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At least 343 records · Page 19Linked to original sources
PubMed2007

Minimally invasive parathyroidectomy using the lateral focused miniincision approach: Is there a learning curve for surgeons experienced in the open procedure?

BACKGROUND: Minimally invasive parathyroidectomy (MIP) has gained acceptance as the standard of care for management of primary hyperparathyroidism in which a single adenoma can be localized. The aim of this study was to determine if there is a learning curve for MIP using the lateral focused miniincision approach performed by surgeons experienced in open parathyroidectomy. STUDY DESIGN: This is a retrospective case series comprising all parathyroid operations undertaken by three surgeons in the University of Sydney Endocrine Surgical Unit from 2003 to 2005. Outcomes of the experienced surgeon were compared with those of the two surgeons commencing practice. RESULTS: There were 699 parathyroidectomies performed in the Unit during the 36-month period (experienced surgeons: 438 versus commencing physicians: 261). Of the parathyroidectomies performed, 57% done by experienced surgeons were minimally invasive compared with 38% of those performed by surgeons commencing practice (p < 0.001). There were no differences in the number of complications (p = 0.21), conversions to open exploration (p = 0.6), and cure rates (p = 0.9) in the MIP patients in both groups. The initial (first 131 patients) and subsequent (next 130 patients) parathyroidectomy experiences of surgeons commencing practice were examined. In the initial experiences, 28% of the cases were minimally invasive compared with 48% in the subsequent experiences (p < 0.001). There were no differences in the number of complications (p = 0.3), conversions to open exploration (p = 0.9), and cure rates (p = 0.9). CONCLUSIONS: For surgeons experienced in open parathyroidectomy, there is no technical learning curve using the lateral focused miniincision technique for MIP. There is, however, a learning curve for patient selection.

Clinical Competence↗
PubMed2003

Five-year results of a merger between vascular surgeons and interventional radiologists in a university medical center.

OBJECTIVES: We examined economic and practice trends after 5 years of a merger between vascular surgeons and interventional radiologists. METHODS: In 1998 a merger between the Division of Vascular Surgery and the Section of Interventional Radiology at the University of Rochester established the Center for Vascular Disease (CVD). Business activity was administered from the offices of the vascular surgeons. RESULTS: In 1998 the CVD included five vascular surgeons and three interventional radiologists, who generated a total income of $5,789,311 US dollars (34% from vascular surgeons, 24% from interventional radiologists, 42% from vascular laboratories). Vascular surgeon participation in endoluminal therapy was limited to repair of abdominal aortic aneurysms (AAAs). Income was derived from 1011 major vascular procedures, 10,510 catheter-based procedures in 3286 patients, and 1 inpatient and 3 outpatient vascular laboratory tests. In 2002 there were six vascular surgeons (five, full-time equivalent) and four interventional radiologists, and total income was $6,550,463 US dollars despite significant reductions in unit value reimbursement over the 5 years, a 4% reduction in the number of major vascular procedures, and a 13% reduction in income from vascular laboratories. In 2002 the number of endoluminal procedures increased to 16,026 in 7131 patients, and contributions to CVD income increased from 24% in 1998 to 31% in 2002. Three of the six vascular surgeons performed endoluminal procedures in 634 patients in 2002, compared with none in 1998. CONCLUSIONS: Gross revenues increased in a declining reimbursement and conventional practice environment, because of the increased number of endoluminal procedures, in part provided by vascular surgeons. The implications of these data should be considered by those responsible for training vascular surgeons.

Academic Medical Centers↗
PubMed2004

Long-term survival and temporal trends in patient and surgeon factors after elective and ruptured abdominal aortic aneurysm surgery.

