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Bidwell SS, Fry BT, Telem DA. Is Preoperative Optimization Right for Every Hernia Patient?: It's Time to Optimize the Optimization Process. JAMA Surg 2024; 159:475-476. [PMID: 38446450 DOI: 10.1001/jamasurg.2023.7455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
This Viewpoint discusses developing a more nuanced preoperative optimization strategy for hernia repair that considers patient and disease factors to determine the right operation for the right patient at the right time.
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Affiliation(s)
| | - Brian T Fry
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor
- University of Michigan Center for Healthcare Outcomes & Policy, Ann Arbor
| | - Dana A Telem
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor
- University of Michigan Center for Healthcare Outcomes & Policy, Ann Arbor
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O'Neill SM, Fry BT, Weng W, Rubyan M, Howard RA, Ehlers AP, Englesbe MJ, Dimick JB, Telem DA. Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair. Surg Endosc 2024; 38:414-418. [PMID: 37821560 DOI: 10.1007/s00464-023-10498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Documentation of intraoperative details is critical for understanding and advancing hernia care, but is inconsistent in practice. Therefore, to improve data capture on a statewide level, we implemented a financial incentive targeting documentation of hernia defect size and mesh use. METHODS The Abdominal Hernia Care Pathway (AHCP), a voluntary pay for performance (P4P) initiative, was introduced in 2021 within the statewide Michigan Surgical Quality Collaborative (MSQC). This consisted of an organizational-level financial incentive for achieving 80% performance on eight specific process measures for ventral hernia surgery, including complete documentation of hernia defect size and location, as well as mesh characteristics and fixation technique. Comparisons were made between AHCP and non-AHCP sites in 2021. RESULTS Of 69 eligible sites, 47 participated in the AHCP in 2021. There were N = 5362 operations (4169 at AHCP sites; 1193 at non-AHCP sites). At AHCP sites, 69.8% of operations had complete hernia documentation, compared to 50.5% at non-AHCP sites (p < 0.0001). At AHCP sites, 91.4% of operations had complete mesh documentation, compared to 86.5% at non-AHCP sites (p < 0.0001). The site-level hernia documentation goal of 80% was reached by 14 of 47 sites (range 14-100%). The mesh documentation goal was reached by 41 of 47 sites (range 4-100%). CONCLUSIONS Addition of an organizational-level financial incentive produced marked gains in documentation of intra-operative details across a statewide surgical collaborative. The relatively large effect size-19.3% for hernia-is remarkable among P4P initiatives. This result may have been facilitated by surgeons' direct role in documenting hernia size and mesh use. These improvements in data capture will foster understanding of current hernia practices on a large scale and may serve as a model for improvement in collaboratives nationally.
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Affiliation(s)
- Sean M O'Neill
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
| | - Brian T Fry
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Wenjing Weng
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA
| | - Michael Rubyan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ryan A Howard
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Englesbe
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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Abstract
Importance Roux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care. Observations Given the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted. Conclusions and Relevance The etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.
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Affiliation(s)
- Brian T Fry
- Department of Surgery, University of Michigan, Ann Arbor
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Abstract
OBJECTIVE To evaluate the association between postoperative opioid prescription size and patient-reported satisfaction among surgical patients. SUMMARY BACKGROUND DATA Opioids are overprescribed after surgery, which negatively impacts patient outcomes. The assumption that larger prescriptions increase patient satisfaction has been suggested as an important driver of excessive prescribing. METHODS This prospective cohort study evaluated opioid-naive adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The primary outcome was patient satisfaction, collected via a 30-day postoperative survey. Satisfaction was measured on a scale of 0 to 10 and dichotomized into "highly satisfied" (9-10) and "not highly satisfied" (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). Hierarchical logistic regression was performed to evaluate the association between prescription size and satisfaction while adjusting for clinical covariates. RESULTS One thousand five hundred twenty patients met the inclusion criteria. Mean age was 53 years and 43% of patients were female. One thousand two hundred seventy-nine (84.1%) patients were highly satisfied and 241 (15.9%) were not highly satisfied. After multivariable adjustment, there was no significant association between opioid prescription size and satisfaction (OR 1.00, 95% CI 0.99-1.00). The predicted probability of being highly satisfied ranged from 83% for the smallest prescription (25 mg OME) to 85% for the largest prescription (750 mg OME). CONCLUSIONS In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction. This implies that surgeons can provide significantly smaller opioid prescriptions after surgery without negatively affecting patient satisfaction.
