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At least 811 records · Page 45Linked to original sources
PubMed2001

Do new surgeons have higher surgical-site infection rates?

We compared class I surgical-site infection (SSI) rates for new and experienced surgeons. Data showed that new surgeons in two surgical subspecialties associated with higher baseline SSI rates had rates higher than their experienced colleagues. They took longer in the operating room (OR), but did not operate on sicker patients. As the surgeons gained more experience (as measured by cumulative cases), their OR times and SSI rates decreased toward their colleagues'. New surgeons who perform infection-prone surgery may have higher SSI rates than more experienced colleagues until they gain experience. A new surgeon's SSI rate could be one factor considered in assessing competence.

Clinical Competence↗
PubMed1994

HIV screening of surgeons and dentists: a cost-effectiveness analysis.

OBJECTIVE: To assess the cost-effectiveness of human immunodeficiency virus (HIV) screening strategies of surgeons and dentists. DESIGN: We constructed a model to project costs and HIV transmissions prevented over 15 years for four screening scenarios: 1) one-time voluntary screening, 2) one-time mandatory screening, 3) annual voluntary screening, and 4) annual mandatory screening. One-time screening occurs only in the first year of the program; annual screening occurs once each year. Under mandatory screening, all practitioners are tested and risks of practitioner-to-patient transmission are eliminated for all practitioners testing positive. Voluntary screening assumes 90% of HIV-positive and 50% of HIV-negative practitioners are tested, and risks of transmission in the clinical setting are eliminated for 90% of HIV-positive surgeons and dentists. All costs and benefits are discounted at 5% per annum over 15 years. RESULTS: Using "best-case" scenario assumptions, we find for surgeons that a one-time voluntary screening program would be most cost-effective, at $899,336 for every HIV transmission prevented. For dentists, the one-time voluntary program also is the most cost-effective, at $139,571 per transmission prevented. Annual mandatory programs were least cost-effective for both surgeons and dentists, at $63.3 million and $2.2 million per transmission prevented, respectively. CONCLUSIONS: HIV screening of surgeons and dentists ranks among the more expensive medical lifesaving programs, even using liberal assumptions about program effectiveness. Frequency of screening and whether testing is mandatory or voluntary dramatically affect cost per transmission prevented; these features should be considered carefully in designing specific HIV screening programs.

AIDS Serodiagnosis↗
PubMed1979

Hepatitis B virus infections among Danish surgeons.

Acute viral hepatitis B is considered to be an occupational risk to health-care workers worldwide. At the 1977 annual meeting of the Danish Society of Surgeons, 224 participants were examined for the presence of hepatitis B surface antigen (HGsAg) and antibody to HBsAg (anti-HBs) with use of a radioimmunoassay. None of the surgeons was HBsAg-positive, but 23% had anti-HBs. The prevalence of anti-HBs was five times higher among these surgeons than that in an age-matched control population. Hepatitis acquired during occupation as a surgeon was predominantly of type B, in contrast to hepatitis acquired before entering the surgical profession. Danish surgeons must be regarded as a group at high risk of hepatitis B infection.

Adult↗
PubMed2005

Time to return to work and surgeons' recommendations after carpal tunnel release.

BACKGROUND: Time to return to work after carpal tunnel release is extremely variable suggesting that only a small proportion of total sick-leave is for medical reasons. AIMS: To determine factors predicting a delayed return to work. METHODS: Fifty consecutive employed patients undergoing carpal tunnel surgery were tested pre-operatively, and then at 1 month post-operatively using both questionnaires and objective testing. Further follow-up by telephone was carried out every 2 weeks up until 90 days. RESULTS: Forty-nine of the 50 workers had returned to work by 3 months. Time to return to work was extremely variable ranging from 1 to 88 days in those who returned to work. Post-operative recommendations by the surgeon also varied widely from 1 to 36 days. The surgeons' recommendations were the strongest predictors of delayed return to work [odds ratio 30.5; 95% confidence interval (CI), 3.2-288], with physical work (odds ratio 27.7; 95% CI, 1.5-507) and lack of self-rated health (odds ratio 5.0; 95% CI, 1.11-100) adding significantly to the logistic regression model, which was highly predictive (area under the receiver-operator curve of 88%). Patient symptoms and objective findings of disability did not add significantly to a logistic regression model either predicting return to work or the surgeon's recommendations. CONCLUSIONS: Our study suggests that workers will return to work in less than 3 weeks if recommended by the surgeon. A randomized controlled trial is warranted to determine if a higher proportion of workers returning in less than 3 weeks can be obtained by standardizing surgeons' recommendations.