OBJECTIVE: Records for all patients in Ontario who underwent elective repair of abdominal aortic aneurysms (AAAs) or repair of ruptured AAAs between 1993 and 1999 were studied to determine whether the profile of surgeons or patients changed and to determine whether postoperative mortality changed over time. The secondary objective was to describe long-term survival after AAA surgery. METHODS: A population-based retrospective cohort was assembled from administrative data. Surgeon billing records were used to identify operations performed between 1993 and 1999. Chi(2) and linear regression analyses were used to determine whether variables changed over time. Kaplan-Meier survival curves were used to estimate long-term survival. RESULTS: For patients undergoing elective AAA repair, average annual surgeon volume (P <.0001) and proportion of patients operated on by vascular surgeons (P =.02) increased over the study period; similar trends were noted for patients undergoing repair of ruptured AAAs. Surgeon volume was clearly correlated with mortality after both elective AAA repair and repair of ruptured AAAs; however, the benefit of this effect was modest beyond a surgeon volume of 6 to 10 ruptured AAA repairs per year or 20 to 30 elective AAA repairs per year. No change in crude 30-day mortality (4.5% for elective AAA repair and 40.4% for repair of ruptured AAAs) was noted during the study. CONCLUSION: Despite the finding that surgery to repair ruptured AAAs and elective repair of AAAs is being increasingly performed by high-volume vascular surgeons, there was no change in early mortality between 1993 and 1999. This may have been because average surgeon volume was already relatively high at the beginning of the study period, which translated into only modest benefit to further increases in surgeon volume.

Aged↗
PubMed2000

Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons.

PURPOSE: Previous studies have suggested that specialists may achieve better clinical outcomes for patients, albeit often at greater cost. We sought to compare outcomes of care and resource utilization among patients with shoulder or knee problems who were treated by general internists, rheumatologists, and orthopedic surgeons. SUBJECTS AND METHODS: Outpatients with knee or shoulder complaints who were seen by general internists, rheumatologists, or orthopedic surgeons at an academic medical center were administered questionnaires at enrollment in the study and again 3 months later. The questionnaires included validated measures of satisfaction, functional status, and pain severity, as well as resource utilization. We compared baseline clinical characteristics, satisfaction with care, resource utilization, and changes in function and symptoms during 3 months of follow-up among patients who were cared for by the three different types of providers. RESULTS: A total of 534 patients responded to the baseline survey and 436 (82%) to the 3-month follow-up survey. About 60% (n = 323) had knee pain. Orthopedists cared for 40% (n = 211) of the patients, with the remainder treated in approximately equal numbers by general internists or rheumatologists. At baseline, patients of internists had less severe pain (differences of 0.3 to 0.6 points on a 1 to 5 scale, P <0.05) and functional limitations (differences of 0.4 to 0.6 points on a 1 to 5 scale, P <0.0006) than patients of rheumatologists and orthopedic surgeons. Adjusting for baseline differences, there were no significant differences among provider groups in pain relief or functional improvement during follow-up. However, in adjusted analyses, patients with shoulder pain who were cared for by orthopedic surgeons were least satisfied with the office environment [adjusted mean (+/- SD) satisfaction score of 1.6 +/- 0.8 on a 1 to 4 scale for orthopedic surgeons vs 1.3 +/- 0.8 for rheumatologists and 1.4 +/- 0.8 for internists, P = 0.004]. Among patients with knee pain, those treated by rheumatologists and orthopedic surgeons were more satisfied with the doctor-patient interaction (adjusted mean satisfaction scores of 1.1 +/- 0.9 for rheumatologists and 1.2 +/- 0.7 for orthopedic surgeons on a 1 to 4 scale vs 1.4 +/- 0.8 for general internists, P = 0.003). Orthopedic surgeons obtained significantly more radiographs of the knee or shoulder and more magnetic resonance imaging scans of the knee. Rheumatologists performed significantly more aspirations or injection procedures. Among all patients, those treated by rheumatologists were most satisfied with the physician interaction, and those treated by orthopedic surgeons were most satisfied with treatment results. CONCLUSION: The relative benefits of specialist compared with generalist care for patients with knee or shoulder pain depend on the importance attached to resource utilization, patient satisfaction, and health outcomes.

Academic Medical Centers↗
PubMed1987

Thoracic surgery manpower: the fourth manpower study of thoracic surgery: 1985 report of the Ad Hoc Committee on Manpower of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons.

