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Sarikonda A, Leibold A, Sami A, Mansoor Ali D, Tecce E, August A, O'Leary M, Thalheimer S, Heller J, Prasad S, Sharan A, Jallo J, Harrop J, Vaccaro AR, Sivaganesan A. Do Busier Surgeons Have Lower Intraoperative Costs? An Analysis of Anterior Cervical Discectomy and Fusion Using Time-Driven Activity-Based Costing. Clin Spine Surg 2024:01933606-990000000-00294. [PMID: 38637916 DOI: 10.1097/bsd.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN The present study is a single-center, retrospective cohort study of patients undergoing neurosurgical anterior cervical discectomy and fusion (ACDF). OBJECTIVE Our objective was to use time-driven activity-based costing (TDABC) methodology to determine whether surgeons' case volume influenced the true intraoperative costs of ACDFs performed at our institution. SUMMARY OF BACKGROUND DATA Successful participation in emerging reimbursement models, such as bundled payments, requires an understanding of true intraoperative costs, as well as the modifiable drivers of those costs. Certain surgeons may have cost profiles that are favorable for these "at-risk" reimbursement models, while other surgeons may not. METHODS Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. All surgeons performing ACDFs at our primary and affiliated hospital sites from 2017 to 2022 were divided into four volume-based cohorts: 1-9 cases (n=10 surgeons, 38 cases), 10-29 cases (n=7 surgeons, 126 cases), 30-100 cases (n=3 surgeons, 234 cases), and > 100 cases (n=2 surgeons, 561 cases). RESULTS The average total intraoperative cost per case was $7,116 +/- $2,945. The major cost contributors were supply cost ($4,444, 62.5%) and personnel cost ($2,417, 34.0%). A generalized linear mixed model utilizing Poisson distribution was performed with the surgeon as a random effect. Surgeons performing 1-9 total cases, 10-29 cases, and 30-100 cases had increased total cost of surgery (P < 0.001; P < 0.001; and P<0.001, respectively) compared to high-volume surgeons (> 100 cases). Among all volume cohorts, high-volume surgeons also had the lowest mean supply cost, personnel cost, and operative times, while the opposite was true for the lowest-volume surgeons (1-9 cases). CONCLUSION It is becoming increasingly important for hospitals to identify modifiable sources of variation in cost. We demonstrate a novel use of TDABC for this purpose. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Advith Sarikonda
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Ashmal Sami
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Daniyal Mansoor Ali
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Eric Tecce
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Ari August
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Matthew O'Leary
- Department of Medicine, Drexel University College of Medicine
| | - Sara Thalheimer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | | | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
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Howard RA, Thelen AE, Chen X, Gates R, Krumm AE, Millis MA, Gupta T, Brown CS, Bandeh-Ahmadi H, Wnuk GM, Yee CC, Ryan AM, Mukherjee B, Dimick JB, George BC. Mortality and Severe Complications Among Newly Graduated Surgeons in the United States. Ann Surg 2024; 279:555-560. [PMID: 37830271 PMCID: PMC10939969 DOI: 10.1097/sla.0000000000006128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To evaluate severe complications and mortality over years of independent practice among general surgeons. BACKGROUND Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons. METHODS We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics. RESULTS The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice. CONCLUSIONS Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.
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Affiliation(s)
- Ryan A Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Angela E Thelen
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Xilin Chen
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Rebecca Gates
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Andrew E Krumm
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, PA
| | - Michael Andrew Millis
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Tanvi Gupta
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Hoda Bandeh-Ahmadi
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Greg M Wnuk
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Chia Chye Yee
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Andrew M Ryan
- Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
- Center for Evaluating Health Reform, University of Michigan, Ann Arbor, MI
| | - Bhramar Mukherjee
- Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, PA
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Acker RC, Kelz RR. Cutting Through the Learning Curve: The New Surgeon Battle Between Inexperience and Competence. Ann Surg 2024; 279:561-562. [PMID: 38116655 DOI: 10.1097/sla.0000000000006186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Rachael C Acker
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA
- Leonard David Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia, PA
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Gülensoy B, Şimşek S. Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis. Med Sci Monit 2024; 30:e943815. [PMID: 38491725 PMCID: PMC10953316 DOI: 10.12659/msm.943815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND We aimed to compare the effectiveness of microscopic unilateral laminotomy for bilateral decompression (ULBD) and microscopic bilateral laminotomy for bilateral decompression (BLBD) in the early postoperative period among patients with single-level lumbar spinal stenosis (LSS). MATERIAL AND METHODS A retrospective cohort study was conducted on patients with LSS who underwent ULBD or BLBD between January 2020 and December 2023, including 94 patients who underwent ULBD and 58 who underwent BLBD. Patient demographics, comorbidities, smoking status, and data related to LSS were reviewed. Preoperative and postoperative assessments on day 10 included back pain visual analog scale (VAS), walking distance, and Odom criteria. Disability was evaluated using the self-assessment Oswestry Disability Index (ODI) preoperatively and on day 30. Additionally, wound infection, postoperative modified MacNab criteria, and pain (back, leg, and hip) were recorded. RESULTS Age and sex were similar in the 2 groups. Both surgeries significantly reduced low back pain, increased walking distance, and improved Odom category on day 10, compared with baseline (P<0.001 for all). A significant decrease in 30-day ODI, compared with baseline, was observed in both groups (P<0.001 for both). The ULBD group had a significantly higher percentage of patients with wound infection (P=0.014); however, the ODI score among ULBD recipients was significantly lower (better) on day 30 (P=0.047). CONCLUSIONS ULBD may represent a less invasive, more effective, and safer surgical alternative than BLBD and classical laminectomy in patients with single-level LSS, but precautions are essential concerning wound infection.
