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PubMed2005

Proficiency of surgeons in inguinal hernia repair: effect of experience and age.

OBJECTIVES: We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. SUMMARY BACKGROUND DATA: In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant differences in recurrence rates (RR) for the laparoscopic procedure as a result of surgeons' experience. We have also reported significant differences in RR for the open procedure related to resident postgraduate year (PGY) level. METHODS: We analyzed data from unilateral laparoscopic and open herniorrhaphies from CSP 456 (n = 1629). Surgeon's experience (experienced > or =250 procedures; inexperienced <250), surgeon's age, median PGY level of the participating resident, operation time, and hospital observed-to-expected (O/E) ratios for mortality were potential independent predictors of RR. RESULTS: Age was dichotomized into older (> or =45 years) and younger (<45 years). Surgeon's inexperience and older age were significant predictors of recurrence in laparoscopic herniorrhaphy. The odds of recurrence for an inexperienced surgeon aged 45 years or older was 1.72 times that of a younger inexperienced surgeon. For open repairs, although surgeon's age and operation time appeared to be related to recurrence, only median PGY level of <3 was a significant independent predictor. CONCLUSION: This analysis demonstrates that surgeon's age of 45 years and older, when combined with inexperience in laparoscopic inguinal herniorrhaphies, increases risk of recurrence. For open repairs, only a median PGY level of <3 was a significant risk factor.

Adult↗
PubMed2003

The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients.

BACKGROUND: The presence of a surgeon at the initial assessment and care of the trauma patient has been the focal point of trauma center designation. However, for Level I verification, the American College of Surgeons Committee on Trauma currently does not require the presence of an attending trauma surgeon in the hospital (IH), provided senior surgical residents are immediately available. Likewise, the state of Missouri does not mandate an IH presence of the attending trauma surgeon but requires senior (postgraduate year 4 or 5) level surgical residents to immediately respond, with a 20-minute response time mandated for the attending surgeon if IH or out of the hospital (OH). Nevertheless, some claim that IH coverage by attending surgeons provides better care for seriously injured patients. METHODS: This retrospective study assessed patient care parameters over the past 10 years on critically injured patients to detect any difference in outcome whether the surgeon was IH or OH at the time of the trauma team activation (cardiopulmonary instability, Glasgow Coma Scale [GCS] score < 9, penetrating truncal injury). Patients were subcategorized into blunt/penetrating, shock (systolic blood pressure < 90 mm Hg) on arrival, GCS score < 9, Injury Severity Score (ISS) > 15, or ISS > 25. Response was examined from 8 am to 6 pm weekdays (IH) or 6 pm to 8 am weekdays and all weekends (OH). Patient care parameters examined were mortality, complications, time in the emergency department, time to the operating room, time to computed tomographic scanning, intensive care unit length of stay (LOS), and hospital LOS. RESULTS: For all patients (n = 766), there was no significant difference in any parameters except intensive care unit LOS (IH, 4.90 +/- 7.96 days; OH, 3.58 +/- 7.69 days; p < 0.05). For blunt trauma (n = 369), emergency department time was shorter (99.71 +/- 88.26 minutes vs. 126.51 +/- 96.68 minutes, p < 0.01) and hospital LOS was shorter (8.04 +/- 1.02 days vs. 11.08 +/- 1.15 days, p < 0.05) for OH response. For penetrating trauma (n = 377), shock (n = 187), GCS score < 9 (n = 248), ISS > 15 (n = 363), and ISS > 25 (n = 230), there were no statistically significant differences in any patient care parameter between IH and OH response. For those in most need of urgent operation-penetrating injuries and shock-there were no differences in time to operating room or mortality for OH or IH response. CONCLUSION: As long as initial assessment and care is provided by senior level IH surgical residents and as long as the attending surgeon responds in a defined period of time (if OH) to guide critical decision-making, the IH presence of an attending surgeon has not been shown in this retrospective study to improve care of the critically injured patient.

Glasgow Coma Scale↗
PubMedDate not supplied

Mental readiness in surgeons and its links to performance excellence in surgery.

