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At least 523 records · Page 29Linked to original sources
PubMed2003

Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data.

OBJECTIVE: As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons' mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk. DESIGN: Retrospective analysis of prospectively collected data. SETTING: All NHS centres in the geographical north west of England that undertake cardiac surgery in adults. PARTICIPANTS: All patients undergoing isolated bypass graft surgery for the first time between April 1999 and March 2002. MAIN OUTCOME MEASURES: Surgeon specific postoperative mortality and predicted mortality by EuroSCORE. RESULTS: 8572 patients were operated on by 23 surgeons. Overall mortality was 1.7%. Observed mortality between surgeons ranged from 0% to 3.7%; predicted mortality ranged from 2% to 3.7%. Eighty five per cent (7286) of the patients had a EuroSCORE of 5 or less; 49% of the deaths were in this lower risk group. A large proportion of the variability in predicted mortality between surgeons was due to a small but differing number of high risk patients. CONCLUSIONS: It is possible to collect risk stratified data on all patients undergoing coronary bypass surgery. For most the predicted mortality is low. The small proportion of high risk patients is responsible for most of the differences in predicted mortality between surgeons. Crude comparisons of death rates can be misleading and may encourage surgeons to practise risk averse behaviour. We recommend a comparison of death rates that is stratified by risk and based on low risk cases as the national benchmark for assessing consultant specific performance.

Adult↗
PubMed2004

Improving mortality of coronary surgery over first four years of independent practice: retrospective examination of prospectively collected data from 15 surgeons.

OBJECTIVE: To study the "learning curve" associated with independent practice in coronary artery surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: All NHS centres in north west England that carry out cardiac surgery in adults. PARTICIPANTS: 18 913 patients undergoing coronary artery surgery for the first time between April 1997 and March 2003, 5678 of whom were operated on by 15 surgeons in the first four years after their consultant appointment. MAIN OUTCOME MEASURES: Observed and predicted mortality (EuroSCORE) for surgeons in their first, second, third, and fourth years after appointment as a consultant compared with figures for established surgeons. RESULTS: Overall mortality decreased over the six years of study (P = 0.01). Of the patients operated on by established surgeons or newly appointed consultants, 265/13,235 (2.0%) and 109/5678 (1.9%), respectively, died (P = 0.71). There was a progressive decrease in observed mortality with time after appointment as a consultant from 2.2% in the first year to 1.2% in the fourth year (P = 0.049). This result remained significant after adjustment for time and case mix (P = 0.019). CONCLUSIONS: Mortality in patients operated on by newly appointed consultant surgeons is similar to mortality in patients operated on by established surgeons. There are significant decreases in crude and risk adjusted mortality in the four years after appointment. These findings should influence the nature of practice in newly appointed surgeons.

Adult↗
PubMed2005

Trauma calls: role of the general surgeon and CT scanning.

BACKGROUND AND OBJECTIVE: General surgeons are required in only a minority of trauma call cases to assess for abdominal injuries. Computed tomography (CT) accurately detects blunt abdominal injuries and may have replaced the need for general surgeons at trauma calls. This study evaluated the role of general surgeons at trauma calls and assessed use of CT in cases of suspected abdominal trauma. METHODS: (a) Eighteen month analysis of trauma calls at a district general hospital and (b) three month prospective study of all trauma cases presenting to A&E. RESULTS: (a) There were 73 trauma calls and the mechanism of injury in most cases was a road traffic accident (RTA). Most patients had orthopaedic and/or neurosurgical injuries. The general surgeons assessed 22 trauma call patients. Abdominal injury was excluded in 13 (four by clinical examination and nine following CT). (b) Forty three patients fulfilled the criteria for a trauma call and 14 trauma calls were made. The mechanism of injury in most was RTA and most had orthopaedic and/or neurosurgical injuries. The general surgeons assessed 10/43 potential trauma call patients, and abdominal injury was excluded in five (one by clinical examination and four following CT). CONCLUSION: A&E staff managed most trauma calls. Most patients did not require general surgical intervention. For penetrating injuries, presence of a general surgeon remained crucial. For blunt injuries CT was an important adjunct. These data suggest that general surgeons do not routinely have to attend all trauma calls but can be called if abdominal and/or vascular injuries are specifically suspected.