Responding to a survey about their practice in 1985, 2,969 (70%) Board-certified thoracic surgeons provided data that were compared with data from manpower surveys in 1980 and 1976. (table; see text) Thoracic surgeons were most active between ages 35 and 54 years when they accomplished 61% of all general thoracic and 85% of cardiac operations. Surgeons older than 50 years performed significantly more general thoracic operations than younger surgeons, and the younger group performed significantly more cardiac operations than their older counterparts. Solo practice continued to decline. In smaller referral areas, the number of general thoracic procedures per surgeon increased, but the number of cardiac operations have decreased compared with 1980. Overall, general thoracic and cardiac operations increased, but peripheral vascular procedures and pacemaker insertions decreased in almost all nine census regions. Fewer general thoracic and cardiac operations were performed per thoracic surgeon in the western United States than in central and eastern regions. In response to questions about work load, 55% believed that their clinical activity was satisfactory, 42% operated too little, and 3% operated too much. The 363 non-Thoracic Board-certified surgeons who responded performed 14% of general thoracic and 8% of cardiac surgery in 1985. During the first half of the 1980s, our specialty certified an average of 134 thoracic surgeons annually, which is higher than the 120 surgeons per year estimated to meet the projected demand.

Adult↗
PubMed1997

Pediatric surgeons' activities and future plans.

OBJECTIVE: The authors aim was to survey members of the Canadian Association of Paediatric Surgeons (CAPS) on their demographics, practice, and future plans. MATERIALS AND METHODS: A questionnaire was mailed to 86 members. RESULTS: We received 60 questionnaires (70%), with a return rate including 85% men and 15% women. Seventeen percent of the respondents do not have children, 8% did not answer the question pertaining to children, and 8% expect to have more children. Among the 75% of surgeons with children, 16% have reduced the number of hours worked, from 2 hours to more than 1 day per week, for a number of years. Younger surgeons and women are more likely to reduce their work load for their family life. Most surgeons practice in an academic (64%) or a mixed setting (25%), with only 12% involved in private practice. On average, 69% of their time is devoted to patient care; teaching and research each take an average of 10% of the surgeon's time, while 9% of their time is spent on administrative duties. Study respondents work an average of 57 hours per week, and 45 weeks per year. Age significantly influenced the number of hours worked per week, and the number of weeks worked on a yearly basis. Gender and type of practices did not significantly influence the number of hours or weeks worked, whereas location of practice did. Spouse activity also had an impact on the number of hours and weeks worked. When asked about their preference for the next 5 years, 30% of surgeons would opt for a decrease in their level of activity, and 15% wish to retire. Irrespective of the age group or the type of practice, surgeons would prefer to decrease their level of activity. A recurring theme submitted by respondents is the need for increased time for teaching and research and less administrative work. Finally, 60% of surgeons were very satisfied with their work, 27% were satisfied, and 12% were unsatisfied. CONCLUSION: Lifestyle and family commitment have an impact on pediatric surgeons' activity and should be considered when analyzing work force requirements.

Adult↗
PubMed1995

Venous reflux in symptom-free vascular surgeons.

PURPOSE: Work posture and occupation are among the most controversial predisposing factors associated with venous disease. We examined the distribution and extent of venous reflux in the lower extremities of symptom-free vascular surgeons, who were typically classified as leading a life of prolonged standing, in comparison to a group of symptom-free volunteers. METHODS: In this prospective study (January 1991 to April 1994), the venous system in the lower limb veins of 28 vascular surgeons (56 limbs) and 25 normal volunteers (50 limbs) was examined by color-flow duplex imaging. The two groups were matched for age (29 to 45 years) and sex (all men). Subjects with clinical signs and symptoms of venous disease, history of deep or superficial vein thrombosis, or previous venous operation or injection sclerotherapy were not included in the study (12 vascular surgeons). RESULTS: Venous reflux was detected in 29 limbs of vascular surgeons (52%) and in 16 limbs of the control group (32%) (chi-squared test = 4.232, p = 0.039). In the latter, superficial venous incompetence was detected in 9 of 50 limbs (18%), deep venous or perforator incompetence in 3 of 50 limbs (6%), and venous incompetence involving both the superficial and deep systems in 4 of 50 limbs (8%). In the group of vascular surgeons, reflux in the superficial veins was seen in 22 of 56 limbs (39%), in the deep and or perforating veins in 4 of 56 limbs (7%), and in both the superficial and deep veins in 3 of 56 limbs (5%). Superficial venous reflux was more frequently encountered in the limbs of 45% of vascular surgeons (25 of 56) than in the limbs of the control subjects 26% (13 of 50) (chi-squared test = 3.99, p = 0.047). Distal long saphenous vein reflux alone accounted for 39% (5 of 13) of any superficial venous incompetence in the limbs of the control subjects, and was higher, at 48% (12/25), in the vascular surgeons. Reflux in the gastrocnemial veins was equally distributed between the limbs of the control subjects (10%) and the vascular surgeons (11%). CONCLUSIONS: Venous reflux was more frequently seen among symptom-free vascular surgeons than normal individuals of a nonmedical vocation. The superficial system was by far the most common site of venous incompetence in both groups. Below-knee-long saphenous vein reflux in any combination was present in more than 75% of the limbs with superficial venous incompetence.

