The surgeon-patient interaction in older women with breast cancer: what are the determinants of a helpful discussion?

BACKGROUND: Surgery is a key modality in the treatment of breast cancer. The patient-physician interaction is a key determinant of a range of outcomes, but there is little work examining the surgeon-breast cancer patient interaction. We analyzed data from 240 women with a new breast cancer diagnosis to better understand this interaction and to delineate the patient, surgeon, and surgeon-patient interaction-level characteristics affecting this interaction. METHODS: A cross-sectional survey was conducted in Los Angeles County of 240 women with a new breast cancer diagnosis aged>or=55 years. Women were asked to rate on a scale of 0 to 10 how helpful overall the way their surgeon discussed their breast cancer with them was. Logistic regression models were constructed to assess the relationship of patient, surgeon, and surgeon-patient interaction characteristics to the outcome variable. RESULTS: Forty-four percent of women said that they found the way their surgeon discussed their breast cancer with them extremely helpful. Women with a higher level of perceived self-efficacy, a longer consultation time with the surgeon, a higher interactive information-giving score, and a higher participatory decision-making score had significantly higher odds of reporting the discussion to be "extremely helpful." CONCLUSIONS: Our results indicate that strategies to improve the patient's perceived self-efficacy (preparing questions beforehand, practicing, watching a role model, and so on) will improve the surgeon-patient discussion. At a systems level, adequate time should be budgeted for the consultation, and we must ensure that adequate communication skills are imparted to surgeons during their educational training.

Aged↗
PubMed2001

Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population.

BACKGROUND: The mortality and complication rates of many surgical procedures are inversely related to hospital procedure volume. The objective of this study was to determine whether the volumes of primary and revision total hip replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. METHODS: We analyzed claims data of Medicare recipients who underwent elective primary total hip replacement (58,521 procedures) or revision total hip replacement (12,956 procedures) between July 1995 and June 1996. We assessed the relationship between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first ninety days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. RESULTS: Twelve percent of all primary total hip replacements and 49% of all revisions were performed in centers in which ten or fewer of these procedures were carried out in the Medicare population annually. In addition, 52% of the primary total hip replacements and 77% of the revisions were performed by surgeons who carried out ten or fewer of these procedures annually. Patients treated with primary total hip replacement in hospitals in which more than 100 of the procedures were performed per year had a lower risk of death than those treated with primary replacement in hospitals in which ten or fewer procedures were performed per year (mortality rate, 0.7% compared with 1.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.38, 0.89). Patients treated with primary total hip replacement by surgeons who performed more than fifty of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed five or fewer of the procedures per year (dislocation rate, 1.5% compared with 4.2%; adjusted odds ratio, 0.49; 95% confidence interval, 0.34, 0.69). Patients who had revision total hip replacement done by surgeons who performed more than ten such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed three or fewer of the procedures per year (mortality rate, 1.5% compared with 3.1%; adjusted odds ratio, 0.65; 95% confidence interval, 0.44, 0.96). CONCLUSIONS: Patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total hip replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status.

Arthroplasty, Replacement, Hip↗
PubMed1999

Probable transmission of HIV from an orthopedic surgeon to a patient in France.

BACKGROUND: Transmission of HIV from infected health care workers to patients has been documented in only one cluster involving 6 patients of a dentist in Florida. In October 1995, the French Ministry of Health offered HIV testing to patients who had been operated on by an orthopedic surgeon in whom AIDS was recently diagnosed. OBJECTIVE: To determine whether the surgeon transmitted HIV to patients during operations. DESIGN: Epidemiologic investigation. SETTING: The practice of an orthopedic surgeon in a French public hospital. PARTICIPANTS: 1 surgeon and 983 of his former patients. MEASUREMENTS: 3004 patients who had undergone invasive procedures were contacted by mail for counseling and HIV testing. One HIV-positive patient was interviewed, and DNA sequence analysis was performed to compare the genetic relation of the patient's and the surgeon's viruses. Infection-control precautions and the surgeon's practices were assessed. RESULTS: Of 983 patients in whom serologic status was ascertained, 982 were HIV negative and 1 was HIV positive. The HIV-positive patient, a woman born in 1925, tested negative for HIV before placement of a total hip prosthesis with bone graft (a prolonged operation) performed by the surgeon in 1992. She had no identified risk for HIV exposure. Molecular analysis indicated that the viral sequences obtained from the surgeon and the HIV-infected woman were closely related. Infection-control precautions were in accordance with recommendations, but blood contact between the surgeon and his patients occurred commonly during surgical procedures. CONCLUSIONS: An HIV-infected surgeon may have transmitted HIV to one of his patients during surgery.