Adult↗
PubMed1997

Postoperative nausea and vomiting: a comparative survey of the attitudes, perceptions, and practice of Swiss anesthesiologists and surgeons.

Managing postoperative nausea and vomiting (PONV) depends on awareness of the problem, the therapeutic measures available, and effective implementation control systems. We mailed 616 PONV questionnaires to all 129 Swiss hospitals with anesthesiological and surgical departments. The responses [192 (31%) completed questionnaires from 87 (67%) hospitals] are representative of Swiss hospital anesthesiologists and surgeons. Anesthesiologists' perceptions of PONV are closer to those found in the literature than surgeons'. More than three quarters of anesthesiologists and less than half of surgeons practice PONV prophylaxis. Half of the respondents are dissatisfied with present antiemetics. Anesthesiologists worry about the cost of PONV prophylaxis, and surgeons are concerned about their lack of theoretical knowledge. Formal PONV policies are rare, with little consensus on treatment responsibilities. Sixty percent of respondents document PONV occurrence, and less than 20% perform any formal PONV audit. This survey identifies factors amenable to improvement regarding PONV management in Swiss hospitals. PONV education is a necessity, particularly for surgeons. Cost needs to be addressed with anesthesiologists. The limited therapeutic efficacy of antiemetics is a concern. PONV management needs standardization, organization, consensus, and research. Better audits and visibility in patients' charts could further improve the quality of PONV management.

Anesthesiology↗
PubMed2002

Sampling error can significantly affect measured hospital financial performance of surgeons and resulting operating room time allocations.

UNLABELLED: Hospitals with limited operating room (OR) hours, those with intensive care unit or ward beds that are always full, or those that have no incremental revenue for many patients need to choose which surgeons get the resources. Although such decisions are based on internal financial reports, whether the reports are statistically valid is not known. Random error may affect surgeons' measured financial performance and, thus, what cases the anesthesiologists get to do and which patients get to receive care. We tested whether one fiscal year of surgeon-specific financial data is sufficient for accurate financial accounting. We obtained accounting data for all outpatient or same-day-admit surgery cases during one fiscal year at an academic medical center. Linear programming was used to find the mix of surgeons' OR time allocations that would maximize the contribution margin or minimize variable costs. Confidence intervals were calculated on these end points by using Fieller's theorem and Monte-Carlo simulation. The 95% confidence intervals for increases in contribution margins or reductions in variable costs were 4.3% to 10.8% and 6.0% to 8.9%, respectively. As many as 22% of surgeons would have had OR time reduced because of sampling error. We recommend that physicians ask for and OR managers get confidence intervals of end points of financial analyses when making decisions based on them. IMPLICATIONS: The common approach of using one fiscal year of perioperative accounting data can be insufficient to prevent random error from influencing important management decisions. When accounting data are used for hospital and operating room management decision making, confidence intervals should be calculated for the key financial variables (e.g., variable cost per hour of operating room time).

Costs and Cost Analysis↗
PubMed2000

Surgeon and type of anesthesia predict variability in surgical procedure times.