Adult↗
PubMed1998

A survey of current attitudes of British and Irish vascular surgeons to venous sclerotherapy.

AIM: To determine current practice amongst vascular surgeons regarding venous sclerotherapy. METHOD: A postal questionnaire was sent to 350 members of the Vascular Surgical Society of Great Britain and Ireland. RESULTS: There were 218 replies (62%). Forty surgeons (18.3%) never injected varicose veins (VV) although six injected venous flares. Most surgeons (n = 168, 77.1%) reserved sclerotherapy for residual VV postoperatively. Primary varicose veins without proximal incompetence were injected by 152 (69.7%) and recurrent VV without proximal incompetence by 141 (64.7%). Sixteen surgeons only injected residual postoperative VV. Few surgeons injected VV in the presence of proximal incompetence. Where specified, 46% of respondents were injecting fewer VVs than in previous years. Only 5% were injecting more. By contrast, 44% were injecting more venous flares than previously (p < 0.001). Eight different sclerosants were used, the commonest being STD (146 surgeons) and Sclerovein (33). The median number of patients treated with sclerotherapy was 11-50 per year compared with 51-150 per year who were operated upon. The median time advised for compression was 2 weeks (range--a few minutes--2 months). Treatment was repeated at a median of 4 weeks (0-6 months). Thirty-two surgeons obtained written consent. All but eight respondents discussed potential complications, the commonest being staining and ulceration. Forty-six surgeons had patients who had experienced serious complications, the commonest being ulceration. There was one reported death from a pulmonary embolus. CONCLUSION: Sclerotherapy is being used less frequently for VV. Most surgeons use it for residual VV and for those without proximal incompetence.

Attitude of Health Personnel↗
PubMed2002

The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer.

BACKGROUND: With conventional blunt surgical resection of rectal cancer, local recurrence rates are high and the individual surgeon putatively influences patient outcome. With total mesorectal excision (TME) local recurrence rates have been reduced and intersurgeon variability may be less important. The 'TME project' was a collaborative project that included surgical workshops in Stockholm between 1994 and 1997. The aim of this study was to assess the impact of the project on the practice of rectal cancer surgery in Stockholm and to analyse whether surgeon case volume and participation in the workshops influenced patient outcome. METHODS: All 652 patients who had an abdominal resection for rectal cancer in Stockholm between 1995 and 1997 were included. Outcome was compared in patients operated on by teams that included high-volume surgeons (more than 12 operations per year) with teams that included low-volume surgeons (12 operations or fewer per year), as well as between teams that including workshop participants and non-participants. RESULTS: Forty-six surgeons operated on the 652 patients. Five high-volume surgeons operated on 48 per cent of the patients. In these, outcome was significantly better than in patients treated by low-volume surgeons (local recurrence rate 4 versus 10 per cent (P = 0.02); rate of rectal cancer death 11 versus 18 per cent (P = 0.007)). Twenty-six surgeons were workshop participants and performed 93 per cent of the operations. Radiotherapy, TME and sphincter-preserving surgery were more common among patients treated by workshop participants. CONCLUSION: The TME project has had an impact on rectal cancer surgical practice in Stockholm. Variability in patient outcome was mainly related to case volume, with better results obtained in patients treated by high-volume surgeons.

Adult↗
PubMed2003

Impact of surgeon and surgical center characteristics on choice of permanent vascular access.