Base Sequence↗
PubMed2001

Current practice of abdominal fascial closure: a survey of Ontario general surgeons.

OBJECTIVES: To determine the current practice of abdominal fascial closure among provincial general surgeons. The primary objective was to determine the proportion of surgeons choosing absorbable versus nonabsorbable sutures. Secondary objectives included determining knowledge and attitudes of surgeons to evidence-based medicine and concordance of current practice with level I evidence. DESIGN: A survey. SETTING: The province of Ontario. PARTICIPANTS: One hundred general surgeons. METHODS: A stratified random sample of community and academic surgeons was assembled and a questionnaire was mailed to them. Common clinical scenarios and questions pertaining to attitudes and knowledge of evidence-based medicine were included. MAIN OUTCOME MEASURES: Use of absorbable versus nonabsorbable suture material. Willingness to change current practice on evidence-based level I reports. RESULTS: Most surgeons (86%) chose an absorbable suture for abdominal fascial closure. Nonabsorbable suture was chosen by 58% of surgeons in the highly contaminated surgical scenario. Eighty-one percent of surgeons indicated they would be willing to change their current practice of fascial closure if there was evidence that the incidence of wound complications was reduced. Polyglactin (Vicryl) was the most commonly chosen suture. CONCLUSIONS: The current practice of abdominal fascial closure among Ontario general surgeons is in disagreement with the findings from a recent meta-analysis, recommending a nonabsorbable suture for a 32% relative risk reduction in the incisional hernia rate. The majority of surgeons employ a continuous absorbable closure in common surgical scenarios. A definitive randomized controlled trial comparing continuous nonabsorbable closure versus continuous absorbable closure is warranted.

Abdomen↗
PubMed2004

Surgeons' experiences of complaints to the Health and Disability Commissioner.

AIMS: To investigate details of patient complaints to the Health and Disability Commissioner about surgeons-to identify factors in the patient-surgeon interaction that might make a complaint more likely, and to consider ways of improving the complaints environment. METHODS: A questionnaire was developed asking specific questions about surgeons and their practice, number of complaints since 1996 and specific questions about their last Health and Disability Commissioner complaint. The questionnaire was mailed to surgeons on the mailing lists of the New Zealand Orthopaedic Association and The New Zealand Association of General Surgeons. Anonymous responses were entered into an Microsoft Access database. RESULTS: Responses were received from 280 (86%) of the 325 people contacted. Of these 280 replies, 259 were eligible for analysis. 149 (58%) of these 259 responses were from doctors who had received a complaint. There were 282 complaints, which gives an annual rate of complaints per person (inclusive of all respondents) of 0.16 over the 7 years: 1996 to 2002--but during 2000 to 2002 this rate was 0.34. The peak of complaints was in 2000. Those in mid-career (ie, 10-15 years of practice) and in private practice were at increased risk. Patients who complained were more likely to be female (58%) and in older ages. Respondents presented a very negative impression of their experience of the complaints process. In 91.1% of cases, either no action was taken or the surgeon was not in breach. Only 2.2% of cases were referred for disciplinary proceedings. CONCLUSION: Complaints against surgeons are common. The 'highest-risk surgeon' is a subspeciality general surgeon in private practice. The most likely people to complain are middle-class, white females aged 35-70 years. It would appear likely that the present system does not resolve issues for the patient or the surgeon. Radical changes are needed, and are beginning to occur, in the complaints environment. Especially needed is acceptance and disclosure of harm and error (away from a culture of blame and discipline). Therefore, if medical practitioners are to move with confidence into this more open environment, a more supportive political/media/organisational culture is needed, with a focus on valuing disclosure and learning from mistakes.

Adult↗
PubMed2004

[Design of a prototype operating seat with SESAM (Ergonomic System of Mobile Forearm Rests) mobile armrests designed to optimize the surgeon's ergonomy during pelvic laparoscopy].