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Affiliation(s)
- Bülent Gülensoy
- Department of Neurosergury, Lokman Hekim University Faculty of Medicine, Ankara, Turkey
| | - Serkan Şimşek
- Department of Neurosergury, Medipol University Faculty of Medicine, Ankara, Turkey
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George BC, Thelen AE, Howard RA, Kendrick DE, Chen X, Clark MJ, Gupta T, Brown CS, Bandeh-Ahmadi H, Luckoski JL, Wnuk GM, Fan Z, Krumm AE, Ryan AM, Buyske J, Mukherjee B, Dimick JB. Evaluating Educational Outcomes Using Patient Outcomes of New Surgeons Performing Partial Colectomy Compared to Cholecystectomy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S143-S148. [PMID: 37983406 DOI: 10.1097/acm.0000000000005368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Despite ongoing efforts to improve surgical education, surgical residents face gaps in their training. However, it is unknown if differences in the training of surgeons are reflected in the patient outcomes of those surgeons once they enter practice. This study aimed to compare the patient outcomes among new surgeons performing partial colectomy-a common procedure for which training is limited-and cholecystectomy-a common procedure for which training is robust. METHOD The authors retrospectively analyzed all adult Medicare claims data for patients undergoing inpatient partial colectomy and inpatient cholecystectomy between 2007 and 2018. Generalized additive mixed models were used to investigate the associations between surgeon years in practice and risk-adjusted rates of 30-day serious complications and death for patients undergoing partial colectomy and cholecystectomy. RESULTS A total of 14,449 surgeons at 4,011 hospitals performed 340,114 partial colectomy and 355,923 cholecystectomy inpatient operations during the study period. Patients undergoing a partial colectomy by a surgeon in their 1st vs 15th year of practice had higher rates of serious complications (5.22% [95% CI, 4.85%-5.60%] vs 4.37% [95% CI, 4.22%-4.52%]; P < .01) and death (3.05% [95% CI, 2.92%-3.17%] vs 2.83% [95% CI, 2.75%-2.91%]; P < .01). Patients undergoing a cholecystectomy by a surgeon in their 1st vs 15th year of practice had similar rates of 30-day serious complications (4.11% vs 3.89%; P = .11) and death (1.71% vs 1.70%; P = .93). CONCLUSIONS Patients undergoing partial colectomy faced a higher risk of serious complications and death when the operation was performed by a new surgeon compared to an experienced surgeon. Conversely, patient outcomes following cholecystectomy were similar for new and experienced surgeons. More attention to partial colectomy during residency training may benefit patients.