BACKGROUND: The impact of the surgeon and surgical center characteristics on choice of autogenous arteriovenous (AV) fistula versus artificial AV graft as permanent vascular access for hemodialysis has not been studied. METHODS: We used national data from the Department of Veterans Affairs Veterans Health Administration to measure the association of surgeon and surgical center characteristics with choice of initial permanent vascular access among patients undergoing their first vascular access placement procedure between October 1, 2000 and September 30, 2001 (fiscal year 2001). Data were analyzed using a hierarchical logistic regression model clustered for surgical center and surgeon. RESULTS: The study population included 1114 patients, 74 Veterans Administration Medical Centers, and 182 surgeons. Seventy-two percent of patients received an AV fistula as their initial form of permanent vascular access. After adjusting for differences in patient, center, and surgeon characteristics, odds of AV fistula placement at high volume centers (>30 procedures per year) were more than three times greater than at low volume centers [odds ratio (OR) 3.26, 95% confidence interval (95% CI) 1.37 to 7.75, P = 0.008]. In addition, a strong clustering effect was present at the level of the surgeon (OR 1.55, 95% CI 1.19 to 2.03, P = 0.001) but not at the level of the surgical center, indicating an association with surgeon practice pattern. CONCLUSION: Barriers to AV fistula placement can exist at the levels of the surgeon and surgical center, respectively. Future strategies to improve AV fistula placement rates should target surgeons and surgical centers in addition to patients, nephrologists, and primary care providers.

Aged↗
PubMed1997

Transmission of hepatitis B to patients from four infected surgeons without hepatitis B e antigen.

BACKGROUND: Transmission of hepatitis B virus (HBV) to patients by infected surgeons who carry hepatitis B e antigen (HBeAg) has been documented repeatedly. In the United Kingdom HBeAg-positive surgeons are not permitted to perform certain procedures that carry a risk that patients might be exposed to the blood of a health care worker. There are no practice restrictions for carriers of hepatitis B surface antigen without detectable HBeAg, unless transmission has been demonstrated. METHODS: In four unconnected cases of acute hepatitis B, surgery was identified as a possible source, so we tested the surgical teams for serologic markers of HBV infection. In each case a surgeon was found to be infected with the virus. HBV DNA was amplified by a nested polymerase chain reaction from serum from the four infected surgeons and the four patients, and direct nucleotide sequencing of two regions of the HBV genome was performed. Alternative sources of infection were ruled out. Other patients on whom three of the surgeons had recently performed procedures were offered testing. RESULTS: All four surgeons were carriers of HBV, but none had detectable serum HBeAg. The nucleotide sequences of HBV DNA from the surgeons were indistinguishable from those from the corresponding patients. The screening of other exposed patients identified at least two other patients who had probably acquired hepatitis B infection from one of these surgeons. CONCLUSIONS: Surgeons who are carriers of HBV without detectable serum HBeAg can transmit HBV to patients during procedures.

Adult↗
PubMed2002

Transmission of hepatitis B virus from a surgeon to his patients during high-risk and low-risk surgical procedures during 4 years.

OBJECTIVE: We investigated cases of acute hepatitis B in The Netherlands that were linked to the same general surgeon who was infected with hepatitis B virus (HBV). DESIGN: A retrospective cohort study was conducted of 1,564 patients operated on by the surgeon. Patients were tested for serologic HBV markers. A case-control study was performed to identify risk factors. RESULTS: The surgeon tested positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with a high viral load. He was a known nonresponder after HBV vaccination and had apparently been infected for more than 10 years. Forty-nine patients (3.1%) were positive for HBV markers. Transmission of HBV from the surgeon was confirmed in 8 patients, probable in 2, and possible in 18. In the remaining 21 patients, the surgeon was not implicated. Two patients had a chronic HBV infection. One case of secondary transmission from a patient to his wife was identified. HBV DNA sequences from the surgeon were completely identical to sequences from 7 of the 28 patients and from the case of secondary transmission. The duration of the operation and the occurrence of complications during or after surgery were identified as independent risk factors. Although the risk of HBV infection during high-risk procedures was 7 times higher than that during low-risk procedures, at least 8 (28.6%) of the 28 patients were infected during low-risk procedures. CONCLUSIONS: Transmission of HBV from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons and optimization of infectious disease surveillance. Policies allowing HBV-infected surgeons to perform presumably low-risk procedures should be reconsidered.