The purpose of this study was to assess mental factors related to surgical excellence among surgeons. In-depth interviews were conducted with 33 highly proficient surgeons involved in high- (51%) and low- (49%) mortality-risk surgery. A "Surgeon Interview Guide" was developed for eliciting relevant qualitative and quantitative data. The success elements from Orlick's "Model of Human Excellence," based on work with elite athletes, were used as the basic framework for the qualitative analysis of the interview transcripts. Of the three major readiness factors rated by the surgeons--mental, technical, and physical--surgeons rated mental readiness as most important for performance excellence in surgery; 49, 41, and 10%, respectively. Mental readiness was also the factor that showed the most significant change between successful and disappointing surgical performances (p = 0.003). The following mental factors were identified as important among highly qualified surgeons and in surgeons performing high-mortality-risk surgery: commitment, self-belief, positive imagery, mental readiness, full focus, distraction control, and constructive evaluation. Highly successful experienced surgeons perform at an exceptional level largely because of the quality of their mental skills. Residents in surgery may benefit from systematic mental training in similar mental skills. This approach has been effective in other high-performance disciplines and could likewise play a meaningful role in helping surgeons improve their mental readiness for the challenges they face.

Female↗
PubMed2006

Referrals to high-quality cardiac surgeons: patients' race and characteristics of their physicians.

OBJECTIVE: To examine the referral process to cardiac surgeons in order to explain racial disparities in access to high-quality cardiac surgeons. DATA SOURCES/STUDY SETTINGS: All white and black Medicare fee-for-service patients undergoing coronary artery bypass graft (CABG) surgery in New York State during 1997-1999. STUDY DESIGN: A retrospective analysis of referral patterns for white and black patients in relation to the quality of the cardiac surgeon, measured by the surgeon's risk-adjusted mortality rate (RAMR), and in relation to characteristics of the physician providing the majority of cardiac care before the surgery. The average RAMRs of the surgeons to whom different physicians referred patients were compared using t-tests and paired t-tests. A hierarchical multivariate regression model was estimated to test hypotheses about the effect of physicians' characteristics on referrals of blacks to low-quality surgeons. DATA EXTRACTION METHOD: Variables were constructed from Medicare claims. PRINCIPAL FINDINGS: The differential in surgeons' quality for white and black patients is partially due to the physician providing the majority of cardiac care before the surgery. There is both across- and within-physician variation in referrals. Of the physician characteristics investigated, only the number of black patients referred to CABG and the percent of all cardiac referrals to the same hospital decrease the difference in surgeons' quality between whites and blacks. CONCLUSIONS: Several different pathways lead blacks to cardiac surgeons of lower quality. Further research is needed to understand the causes and inform policies designed to minimize disparities in access to high-quality providers.

Black or African American↗
PubMed1988

Necessary conditions for supporting a general surgeon in rural areas.

Loss of a general surgeon in a rural community cna alter the referral patterns, the image and utilization of the local hospital, and even the market share of local primary care physicians. Prior research has not defined the necessary and/or sufficient conditions for a rural county to be able to support a local general surgeon. Based upon empirical analysis of 96 rural Missouri counties and the limited literature available on rural surgeons and physician referral rates, a first approximation of those conditions are offered. We conclude that a rural county with a hospital, a population base of more than 15,000 people, and at least 11 potential referring physicians has sufficient conditions to enable it to support a local general surgeon. Among those rural Missouri counties not meeting the above conditions but having a general surgeon in 1984, we estimate that 8 to 10 potential referring physicians appear to be the minimum necessary condition for supporting a rural general surgeon through patient referral. From those conclusions, we argue that any rural hospital currently without a surgeon should re-examine its situation. To prepare for a competitive future, such a hospital should take every opportunity to expand the referral base necessary to support a full-time local surgeon rather than place long-term reliance upon itinerant general surgeons.

Catchment Area, Health↗
PubMed2003

Survey among surgeons on surgical treatment strategies for secondary peritonitis.