Abdominal Injuries↗
PubMed2002

Influence of surgeons' specialty on the selection of vascular access for hemodialysis treatment.

BACKGROUND/AIMS: Various patient-related factors could not explain the variability of access types across facilities in the published literature. The aim of this study was to investigate the influence of surgeons' specialty on access type selection for hemodialysis treatment. METHODS: The directors (nephrologists) of all renal units in Greece (n = 92) were surveyed by a closed questionnaire. RESULTS: The response rate was 75%. There was no statistically significant difference in the percentage of patients predominantly with autologous arteriovenous fistulae between units where only vascular surgeons were performing access surgery and those where either general surgeons or transplant surgeons were operating (mean value in all renal units 80.8%, range 43-97%). However, the difference between the three groups of renal units regarding their surgeons' ability to create complex access procedures and to correct complications (as an index of surgeons' skill) was statistically significant (p < 0.001). CONCLUSION: The general surgeons of the new generation are not often using vascular surgical techniques and may have less opportunities to develop expertise in vascular access creation.

Arteriovenous Shunt, Surgical↗
PubMed1990

Transformations in self-understanding in surgeons whose treatment efforts were not successful.

This study, dealing with cardiac and cancer surgeons' reactions to treatment failure (i.e., situations where surgeons despite their best efforts were unable to successfully treat their patients) found changes in the surgeons that bore striking resemblance to certain changes in people undergoing psychotherapy. Twenty surgeons participated. Each reported on two of his patients, all of whom had undergone surgery that failed to stem the progress of their disease. The life expectancy of these patients was approximately one year. Each surgeon saw one of his patients only until completion of the customary postoperative care and then referred him/her back to the original physician. The other patient was seen by the surgeon on a once-monthly basis even after postoperative care had been completed. While the surgeons had decided to be part of the study "for the possible good of the patients," many reported experiences of transformations in their own self-understanding. The particular elements of healing and self-understanding included a sense of self-forgiveness and acceptance, a strengthened feeling of human connectedness, an enhanced sense of meaning about what they were doing, and a sense of openness and hope for the future. Perhaps this self-transformative process and the possible mechanisms for change discussed mimic what happens in psychotherapy patients.

Adaptation, Psychological↗
PubMed2005

Ethical challenges in surgery as narrated by practicing surgeons.

BACKGROUND: The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. METHODS: Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. CONCLUSION: The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.

Attitude of Health Personnel↗
PubMed2005

Action ethical dilemmas in surgery: an interview study of practicing surgeons.

BACKGROUND: The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. METHODS: Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. CONCLUSION: The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.

Attitude of Health Personnel↗
PubMed2006

The journals of importance to UK clinicians: a questionnaire survey of surgeons.

BACKGROUND: Peer-reviewed journals are seen as a major vehicle in the transmission of research findings to clinicians. Perspectives on the importance of individual journals vary and the use of impact factors to assess research is criticised. Other surveys of clinicians suggest a few key journals within a specialty, and sub-specialties, are widely read. Journals with high impact factors are not always widely read or perceived as important. In order to determine whether UK surgeons consider peer-reviewed journals to be important information sources and which journals they read and consider important to inform their clinical practice, we conducted a postal questionnaire survey and then compared the findings with those from a survey of US surgeons. METHODS: A questionnaire survey sent to 2,660 UK surgeons asked which information sources they considered to be important and which peer-reviewed journals they read, and perceived as important, to inform their clinical practice. Comparisons were made with numbers of UK NHS-funded surgery publications, journal impact factors and other similar surveys. RESULTS: Peer-reviewed journals were considered to be the second most important information source for UK surgeons. A mode of four journals read was found with academics reading more than non-academics. Two journals, the BMJ and the Annals of the Royal College of Surgeons of England, are prominent across all sub-specialties and others within sub-specialties. The British Journal of Surgery plays a key role within three sub-specialties. UK journals are generally preferred and readership patterns are influenced by membership journals. Some of the journals viewed by surgeons as being most important, for example the Annals of the Royal College of Surgeons of England, do not have high impact factors. CONCLUSION: Combining the findings from this study with comparable studies highlights the importance of national journals and of membership journals. Our study also illustrates the complexity of the link between the impact factors of journals and the importance of the journals to clinicians. This analysis potentially provides an additional basis on which to assess the role of different journals, and the published output from research.