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Affiliation(s)
- Brian T Fry
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ryan A Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
| | - Vidhya Gunaseelan
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
- Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Jay S Lee
- Department of Surgery, Memorial Sloan Kettering, New York, NY
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
- Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
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Abstract
BACKGROUND The "surgical personality" is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as "suspect" because they seemingly threaten professional competency. We report on exit interviews of surgeons who participated in a coaching program and demonstrate how their narratives challenge the surgical "personality" and forge an evolving and more open professional surgical identity. METHODS We interviewed n = 34 bariatric surgeons at the end of a 2-year surgical coaching program. Transcribed interviews were analyzed in NVivo, computer-assisted qualitative data analysis software. Coding of transcripts was approached through iterative steps. We utilized an exploratory method; each member of our team independently examined 3 transcripts to evaluate emergent themes early in the investigation. The team met to discuss our independent themes and develop the codebook collectively. We created a descriptive framework for our first round of coding based on emerging themes and employed an interpretive framework to arrive at our themes. RESULTS Three major themes emerged from our data. Participants in this study discussed the ways that participation in the coaching program initially conflicted with their identity as a competent professional. Surgeons were acutely aware of how participation might have destabilized their surgical identity because they might be viewed as vulnerable. Despite these concerns about image, surgeons found impetus for improvement because of poor outcome scores or because they desired early career affirmation. Finally, surgeons report that the safe spaces of intentional coaching contributed to their ideas about how surgeons, and ultimately surgery, can change. CONCLUSIONS Participation in a coaching program challenged how surgeons thought of themselves in relationship to social and peer expectations. Our results indicate that surgeons do feel peer and social pressures related to identity but are much more complex and nuanced than has been previously discussed. The safe space of intentional coaching allowed participants to practice vulnerability without the pressures of sometimes caustic professional norms. Participants in this study viewed coaching as the way to improve the culture of surgery.
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Affiliation(s)
- Mary E Byrnes
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan
| | - Tedi A Engler
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan
| | - Caprice C Greenberg
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan
- Department of Surgery, University of Wisconsin, and the Wisconsin Surgical Outcomes Research Program (WiSOR), Madison, Wisconsin
| | - Brian T Fry
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan
| | - Janet Dombrowski
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan
| | - Justin B Dimick
- Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan
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Kemp MT, Rivard SJ, Anderson S, Audu CO, Barrett M, Fry BT, Lane M, Vu JV, Young BAC, Englesbe M, Sandhu G, Coleman DM. Trainee Wellness and Safety in the Context of COVID-19: The Experience of One Institution. Acad Med 2021; 96:655-660. [PMID: 33208674 DOI: 10.1097/acm.0000000000003853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The COVID-19 pandemic has had significant ramifications for provider well-being. During these unprecedented and challenging times, one institution's Department of Surgery put in place several important initiatives for promoting the well-being of trainees as they were redeployed to provide care to COVID-19 patients. In this article, the authors describe these initiatives, which fall into 3 broad categories: redeploying faculty and trainees, ensuring provider safety, and promoting trainee wellness. The redeployment initiatives are the following: reframing the team mindset, creating a culture of grace and forgiveness, establishing a multidisciplinary wellness committee, promoting centralized leadership, providing clear communication, coordinating between departments and programs, implementing phased restructuring of the department's services, establishing scheduling flexibility and redundancy, adhering to training regulations, designating a trainee ombudsperson, assessing physical health risks for high-risk individuals, and planning for structured deimplementation. Initiatives specific to promoting provider safety are appointing a trainee safety advocate, guaranteeing personal protective equipment and relevant information about these materials, providing guidance regarding safe practices at home, and offering alternative housing options when necessary. Finally, the initiatives put in place to directly promote trainee wellness are establishing an environment of psychological safety, providing mental health resources, maintaining the educational missions, solidifying a sense of community by showing appreciation, being attentive to childcare, and using social media to promote community morale. The initiatives to carry out the department's strategy presented in this article, which were well received by both faculty and trainee members of the authors' community, may be employed in other departments and even outside the context of COVID-19. The authors hope that colleagues at other institutions and departments, independent of specialty, will find the initiatives described here helpful during, and perhaps after, the pandemic as they develop their own institution-specific strategies to promote trainee wellness.
