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Perrone K, Earley M, Rosenberg G, Pugh C, Kin C. Physiologic readiness and subjective workload of performing operations: A prospective observational study of attending and trainee surgeons. Am J Surg 2025; 241:116175. [PMID: 39788069 DOI: 10.1016/j.amjsurg.2024.116175] [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: 10/12/2024] [Revised: 12/20/2024] [Accepted: 12/30/2024] [Indexed: 01/12/2025]
Abstract
Physical health and perceived workload are determinants of career satisfaction and longevity for surgeons. The aim of this prospective observational study was to determine if biometric indicators of physical recovery among surgeons are associated with perceived workload during operations. The primary outcome was whether there was an association between surgeon self-assessment and a physiologic recovery score based on heart rate variability measured with a wearable biometric sensor. These associations were evaluated through mixed-effects regression models. Of the 66 participants, 29 were attending surgeons and 37 were surgical trainees across multiple surgical subspecialities. There was no association between recovery score and perceived workload for either trainees or attendings. Differences in self-assessment scores were identified between trainees based on gender and years in training, as well as for attendings based on years in practice. Additionally, recovery scores were higher for both junior trainees and attendings compared to their senior counterparts. These findings underscore the importance of awareness of differences in experience among surgeons and may reveal targets for improvement in performance and career satisfaction.
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Affiliation(s)
- Kenneth Perrone
- Stanford University Department of Surgery, Stanford, CA, USA
| | - Michelle Earley
- Stanford University Department of Surgery, Stanford, CA, USA
| | - Graeme Rosenberg
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carla Pugh
- Stanford University Department of Surgery, Stanford, CA, USA
| | - Cindy Kin
- Stanford University Department of Surgery, Stanford, CA, USA.
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Ozkaynak M, Smyth HL, Sarabia C, Cook PF, Mistry RD, Schmidt SK. Examining clinicians' fatigue in a pediatric emergency department. APPLIED ERGONOMICS 2025; 125:104465. [PMID: 39778273 DOI: 10.1016/j.apergo.2025.104465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 01/01/2025] [Accepted: 01/02/2025] [Indexed: 01/11/2025]
Abstract
We examined fatigue among emergency department (ED) clinicians. ED clinicians are susceptible to burnout, because of fatigue. Fatigue represents a latent hazard in ED care, being associated with impaired clinician performance, poor patient outcomes, and a negative impact on patient safety. Thirty-five pediatric clinicians were surveyed at the beginning and end of their shifts. The 20-item Swedish Occupational Fatigue Inventory survey was used to evaluate fatigue. Paired t-tests were used to examine whether fatigue scores changed over the course of a shift. The associations between the five fatigue subscales and various factors were modeled with multilevel linear regressions. Surveys (N = 827) were administered over 425 shifts. Clinician fatigue depended on time spent within the shift, shift type, clinician's gender, age, and clinician's role. Analysis showed other individual characteristics and shift factors also may affect fatigue. Clinicians with varying fatigue levels have different needs that should be considered in information technology design and evaluation.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO, USA.
| | - Heather L Smyth
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Cristian Sarabia
- College of Nursing, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Paul F Cook
- College of Nursing, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Rakesh D Mistry
- Section of Pediatric Emergency Medicine, Department of Pediatrics Yale School of Medicine, New Haven, CT, USA
| | - Sarah K Schmidt
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Hejazi-Garcia C, Howard SD, Quinones A, Hsu JY, Ali ZS. The association between surgical start time and spine surgery outcomes. Clin Neurol Neurosurg 2025; 248:108663. [PMID: 39603109 DOI: 10.1016/j.clineuro.2024.108663] [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: 10/02/2024] [Revised: 11/11/2024] [Accepted: 11/23/2024] [Indexed: 11/29/2024]
Abstract
OBJECTIVE Neurosurgical operations, including spine surgeries, often occur outside "normal business hours" due to the urgent or emergent nature of cases. This study investigates the association of surgical start time (SST) with spine surgery outcomes. METHODS A retrospective cross-sectional study was performed using electronic health record data from a multi-hospital academic health system from 2017 to 2024. Eligible patients included adults who underwent spine surgery with a recorded SST. Patients were separated into a regular hours group (7:00 A.M. to 5:00 P.M.) and an afterhours group (SST outside this time window). The association between SST and extended length of stay (greater than 3 days), readmission, and discharge disposition was examined. RESULTS The sample included 12,658 patients with 10,737 (84.8 %) patients in the regular hours group and 1921 (15.2 %) patients in the afterhours group. Afterhours SST had significantly increased rates of extended length of stay, non-home discharge disposition, and readmission compared to regular hours SST. Adjusting for age, comorbidities, case classification, the time from admission to SST, and surgery type, afterhours SST was significantly associated with non-home discharge disposition (OR 1.27, 95 % CI 1.12 - 1.45, p < 0.001). CONCLUSION This is the largest study to examine the association of SST with outcomes of spine surgery. Controlling for potential confounders, afterhours SST was significantly associated with non-home discharge disposition.