BACKGROUND: There is controversy about performing either a planned relaparotomy (PR) or relaparotomy on demand (ROD) in patients with secondary peritonitis. Subjective factors influencing surgeons in decision making for either surgical treatment strategy have never been studied. METHODS: All 858 surgeons of the Association of Surgeons of The Netherlands were sent a survey with 16 case vignettes simulating peritonitis patients and evaluating the preference for PR or ROD. RESULTS: Sixty-two percent of surgeons responded to the survey. Of the returned surveys, 407 were eligible for evaluation. The responding surgeons had a slight overall preference for the ROD strategy, as shown by the mean overall preference score of 5.2 (range 3.54-6.52, with a maximal score of 7). Gastrointestinal surgeons and surgeons working in regional and smaller hospitals were significantly more in favour of a ROD strategy than their counterparts. Factors significantly influencing the preference towards PR were ischaemia as aetiology and performing a primary anastomosis; as for ROD, it was small bowel as focus, local extent of contamination and the question whether abdominal closure was possible. However, there was a considerable variability in treatment decisions by surgeons. CONCLUSION: The majority of responding surgeons would make a choice for a particular treatment strategy based on peritonitis and surgical treatment characteristics. There was a slight overall preference towards the ROD strategy despite the considerable variability per case vignette.

Adult↗
PubMed1992

The use of thromboprophylaxis in total hip replacement surgery: are the attitudes of orthopaedic surgeons changing?

We conducted a survey of all 926 active members of the British Orthopaedic Association using a postal questionnaire to find out their current attitude to thromboprophylaxis in total hip replacement surgery. Previous surveys have been performed, and with all the recent literature on the subject we wanted to see if the attitude of British orthopaedic surgeons has changed. There were 676 replies, a response rate of 73%. Fifty-five replies were excluded, those from surgeons who had retired from practice or whose practice did not include total hip replacement surgery. Of the remaining 621 surgeons, 466 (75%) use some method of thromboprophylaxis, with 367 (59%) routinely using prophylactic pharmacological agents and 99 (16%) using mechanical methods of thromboprophylaxis. Twenty-five per cent (155) of surgeons used no routine method of thromboprophylaxis. Eight-six per cent (534) of surgeons used a pharmacological method of prophylaxis in those patients thought to have a high risk of developing a deep vein thrombosis (DVT) (eg previous DVT, cardiovascular disease, obesity). Thirty-two different methods of thromboprophylaxis were used. Low molecular weight heparin is now being used by 19% of surgeons routinely and by 25% of surgeons in high risk cases, whereas 3 years ago it was not used at all. Our survey shows that although there is still a great reluctance for British orthopaedic surgeons to use pharmacological agents routinely in thromboprophylaxis. Amongst those that do, low molecular weight heparin is being increasingly used. More surgeons may want to use low molecular weight heparin routinely, but in some hospitals it is not currently available.

Attitude of Health Personnel↗
PubMedDate not supplied

Judgment analysis of surgeons' prioritization of patients for elective general surgery.

BACKGROUND: Access to elective general surgery in New Zealand is governed by clinicians' judgment of priority using a visual analog scale (VAS). This has been criticized as lacking reliability and transparency. Our objective was to describe this judgment in terms of previously elicited cues. METHODS: We asked 60 general surgeons in New Zealand to assess patient vignettes using 8 VAS scales to determine priority. They then conducted judgment analysis to determine agreement between surgeons. Cluster analysis was performed to identify groups of surgeons who used different cues. Multiple regression for the combined surgeons was undertaken to determine the predictability of the 8-scale VAS. RESULTS: Agreement between surgeons was poor (ra=0.48). The cause of poor agreement was mostly due to poor consensus (G) between surgeons in how they weighted criteria. Using cluster analysis, we classified the surgeons into 2 groups: 1 took more account of quality of life and diagnosis, whereas the other group placed more weight on the influence of treatment. The 8-scale VAS showed good predictability in assigning a priority score (R2=0.66). DISCUSSION: The level of agreement reflects surgeons' practice variation. This is exemplified by 2 distinct surgeon groups that differ in how criteria were weighted.

Elective Surgical Procedures↗
PubMed2004

Perioperative complication rate of total ankle replacement is reduced by surgeon experience.