Adolescent↗
PubMed1998

The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.

OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy.

Clinical Competence↗
PubMed1996

Violence prevention involvement among trauma surgeons: description and preliminary evaluation.

UNLABELLED: Violence has become a primary focus for the national agenda and a growing public health concern in the medical community. Although prevention is a major component of public health policy, it is unclear what contribution trauma surgeons and trauma centers are making toward violence prevention. PURPOSE: The purpose of this study was to assess the extent of violence prevention activity at trauma centers, the involvement and attitudes of trauma surgeons toward violence prevention, and the perceived need for a formal violence prevention curriculum. METHODS: Self-report postal surveys were sent to trauma directors and associate directors at 430 Level I and Level II trauma centers throughout the United States. A descriptive analysis was performed using the 230 (53%) returns. RESULTS: 55% of Centers reported an active violence prevention program with surgeons participating in these existing programs 47% of the time. Overall, only 26% of surgeons reported being active in violence prevention activities, although 71% thought that violence prevention should be an integral part of trauma center activity. Trauma surgeon involvement in violence prevention and the presence of an active institutional program was demonstrated significantly (p <0.001, chi2). Lack of available time and "not knowing where to start" were cited as the most common reasons for lack of involvement in violence prevention activity. CONCLUSION: There is strong support among trauma surgeons for violence prevention programs and for the integration of these programs into the trauma center. A relatively small number of surgeons actually are engaged in violence prevention activity, but most (69%) are willing to become personally involved. The data suggest that established violence prevention programs facilitate involvement of trauma surgeons in violence prevention activity. The discrepancy between actual involvement in, and general support for, violence prevention efforts may be explained by a lack of established roles and previous experience for surgeons and by limited guidance outside of existing programs.

Attitude of Health Personnel↗
PubMed1998

Surveyed opinion of American trauma surgeons in management of colon injuries.

BACKGROUND: Primary repair or resection and anastomosis of colon wounds have been advocated in many recent studies, but the proportion of trauma surgeons accepting these recommendations is unknown. OBJECTIVE: To determine the current preferences of American trauma surgeons for colon injury management. METHODS: Four hundred forty-nine members of the American Association for the Surgery of Trauma were surveyed regarding their preferred management of eight types of colon wounds among three options: diverting colostomy (DC), primary repair (PR), or resection and anastomosis (RA). The influence of selected patient factors and surgeons' characteristics on the choice of management was also surveyed. RESULTS: Seventy-three percent of surgeons completed the survey. Ninety-eight percent chose PR for at least one type of injury. Thirty percent never selected DC. High-velocity gunshot wound was the only injury for which the majority (54%) would perform DC. More than 55% of the surgeons favored RA when the isolated colon injury was a contusion with possible devascularization, laceration greater than 50% of the diameter, or transection. Surgeons who managed five or fewer colon wounds per year chose DC more frequently (p < 0.001) and PR less frequently (p < 0.001) than surgeons who managed six or more colon wounds per year. CONCLUSION: The prevailing opinion of trauma surgeons favors primary repair or resection of colon injuries, including anastomosis of unprepared bowel. Surgeons who manage fewer colon wounds prefer colostomy more frequently.

Adult↗
PubMed2000

What's a trauma surgeon worth? A salary survey of the Eastern Association for the Surgery of Trauma.