Attitude of Health Personnel↗
PubMed2006

Qualitative evaluation of a form for standardized information exchange between orthopedic surgeons and occupational physicians.

BACKGROUND: Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advice to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. METHODS: The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. RESULTS: The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. CONCLUSION: The information exchange form was regarded to be useful and could be used in practice. The occupational physician should take the initiative for using this form and most physicians felt the information should only be exchanged for patients who do not recover as expected. That means that the advantage of giving information early in the treatment is lost.

Adolescent↗
PubMed2006

Attitudes and practices of breast cancer consultations regarding sexual issues: a nationwide survey of Japanese surgeons.

PURPOSE: To investigate doctors' current practices and attitudes and correlates of sexuality-related consultations in clinical encounters. METHODS: A nationwide, self-administered mail survey was conducted with 1,313 board-certified Japanese breast surgeons in August 2001. Surgeons were asked about their experiences regarding consultations about sexual issues, attitudes toward sex-related statements, and advice to a patient's hypothetical question on having sex after undergoing breast cancer treatment. RESULTS: Of the surveyed sample, 635 surgeons (50.3%) responded. Of these surgeons, 32.4% had been consulted about sexual issues by patients or families. Multiple logistic regression analysis suggested that female respondents (P < .01), respondents whose hospitals conduct a large number of breast cancer operations annually (P < .01), and respondents who agreed that "Surgeons have a professional responsibility to deal with patients' sexual issues" (P < .01) were significantly more likely to be consulted. Respondents who agreed that "If any sexual problem exists, patients will raise the topic before surgeons ask them" were less likely to be consulted (P < .05). Respondents' attitudes toward the sex-related statements showed that, although the majority recognized the importance of patients' sexuality-related concerns, they did not necessarily think that surgeons had a professional responsibility to deal with them. Regarding their advice in response to the question of "Are there any particular things to be careful about when having sex after surgery?", 32.8% answered "nothing in particular." CONCLUSION: This study shows that talking about sex-related topics is still repressed in patient-doctor encounters in Japan. It is an urgent matter to increase doctors' awareness and clinical skills to deal with patients' sexual issues.

Adult↗
PubMedDate not supplied

Do vascular surgeons improve the outcome of carotid endarterectomy? An analysis of 12,618 elective cases in the state of Connecticut.

Because cardiac complications may predict long-term survival after carotid endarterectomy (CEA), this study evaluates contemporary outcome, including cardiac complications, after CEA. Patients in Connecticut hospitals undergoing CEA between 1991 and 2002 were identified using the state discharge database (Chime, Inc.; ). Of the 12,618 CEAs performed, there were 53 (0.4%) deaths, 155 (1.2%) neurologic complications, and 300 (2.4%) cardiac complications. Despite an increase in patient age (p < .0001, Kruskal-Wallis test) over time, there were decreases in mortality (p = .0001, chi-square), postoperative stroke (p = .001), and cardiac complications (p = .0003). Vascular surgeons performed a minority of the procedures in the state (11%), but there were fewer cardiac complications after CEA performed by vascular surgeons than general surgeons (0.8% vs 3.0%; p < .0001). Multivariable logistic regression demonstrated that the risk of a cardiac complication was elevated in patients operated on by a nonvascular surgeon, patients with previous heart disease or stroke, and the elderly. In a state with very high performance of CEA by general and nonvascular surgeons, postoperative mortality and neurologic complications remain low. However, there were fewer cardiac complications when a vascular surgeon performed the procedure. These results suggest that increased referral to vascular surgeons could improve procedural safety.

Age Factors↗
PubMed2003

Expect the best, prepare for the worst: surgeon and patient expectation of the outcome of primary total hip and knee replacement.

A cross-sectional study of 100 surgeons and 370 patients awaiting primary total hip or knee replacement was carried out. Oxford hip or knee score questionnaires were sent to the surgeons and patients. They were asked to predict the level of symptoms expected 6 months following surgery. The Oxford scores derive a value of 12-60, with a greater score indicating worsening symptoms. The mean pre-operative score was 45.12 for the hip patients and 42.96 for the knee patients, and the patients expected this to drop to 23.70 and 25.66, respectively, 6 months' postoperatively. This was a significant difference for both groups. The surgeons expected the patients to have a mean postoperative score of 20.91 for the hip group and 22.19 for the knee group. The surgeons' scores were significantly lower than those from the patients. There was a significant difference between the patients' and surgeons' expectations of the results of total knee and hip replacement surgery. The surgeons expected better results than the patients. We believe that this is the first study that directly compares surgeon and patient expectations of lower limb arthroplasty.