BACKGROUND: Recent studies suggest the perioperative complication rate of total ankle arthroplasty decreases as a surgeon becomes familiar with the procedure. This study tests the hypothesis that the number of perioperative adverse events will decrease as surgeon experience with total ankle replacement increases. METHODS: Ten surgeons completed retrospective chart and radiographic reviews of their first 10 cases as well as 10 subsequent cases of the Scandinavian Total Ankle Replacement (STAR). Not all surgeons completed 10 cases within the allotted time periods, and two patients were excluded for less than 3-month follow-up, resulting in 187 cases for review. The surgeons performed an average of 12.8 (range, 0-61) STARs between these two time periods. Cases were divided into Early Group if they were among the first five STARs a surgeon performed and Late Group if they were after the first five. RESULTS: The average patient age was 60.4 +/- 12.8 years. The etiology of arthrosis included 96 (51%) of 187 posttraumatic, 49 (26%) idiopathic, and 33 (18%) rheumatoid. Patients in Early Group had a 3.1 times greater chance of having a perioperative adverse event (95% CI 1.6-6.1, p <.001), and a 3.2 times greater chance of having a perioperative wound problem (95% CI 1.5-6.8, p =.002) than patients in Late Group. Patients in Early Group took 1 week longer to heal their wounds than patients in Late Group (4.5 vs. 3.5 weeks, p =.046). CONCLUSIONS: This study shows a decrease in the perioperative adverse event rate commensurate with surgeon experience with STAR. In contrast to other reports, this study was unable to show a decrease in the number of perioperative fractures with increasing surgeon experience. This information is important for planning how best to train surgeons new to total ankle replacement and for patient counseling regarding the potential risks of the procedure.

Ankle Injuries↗
PubMed2003

Incidence of wrong-site surgery among hand surgeons.

BACKGROUND: Until recently, wrong-site surgery had received little attention and had been considered a random, infrequent event. In 1997, the American Academy of Orthopaedic Surgeons (AAOS) Task Force on Wrong-Site Surgery was formed to determine the incidence of wrong-site surgery and to initiate the "Sign Your Site" campaign. The purpose of our study was to determine the incidence of wrong-site surgery among hand surgeons, elucidate surgeons' practice habits and measures taken to prevent its occurrence, and evaluate the effectiveness of the AAOS "Sign Your Site" campaign. METHODS: One thousand, five hundred and sixty active members of the American Society for Surgery of the Hand (ASSH) were polled by mail. Each member received a confidential twenty-nine-question survey. Nonrespondents were sent a second, identical survey. One thousand and fifty (67%) of the surgeons responded. RESULTS: One hundred and seventy-three surgeons (16%) reported that they had prepared to operate on the wrong site but then noticed the error prior to the incision, and 217 (21%) reported performing wrong-site surgery at least once. Of an estimated 6,700,000 surgical procedures, 242 were performed at the wrong site, an incidence of one in 27,686 procedures. The three most common locations of wrong-site surgery were the fingers (153), hands (twenty), and wrists (twenty-one). Permanent disability occurred in twenty-one patients (9%). Ninety-three cases (38%) led to legal action or monetary settlement. Seventy percent of the responding orthopaedic surgeons were aware of the "Sign Your Site" campaign, and 45% had changed their practice habits as a result. CONCLUSIONS: Prior to the AAOS "Sign Your Site" campaign, the issue of wrong-site surgery by hand surgeons had not been addressed. Although wrong-site surgery is rare, 21% of hand surgeons reported performing it at least once during their careers. Since the institution of the "Sign Your Site" campaign, 45% of orthopaedic hand surgeons have changed their practice habits, and almost all routinely take some action to prevent wrong-site surgery.

Hand↗
PubMed2004

The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty.