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Affiliation(s)
| | - Susanna D Howard
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Addison Quinones
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zarina S Ali
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
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Bauer TM, Pienta MJ, Wu X, Thompson MP, Hawkins RB, Pruitt AL, Delucia A, Lall SC, Pagani FD, Likosky DS. Outcomes of nonemergency cardiac surgery after overnight operative workload: A statewide experience. JTCVS OPEN 2024; 20:101-111. [PMID: 39296458 PMCID: PMC11405977 DOI: 10.1016/j.xjon.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 04/26/2024] [Indexed: 09/21/2024]
Abstract
Objective Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest before same-day, first-start scheduled cases. This study evaluated the frequency and associated impact of a surgeon's overnight operative workload on the outcomes of their same-day, first-start operations. Methods A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between July 1, 2011, and March 1, 2021. Nonemergency, first-start, Society of Thoracic Surgeons predicted risk of mortality operations were stratified by whether or not the surgeon performed an overnight operation that ended after midnight. A generalized mixed effect model was used to evaluate the effect of overnight operations on a Society of Thoracic Surgeons composite outcome (5 major morbidities or operative mortality) of the first-start operation. Results Of all first-start operations, 0.4% (239/56,272) had a preceding operation ending after midnight. The Society of Thoracic Surgeons predicted risk of morbidity and mortality was similar for first-start operations whether preceded by an overnight operation or not (overnight operation: 11.3%; no overnight operation: 11.7%, P = .42). Unadjusted rates of the primary outcome were not significantly different after an overnight operation (overnight operation: 13.4%; no overnight operation: 12.3%, P = .59). After adjustment, overnight operations did not significantly impact the risk of major morbidity or mortality for first-start operations (adjusted odds ratio, 1.1, P = .70). Conclusions First-start cardiac operations performed after an overnight operation represent a small subset of all first-start Society of Thoracic Surgeons predicted risk operations. Overnight operations do not significantly influence the risk of major morbidity or mortality of first-start operations, which suggests that surgeons exercise proper judgment in determining appropriate workloads.
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Affiliation(s)
- Tyler M Bauer
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Michael J Pienta
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | | | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Andrew L Pruitt
- Department of Cardiac Surgery, St Joseph Mercy, Ann Arbor, Mich
| | - Alphonse Delucia
- Department of Cardiac Surgery, Bronson Medical Center, Kalamazoo, Mich
| | - Shelly C Lall
- Department of Cardiac Surgery, Munson Healthcare, Traverse City, Mich
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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Chen P, Xin X, Yang Y, Zhang Y, Ren T, Jia X, Liu X. Impact of weekday of esophageal cancer surgery on long-term oncological outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108005. [PMID: 38387297 DOI: 10.1016/j.ejso.2024.108005] [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: 09/17/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Studies about the influence of weekday of esophagectomy on survival are limited and show conflicting results. This study aimed to explore whether weekday of esophagectomy affects patient's survival outcomes. METHODS Patients who underwent esophagectomy in a grade-A tertiary hospital from January 2015 to December 2016 were enrolled. The primary outcome was 5-year overall survival (OS). The secondary outcomes were 5-year disease-free survival (DFS) and days of hospitalization. The impact of weekday surgery on 5-year OS and DFS were evaluated with Cox regression, and impact on days of hospitalization was assessed using logistic regression. Propensity score matching (PSM) analysis was used to balance the confounding factors. RESULTS A total of 1478 patients were included. The 5-year OS and DFS were 63.77% and 59.26% respectively. Multivariate analyses adjusted for covariables indicated that weekday was not significantly associated with OS (P = 0.076), nor days of hospitalization (P = 0.824), but it appeared to be associated with DFS (P = 0.044). Additionally, PSM analysis showed no significant effect of weekday on the 5-year OS, nor DFS and days of hospitalization. CONCLUSION In patients diagnosed with squamous esophageal cancer, the survival outcome of patients was not influenced by weekday.
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Affiliation(s)
- Peinan Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Xin Xin
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Yi Zhang
- Department of Medical Record, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Tongtong Ren
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Xiaocan Jia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China.
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China.
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Jerath A, Satkunasivam R, Kaneshwaran K, Aminoltejari K, Chang A, MacDonell DSY, Kealey A, Ladowski S, Sarmah A, Flexman AM, Lorello GR, Nabecker S, Coburn N, Conn LG, Klaassen Z, Ranganathan S, Riveros C, McCartney CJL, Detsky AS, Wallis CJD. Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study. Ann Surg 2024; 279:569-574. [PMID: 38264927 DOI: 10.1097/sla.0000000000006217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To examine the association of anesthesiologist sex on postoperative outcomes. BACKGROUND Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown. METHODS We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations. RESULTS Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00-1.05, P =0.048). CONCLUSIONS We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study.