Adult↗
PubMed2001

Cleft lip and palate management by U.K. consultant oral and maxillofacial surgeons: a national survey.

OBJECTIVE: Following the report of the Clinical Standards Advisory Group (CSAG), a national survey of U.K. consultant oral and maxillofacial surgeons was performed to determine the current cleft lip and palate practice of this group prior to the implementation of proposed radical changes in the delivery of cleft services. The views of these surgeons regarding the proposed changes was also sought. DESIGN: An anonymous postal questionnaire sent to all 266 consultants in the U.K., which requested information on the practice of cleft surgery during a defined 1-year period (March 1997 through February 1998). It included the numbers and types of procedures performed, the involvement of multidisciplinary care, research and audit activity, and questions regarding the implementation of CSAG. RESULTS: One hundred ninety-one replies (72% response rate). Seventy-three surgeons were actively involved with mainly secondary cleft surgery. A varied number and range of procedures were undertaken, with most surgeons performing less than five of each procedure per year. Audit and research activity was 26%. The majority of both noncleft and cleft surgeons agreed with proposals made by CSAG (except for cleft osteotomy procedures). CONCLUSIONS: In the U.K. at present, there are many oral and maxillofacial surgeons performing mainly secondary cleft surgery; overall, the number of procedures performed by these surgeons per year is small. Intraspecialty referral is suggested to further improve patient outcome.

Alveoloplasty↗
PubMed1997

Are the best coronary artery bypass surgeons identified by physician surveys?

OBJECTIVES: This study assessed the validity of surveys for identifying the best coronary artery bypass surgeons. METHODS: Data on physicians who performed coronary artery bypass surgery were available from New York, Pennsylvania, and Wisconsin. Data on physicians' reputation were obtained from one national and five city surveys. The measure of surgical performance was the mortality ratio (MR), that is, the ratio of the observed to the predicted patient mortality rate. RESULTS: Mortality ratios were very similar for the 10,722 patients treated by the 31 surgeons defined as "best" doctors in the surveys (MR = 98) and for the 74,854 patients treated by 243 other surgeons who had more than a minimal number of cases (MR = .96). The mortality ratio was 1.34 for the patients treated by surgeons with the lowest volumes and .87 for the surgeons who performed more than 400 coronary artery bypass surgeries in 3 years. CONCLUSIONS: These results suggest that the quality of a coronary artery bypass surgeon may be more closely associated with patient volume than with the surgeon's reputation among peers.

Attitude of Health Personnel↗
PubMed2007

Perceptions and competence in evidence-based medicine: Are surgeons getting better? A questionnaire survey of members of the Dutch Orthopaedic Association.

BACKGROUND: The Journal of Bone and Joint Surgery, American Volume (The Journal) recently initiated a section called "Evidence-Based Orthopaedics." Furthermore, a level-of-evidence rating is now used in The Journal to help readers in clinical decision-making. Little is known about whether this recent emphasis has influenced surgeons' perceptions about and competence in evidence-based medicine. Therefore, we examined perceptions and competence in evidence-based medicine among Dutch orthopaedic surgeons. METHODS: Members of the Dutch Orthopaedic Association were surveyed to examine their attitudes toward evidence-based medicine and their competence in evidence-based medicine. We evaluated competences using a newly developed instrument tailored to surgical practice. RESULTS: Of the 611 members, 367 surgeons (60%) responded. Orthopaedic surgeons welcomed evidence-based medicine. Practical evidence-based medicine resources were perceived as the best method to move from opinion-based or experience-based to evidence-based practice. Four variables were significantly and positively associated with the competence instrument: (1) a younger age, particularly between thirty-six and forty-five years (p = 0.007), (2) experience of less than ten years (p = 0.032), (3) having a PhD degree (p < 0.001), and (4) working in an academic or teaching setting (p = 0.004). The majority of the respondents were aware of The Journal's evidence-based medicine section (84%) and level-of-evidence ratings (65%), and 20% used The Journal's evidence-based medicine abstracts in clinical decision-making. This increased awareness of evidence-based medicine was also reflected in the frequent use of Cochrane reviews in clinical decision-making (27% of the respondents). Surgeons who used and those who were aware of but did not use The Journal's evidence-based medicine abstracts or Cochrane reviews in clinical decision-making had significantly higher competence instrument scores than those who were unaware of these resources (p = 0.03 and p < 0.001, respectively). CONCLUSIONS: Evidence-based medicine is welcomed by Dutch orthopaedic surgeons. The recent emphasis on evidence-based medicine is reflected in an increased awareness about The Journal's evidence-based medicine section, levels of evidence, and the largest evidence-based medicine resource: the Cochrane reviews. Younger orthopaedic surgeons had better knowledge about evidence-based medicine. The development and use of evidence-based resources as well as preappraised summaries such as The Journal's evidence-based medicine abstracts and Cochrane reviews were perceived as the best way to move from opinion-based to evidence-based orthopaedic practice.