BACKGROUND: As far as we know, no previous study has determined the relationship between volume and outcomes for shoulder arthroplasty. We hypothesized that surgeons and hospitals with higher caseloads of total shoulder arthroplasties and hemiarthroplasties have better outcomes as measured by decreased mortality rate, shorter length of stay in the hospital, reduced postoperative complications, and routine disposition of patients on discharge. METHODS: Data on patients undergoing shoulder arthroplasty were extracted from the Nationwide Inpatient Sample databases for the years 1988 through 2000. Logistic regression with generalized estimating equations and multiple linear regression models were used to estimate the adjusted association between surgeon and hospital volume and outcomes for total shoulder arthroplasty and hemiarthroplasty after adjusting for comorbidity, age, race, household income, and sex. RESULTS: The mortality rates for patients who had a total shoulder arthroplasty performed by surgeons who did fewer than two procedures per year (0.36%) or who did between two and fewer than four procedures per year (0.32%) were higher than those for patients who had a total shoulder arthroplasty performed by surgeons who did four procedures or more per year (0.20%). The risk-adjusted rate of postoperative complications after hemiarthroplasty was significantly higher for patients managed by surgeons who performed fewer than two procedures per year (1.68%) than for those managed by surgeons with a volume of five procedures or more per year (0.97%). The possibility of postoperative complications when total shoulder arthroplasty was performed in hospitals with a volume of fewer than five procedures (1.44%) or in those with a volume of five to ten procedures per year (1.45%) was significantly higher than that in hospitals where ten procedures or more were performed every year (0.64%). The mean lengths of stay in the hospital after total shoulder arthroplasty and hemiarthroplasty were significantly longer when the operations were performed by surgeons who did fewer than two procedures per year or when they were done in hospitals with a volume of fewer than five procedures per year or with a volume of five to fewer than ten procedures per year than when they were done in hospitals or by surgeons in the highest volume category (p < 0.001). CONCLUSIONS: Patients who have a total shoulder arthroplasty or hemiarthroplasty performed by a high-volume surgeon or in a high-volume hospital are more likely to have a better outcome. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Aged↗
PubMed2004

Increasing the placement of native veins arteriovenous fistulae--the role of access surgeons' education and profiling.

BACKGROUND: The utilization of native veins arteriovenous (AV) fistulae in the US remains low despite their superiority over other types of hemodialysis access. METHODS: A nephrologist-driven, quality improvement project that concentrated on access surgeons was utilized to increase fistulae placement. Period I of the project (1998-2000) entailed surgeons' education about advantages of fistulae and methods to increase their placement. During period II (2001-2002), referral patterns to surgeons were altered according to their performance, and surgeons out of the area were utilized. Data on patient characteristics, type of access placed and access complications were measured. RESULTS: Fistulae constituted 45% of AV access placed in period I and 79% of those placed in period II. Fistulae prevalence, which was 15% at the end of the pre-project period, increased to 27% at the end of period I and 49% at the end of period II. All changes were statistically significant. Complication rates did not increase. Fistulae placement by surgeons operating in both periods increased in period II. The distribution of types of access placed and outcomes differed significantly among surgeons. CONCLUSIONS: Fistulae placement could be increased when the nephrologist works with access surgeons and monitors their performance. Profiling of access surgeons by policy-makers could be a useful method for the identification of surgeons with better skill.

Aged↗
PubMed1998

Surgeons' opinions about the NHMRC clinical practice guidelines for the management of early breast cancer.

OBJECTIVE: To explore the opinions of surgeons about the NHMRC clinical practice guidelines for the management of early breast cancer (the Guidelines) and their views about and use of the accompanying Consumer's guide. DESIGN: Cross-sectional telephone survey. PARTICIPANTS AND SETTING: Surgeons throughout Australia who manage breast cancer, designated as "breast" or "general" (members or non-members of the Royal Australasian College of Surgeons' Section of Breast Surgery) and "urban" or "rural". RESULTS: Among 150 respondents (64% response rate) more than 80% of surgeons reported having read all or most of the Guidelines and believed they were useful in improving women's management and wellbeing, easy to understand, evidence-based, a good summary of recent evidence, and that they would assist agreement between women and healthcare providers. Surgeons agreed with most of the recommendations in the Guidelines, but 26% disagreed that "women should ideally be treated by a specialist who treats a large number of similar patients and who has access to the full range of treatment options in a multidisciplinary setting". In terms of medicolegal implications, 41% believed that the Guidelines would protect clinicians, while, of the 37% of surgeons who believed that they would expose doctors to increased problems, significantly more breast than general surgeons believed this (50% v. 19%; P < 0.001). Only 37% of surgeons routinely gave the Consumer's guide to all or more than half their patients. CONCLUSIONS: Surgeons are generally positive about the Guidelines, but certain issues should be addressed if they are to be optimally implemented, including confusion about the medicolegal implications, perceived difficulties with providing multidisciplinary care and poor use of the Consumer's guide.