BACKGROUND: Variability in surgical procedure times increases the cost of healthcare delivery by increasing both the underutilization and overutilization of expensive surgical resources. To reduce variability in surgical procedure times, we must identify and study its sources. METHODS: Our data set consisted of all surgeries performed over a 7-yr period at a large teaching hospital, resulting in 46,322 surgical cases. To study factors associated with variability in surgical procedure times, data mining techniques were used to segment and focus the data so that the analyses would be both technically and intellectually feasible. The data were subdivided into 40 representative segments of manageable size and variability based on headers adopted from the common procedural terminology classification. Each data segment was then analyzed using a main-effects linear model to identify and quantify specific sources of variability in surgical procedure times. RESULTS: The single most important source of variability in surgical procedure times was surgeon effect. Type of anesthesia, age, gender, and American Society of Anesthesiologists risk class were additional sources of variability. Intrinsic case-specific variability, unexplained by any of the preceding factors, was found to be highest for shorter surgeries relative to longer procedures. Variability in procedure times among surgeons was a multiplicative function (proportionate to time) of surgical time and total procedure time, such that as procedure times increased, variability in surgeons' surgical time increased proportionately. CONCLUSIONS: Surgeon-specific variability should be considered when building scheduling heuristics for longer surgeries. Results concerning variability in surgical procedure times due to factors such as type of anesthesia, age, gender, and American Society of Anesthesiologists risk class may be extrapolated to scheduling in other institutions, although specifics on individual surgeons may not. This research identifies factors associated with variability in surgical procedure times, knowledge of which may ultimately be used to improve surgical scheduling and operating room utilization.

Adolescent↗
PubMed1996

Patient, hospital, and surgeon factors associated with breast conservation surgery. A statewide analysis in North Carolina.

OBJECTIVE: The objective of this study was to determine the trend of breast conservation surgery (BCS) in North Carolina over a 6-year period and to identify patient, hospital, and surgeon factors associated with the use of BCS. SUMMARY BACKGROUND DATA: Despite evidence that BCS is an appropriate method of treatment for early stage breast cancer, surgeons in the United States have been slow to adopt this treatment method. METHODS: Cases of primary breast cancer surgery in all 157 hospitals in the state from 1988 to 1993, inclusive (N = 20,760), were obtained from the State Medical Database Commission, Area Resource File, American Hospital Association and State Board of Medical Examiner's Databases. Multiple logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) to determine factors associated with BCS. RESULTS: The rate of BCS doubled from 7.3% in 1988 to 14.3% in 1993, with an overall rate of 10.2% (2117/ 20.760). Multiple logistic regression identified the following factors associated with BCS: patient age younger than 50 years of age (OR = 1.7, 95% CI = 1.4, 2.1), patient age 50 to 69 years of age (OR = 1.2, 95% CI = 1.1, 1.4), private insurance (OR = 1.2, 95% CI = 1.0, 1.4), hospital bed size 401+(OR = 2.0, 95% CI = 1.6, 2.5), bed size 101 to 400 (OR = 1.7, 95% CI = 1.3, 2.1), and surgeon graduation from medical school since 1981 (OR = 1.6, 95% CI = 1.2, 2.0). CONCLUSIONS: Rates of BCS in North Carolina are low. Least likely to have BCS were women older than 70 years of age, without private insurance, treated at small hospitals by older surgeons. To increase the use of BCS, widespread education of surgeons, other health care providers, policy makers, and the general public is warranted.

Age Factors↗
PubMed1998

Surgeon-performed ultrasound: its use in clinical practice.

OBJECTIVE: To highlight areas where surgeon-performed ultrasound (US) is an effective diagnostic and therapeutic tool. SUMMARY BACKGROUND DATA: The success of US in trauma and technologic advances have enhanced the interest and ability of surgeons to perform their own US examinations. METHODS: General surgeons perform US examinations of the thyroid gland, breast, gastrointestinal tract, peritoneal cavity (laparoscopy), and vascular system. Essentials of these examinations are discussed and a plan for educating surgical residents in US is outlined. RESULTS: Focused assessment for the sonographic examination of the trauma patient, or FAST, is replacing central venous pressure measurements to detect hemopericardium and diagnostic peritoneal lavage to detect hemoperitoneum. Bedside US can be used to detect a pleural effusion so well in critically ill patients that lateral decubitus x-rays are rarely needed. US-directed biopsy of breast lesions is a common office procedure. Laparoscopic US allows tumor staging without formal celiotomy, and many hepatic and pancreatic surgical procedures include US as an adjunct. Endoscopic and endorectal US have added a new dimension to the assessment of many gastrointestinal lesions. Color flow duplex imaging and endoluminal US have significantly expanded the diagnostic and therapeutic aspects of vascular imaging. The training program developed at Emory University and Grady Memorial Hospital is offered as a model for educating surgical residents in US techniques. CONCLUSIONS: US is a valuable addition to the general surgeon's diagnostic armamentarium and is rapidly becoming an integral part of the surgeon's clinical practice.

