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Sisak S, Price AD, Foote DC, Montgomery KB, Lindeman B, Cho NL, Sheu NO, Postlewait LM, Smith SR, Markesbery KC, Meister KM, Kader S, Abelson JS, Anstadt MJ, Patel PP, Marks JA, Callahan ZM, Kimbrough MK, Byrd SE, Stopenski SJ, Nahmias JT, Patel JA, Wilt W, Dodwad SJM, Adams SD, Willis RE, Farr D, Harvey J, Woeste MR, Martin RCG, Al Yafi M, Sutton JM, Cortez AR, Holm TM. A multi-institutional study from the US ROPE consortium examining factors associated with endocrine surgery exposure for general surgery residents. Surgery 2024; 175:107-113. [PMID: 37953151 PMCID: PMC10906110 DOI: 10.1016/j.surg.2023.05.048] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Prior analyses of general surgery resident case logs have indicated a decline in the number of endocrine procedures performed during residency. This study aimed to identify factors contributing to the endocrine operative experience of general surgery residents and compare those who matched in endocrine surgery fellowship with those who did not. METHODS We analyzed the case log data of graduates from 18 general surgery residency programs in the US Resident Operative Experience Consortium over an 11-year period. RESULTS Of the 1,240 residents we included, 17 (1%) matched into endocrine surgery fellowships. Those who matched treated more total endocrine cases, including more thyroid, parathyroid, and adrenal cases, than those who did not (81 vs 37, respectively, P < .01). Program-level factors associated with increased endocrine volume included endocrine-specific rotations (+10, confidence interval 8-12, P < .01), endocrine-trained faculty (+8, confidence interval 7-10, P < .01), and program co-location with otolaryngology residency (+5, confidence interval 2 -8, P < .01) or endocrine surgery fellowship (+4, confidence interval 2-6, P < .01). Factors associated with decreased endocrine volume included bottom 50th percentile in National Institute of Health funding (-10, confidence interval -12 to -8, P < .01) and endocrine-focused otolaryngologists (-3, confidence interval -4 to -1, P < .01). CONCLUSION Several characteristics are associated with a robust endocrine experience and pursuit of an endocrine surgery fellowship. Modifiable factors include optimizing the recruitment of dedicated endocrine surgeons and the inclusion of endocrine surgery rotations in general surgery residency.
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Affiliation(s)
- Stephanie Sisak
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH
| | - Adam D Price
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH
| | - Darci C Foote
- Beaumont Health, Department of Surgery, Royal Oak, MI; University of Michigan, Department of Surgery, Ann Arbor, MI
| | | | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL
| | - Nancy L Cho
- Brigham and Women's Hospital, Department of Surgery, Boston, MA
| | - Nora O Sheu
- Brigham and Women's Hospital, Department of Surgery, Boston, MA
| | | | | | | | | | - Sarah Kader
- Lahey Hospital and Medical Center, Department of Surgery, Burlington, MA
| | | | | | - Purvi P Patel
- Loyola University, Department of Surgery, Maywood, IL
| | - Joshua A Marks
- Thomas Jefferson University, Department of Surgery, Philadelphia, PA
| | | | | | - Samuel E Byrd
- University of Arkansas for Medical Sciences, Department of Surgery, Little Rock, AR
| | | | - Jeffry T Nahmias
- University of California at Irvine, Department of Surgery, Orange, CA
| | - Jitesh A Patel
- University of Kentucky, Department of Surgery, Lexington, KY
| | - Wesley Wilt
- University of Kentucky, Department of Surgery, Lexington, KY
| | | | - Sasha D Adams
- McGovern Medical School at UTHealth, Department of Surgery, Houston, TX
| | - Ross E Willis
- University of Texas Health Science Center at San Antonio, Department of Surgery, San Antonio, TX
| | - Deborah Farr
- University of Texas Southwestern Medical Center, Department of Surgery, Dallas, TX
| | - Jalen Harvey
- University of Texas Southwestern Medical Center, Department of Surgery, Dallas, TX
| | | | | | - Motaz Al Yafi
- University of Toledo, Department of Surgery, Toledo, OH
| | - Jeffrey M Sutton
- Medical University of South Carolina, Division of Oncologic and Endocrine Surgery, Department of Surgery, Charleston, SC
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH; University of San Francisco, Department of Surgery, San Francisco, CA
| | - Tammy M Holm
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH.
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Soelling SJ, Mahvi DA, Liu JB, Sheu NO, Doherty G, Nehs MA, Cho NL. Impact of Obesity on Risk of Hypocalcemia After Total Thyroidectomy: Targeted National Surgical Quality Improvement Program Analysis of 16,277 Patients. J Surg Res 2023; 291:250-259. [PMID: 37478649 DOI: 10.1016/j.jss.2023.06.006] [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: 12/05/2022] [Revised: 05/20/2023] [Accepted: 06/13/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Hypocalcemia following total thyroidectomy (TT) is common due to postoperative parathyroid dysfunction and vitamin D deficiency. Given the association between obesity and vitamin D deficiency, we sought to correlate body mass index (BMI) with hypocalcemia after TT. METHODS Patients undergoing TT between 2016 and 2020 were identified from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted database. Univariable and multivariable regressions, stratified by BMI category (normal, overweight, obese), identified factors associated with hypocalcemia prior to discharge, within 30 d, and severe hypocalcemic events (emergent evaluation, intravenous calcium supplementation, or readmission). RESULTS Sixteen thousand two hundred seventy seven TT were performed with available BMI data. Three thousand five hundred thirty one (21.7%) patients had normal BMI, 4823 (29.6%) were overweight, and 7772 (47.7%) were obese. Patients with BMI ≥ 25 had decreased risk of hypocalcemia before discharge (9.8% versus 13%, odds ratio [OR] 0.73, P < 0.001), 30 d (8.1% versus 10.4%, OR 0.76, P < 0.001), and severe hypocalcemic events (5.5% versus 6.4%, OR 0.84, P = 0.029) compared to normal BMI patients. On multivariable analysis for normal BMI patients, age < 45 y was a risk factor for hypocalcemia before discharge, 30 d, and severe hypocalcemic events (P < 0.05 for all). Additional risk factors in this group for 30-d hypocalcemia included parathyroid autotransplant and central neck dissection (P < 0.05) and recurrent laryngeal nerve injury for severe hypocalcemic events (P = 0.01). CONCLUSIONS Younger patients with BMI < 25 are at an increased risk for hypocalcemia and severe hypocalcemic events after TT. These patients may benefit from preoperative counseling and increased calcium/vitamin D supplementation to reduce prolonged hospitalization and mitigate morbidity.
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Affiliation(s)
- Stefanie J Soelling
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David A Mahvi
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jason B Liu
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora O Sheu
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerard Doherty
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew A Nehs
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy L Cho
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
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