Academies and Institutes↗
PubMed1999

Training of surgeons in Kenya at the University of Nairobi teaching hospital.

OBJECTIVE: To determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, since its inception in 1967. DESIGN: This was a retrospective (1975-1987) and prospective study (1988-1999). SETTING: Kenyatta National Hospital, a National Referral Hospital and University of Nairobi Teaching Hospital. SUBJECTS: All surgeons trained by the Department of Surgery of the University of Nairobi for postgraduate MMed in general surgery, anaesthesia, ENT surgery and ophthalmology from 1975 to March 1999. RESULTS: Two hundred and eighty-five surgeons with Master of Medicine degree were trained by the Department of Surgery of the University of Nairobi between 1975 and March 1999. They included 181 (63.51%) general surgeons; 46 (16.14%) anaesthetists; 35 (12.28%) ophthalmologists and 23 (8.07% ear, nose and throat (ENT) surgeons. One hundred and seventy-six, (61.75%) were from retrospective studies; 94 (32.98%) were from prospective studies while 15 (5.26%) were from both retrospective and prospective studies. Two hundred and thirty-two (81.40%) surgeons were Kenyans while 53 (18.60%) were foreigners. The majority, 42 (79.24%) of the foreigners were from other African countries. Thirty one (58.50%) were from neighbouring Uganda, Sudan, Tanzania, Ethiopia and Zambia. There was also one PhD in anaesthesia and one MD in urology during the same period. CONCLUSION: The University of Nairobi, Department of Surgery based at Kenyatta National Hospital has played a very significant and leading role in the training of surgeons for Kenya and even other African and foreign countries since its inception. Of the forty surgeons who constitute the academic staff in the Departments of General Surgery, Orthopaedic Surgery and Ophthalmology of the University of Nairobi, thirty-five surgeons (87.50%) have been trained by the Faculty of Medicine at KNH.

Education, Medical, Graduate↗
PubMed2002

[Distribution of colonic surgery among surgeons in the city of Copenhagen].

INTRODUCTION: The outcome of some surgical procedures is related to the surgeon's experience. We examined how much experience surgeons in 12 hospitals in the region of Copenhagen gained in colon surgery in 1999. MATERIAL AND METHODS: The Ministry of Health identified the number of colon patients operated on in the region of Copenhagen in 1999. The departments were asked to validate the lists of patients and to fill in a questionnaire describing the surgeon's experience in that year. RESULTS: Eleven of 12 departments answered the questionnaire (92%). One hundred and two senior surgeons operated on 674 patients. Forty of the surgeons operated on one to four patients in 1999, and only five performed 15 or more operations. More than 50% of the surgical procedures were carried out by surgeons who performed fewer than 10 colon operations in 1999. Most of the low-volume surgeons' operations were performed during calls. DISCUSSION: Colon surgery in the region of Copenhagen was performed by a large number of surgeons in many hospitals in 1999. Hospital volume was not associated with surgeon volume.

Clinical Competence↗
PubMed2003

Workforce patterns of rural surgeons in West Virginia.

Rural general surgeons perform a wide variety of procedures and have practices different from those of surgeons in larger communities. Because of this residents completing a classical general surgery training program may not be prepared for the rural setting. The 219 licensed physicians in West Virginia who list general surgery as their practice specialty with the State Board were surveyed to determine the nature of the rural surgery workforce and to examine the caseload of these surgeons. The majority of rural surgeons were satisfied with their current situation; however, 22 per cent stated that they would leave the practice of medicine if financially able. One-third of these surgeons regarded the rural setting as having an adverse impact on their practice. More than half of those surveyed stated that they would not encourage a young person to pursue a career in medicine. For one-third of rural surgeons general medicine was part of daily practice. The caseload varied by community size. Surgeons in communities of fewer than 10,000 people performed a lower percentage of general surgical procedures than surgeons in urban areas. They listed obstetric and gynecologic (9%), urologic (5%), otolaryngologic (9%), and orthopedic (4%) procedures as part of their regular cases. Endoscopic procedures comprise 17 to 24 per cent of total procedures regardless of community size. We conclude that resident surgeons planning to pursue a career in rural general surgery should broaden their operative and general medicine experiences to meet the needs of the communities in which they will serve.