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Affiliation(s)
- Angela Jerath
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Kirusanthy Kaneshwaran
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Khatereh Aminoltejari
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ashton Chang
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - D Su-Yin MacDonell
- Department of Anesthesiology, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Alayne Kealey
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Ladowski
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Sarmah
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- The Wilson Centre, Toronto General Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lesley G Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia - Augusta University, Augusta, Georgia, USA
| | | | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Colin J L McCartney
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
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Kawa N, Araji T, Kaafarani H, Adra SW. A Narrative Review on Intraoperative Adverse Events: Risks, Prevention, and Mitigation. J Surg Res 2024; 295:468-476. [PMID: 38070261 DOI: 10.1016/j.jss.2023.11.045] [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: 09/12/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Adverse events from surgical interventions are common. They can occur at various stages of surgical care, and they carry a heavy burden on the different parties involved. While extensive research and efforts have been made to better understand the etiologies of postoperative complications, more research on intraoperative adverse events (iAEs) remains to be done. METHODS In this article, we reviewed the literature looking at iAEs to discuss their risk factors, their implications on surgical care, and the current efforts to mitigate and manage them. RESULTS Risk factors for iAEs are diverse and are dictated by patient-related risk factors, the nature and complexity of the procedures, the surgeon's experience, and the work environment of the operating room. The implications of iAEs vary according to their severity and include increased rates of 30-day postoperative morbidity and mortality, increased length of hospital stay and readmission, increased care cost, and a second victim emotional toll on the operating surgeon. CONCLUSIONS While transparent reporting of iAEs remains a challenge, many efforts are using new measures not only to report iAEs but also to provide better surveillance, prevention, and mitigation strategies to reduce their overall adverse impact.
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Affiliation(s)
- Nisrine Kawa
- Department of Dermatology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York
| | - Tarek Araji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haytham Kaafarani
- Division of Trauma, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Emergency Surgery and Critical Care, Boston, Massachusetts
| | - Souheil W Adra
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Zheng S, Wang J, Zhang H, Wang S, Meng X. The effect of surgery started at different time point during the day on the clinical outcomes of mitral valve surgery. Front Cardiovasc Med 2024; 11:1360763. [PMID: 38433755 PMCID: PMC10904606 DOI: 10.3389/fcvm.2024.1360763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Background The clinical prognosis of mitral valve surgery at morning, afternoon, and evening is not yet clear. The aim of the study is to investigate the impact of different time periods of surgery in the morning, afternoon and evening on the short-term and long-term results of mitral valve surgery. Methods From January 2018 to December 2020, 947 patients with mitral valve surgery in our department were selected. These patients were divided into 3 groups according to the starting time of surgery. Morning group (operation start time 8:00-10:30, n = 231), afternoon group (operation start time 12:00-14:30, n = 543), and evening group (operation start time 17:30-20:00, n = 173). The short-term and long-term results of the three groups were compared. Results There were no significant difference in the long-term mortality, long-term risk of stroke and reoperation. And there were no significant difference in in-hospital outcomes, including mortality, stroke, cardiopulmonary bypass time, aortic cross clamp time, mitral valve repair convert to mitral valve replacement, number of aortic cross clamp ≥2 times, unplanned secondary surgery during hospitalization (including thoracotomy hemostasis, thoracotomy exploration, redo mitral valve surgery, and debridement), intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous renal replacement therapy, mechanical ventilation time, and intensive care unit length of stay. Conclusion There is no significant difference in the risk of short-term and long-term survival and adverse events after mitral valve surgery at different time periods in the morning, afternoon, and evening. Mitral valve surgery at night is safe.
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Affiliation(s)
- Shuai Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Anderson E, Sing D, Pechero G, Hagar A, Dvozhinskiy A, Fraifogl J, Fischer D, Alqudhaya R, Baig MS, Bramlett K, Gary J, Mullis B, Ryan S, Marcantonio A, Leighton R, Ricci W, Vallier H, Horwitz D, Tornetta P. Hip Fracture Repair by the Post-Call Surgeon: A Multicenter Retrospective Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00011. [PMID: 38364105 PMCID: PMC10876225 DOI: 10.5435/jaaosglobal-d-24-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate surgeons' ability to perform or supervise a standard operation with agreed-upon radiologic parameters after being on call. METHODS We reviewed a consecutive series of patients with intertrochanteric hip fractures treated with a fixed angle device at 9 centers and compared corrected tip-apex distance and reduction quality for post-call surgeons versus those who were not. Subgroup analyses included surgeons who operated the night before versus not and attending-only versus resident involved cases. Secondary outcomes included union and perioperative complications. RESULTS One thousand seven hundred fourteen patients were of average age 77 years. Post-call surgeons treated 823 patients and control surgeons treated 891. Surgical corrected tip-apex distance did not differ between groups: on-call 18 mm versus control 18 mm (P = 0.59). The Garden indices were 160° on the AP and 179° on the lateral in both groups. In 66 cases performed by surgeons who operated the night before, the TAD was 17 mm. No difference was noted in corrected tip-apex distance with and without resident involvement (P = 0.101). No difference was observed in pooled fracture-related complications (P = 0.23). CONCLUSION Post-call surgeons demonstrated no difference in quality and no increase in complications when performing hip fracture repair the next day compared with surgeons who were not on call.