BACKGROUND: Professional compensation is an important consideration for all physicians. Few objective data specific to trauma surgery are available to those seeking employment or contract renegotiation in the United States. National benchmark salary data should assist trauma surgeons in securing fair and equitable compensation. The purpose of this study was to survey trauma surgeons who are members of the Eastern Association for the Surgery of Trauma regarding current salary levels, benefits, contract arrangements, practice descriptors, and opinions on professional reimbursement. METHODS: Anonymous self-report questionnaires were mailed to active members of the Eastern Association for the Surgery of Trauma. Only general surgeons practicing in the United States were included. Data were maintained in a confidential database. RESULTS: Of 385 surveys mailed, 207 (53.7%) were returned. There were 172 usable questionnaires, for an overall response rate of 44.6%. Nearly 93% of respondents worked in states east of the Mississippi River. Mean age was 42.4 years (range, 33-50 years) and 94.7% were male. Over 66% of the surgeons were fellowship trained in trauma, and 44% were chiefs of trauma services. The mean years of experience was 8.8 years (range, 1-17 years). Most respondents worked at teaching institutions (88%) and Level I centers (66%). The mean annual compensation was $229,142+/-$78,045 (range, $90,000-$528,000). These salaries were comparable to ranges from academic surveys of general surgeons. Few surgeons had professional guidance negotiating their compensation. Survey respondents were aware of few objective data specific to trauma surgery. CONCLUSION: This preliminary survey provides a unique benchmark for trauma surgeon salaries. Trauma surgeons should benefit from a more informed and structured approach to salary negotiations. Detailed trauma surgeon-specific data obtained periodically are essential to ensuring fair and equitable compensation in this specialty.

Adult↗
PubMed1999

The effect of increased plastic surgeon supply on fees for aesthetic surgery: an economic analysis.

The size of the plastic surgery workforce has important effects on the financial environment of the specialty. Economic theory predicts that increasing the area supply of surgeons performing aesthetic surgery will result in lower fees for their services. This study tested that theory in the actual aesthetic surgery marketplace. The study examined the ratio of plastic surgeons to the general population of several states. It then traced the aesthetic surgery fees resulting from different densities of area plastic surgeons. This information was economically analyzed to project the fee effects of possible future changes in the number of practicing plastic surgeons. For the states of New York, California, and Texas, there is a proportional decrease in fees as the density of plastic surgeons increases. For example, New York has 34 percent more plastic surgeons proportionally than Texas, and its fees are 30 percent lower in real dollars. Economic analysis can project the fee effects of changing the supply of surgeons performing aesthetic surgery. The analysis reveals that a 30 percent national increase in the supply of plastic surgeons would lower fees by approximately 32 percent. Similarly, if the number of plastic surgeons increases by 50 percent, fees will decrease by approximately 53 percent. However, these fee effects can be mitigated by expanding the demand for aesthetic surgery. In conclusion, the size of the plastic surgery workforce has profound effects on the fees paid for aesthetic surgery, and the magnitude of these effects can be understood, predicted, and optimized using the tools of economics.

Fees, Medical↗
PubMed2003

Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens.

PURPOSE: Cancer at the resection margin (a positive surgical margin) after radical prostatectomy is associated with an increased risk of recurrence even after adjusting for other known risk factors, including pretreatment serum prostate specific antigen (PSA), clinical stage, grade and pathological stage (level of extracapsular extension, seminal vesicle invasion and pelvic lymph node status). Of these prognostic factors only surgical margin status can be influenced by surgical technique. We examined variations in the rate of positive surgical margins among surgeons after controlling for the severity of disease and volume of cases per surgeon. MATERIALS AND METHODS: A total of 4,629 men were treated with radical prostatectomy by 1 of 44 surgeons at 2 large urban centers between 1983 and 2002 for clinical stage T1-T3NxM0 prostate cancer. Patients were excluded if they had previously received androgen deprivation therapy or radiation therapy to the pelvis. Positive surgical margins were defined as cancer at the inked resection margin. Other risk factors analyzed were serum PSA, grade (Gleason sum), extracapsular extension level (none, invasion into the capsule, present [not otherwise specified], focal extracapsular extension or established extracapsular extension), seminal vesicle invasion, pelvic lymph node metastases, surgery date, surgeon and volume of cases per surgeon. RESULTS: For the 26 surgeons who each treated more than 10 patients in the study the rate of positive surgical margins was 10% to 48%. On multivariable analysis higher serum PSA, extracapsular extension level, higher radical prostatectomy Gleason sum, surgery date, surgical volume and surgeon were associated with surgical margin status after controlling for all other clinical and pathological variables. CONCLUSIONS: While the clinical and pathological features of cancer are associated with the risk of a positive margin in radical prostatectomy specimens, the technique used by individual surgeons is also a factor. Lower rates of positive surgical margins for high volume surgeons suggest that experience and careful attention to surgical details, adjusted for the characteristics of the cancer being treated, can decrease positive surgical margin rates and improve cancer control with radical prostatectomy.

Clinical Competence↗