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Affiliation(s)
- Brian C George
- B.C. George is associate professor of surgery and director, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Angela E Thelen
- A.E. Thelen is a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan
| | - Ryan A Howard
- R.A. Howard is a research fellow, Center for Health Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniel E Kendrick
- D.E. Kendrick was a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan, and is currently assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Xilin Chen
- X. Chen is a data analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael J Clark
- M.J. Clark is a statistician lead, Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Tanvi Gupta
- T. Gupta is a data analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Craig S Brown
- C.S. Brown is a general surgery resident and research fellow, Center for Health Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hoda Bandeh-Ahmadi
- H. Bandeh-Ahmadi is director of social research, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - John L Luckoski
- J.L. Luckoski is a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan
| | - Greg M Wnuk
- G.M. Wnuk is program manager, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan
| | - Zhaohui Fan
- Z. Fan is a data analyst, Center for Health Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew E Krumm
- A.E. Krumm is assistant professor of learning health sciences, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Ryan
- A.M. Ryan is professor of health services, policy, and practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jo Buyske
- J. Buyske is president and chief executive officer, American Board of Surgery, Philadelphia, Pennsylvania
| | - Bhramar Mukherjee
- B. Mukherjee is professor of epidemiology and chair of biostatistics, Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Justin B Dimick
- J.B. Dimick is professor and chair, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Koehler A, Strauss B, Briken P, Fisch M, Soave A, Riechardt S, Nieder TO. Exploring the Relationship between (De-)Centralized Health Care Delivery, Client-Centeredness, and Health Outcomes-Results of a Retrospective, Single-Center Study of Transgender People Undergoing Vaginoplasty. Healthcare (Basel) 2023; 11:1746. [PMID: 37372864 DOI: 10.3390/healthcare11121746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Transgender health care interventions (e.g., gender-affirming surgery) support transgender and gender-diverse people to transition to their gender and are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different institutions spread over several locations). In this exploratory study, we investigated the relationship between centralized and decentralized delivery of transgender health care, client-centeredness, and psychosocial outcomes. Methods: A retrospective analysis of 45 clients undergoing vaginoplasty at one medical center was conducted. Mann-Whitney U tests assessed differences regarding five dimensions of client-centeredness and psychosocial outcomes between the health care delivery groups. To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identified predictors that were actually related to the outcomes. Results: All aspects of client-centered care were scored average or high. Decentralized delivery of care was more client-centered in terms of involvement in care/shared decision-making and empowerment. However, participants from decentralized health care delivery settings scored lower on psychosocial health (p = 0.038-0.005). Conclusions: The factor of (de-)centralized health care delivery appears to have a significant impact on the provision of transgender health care and should be investigated by future research.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, University Hospital Jena, Stoystrasse 3, 07740 Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Margit Fisch
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Armin Soave
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Silke Riechardt
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Ho JPTF, Özkan S, Zhou N, Apperloo RC, Su N, Becking AG, de Lange J. Influence of Surgeon Experience on Surgical Outcome of Maxillomandibular Advancement for Obstructive Sleep Apnea. J Clin Med 2023; 12:jcm12103504. [PMID: 37240609 DOI: 10.3390/jcm12103504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The primary aim of this study was to assess the association between clinical efficacy outcomes (i.e., polysomnography (PSG) results) of maxillomandibular advancement (MMA) and surgeons' experience. The second aim was to assess the association between the occurrence of postoperative complications of MMA and surgeons' experiences. Patients treated with MMA for moderate to severe obstructive sleep apnea (OSA) were enrolled in this retrospective study. The patient population was divided into two groups based on two different surgeons performing MMA. The associations between surgeons' experience on the one hand and PSG results and postoperative complications on the other hand were investigated. A total of 75 patients were included. There was no significant difference in baseline characteristics between the two groups. The reductions in apnea-hypopnea index and oxygen desaturation index were both significantly greater in group-B than group-A (p = 0.015 and 0.002, respectively). The overall success rate after MMA was 64.0%. There was a negative correlation between surgeon experience and surgical success (odds ratio: 0.963 [0.93, 1.00], p = 0.031). No significant association was found between surgeon experience and surgical cure. Additionally, there was no significant association between surgeon experience and the occurrence of postoperative complications. Within the limitations of this study, it is concluded that surgeon experience may have little to no influence on the clinical efficacy and safety of MMA surgery in OSA patients.
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Affiliation(s)
- Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, 1815 JD Alkmaar, The Netherlands
| | - Semih Özkan
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ruben C Apperloo
- Department of Oral and Maxillofacial Surgery, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Naichuan Su
- Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Alfred G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
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Wu Y, Li S, Yuan J, Zhang H, Wang M, Zhang Z, Qin R. Benchmarking: a novel measuring tool for outcome comparisons in surgery. Int J Surg 2023; 109:419-428. [PMID: 37093075 PMCID: PMC10389472 DOI: 10.1097/js9.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/05/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Benchmarking, a novel measuring tool for outcome comparisons, is a recent concept in surgery. The objectives of this review are to examine the concept, definition, and evolution of benchmarking and its application in surgery. METHODS The literature about benchmarking was reviewed through an ever-narrowing search strategy, commencing from the concept, definition, and evolution of benchmarking to the application of benchmarking and experiences of benchmarking in surgery. PubMed, Web of Science, Embase, and Science Direct databases were searched until 20 September 2022, in the English language according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. RESULTS In the first phase of the literature search, the development of benchmarking was identified. The definitions of benchmarking evolved from a surveying term to a novel quality-improvement tool to assess the best achievable results in surgery. In the second phase, a total of 23 studies were identified about benchmarking in surgery, including esophagectomy, hepatic surgery, pancreatic surgery, rectum resection, and bariatric surgery. All studies were multicenter analyses from national, international, or global expert centers. Most studies (87.0%) adopted the definition that benchmark was the 75th percentile of the median values of centers. Performance metrics to define benchmarks were clinically relevant intraoperative and postoperative outcome indicators. CONCLUSION Benchmarking in surgery is a novel quality-improvement tool to define and measure the best achievable results, establishing a meaningful reference to evaluate surgical performance.