Breast Diseases↗
PubMed1999

Does the subspecialty of the surgeon performing primary colonic resection influence the outcome of patients with hepatic metastases referred for resection?

OBJECTIVE: To compare resection rates and outcome of patients subsequently referred with hepatic metastases whose initial colon cancers were resected by surgeons with different specialty interests. SUMMARY BACKGROUND DATA: Variation in practice among noncolorectal specialist surgeons has led to recommendations that colorectal cancers should be treated by surgeons trained in colorectal surgery or surgical oncology. METHODS: The resectability of metastases, the frequency and pattern of recurrence after resection, and the length of survival were compared in patients referred to a single center for resection of colorectal hepatic metastases. The patients were divided into those whose colorectal resection had been performed by general surgeons (GS) with other subspecialty interests (n = 108) or by colorectal specialists (CS; n = 122). RESULTS No differences were observed with respect to age, sex, tumor stage, site of primary tumor, or frequency of synchronous metastases. Comparing the GS group with the CS group, resectable disease was identified in 26% versus 66%, with tumor recurrence after a median follow-up of 19 months in 75% versus 44%, respectively. Recurrences involving bowel or lymph nodes accounted for 55% versus 24% of all recurrences, with respective median survivals of 14 months versus 26 months. CONCLUSION: Fewer patients referred by general surgeons had resectable liver disease. After surgery, recurrent tumor was more likely to develop in the GS group; their overall outcome was worse than that of the CS group. This observation is partly explained by a lower local recurrence rate in the CS group.

Adult↗
PubMed2000

Critical care medicine education of surgeons: recommendations from the Surgical Section of the Society of Critical Care Medicine.

PERSPECTIVE: The role of surgeons in critical care medicine has a long and esteemed past. The presence of surgeons in intensive care units provides specific insights and perspectives to the care of surgical patients sometimes not fully appreciated by the non-surgical practitioners caring for the same patients. The training and education of surgeons is becoming more complex, fragmented, and lengthy. The knowledge base and skill set required to manage critically ill or injured surgical patients is also becoming more extensive but has the potential of becoming lost in the process of providing the overall educational program for surgical trainees. Simultaneously, nonsurgical specialties are continuing to train individuals with special skills in critical care medicine and the concept of "hospitalists" is becoming more accepted by institutions across the United States. The certification exams in critical care medicine remain under the aegis of the individual medical specialty boards, and there is still not a unified examination process in critical care. Surgeons, in particular, have tremendous pressures these days to spend more clinical time in the operating room, and the task of consistently conducting high quality research is also becoming arduous. This list of reasons could continue but are simply examples for why surgeons need to spend focused attention on how best to train and educate upcoming surgical trainees in regards to the principles of critical care medicine. The critically ill or injured patients need this focused attention and the specialty of surgical critical care medicine needs this attention. The Surgical Section of the Society of Critical Care Medicine has developed this position statement in the hopes that ongoing discussion and refinement of this particular aspect of surgery will continue on several levels.

Critical Care↗
PubMed2003

Survey of the opinions, knowledge and practices of surgeons and internists regarding Helicobacter pylori test-and-treat policy.