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Affiliation(s)
- Michael T Kemp
- M.T. Kemp is a general surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8287-9984
| | - Samantha J Rivard
- S.J. Rivard is a general surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-1274-1183
| | - Sara Anderson
- S. Anderson is an oral and maxillofacial surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher O Audu
- C.O. Audu is a vascular surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-4183-8825
| | - Meredith Barrett
- M. Barrett is a transplant surgery fellow, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-5476-0118
| | - Brian T Fry
- B.T. Fry is a general surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-7185-8579
| | - Megan Lane
- M. Lane is a plastic surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joceline V Vu
- J.V. Vu is a general surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bree Ann C Young
- B.A.C. Young is a thoracic surgery resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Englesbe
- M. Englesbe is professor of surgery, Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8691-9111
| | - Gurjit Sandhu
- G. Sandhu is associate professor of surgery and learning health sciences and vice chair of resident professional development, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-0258-7899
| | - Dawn M Coleman
- D.M. Coleman is associate professor of surgery, Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Vande Walle KA, Quamme SRP, Beasley HL, Leverson GE, Ghousseini HN, Dombrowski JC, Fry BT, Dimick JB, Wiegmann DA, Greenberg CC. Development and Assessment of the Wisconsin Surgical Coaching Rubric. JAMA Surg 2021; 155:486-492. [PMID: 32320026 DOI: 10.1001/jamasurg.2020.0424] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical coaching continues to gain momentum as an innovative method for continuous professional development. A tool to measure the performance of a surgical coach is needed to provide formative feedback to coaches for continued skill development and to assess the fidelity of a coaching intervention for future research and dissemination. Objective To evaluate the validity of the Wisconsin Surgical Coaching Rubric (WiSCoR), a novel tool to assess the performance of a peer surgical coach. Design, Setting, and Participants Surgical coaching sessions from November 2014 through February 2018 conducted by 2 statewide peer surgical coaching programs were audio recorded and transcribed. Twelve raters used WiSCoR to rate the performance of the surgical coach for each session. The study included peer surgical coaches in the Wisconsin Surgical Coaching Program (n = 8) and the Michigan Bariatric Surgery Collaborative coaching program (n = 15). The data were analyzed in 2019. Interventions or Exposures Use of WiSCoR to rate peer surgical coaching sessions. Main Outcomes and Measures There were 282 WiSCoR ratings from the 106 coaching sessions included in the study. WiSCoR was evaluated using a framework, including inter-rater reliability assessed with Gwet weighted agreement coefficent. Descriptive statistics of WiSCoR were calculated. Results Eight coaches (35%) and 11 coachees (29%) were from the Wisconsin Surgical Program and 15 coaches (65%) and 27 coachees (71%) were from the Michigan Bariatric Surgery Collaborative. The validity of WiSCoR is supported by high interrater reliability (Gwet weighted agreement coefficient, 0.87) as well as a weakly positive correlation of WiSCoR to coachee ratings of coaches (r = 0.22; P = .04), rigorous content development, consistent rater training, and the association of WiSCoR with coach and coaching program development. The mean (SD) overall coach performance rating using WiSCoR was 3.23 (0.82; range, 1-5). Conclusions and Relevance WiSCoR is a reliable measure that can assess the performance of a surgical coach, inform fidelity to coaching principles, and provide formative feedback to surgical coaches. While coachee ratings may reflect coachee satisfaction, they are not able to determine the quality of a coach.
