Survey on the surgical skills of orthopedics and traumatology residents from accredited and nonaccredited institutions in İstanbul

Survey of Orthopedic Surgeons' Perceptions of Adopting an Initiative With Cemented Hip Hemiarthroplasties for Fractures

INTRODUCTION

Hip hemiarthroplasty is a surgical procedure that requires the adhesion of the prosthetic implant by utilizing a fixation technique, either cemented or noncemented. The current literature does not provide a clear recommendation on a superior technique, although many countries outside the US have guidelines recommending cemented over noncemented procedures. Further, surgeon perceptions and beliefs related to the cemented and noncemented techniques in hip arthroplasty fractures are generally unknown.

METHODS

Orthopedic surgeon leaders adopted a quality assurance initiative to increase the rate of cemented cases within their practice. A survey was developed to capture the surgeons' perceptions related to fixation technique, affordability, and potential barriers and facilitators. Likert scale data were analyzed with descriptive statistics and chi-square tests.

RESULTS

Sixty-one total joint surgeons throughout 13 locations were invited to participate in the study via email. A total of 38 of the 61 total joint surgeons completed the survey, representing a 62% response rate. Most responses were neutral or disagreed with the use of cement for femoral fixation in hemiarthroplasty.

CONCLUSION

Although some questions elicited strong opinions, many surgeons expressed hesitancy to change their current fixation technique and their desire for autonomy within their clinical practices. However, the large number of neutral responses suggests the potential to engage, educate, and shift the surgeons' perception to adopt the quality assurance initiative and increase the rate of cemented cases.

How Much Experience is Required to Acquire the Skills to Independently Perform Spine Surgery? What Milestones are Needed for Successful Surgery?

Purpose

To assess the number of surgeries needed to acquire the necessary skills to perform spine surgery independently.

Patients and Methods

A questionnaire on 12 different spinal procedures was sent to orthopedic surgeons affiliated with the spine teams of orthopedic departments at either the Akita University or Sapporo Medical University. Participants were asked to identify whether they (A) could independently perform each procedure, (B) could perform each procedure with the assistance of a senior doctor, or (C) were unable to perform each procedure. Those whose response was (A) were asked how many surgeries were required to acquire the necessary skills. Those who responded to (B) or (C) were asked how many surgeries they believed were required to acquire the skills necessary to operate independently. Participants also responded to 10 questions on surgical training techniques and rated the usefulness of each method.

Results

A total of 55 spine surgeons responded to the questionnaire. Group A required significantly fewer surgeries in the following categories to become independent than required Group C: upper cervical spine surgery (7.3/19.3), anterior cervical decompression/fusion (6.7/28.8), posterior cervical decompression/fusion (9.5/27.3), lumbar discectomy (12.6/26.7), endoscopic lumbar discectomy (10.2/24.2), spinal tumor resection (6.5/37.2), and spinal kyphosis surgery (10.3/32.3). Over 80% of participants responded that the following were effective methods: "surgeries where a senior doctor is the main surgeon, and the respondent is the assistant and observer"; "surgeries where the respondent is the main surgeon, and a senior doctor is an assistant"; "self-study using surgery manuals, articles, and textbooks"; and "training through video surgery sessions".

Conclusion

Surgeons who do not perform specific procedures independently require more surgical experience than those who operate independently. Our results may help develop more efficient training methods for spine surgeons.