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Affiliation(s)
- Yi Wu
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Moazzam Z, Lima HA, Alaimo L, Endo Y, Ejaz A, Beane J, Dillhoff M, Cloyd J, Pawlik TM. Hepatopancreatic Surgeons Versus Pancreatic Surgeons: Does Surgical Subspecialization Impact Patient Care and Outcomes? J Gastrointest Surg 2023; 27:750-759. [PMID: 36857013 DOI: 10.1007/s11605-023-05639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Hepatopancreatic (HP) surgeon and hospital procedural volume may vary relative to liver or pancreas cases. We sought to investigate the impact of surgeon and hospital pancreatic subspecialization on patient outcomes. METHODS Patients who underwent pancreatic surgery between 2013-2017 were identified from the Medicare Standard Analytic Files. The surgery subspecialization index (SSI) was calculated to signify surgeon and hospital pancreatic subspecialization, and categorized as low, intermediate, and high SSI. The association of SSI with Textbook Outcome (TO) and its components, failure to rescue (FTR), discharge to home and index admission expenditures was assessed with mixed-effects multivariable logistic regression. RESULTS Among 19,625 patients, most pancreatic procedures were characterized by high SSI (Low SSI: 27.7%, Intermediate SSI: 34.7%, High SSI: 37.7%). Notably, higher SSI was associated with greater odds of achieving a TO [Intermediate SSI: OR 1.16 (95%CI 1.06-1.27); High SSI: OR 1.23 (95%CI 1.11-1.35)] as well as being discharged home, and lower odds of experiencing FTR. Furthermore, this association persisted in both low-volume [referent: Low SSI; Intermediate SSI: OR 1.14 (95%CI 1.01-1.28); High SSI: OR 1.15 (95%CI 1.02-1.31)] and high-volume hospitals [referent: Low SSI; Intermediate SSI: OR 1.16 (95%CI 1.01-1.32); High SSI: OR 1.26 (95%CI 1.09-1.45)]. CONCLUSIONS Greater pancreatic subspecialization was associated with improved postoperative outcomes following pancreatic resection. Amidst increasing efforts to improve quality of care, surgical subspecialization may play a role in determining patient outcomes regardless of total surgeon or hospital volume.
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Affiliation(s)
- Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique Araujo Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Joal Beane
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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10
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The Relationship Among Surgeon Experience, Complications, and Radiographic Outcomes in Spine Deformity Surgery: The Experience of a Junior Surgeon. World Neurosurg 2022; 168:e399-e407. [DOI: 10.1016/j.wneu.2022.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
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11
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Kelz RR, Brooke B, Dossett L. Leveraging the Health Services Research Toolbox for Surgical Education Research. JAMA Surg 2022; 157:649-650. [PMID: 35507341 DOI: 10.1001/jamasurg.2022.0643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Yu R, Rosenbaum PR. Graded Matching for Large Observational Studies. J Comput Graph Stat 2022. [DOI: 10.1080/10618600.2022.2058001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ruoqi Yu
- Department of Statistics, University of California, Berkeley
| | - Paul R. Rosenbaum
- Department of Statistics and Data Science, Wharton School, University of Pennsylvania
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13
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Mohanty A, Lombardo AM, Judge C, Gundeti MS. Are there disparities in access to robot-assisted laparoscopic surgery among pediatric urology patients? US institutional experience. Int J Urol 2022; 29:661-666. [PMID: 35340066 PMCID: PMC9545788 DOI: 10.1111/iju.14866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 01/22/2023]
Abstract
Objective Literature suggests access to robotic surgery varies by race and payer status. We seek to investigate whether disparities exist in robot‐assisted laparoscopic surgery among the pediatric urology population at our tertiary academic medical center and, if so, to find plausible reasons why. Methods Retrospective analysis identified patients who underwent open or robot‐assisted laparoscopic surgery by a single surgeon at a tertiary care center between 2008 and 2019. Univariate and multivariate analyses determined the relationship of patient demographic and socioeconomic factors to procedure approach. Results Among 356 patients, race, age, American Society of Anesthesiologists status, and year of surgery were significant by univariate analysis. Insurance status was not significant (P = 0.066). Multivariate analysis indicated that age, American Society of Anesthesiologists status, and year of surgery were statistically significant (P < 0.001, P = 0.005, P < 0.001). By multivariate logistic regression, Black and Hispanic patient race were not significant with an odds ratio of 0.60 (0.35–1.02) (P = 0.061). In 60.2% of open cases, open approach selection was attributable to complex pathology, limitations of robotic approach, and surgeon's robot‐assisted laparoscopic learning curve. Conclusions Optimal procedure approach was determined by case complexity and surgeon's robot‐assisted laparoscopic learning curve and was independent of patient race and payer status. This study did not find racial or socioeconomic disparities in robotic surgery within pediatric urology at our tertiary medical center, inconsistent with previous literature.