Adult↗
PubMed2006

Management of patients with small pulmonary nodules: a survey of radiologists, pulmonologists, and thoracic surgeons.

OBJECTIVE: The objective of our study was to survey recommendations for the management of small pulmonary nodules found on helical CT from radiologists, pulmonologists, and thoracic surgeons. MATERIALS AND METHODS: We surveyed 774 radiologists, 623 pulmonologists, and 101 thoracic surgeons. All are members of an associated Austrian scientific society and were asked for their recommendations in 13 hypothetical cases. Statistical analysis was focused on possible differences between medical specialities, residents and fellows, and male and female doctors and on a possible influence of the number of years in training or in medical practice. RESULTS: Complete surveys were returned from 91 radiologists, 74 pulmonologists, and 12 thoracic surgeons. The most frequent recommendation from radiologists was follow-up, whereas the most frequent recommendation from pulmonologists and surgeons was biopsy. The most frequently advised CT follow-up period was 3 months. Whereas thoracic surgeons preferred video-assisted thoracoscopy, radiologists and pulmonologists recommended less invasive procedures (bronchoscopy, CT-guided biopsy) to gain a specific diagnosis. CONCLUSION: There are significant differences in the management of small pulmonary nodules among radiologists, pulmonologists, and thoracic surgeons. Whereas radiologists tend to recommend short-term follow-up, pulmonologists and thoracic surgeons prefer a more aggressive approach, especially in patients with a higher likelihood of malignancy.

Austria↗
PubMed1995

Hepatitis B virus, surgeons, and surgery.

Surgeons continue to be at high risk for occupationally acquired HBV infection. Immunization against HBV is safe and effectively prevents transmission of HBV from patients to surgeons. Such immunization is also the most effective way to reduce the risk of transmission of HBV from surgeons to patients. Postvaccination testing, although not required, should be strongly considered. Such testing will confirm the success of vaccination and can, in conjunction with testing for HBsAg, identify surgeons who are unknowingly carriers. State laws and guidelines regarding restrictions of HBeAg-positive surgeons vary and surgeons should be familiar with the laws and guidelines that apply in their state. Until all surgeons are successfully immunized, HBV is likely to remain a threat.

Hepatitis B↗
PubMed1999

Estimating the duration of a case when the surgeon has not recently scheduled the procedure at the surgical suite.

UNLABELLED: For some scheduled cases, there may be no previous cases of the same procedure type by the same surgeon for use in estimating the duration of the new case. We evaluated which of 16 different methods of analysis of other surgeons' cases of the same procedure type resulted in the most accurate prediction of the duration of the case that the surgeon had not recently scheduled. We analyzed durations for 4,955 cases, from an operating room information system, for which a surgeon had only scheduled the procedure once, and for which other surgeons had scheduled that same procedure one or more times. Using these data, we determined the difference between the actual duration of the new case and the estimated duration of the new case as calculated by each of the methods (average absolute error of 1.1 h with average case duration of 3.1 h). IMPLICATIONS: When no recent historical time data are available for a surgeon doing a given procedure, the mean of the durations of cases of the same scheduled procedure performed by other surgeons is as accurate an estimate as more sophisticated analyses. More research is needed to improve the precision of estimates of case durations.

Appointments and Schedules↗