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Affiliation(s)
- Eliza Anderson
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - David Sing
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Guillermo Pechero
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Andrew Hagar
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Aleksey Dvozhinskiy
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Joanne Fraifogl
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Dylan Fischer
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Rashed Alqudhaya
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Mirza Shahid Baig
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Kasey Bramlett
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Joshua Gary
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Brian Mullis
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Scott Ryan
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Andrew Marcantonio
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Ross Leighton
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - William Ricci
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Heather Vallier
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Daniel Horwitz
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
| | - Paul Tornetta
- From the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Anderson, Dr. Sing, and Dr. Tornetta); the Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX (Dr. Pechero, Dr. Gary); the Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA (Dr. Hagar, Dr. Ryan); the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Dvozhinskiy and Dr. Ricci); the Department of Orthopaedic Surgery, MetroHealth, Cleveland, OH (Ms. Fraifogl and Dr. Vallier); the Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, IN (Dr. Fischer, Dr. Mullis); the Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, Halifax, NS (Dr. Alqudhaya and Dr. Leighton); the Department of Orthopaedic Surgery, Geisinger Health, Pennsylvania, PA (Dr. Baig and Dr. Horwitz); and the Department of Orthopaedic Surgery, Beth Israel Lahey Health, Burlington, MA (Ms. Bramlett, Dr. Marcantonio)
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10
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Maeda H, Endo H, Ichihara N, Miyata H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Seto Y, Yamaue H, Yamamoto M, Kitagawa Y, Uemura S, Hanazaki K. Days of the week and 90-day mortality after esophagectomy: analysis of 33,980 patients from the National Clinical Database. Langenbecks Arch Surg 2024; 409:36. [PMID: 38217701 DOI: 10.1007/s00423-023-03214-7] [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: 06/10/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The effect of the days of the week on the short-term outcomes after elective surgeries has been suggested; however, such data on esophagectomies remain limited. This study aimed to investigate the association between the day of the week and mortality rates after elective esophagectomy using a large-scale clinical database in Japan. METHODS The data of elective esophagectomies, registered in the National Clinical Database in Japan, for esophageal cancer treatment between 2012 and 2017 were analyzed. We hypothesized that the later days of the week could have higher odds ratios of death after elective esophagectomy. With 22 relevant clinical variables and days of surgery, 90-day mortality was evaluated using hierarchical logistic regression modeling. RESULTS Ninety-day mortality rates among 33,980 patients undergoing elective esophagectomy were 1.8% (range, 1.5-2.1%). Surgeries were largely concentrated on earlier days of the week, whereas esophagectomies performed on Fridays accounted for only 11.1% of all cases. Before risk adjustment, lower odds ratios of 90-day mortality were found on Tuesday and a tendency towards lower odds ratios on Thursday. In the hierarchical logistic regression model, 21 independent factors of 90-day mortality were identified. However, the adjusted odds ratios of 90-day mortality for Tuesday, Wednesday, Thursday, and Friday were 0.87, 1.09, 0.85, and 0.88, respectively, revealing no significant difference. CONCLUSION The results imply that the variation in 90-day mortality rates after esophagectomy on different days of the week may be attributed to differing preoperative risk factors of the patient group rather than the disparity in medical care provided.
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Affiliation(s)
- Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Hasegawa
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kinji Kamiya
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological and Pediatric Surgery, Graduate School of Medicine, Gifu University, Gifu, 501-1193, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | | | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
- Department of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
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11
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Bayat Z, Kennedy ED, Victor JC, Govindarajan A. Surgeon factors but not hospital factors associated with length of stay after colorectal surgery - A population based study. Colorectal Dis 2023; 25:2354-2365. [PMID: 37897114 DOI: 10.1111/codi.16794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/27/2023] [Accepted: 08/31/2023] [Indexed: 10/29/2023]
Abstract
AIM Length of stay (LOS) after colorectal surgery (CRS) is a significant driver of healthcare utilization and adverse patient outcomes. To date, there is little high-quality evidence in the literature examining how individual surgeon and hospital factors independently impact LOS. We aimed to identify and quantify the independent impact of surgeon and hospital factors on LOS after CRS. METHODS A retrospective population-based cohort study was conducted using validated health administrative databases, encompassing all patients from the province of Ontario, Canada. All patients from 121 hospitals in Ontario who underwent elective CRS between 2008 and 2019 in Ontario were included, and factors pertaining to these patients and their treating surgeon and hospital were assessed. A negative binomial regression model was used to assess the independent effect of surgeon and hospital factors on LOS, accounting for a comprehensive collection of determinants of LOS. To minimize unmeasured confounding, the analysis was repeated in a subgroup comprising patients undergoing lower-complexity CRS without postoperative complications. RESULTS A total of 90,517 CRS patients were analysed. Independent of patient and procedural factors, low surgeon volume (lowest volume quartile) was associated with a 20% increase in LOS (95% CI: 12-29, p < 0.0001) compared to high surgeon volume (highest volume quartile). In the 22,639 patients undergoing uncomplicated lower-complexity surgeries, a 43% longer LOS was seen in the lowest volume surgeon quartile (95% CI: 26-61, p < 0.0001). In both models, more years-in-practice was associated with a small increase in LOS (RR 1.02, 95% CI: 1.02-1.03, p < 0.0001). Hospital factors were not significantly associated with increased LOS. CONCLUSIONS Surgeon factors, including low surgeon volume and increasing years-in-practice, were strongly and independently associated with longer LOS, whereas hospital factors did not have an independent impact. This suggests that LOS is driven primarily by surgeon-mediated care processes and may provide actionable targets for provider-level interventions to reduce LOS after CRS.