INTRODUCTION: Pelvic laparoscopic surgery offers multiple advantages for patients, but requires uncomfortable, non-ergonomic positions for the surgeon. Only a remote operator (Robot "slave" reproducing the surgeon's movements performed on a "master" console situated away from the patient), like Da-Vinci or Zeus (Intuitive Surgical) can improve the laparoscopic surgeon's working conditions. The objective of this study, based on an ergonomic analysis and recording of a laparoscopic surgeon's movements, was to define the specifications for the manufacture of an operating seat with armrests, based on the surgeon's position using a remote operator. MATERIAL AND METHODS: Movements of the centre of pressure and upper limbs of 12 urologists and gynaecologists with various levels of experience, were recorded using a force platform and a SAGA 3 RT movement analysis system (Biogesta), during 4 exercises performed on a pelvi-trainer, with the surgeon positioned to the left (introduction of a needle, unravelling of a cord, dissection, suture). Ergonomic analysis of the laparoscopic surgeon's movements was based on video recordings of a surgeon under real operating conditions. The specifications were defined from all of these data. RESULTS AND DISCUSSION: The small amplitude of movements of the surgeon 's centre of pressure (< 45 cm2) confirmed that surgeons can be seated during laparoscopy. Recordings of the upper defined the elbow working zones and the need for 3D mobile armrests. Ergonomic analysis of posture defined the characteristics of the prototype. On the basis of these specifications, a prototype operating seat was developed. This prototype now needs to be validated or invalidated clinically.

Arm↗
PubMed1994

General surgical practice patterns in Nova Scotia: the role of the "generalist" general surgeon.

OBJECTIVE: To determine the role of traditional "generalist" general surgeons in Nova Scotia. DESIGN: An anonymous mail survey. SETTING: The Province of Nova Scotia. PARTICIPANTS: Sixty-two active general surgeons listed on the Nova Scotia Provincial Medical Board Registry. INTERVENTIONS: A questionnaire to compare the practice patterns of community surgeons, regional surgeons and tertiary care surgeons. MAIN OUTCOME MEASURES: The availability of non-general-surgery subspecialty colleagues in the hospital setting, the extent of non-general-surgery subspecialty practices of the participating surgeons, the types of procedures they commonly perform and the adequacy of their general surgery training to meet their present practice requirements. RESULTS: The questionnaire response rate was 79%. Community surgeons had few non-general-surgery subspecialty colleagues, and the majority maintained broad "generalist" general surgical practices. Regional surgeons had more non-general-surgery subspecialty colleagues, but many still had surgical practices that included the non-general-surgery subspecialties. Tertiary surgeons had adequate non-general-surgery subspecialty colleagues and maintained narrow general surgery practices. CONCLUSIONS: In Nova Scotia, "generalist" general surgeons presently provide non-general-surgery subspecialty services in both regional and community hospital settings.

Data Collection↗
PubMed1996

Response to the discovery of two practising surgeons infected with hepatitis B.

Two surgeons (henceforth called A and B) working in neighbouring district general hospitals were found, on routine testing, to carry hepatitis B e antigen and therefore to be at high risk of transmitting infection. Neither surgeon gave a history of injury at work. The only exposure prone operations performed by surgeon A were 16 repairs of uncomplicated inguinal hernias. Two of the 16 patients were found to have acute hepatitis B. In contrast, 15 cases on whom surgeon B performed exposure prone orthopaedic procedures remained free of hepatitis B virus infection. The follow up protocol for the patients of the two surgeons differed in that all surgeon B's patients were immunised using an accelerated course of hepatitis B vaccine, which had not been offered to patients of surgeon A. The detection of two cases of hepatitis B among patients operated on by an infected surgeon illustrates the importance of evaluating the risk of exposure associated with particular procedures when deciding whether to check patients who may have been exposed to a high risk surgeon. Surgeon A had been vaccinated before arriving in the United Kingdom and this incident highlights the need to verify immunity after vaccination against hepatitis B virus.

Blood-Borne Pathogens↗
PubMedDate not supplied

Benchmarking surgeon satisfaction at academic health centers: a nationwide comparative survey.