Demography↗
PubMed1992

Risk of hepatitis B and human immunodeficiency virus transmission to a patient from an infected surgeon due to percutaneous injury during an invasive procedure: estimates based on a model.

The objective was to estimate the probability of sporadic hepatitis B virus (HBV) and human immunodeficiency virus (HIV) transmission to a patient from an infected surgeon due to percutaneous injury during an invasive procedure. Risk was estimated based on a model involving three probabilities: A, the probability that the surgeon will sustain a percutaneous injury during an invasive procedure; B, the probability that the sharp object causing the injury and now contaminated with the surgeon's blood will contact the patient's wound; and C, the probability that infection would be transmitted to the patient after such an exposure. The probability of transmission during one procedure is p = A x B x C. The probability of transmission to at least one patient during N procedures is 1-(1-p)N. Values for A, B, and C were estimated from prospective studies. The estimated probability of transmission from an infected surgeon to a patient during a single procedure is 0.00024-0.0024% for HIV and 0.024-0.24% for HBV if the surgeon is positive for hepatitis B e antigen (HBeAg). The estimated probability of transmission to at least one patient during 3,500 procedures (estimated to be performed during an HIV-infected surgeon's remaining working life) is 0.81-8.1% for HIV; 57-100% for HBV if the surgeon is an HBeAg carrier. These estimates represent population averages and may not necessarily apply to a particular procedure performed by a particular surgeon, for which the risk may be considerably lower or higher than the estimated average. This risk assessment, which is based on limited data and does not take clusters of transmission into account, predicts that the risk of sporadic HBV transmission from infected surgeons to patients due to percutaneous injury during an invasive procedure is small and that the risk of HIV transmission is less than that for HBV. More data are needed to understand both sporadic and epidemic transmission in order to further reduce patient risk.

Carrier State↗
PubMed2003

Comparison of temperament and character profiles of anesthesiologists and surgeons: a preliminary study.

BACKGROUND: Given the high levels of stress in anesthesiologists and also their close working liaison with surgeons, it may be worthwhile to compare the personality profiles of these two groups of professionals. AIM: To compare the personality profiles of surgeons and anesthesiologists, using a well-standardized and validated instrument. SETTINGS AND DESIGN: Survey (cross-sectional) on surgeons and anesthesiologists working in several medical institutes in India. MATERIAL & METHODS: The self-report Temperament and Character Inventory, 125-item version (TCI-125) was mailed out to an incidental sample of surgeons and anesthesiologists working in medical institutes in India. Of the 200 questionnaires sent (100 to anesthesiologists and surgeons each), 93 completed responses were returned (46 anesthesiologists, 47 surgeons; return rate 46.5%). STATISTICAL ANALYSIS: Student's unpaired 't' test; P<0.05 was considered statistically significant. RESULTS: The mean scores of anesthesiologists vis-a-vis surgeons on the various temperament dimensions were Novelty seeking: 8.6 vs. 9.2; Harm avoidance: 7.3 vs. 8.1; Reward dependence: 8.1 vs. 8.0; and Persistence: 3.0 vs. 3.1, respectively. Similar scores for the character dimensions were Self-directedness: 16.9 vs. 15.9; Cooperativeness: 17.5 vs. 16.5; and Self-transcendence: 7.0 vs. 6.7, respectively. There was no significant difference between the surgeons and anesthesiologists on any of the temperament and character variables of personality chosen for the study. CONCLUSION: Personality measures did not differ significantly between surgeons and anesthesiologists in this preliminary investigation. If replicated on a larger and more representative sample, the findings have clinical relevance to improve the working relationship between these two groups of closely working professionals.

Adult↗