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Affiliation(s)
- Zubair Bayat
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Erin D Kennedy
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J Charles Victor
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Anand Govindarajan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
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12
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Gläsener D, Post J, Cyrol D, Sammito S. Fatigue among Air crews on (Ultra)-Long-Range flights - A comparison of subjective fatigue with objective concentration ability. Heliyon 2023; 9:e21669. [PMID: 38027567 PMCID: PMC10663845 DOI: 10.1016/j.heliyon.2023.e21669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Long duty times are common in the aviation industry, especially with the introduction of ultra long range flights (ULR). This article aims to compare the subjective fatigue assessment and concentration ability of flight crews with objective concentration and alertness tests during (U)LR-flights. Method The study examined different (U)LR-flights. Before, during and after the flights subjective fatigue and concentration ability of the flight crew was examined with visual analog scale and objective attention and concentration ability with the FAIR-2 test respectively the 3-min Psychomotor Vigilance Test. For statistical analysis we used a repeated ANOVA with a post-hoc-analysis and a Wilcoxon signed-rank test for connected samples. Results In total 28 crew members were examined. Subjective concentration ability declined and fatigue increased significantly over the course of flights. However, no significant changes were observed in the objective concentration tests performed before and after the flights. Conclusions The study found that fatigue significantly increased with flight time, particularly during night hours at the window of circadian low of the crews. However, objective concentration performance showed no significant deterioration over time. The study's results were consistent with previous research, except for the finding that objective concentration was still stable. The study also compared the findings to another profession and found similar results regarding the performance of complex tasks after long working hours while experiencing fatigue. Pratical applications This study helps to understand the effects of ultra long-range flight on fatigue and concentration of the air crew and can help to improve safety issues on such flights.
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Affiliation(s)
- David Gläsener
- German Air Force Centre of Aerospace Medicine, Cologne, Wahn, Germany
- Faculty of Aerospace Engineering, Bundeswehr University Munich, Germany
| | - Janina Post
- German Air Force Centre of Aerospace Medicine, Cologne, Wahn, Germany
| | - David Cyrol
- German Air Force Centre of Aerospace Medicine, Cologne, Wahn, Germany
| | - Stefan Sammito
- German Air Force Centre of Aerospace Medicine, Cologne, Wahn, Germany
- Occupational Medicine, Faculty of Medicine, Otto-von-Guericke-University of Magdeburg, Germany
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13
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Wallis CJD, Jerath A, Aminoltejari K, Kaneshwaran K, Salles A, Coburn N, Wright FC, Gotlib Conn L, Klaassen Z, Luckenbaugh AN, Ranganathan S, Riveros C, McCartney C, Armstrong K, Bass B, Detsky AS, Satkunasivam R. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg 2023; 158:1185-1194. [PMID: 37647075 PMCID: PMC10469289 DOI: 10.1001/jamasurg.2023.3744] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/07/2023] [Indexed: 09/01/2023]
Abstract
Importance Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed. Objective To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries. Design, Setting, and Participants A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019. Analysis was performed between July 15 and October 20, 2022. Exposure Surgeon sex. Main Outcomes and Measures An adverse postoperative event, defined as the composite of death, readmission, or complication, was assessed at 90 days and 1 year following surgery. Secondarily, each of these outcomes was assessed individually. Outcomes were compared between patients treated by female and male surgeons using generalized estimating equations with clustering at the level of the surgical procedure, accounting for patient-, procedure-, surgeon-, anesthesiologist-, and facility-level covariates. Results Among 1 165 711 included patients, 151 054 were treated by a female and 1 014 657 by a male surgeon. Overall, 14.3% of the patients had 1 or more adverse postoperative outcomes at 90 days and 25.0% had 1 or more adverse postoperative outcomes 1 year following surgery. Among these, 2.0% of patients died within 90 days and 4.3% died within 1 year. Multivariable-adjusted rates of the composite end point were higher among patients treated by male than female surgeons at both 90 days (13.9% vs 12.5%; adjusted odds ratio [AOR], 1.08; 95% CI, 1.03-1.13) and 1 year (25.0% vs 20.7%; AOR, 1.06; 95% CI, 1.01-1.12). Similar patterns were observed for mortality at 90 days (0.8% vs 0.5%; AOR 1.25; 95% CI, 1.12-1.39) and 1 year (2.4% vs 1.6%; AOR, 1.24; 95% CI, 1.13-1.36). Conclusions and Relevance After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons. These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions.