BACKGROUND: Forty-six academic health centers (AHCs) belonging to the University HealthSystem consortium joined forces to compare the efficiency of their surgical services and to identify best practices. In addition to measures of operational performance, surgeon satisfaction with the surgical services provided was measured by using a standardized questionnaire. METHODS: From hospital records, indicators of the efficiency of surgical services were collected in three main areas: scheduling, preoperative testing and assessment, and the intraoperative process. Responding to a mail questionnaire, a sample of surgeons rated their satisfaction with key aspects of surgical services including scheduling, operating room staff, and equipment/supplies. On the basis of a review of the operational measures and the survey results, high performers were identified. Site visits were made to several of these high performers to uncover the critical factors responsible for their success. RESULTS: The survey revealed distinct variations in surgeon satisfaction across the participating institutions. Numerical benchmarks were obtained for surgeon satisfaction with each key component of surgical services. Scheduling was the most important component of overall surgeon satisfaction, explaining 71% of the variance in the rating of overall satisfaction with surgical services. High operational efficiency and high surgeon satisfaction were not incompatible. Several of the participating institutions were able to achieve both. These results were disseminated to all of the participants at a national meeting as well as in written form. CONCLUSIONS: The surgeon satisfaction survey allowed the participants to establish benchmarks for surgeon satisfaction for each key component of the surgical services they receive. The site visits revealed several common characteristics of highly efficient surgical services. Taken by themselves, the participating institutions might have been reluctant to consider adopting these best practices for fear of alienating the surgical staff. The availability of data on surgeon satisfaction showed the participants that these best practices can coexist with high levels of surgeon satisfaction. This has helped to promote their adoption by the other participating institutions.

Academic Medical Centers↗
PubMed2003

Differences between endocrine surgeons and endocrinologists in the management of non-toxic multinodular goitre.

BACKGROUND: It is not known whether the management of multinodular goitre differs between endocrinologists and endocrine surgeons. METHODS: A questionnaire containing a hypothetical case (a 42-year-old euthyroid woman with a 50-80-g multinodular goitre) and 11 variations on the case was sent to endocrinologists and endocrine surgeons in Australia. RESULTS: The response rate was 55 per cent, including 45 endocrine surgeons and 127 endocrinologists. For the index case, serum thyroid-stimulating hormone (TSH), fine-needle aspiration biopsy and ultrasonography were widely used by both groups. Thyroid antibodies and scintigraphy were ordered by a greater proportion of endocrinologists than surgeons, and computed tomography more frequently by surgeons than endocrinologists. Treatment recommendations differed significantly between specialties for the index case (endocrinologists: no treatment 65 per cent, thyroxine 22 per cent, surgery 10 per cent, radioiodine 3 per cent; surgeons: no treatment 67 per cent, thyroxine 2 per cent, surgery 31 per cent; P < 0.001) and for seven of the variations. In particular, for a patient with suppressed TSH, most endocrinologists (60 per cent) recommended radioiodine treatment, whereas there was no consensus among surgeons (surgery 40 per cent, no treatment 36 per cent, radioiodine 21 per cent). For a patient with a partly intrathoracic goitre, most surgeons (88 per cent) recommended surgery, whereas there was no consensus among endocrinologists (surgery 45 per cent, no treatment 34 per cent, thyroxine treatment 13 per cent, radioiodine 8 per cent). CONCLUSION: There are clinically significant differences between endocrine surgeons and endocrinologists in the management of multinodular goitre.

Adult↗
PubMed2003

Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection.

BACKGROUND AND OBJECTIVES: A strong association between high hospital procedure volume and survival following colon cancer resection has been demonstrated. However, the importance of surgeon case volume as a determinant of outcome has been less well studied, and it is unclear whether hospital or surgeon volume is the more powerful predictor of outcomes. METHODS: A retrospective population-based cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database identified 24,166 colon cancer patients aged 65 years and older who had surgery for a primary tumor diagnosed in 1991-1996 in a SEER area. Hospital and surgeon-specific procedure volume was ascertained based on the number of claims submitted over the 6-year study period. Outcome measures were mortality at 30 days and 2 years, overall survival, and the frequency of operations requiring an intestinal stoma. Age, sex, race, comorbid illness, cancer stage, socioeconomic status, emergent hospitalization, and the presence of obstruction/perforation were used to adjust for differences in case-mix. RESULTS: After adjusting for surgeon procedure volume, high hospital procedure volume remained a strong predictor of low post-operative mortality rates (P < 0.001 for each outcome with and without adjustment for surgeon procedure volume). Surgeon-specific procedure volume was also an important predictor of surgical outcomes (P = 0.002 for 30-day mortality, P = 0.001 for 2-year mortality), although this effect was attenuated after adjusting for hospital volume (P = 0.03 for 30-day mortality, P = 0.02 for 2-year mortality). Hospital volume and surgeon volume were each an important predictor of the ostomy rate. Among high volume institutions and surgeons, individual providers with unusually high ostomy rates could be identified. CONCLUSIONS: Both hospital and surgeon-specific procedure volume predict outcomes following colon cancer resection; but hospital volume may exert a stronger effect. Therefore, efforts to optimize the quality of colon cancer surgery should focus on multidisciplinary aspects of hospital care rather than solely on intraoperative technique.