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Affiliation(s)
- Amrita Mohanty
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Alyssa M Lombardo
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Clark Judge
- The University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA
| | - Mohan S Gundeti
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.,The University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA
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14
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A Dual-Institutional Study on First Year Practice Outcomes of Pediatric Surgeons Who Trained in the Era of Work Hour Restrictions. Pediatr Surg Int 2022; 38:277-283. [PMID: 34709434 PMCID: PMC8742777 DOI: 10.1007/s00383-021-05037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In July 2003, an 80-h work week restriction for residencies was mandated. This was met with skepticism regarding its potential impact on operative training. We hypothesized no difference in outcomes for pediatric surgeons who trained under duty hour restrictions compared to historical complication rates. METHODS Dual-institutional review of pediatric patients who underwent five of the most common operations (2013-2018) by first-year pediatric surgeons who trained under duty hour restrictions was performed. Tests of proportions were used to compare complication rates to published rates on data collected prior to 2003. RESULTS Patient mean age was 10.1 years. No significant differences (p values > 0.05) were found in laparoscopic appendectomy rates of infection, bleeding or intra-abdominal abscess compared to previously published rates. Pyloromyotomy rates of infection or duodenal perforation were not different. No differences were detected in rates of infection, recurrence or testicular atrophy for inguinal hernia repair. Umbilical hernia rates of infection, bleeding, and recurrence were also not different. There was no difference in CVC rates of hemopneumothoraces; significantly more bleeding events were detected (1.2% vs. 0.1%; p value = 0.04). CONCLUSION In this study, first-year complication rates of pediatric surgeons who trained under duty hour restrictions were not significantly different when compared to published rates.
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15
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Abstract
BACKGROUND Transitioning from trainee to independent surgeon is challenging, with teaching and mentoring learners adding complexity. This study aimed to identify benefits and challenges of teaching and mentoring residents early in surgical practice. MATERIALS AND METHODS A mixed-methods survey with multiple choice and open-ended questions was developed for early career (first 3 years) and experienced (more than 3 years) surgeons working with residents. The survey was initially piloted by 6 surgeons, revised according to feedback and distributed on Twitter. Quantitative and qualitative analyses were performed. RESULTS Seventy-three valid responses were analyzed, 21 (25%) from early career surgeons and 53 (75%) from experienced surgeons. The majority were women (62%), practiced in academics (78%) and lived in the United States (76%). Most of the early career and experienced surgeons selected the operating room as the most teaching challenging location (62% early career; and 60% experienced). Top teaching challenges of early career surgeons were the need to focus on own skills (24%) and concern for patient safety/outcomes (24%), while experienced surgeons reported need to focus on own skills (23%) and difficulty giving up control (23%). Open-ended responses identified themes related to teaching and mentoring. Comments highlighted benefits of organizational support to facilitate teaching and mentoring and negative experiences due to resident learners not respecting early career surgeons. DISCUSSION This pilot study explores an area not previously studied. Early career surgeons and experienced surgeons find many similar challenges and benefits of teaching and mentoring residents. Challenges and themes identified can guide early career surgeons and organizations with regard to teaching and mentoring.
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Affiliation(s)
- Muneera R Kapadia
- Department of Surgery, Ringgold ID: 2331University of North Carolina at Chapel Hill, NC, USA
| | - Jennifer E Hrabe
- Department of Surgery, Ringgold ID: 21782University of Iowa, IA, USA
| | - Julia Shelton
- Department of Surgery, Ringgold ID: 21782University of Iowa, IA, USA
| | - Lillian M Erdahl
- Department of Surgery, Ringgold ID: 21782University of Iowa, IA, USA
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