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Affiliation(s)
- Christopher J. D. Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Khatereh Aminoltejari
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Frances C. Wright
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia–Augusta University, Augusta
| | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sanjana Ranganathan
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Riveros
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Colin McCartney
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Bass
- George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Allan S. Detsky
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
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14
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Hawkins RB, Nallamothu BK. Surgeons and systems working together to drive safety and quality. BMJ Qual Saf 2023; 32:181-184. [PMID: 36323509 DOI: 10.1136/bmjqs-2022-015045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Robert B Hawkins
- Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
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15
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Zhang D, Gu D, Rao C, Zhang H, Su X, Chen S, Ma H, Zhao Y, Feng W, Sun H, Zheng Z. Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study. BMJ Qual Saf 2023; 32:192-201. [PMID: 35649696 DOI: 10.1136/bmjqs-2021-014244] [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: 09/14/2021] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND With increasing surgical workload, it is common for cardiac surgeons to perform coronary artery bypass grafting (CABG) after other procedures in a workday. To investigate whether prior procedures performed by the surgeon impact the outcomes, we compared the outcomes between CABGs performed first versus those performed after prior procedures, separately for on-pump and off-pump CABGs as they differed in technical complexity. METHODS We conducted a retrospective cohort study of patients undergoing isolated CABG in China from January 2013 to December 2018. Patients were categorised as undergoing on-pump and off-pump CABGs. Outcomes of the procedures performed first in primary surgeons' daily schedule (first procedure) were compared with subsequent ones (non-first procedure). The primary outcome was an adverse events composite (AEC) defined as the number of adverse events, including in-hospital mortality, myocardial infarction, stroke, acute kidney injury and reoperation. Secondary outcomes were the individual components of the primary outcome, presented as binary variables. Mixed-effects models were used, adjusting for patient and surgeon-level characteristics and year of surgery. RESULTS Among 21 866 patients, 10 109 (16.1% as non-first) underwent on-pump and 11 757 (29.6% as non-first) off-pump CABG. In the on-pump cohort, there was no significant association between procedure order and the outcomes (all p>0.05). In the off-pump cohort, non-first procedures were associated with an increased number of AEC (adjusted rate ratio 1.29, 95% CI 1.13 to 1.47, p<0.001), myocardial infarction (adjusted OR (ORadj) 1.43, 95% CI 1.13 to 1.81, p=0.003) and stroke (ORadj 1.73, 95% CI 1.18 to 2.53, p=0.005) compared with first procedures. These increases were only found to be statistically significant when the procedure was performed by surgeons with <20 years' practice or surgeons with a preindex volume <700 cases. CONCLUSIONS For a technically challenging surgical procedure like off-pump CABG, prior workload adversely affected patient outcomes.
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Affiliation(s)
- Danwei Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dachuan Gu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoting Su
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sipeng Chen
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hanping Ma
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Feng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hansong Sun
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
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16
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Kepros J, Haag S, Lewandowski K, Bauer F, Ali H, Markowski H, Green D, Najafi K, Sheppard T. Shift Length and Shift Length Preference Among Acute Care Surgeons. Am Surg 2023; 89:372-378. [PMID: 34111971 DOI: 10.1177/00031348211025752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Work hour restrictions have been imposed by the Accreditation Council for Graduate Medical Education since 2003 for medical trainees. Many acute care surgeons currently work longer shifts but their preferred shift length is not known. METHODS The purpose of this study was to characterize the distribution of the current shift length among trauma and acute care surgeons and to identify the surgeons' preference for shift length. Data collection included a questionnaire with a national administration. Frequencies and percentages are reported for categorical variables and medians and means with SDs are reported for continuous variables. A chi-square test of independence was performed to examine the relation between call shift choice and trauma center level (level 1 and level II), age, and gender. RESULTS Data from 301 surgeons in 42 states included high-level trauma centers. Assuming the number of trauma surgeons in the United States is 4129, a sample of 301 gives the survey a 5% margin of error. The median age was 43 years (M = 46, SD = 9.44) and 33% were female. Currently, only 23.3% of acute care surgeons work a 12-hour shift, although 72% prefer the shorter shift. The preference for shorter shifts was statistically significant. There was no significant difference between call shift length preference and trauma center level, age, or gender. CONCLUSION Most surgeons currently work longer than 12-hour shifts. Yet, there was a preference for 12-hour shifts indicating there is a gap between current and preferred shift length. These findings have the potential to substantially impact staffing models.