BACKGROUND: Helicobacter pylori infection is highly prevalent and may cause disease in 10% to 15% of infected individuals: duodenal and gastric ulcer, gastric cancer and gastric lymphoma. Guidelines for a test-and-treat policy have been published by the European H. pylori working group in Maastricht. GOALS: To assess the current approach to H. pylori-related diseases, indications for testing and eradication therapy, among internists and surgeons of a University affiliated medical center. STUDY: A 15-items questionnaire was formulated according to the Maastricht II test-and-treat recommendation and distributed among the physicians of 6 internal medicine departments and the department of surgery. The questionnaires were completed anonymously at the department's staff meeting, under the supervision of the head of the department. All questions required a yes/no answer; the maximum possible score was 15. The relative ratio (RR) of correct answers was calculated for every question and by subgroups as follows: all participants, internists, surgeons, experts and residents in internal medicine and surgery. RESULTS: The response rate was 68% (55 out of 80 physicians). Total score for all participants was 10.9 (RR = 0.73), significantly lower than the maximum score of 15 (RR = 1.00). The internists had significantly higher average score than the surgeons for 2 questions: causative agent in gastric cancer (p = 0.003) or gastric lymphoma (p = 0.003), 1 question about triple therapy, PPI, penicillin and azythromycin being not recommended (p = 0.022), and for 1 question of test-and-treat policy: should this strategy apply to family members of gastric cancer patients (p = 0.045). Only 56% of the internists and 21% of surgeons knew what MALToma is, and the correlation with H. pylori infection. CONCLUSION: Knowledge of Surgeons and Internists regarding infection and correlation with diseases or test and treat policy should be improved.

Academic Medical Centers↗
PubMedDate not supplied

Reduction of posterior hip dislocations in the lateral position using traction-countertraction: safer for the surgeon?

Closed reduction of a hip dislocation is a physically demanding task for the orthopaedic surgeon. The most commonly used methods for reduction of the hip involve vigorous axial traction on the lower extremity with the patient in the supine position, using an assistant who attempts to hold the pelvis down. The surgeon generally stands over the patient to pull up on the bent knee, which puts the surgeon at risk for a low back injury and, if done while the patient remains on a stretcher, can put the surgeon at risk for a fall from a height. Reduction in the prone position is advocated by some, but caring for the sedated patient in the prone position can be difficult and the patient's pelvis tends to roll off the edge of the stretcher, preventing the achievement of hip flexion, which is desirable in achieving reduction. We describe a traction-countertraction technique that appears to be significantly less dangerous for the surgeon. In this technique the hip is reduced with the patient remaining on the stretcher in the lateral position. In addition, fluoroscopy can be carried out during the reduction maneuver, and the images can be quite helpful in adjusting the direction of manipulative forces.

Hip Dislocation↗
PubMed1992

A pediatric trauma center without a pediatric surgeon: a four-year outcome analysis.

Approximately 25% of all injury victims are in the pediatric age group, and one in four injured children will require a pediatric trauma center. According to the American College of Surgeons as well as many state guidelines, a level I pediatric trauma team should be directed by a pediatric surgeon. In 1986, the pediatric surgeon left our pediatric trauma center, but the center remained open under a cooperative effort by the adult trauma surgeons and pediatric intensivists. We have retrospectively reviewed the charts of all pediatric trauma patients (age less than or equal to 15 years) for the subsequent 4 years to determine the outcome of treatment without a pediatric surgeon. During this period, we treated 303 pediatric patients with multiple or serious single-system injuries. The mean age was 6.9 +/- 0.3 (SEM) years and 66% were boys. Falls were the cause of injury in 31% of the patients, with pedestrian/bicycle, motor vehicle crashes, and penetrating injuries resulting in 26%, 19%, and 3% of the injuries, respectively. The mean ISS was 15.6 +/- 0.8, and 73% of the patients had at least one AIS greater than or equal to 3. Surgical procedures were required in 48% of the patients. There were 27 deaths in this group, most commonly related to head injury (89%). The mean Pediatric Trauma Score of the patients who died was 1.6 +/- 0.8 and no patient with a Pediatric Trauma Score greater than 7 died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Trauma surgeons can render definitive surgical care for major thoracic injuries.