Aged↗
PubMed1996

How do surgeons' probability estimates of operative mortality compare with a decision analytic model?

The aim of this study is to compare surgeons' estimates of operative mortality of patients with an abdominal aneurysm (= dilation of the aorta) with the operative mortality derived from a decision analytic model and to determine how surgeons use clinical information. Four experienced surgeons are asked to estimate, among other things, the operative mortality of 137 patients. Results concerning the accuracy of surgeons' estimates show that surgeons' average operative mortality estimates are quite accurate as compared to the calculated mortalities. The standard deviations of surgeons' estimates are lower than the standard deviation of the model, however, indicating that the surgeons are not as good in distinguishing the high and low risk patients. Furthermore, surgeons show substantial inconsistencies in the weighing of the clinical information, and also differ from the model in how clinical information is weighed. Finally, when comparing the operative mortalities of the patients who died and those who did not, the model shows a modest, but higher discrimination than the surgeons. Physicians' performance seems to be influenced by the difficulty of the task (i.e. the unpredictability of the event and the multidimensionality of the task). In order to improve physicians' probability estimates, the calculations of the decision model can be used as learning tool.

Aortic Aneurysm, Abdominal↗
PubMed1995

A survey of glove preferences of general and orthopaedic surgeons in North West Thames Regional Health Authority.

The glove preferences of all the consultant surgeons and consultant orthopaedic surgeons in North West Thames were surveyed by questionnaire. Responses were received from 59 of 78 general surgeons and 47 of 55 orthopaedic surgeons. Twenty-two percent of general surgeons never double gloved compared with 4% of orthopaedic surgeons (P < 0.01). Seventy-three percent of general surgeons double gloved for 'high risk' patients compared with 17% of orthopaedic surgeons (P < 0.001). When double gloving the majority of surgeons (67%) used their normal sized glove inside and half a size larger on the outside.

Attitude of Health Personnel↗
PubMed2005

Cutting down substance abuse--present state and visions among surgeons and nurses.

BACKGROUND: Although substance abuse is variably common among surgical patients, detection of the problem and brief interventions are seldom undertaken. The aim of the present study was to assess surgeons' and nurses' activity in screening substance abuse among their patients and obstacles concerning intervention of patients with substance abuse. METHODS: Surgeons and nurses of The Department of Surgery, Tampere University Hospital were asked to predict if the surgical patients treated during a 24-h period (n=211) had a substance abuse disorder. This was compared to the patients' self-reports based on the Alcohol Use Disorders Identification Test (AUDIT) and questions about use of other substances. The surgeons and the nurses were also asked to complete a questionnaire related to interventions of patients with substance abuse; perceived knowledge, skills, attitudes and obstacles. RESULTS: Of the surgical patients, 47 (22%) proved to be substance abusers. Out of them, 23% were detected by surgeons and nurses. Of the surgeons (n=44) 83% and of the nurses (n=332) 84% perceived responsibility for intervention but claimed many obstacles. Nurses reported the lack of knowledge as the main obstacle. Of the nurses 18% reported enough knowledge to conduct the whole brief intervention compared to 34% of surgeons (p=0.021). The main obstacle reported by surgeons was the lack of time. CONCLUSIONS: Surgeons and nurses detect only minority of the substance abusing surgical patients. Lack of knowledge and time prevent intervening in patients' substance abuse. These results may be utilized when developing a program to better involve surgeons and nurses in detection and intervention of surgical patients' substance abuse.

Adult↗