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Affiliation(s)
- John Kepros
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Susan Haag
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Karen Lewandowski
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Frank Bauer
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Hirra Ali
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Helen Markowski
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Donald Green
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Kaveh Najafi
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
| | - Tina Sheppard
- 419963HonorHealth, Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
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17
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Field E, Taylor T. The problem with paradoxes: The hidden costs of fatigue. MEDICAL EDUCATION 2022; 56:967-969. [PMID: 35778864 DOI: 10.1111/medu.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emily Field
- Faculty of Arts and Humanities, Western University, London, Ontario, Canada
| | - Taryn Taylor
- Centre for Education Research & Innovation, Western University, London, Ontario, Canada
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18
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Elnahas AI, Reid JN, Lam M, Doumouras AG, Anvari M, Schlachta CM, Alkhamesi NA, Hawel JD, Urbach DR. Bariatric Center Designation and Outcomes Following Repeat Abdominal Surgery in Bariatric Patients. J Surg Res 2022; 280:421-428. [PMID: 36041342 DOI: 10.1016/j.jss.2022.07.032] [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: 03/22/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Repeat abdominal surgery in the bariatric surgery patient population may be challenging for non-bariatric-accredited institutions. The impact of regionalized bariatric care on clinical outcomes for bariatric surgery patients requiring repeat abdominal surgery is currently unknown. This study aims to investigate the association between bariatric center designation and clinical outcomes following hepatobiliary, hernia, and upper and lower gastrointestinal operations among patients with prior bariatric surgery. METHODS This is a cohort study of a large sample of Ontario residents who underwent primary bariatric surgery between 2010 and 2017. A comprehensive list of eligible abdominal operations was captured using administrative data. The primary outcome was 30-d complications. Secondary outcomes included 30-d mortality, readmission, and length of stay. RESULTS Among the 3301 study patients, 1305 (40%) received their first abdominal reoperation following bariatric surgery at a designated bariatric center. Nonbariatric center designation was not associated with significantly higher rates of 30-d complications (5.73% versus 5.72%), mortality (0.80% versus 0.77%), readmissions (1.11% versus 1.85%), or median postoperative length of stay (4 versus 4 d). After grouping the category of reoperations, upper gastrointestinal (odds ratio [OR] 0.66, confidence interval [CI] 0.39-1.11) and abdominal wall hernia surgery (OR 0.52, CI 0.27-0.99) showed a lower adjusted OR for complications among bariatric centers. CONCLUSIONS Our study demonstrates that after adjustment for case-mix and patient characteristics, bariatric surgery patients undergoing repeat abdominal surgery at nonbariatric centers is not associated with higher proportion of complications or mortality. Complex hernia surgery may be considered the most appropriate for referral.
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Affiliation(s)
- Ahmad I Elnahas
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES, London, Ontario, Canada.
| | | | | | - Aristithes G Doumouras
- ICES, London, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Anvari
- ICES, London, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher M Schlachta
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nawar A Alkhamesi
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jeffrey D Hawel
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David R Urbach
- ICES, London, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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19
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Sun EC, Mello MM, Vaughn MT, Kheterpal S, Hawn MT, Dimick JB, Jena AB. Assessment of Perioperative Outcomes Among Surgeons Who Operated the Night Before. JAMA Intern Med 2022; 182:720-728. [PMID: 35604661 PMCID: PMC9127708 DOI: 10.1001/jamainternmed.2022.1563] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE The association between physician fatigue and patient outcomes is important to understand but has been difficult to examine given methodological and data limitations. Surgeons frequently perform urgent procedures overnight and perform additional procedures the following day, which could adversely affect outcomes for those daytime operations. OBJECTIVE To examine the association between an attending surgeon operating overnight and outcomes for operations performed by that surgeon the next day. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, a retrospective analysis of a large multicenter registry of surgical procedures was done using a within-surgeon analysis to address confounding, with data from 20 high-volume US institutions. This study included 498 234 patients who underwent a surgical procedure during the day (between 7 am and 5 pm) between January 1, 2010, and August 30, 2020. EXPOSURES Whether the attending surgeon for the current day's procedures operated between 11 pm and 7 am the previous night. Two exposure measures were examined: whether the surgeon operated at all the previous night and the number of hours spent operating the previous night (including having performed no work at all). MAIN OUTCOMES AND MEASURES The primary composite outcome was in-hospital death or major complication (sepsis, pneumonia, myocardial infarction, thromboembolic event, or stroke). Secondary outcomes included operation length and individual outcomes of death, major complications, and minor complications (surgical site infection or urinary tract infection). RESULTS Among 498 234 daytime operations performed by 1131 surgeons, 13 098 (2.6%) involved an attending surgeon who operated the night before. The mean (SD) age of the patients who underwent an operation was 55.3 (16.4) years, and 264 740 (53.1%) were female. After adjusting for operation type, surgeon fixed effects, and observable patient characteristics (ie, age and comorbidities), the adjusted incidence of in-hospital death or major complications was 5.89% (95% CI, 5.41%-6.36%) among daytime operations when the attending surgeon operated the night before compared with 5.87% (95% CI, 5.85%-5.89%) among daytime operations when the same surgeon did not (absolute adjusted difference, 0.02%; 95% CI, -0.47% to 0.51%; P = .93). No significant associations were found between overnight work and secondary outcomes except for operation length. Operating the previous night was associated with a statistically significant decrease in length of daytime operations (adjusted length, 112.7 vs 117.4 minutes; adjusted difference, -4.7 minutes; 95% CI, -8.7 to -0.8, P = .02), although this difference is unlikely to be meaningful. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that operating overnight was not associated with worse outcomes for operations performed by surgeons the subsequent day. These results provide reassurance concerning the practice of having attending surgeons take overnight call and still perform operations the following morning.