Restrictions on the operative domain of general surgeons threaten the viability of trauma surgery as a career choice. Our study hypothesis is that an experienced trauma surgeon can provide definitive care for life-threatening thoracic trauma. This analysis is based on clinical outcomes at an ACS-verified level I center in which there are more than 3000 trauma admissions managed annually under the direction of four academic trauma surgeons. We selected penetrating cardiac wounds and blunt tears of the thoracic aorta because these injuries are managed exclusively by the trauma service and the endpoints are distinct. During the past 4 years, 40 patients with cardiac wounds were delivered to the ED; 23 patients arrived dead. In the remaining 17, injury mechanisms were 15 stab wounds (SW), one gunshot wound (GSW), and one shotgun (SGW). Four of these patients required ED thoracotomy, and the remaining 13 underwent some form of prethoracotomy pericardial decompression. Survival rate without neurologic deficit was 94% (16 of 17). During this same period, 19 patients with a torn thoracic aorta from blunt injuries arrived with signs of life. In this group the injury mechanisms were automobile crash in 15, and the mean ISS was 39.7 +/- 2.3. One patient was transferred for total cardiopulmonary bypass; 17 of the remaining patients underwent aortic repair employing partial left heart bypass. Sixteen of our 18 patients lived and none developed paraplegia. In summary, excluding patients who arrived dead, survival for penetrating cardiac wounds was 94% and for blunt thoracic aortic tears 89%. In conclusion, these data support our contention that trauma surgeons can render definitive care for thoracic injuries with survival rates comparable to those reported by cardiothoracic surgeons.

Adolescent↗
PubMed1987

Effects of surgeon volume and hospital volume on quality of care in hospitals.

A growing body of evidence indicates that certain surgical procedures exhibit a "volume-outcome" relationship in which a higher volume of patients undergoing a particular procedure at a hospital is associated with better outcomes for those patients. The proportion of a hospital's patients operated on by low-volume or less experienced surgeons also may be associated with poor patient outcomes and thus contribute to the hospital "volume-outcome" relationship. This paper analyzes the influence of hospital volume and the proportion of a hospital's patients operated on by low-volume surgeons on patient outcome for 10 procedures, controlling for other selected factors that may influence outcomes. The analysis is based on 503,662 patient abstracts from 757 hospitals. Results indicate that both hospital volume and the proportion of patients operated on by low-volume surgeons are related to quality of care as measured by patient outcomes. Higher hospital volume is positively related to better patient outcomes. These findings are consistent with earlier hospital "volume-outcome" research and add an additional set of procedures using more recent data to the evidence. Unlike previous research on surgeon volume, a positive relationship was found between higher percentage of patients operated on by low-volume surgeons and poorer hospital quality.

Clinical Competence↗
PubMed1995

The image of plastic surgeons in news media coverage of the silicone breast implant controversy.

We analyzed the portrayal of plastic surgeons in the media by using the qualitative method of narrative analysis of newspaper articles available between July 1991 and June 1992 and popular magazine articles available from 1965 through 1992 in the Tampa Bay area. Plastic surgeons were presented as antagonists in the "horror stories" of sick women, as combatants in a medical community divided in its assessment of health risks, and as profit-oriented businesspersons. Patients were fully developed heroines, whereas plastic surgeons were described negatively by their antagonists, which undermines the expertise, good character, and good will that determine credibility for plastic surgeons. Providing the press with stories about their own efforts to help patients might have helped plastic surgeons receive more favorable press and enhance their credibility. More sophisticated handling of underlying values and the problem of communicating safety also might have been helpful.

Breast Implants↗
PubMed1998

The changing health care marketplace: current industry trends, new provider organizational structures, and effects on plastic surgeons.

Current market forces are driving the health care industry in new directions. The managed care industry is currently undergoing a market shakeout, as manifested by consolidation, increased competition, and lower profits. Medicare is fighting to remain solvent by lowering fees paid to providers, driving patients into managed care plans, and cracking down on billing irregularities. For providers, the combined effect of these trends is lower fees, increased risk-sharing, and increased overhead. Plastic surgeons face new demands in this environment. They must increase their efficiency and form new alliances with other providers. These alliances allow plastic surgeons to maintain a steady stream of patients, to manage risk, to negotiate more lucrative contracts with managed care organizations, and to increase efficiency. To achieve these alliances, plastic surgeons must alter the organizational structure of their practices. Several corporate practice models are becoming more prevalent; these include large group practices, physician practice management companies, and integrated delivery systems. Each structure has advantages for plastic surgeons, but each also requires plastic surgeons to trade varying degrees of financial and professional autonomy for market strength.

Forecasting↗