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Affiliation(s)
- Kara A Vande Walle
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison
| | - Sudha R Pavuluri Quamme
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison
| | - Heather L Beasley
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison
| | - Glen E Leverson
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison
| | - Hala N Ghousseini
- Department of Curriculum and Instruction, University of Wisconsin School of Education, Madison
| | | | - Brian T Fry
- Center for Healthcare Outcomes & Policy, Department of Surgery, University of Michigan, Ann Arbor
| | - Justin B Dimick
- Center for Healthcare Outcomes & Policy, Department of Surgery, University of Michigan, Ann Arbor.,Surgical Innovation Editor,
| | - Douglas A Wiegmann
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison.,Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison
| | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison
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Affiliation(s)
- Brian T. Fry
- University of Michigan Medical School, Ann Arbor
- University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor
| | - Alexander Hallway
- Michigan Surgical and Health Optimization Program, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
| | - Michael J. Englesbe
- University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor
- Michigan Surgical and Health Optimization Program, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
- Michigan Surgical Quality Collaborative, Ann Arbor
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Fry BT, Lee JS, Howard R, Campbell DA, Brummett C, Waljee JF, Englesbe MJ, Vu JV. Opioid Prescribing and Patient Satisfaction after General Surgery. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fry BT, Smith ME, Ghaferi AA, Dimick JB. Variation in Failure to Rescue: Do the Best Hospitals Excel across All Procedures? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jain M, Fry BT, Hess LW, Anger JT, Gewertz BL, Catchpole K. Barriers to efficiency in robotic surgery: the resident effect. J Surg Res 2016; 205:296-304. [PMID: 27664876 DOI: 10.1016/j.jss.2016.06.092] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/06/2016] [Accepted: 06/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robotic surgery offers advantages over conventional operative approaches but may also be associated with higher costs and additional risks. Analyzing surgical flow disruptions (FDs), defined as "deviations from the natural progression of an operation," can help target training techniques and identify opportunities for improvement. MATERIALS AND METHODS Thirty-two robotic surgery operations were observed over a 6-wk period at one 900-bed surgical center. FDs were recorded in detail and classified into one of 11 different categories. Procedure type, robot model, and resident involvement were also recorded. Linear regression analyses were used to evaluate the effects of these parameters on FDs and operative duration. RESULTS Twenty-one prostatectomies, eight sacrocolpopexies, and three nephrectomies were observed. The mean number of FDs was 48.2 (95% confidence interval [CI] 38.6-54.8 FDs), and mean operative duration was 163 min (95% CI 148-179 min). Each FD added 2.4 min (P = 0.025) to a case's total operative duration. The number and rate of FDs were significantly affected by resident involvement (P = 0.008 and P = 0.006, respectively). Resident cases demonstrated mostly training, equipment, and robot switch FDs, whereas nonresident cases demonstrated mostly equipment, instrument changes, and external factor FDs. CONCLUSIONS Although the FDs encountered in resident training are more frequent, they may not significantly increase operative duration. Other FDs, such as equipment or external factors, may be more impactful. Limiting these specific FDs should be the focus of performance improvement efforts.
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Affiliation(s)
- Monica Jain
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Brian T Fry
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Luke W Hess
- Eberly College of Science, Pennsylvania State University, Pennsylvania
| | - Jennifer T Anger
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Bruce L Gewertz
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Ken Catchpole
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.
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