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Affiliation(s)
- Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Michelle M Mello
- Department of Health Policy, Stanford University School of Medicine, Stanford, California.,Stanford Law School, Stanford, California.,Freeman Spogli Institute for International Studies, Stanford University, Stanford, California
| | - Michelle T Vaughn
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Mary T Hawn
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Justin B Dimick
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston.,National Bureau of Economic Research, Cambridge, Massachusetts
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20
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Leya GA, Feldman ZM, Chang DC. Are Surgeons Really More Resilient Than Athletes?: The Trade-off Between Surgeon Outcomes and Surgeon Well-being. JAMA Intern Med 2022; 182:728-729. [PMID: 35604669 DOI: 10.1001/jamainternmed.2022.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gregory A Leya
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Zachary M Feldman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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21
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Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes: A Population-Based Cohort Study. Ann Surg 2022; 276:81-87. [PMID: 35703460 DOI: 10.1097/sla.0000000000005495] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes. SUMMARY BACKGROUND DATA Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and gender-based differences in interpersonal communication and medical practice which may contribute to patients' perioperative outcomes. METHODS We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007-2019 in Ontario, Canada. We assessed the association between differences in sex between surgeon and anesthesiologists (sex discordance) on the primary endpoint of adverse postoperative outcome, defined as death, readmission, or complication within 30-days following surgery using generalized estimating equations. RESULTS Among 1,165,711 patients treated by 3,006 surgeons and 1,477 anesthesiologists, 791,819 patients were treated by sex concordant teams (male surgeon/male anesthesiologist: 747,327 and female surgeon/female anesthesiologist: 44,492) while 373,892 were sex discordant (male surgeon/female anesthesiologist: 267,330 and female surgeon/male anesthesiologist: 106,562). Overall, 12.3% of patients experienced one or more adverse postoperative outcomes of whom 1.3% died. Sex discordance between surgeon and anesthesiologist was not associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR] 1.00, 95% confidence interval [CI] 0.97-1.03). CONCLUSIONS We did not demonstrate an association between intraoperative surgeon and anesthesiologist sex discordance on adverse postoperative outcomes in a large patient cohort. Patients, clinicians, and administrators may be reassured that physician sex discordance in operating room teams is unlikely to clinically meaningfully affect patient outcomes after surgery.
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22
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Zheng Q, Li S, Wen F, Lin Z, Feng K, Sun Y, Bao J, Weng H, Shen P, Lin H, Chen W. The Association Between Sleep Disorders and Incidence of Dry Eye Disease in Ningbo: Data From an Integrated Health Care Network. Front Med (Lausanne) 2022; 9:832851. [PMID: 35187009 PMCID: PMC8854755 DOI: 10.3389/fmed.2022.832851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the association between sleep disorders and dry eye disease (DED) in Ningbo, China. METHODS Our data came from the Yinzhou Health Information System (HIS), including 257932 patients and was based on a 1:1 matching method (sleep disorder patients vs. patients without sleep disorders) during 2013-2020. Sleep disorders and DED were identified using ICD-10 codes. Cox proportional hazards regression was used to identify the association between sleep disorders and DED. RESULTS The eight-year incidence of DED was significantly higher in participants with diagnosis of sleep disorders (sleep disorders: 50.66%, no sleep disorders: 16.48%, P < 0.01). Sleep disorders were positively associated with the diagnosis of DED (HR: 3.06, 95% CI: 2.99-3.13, P < 0.01), when sex, age, hypertension, diabetes and other systemic diseases were adjusted. In the sleep disorders patients, advancing age, female sex, and presence of coexisting disease (hypertension, diabetes, hyperlipidemia, thyroid disease, depression, heart disease, and arthritis) were significantly associated with the development of DED by the multivariate cox regression analysis (all P < 0.05).In addition, there was a significantly positive association between estazolam and the incidence of DED in both sleep disorder and non-sleep disorder groups (all P < 0.05). CONCLUSIONS Sleep disrder was associated with a three-time increased risk of DED. This association can be helpful in effective management of both sleep disorders and DED.
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Affiliation(s)
- Qinxiang Zheng
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Saiqing Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Feng Wen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Zhong Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Kemi Feng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Yexiang Sun
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Jie Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Hongfei Weng
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Peng Shen
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Wei Chen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
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23
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Wallis CJD, Jerath A, Coburn N, Klaassen Z, Luckenbaugh AN, Magee DE, Hird AE, Armstrong K, Ravi B, Esnaola NF, Guzman JCA, Bass B, Detsky AS, Satkunasivam R. Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes. JAMA Surg 2021; 157:146-156. [PMID: 34878511 DOI: 10.1001/jamasurg.2021.6339] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Surgeon sex is associated with differential postoperative outcomes, though the mechanism remains unclear. Sex concordance of surgeons and patients may represent a potential mechanism, given prior associations with physician-patient relationships. Objective To examine the association between surgeon-patient sex discordance and postoperative outcomes. Design, Setting, and Participants In this population-based, retrospective cohort study, adult patients 18 years and older undergoing one of 21 common elective or emergent surgical procedures in Ontario, Canada, from 2007 to 2019 were analyzed. Data were analyzed from November 2020 to March 2021. Exposures Surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient), operationalized as a binary (discordant vs concordant) and 4-level categorical variable. Main Outcomes and Measures Adverse postoperative outcome, defined as death, readmission, or complication within 30-day following surgery. Secondary outcomes assessed each of these metrics individually. Generalized estimating equations with clustering at the level of the surgical procedure were used to account for differences between procedures, and subgroup analyses were performed according to procedure, patient, surgeon, and hospital characteristics. Results Among 1 320 108 patients treated by 2937 surgeons, 602 560 patients were sex concordant with their surgeon (male surgeon with male patient, 509 634; female surgeon with female patient, 92 926) while 717 548 were sex discordant (male surgeon with female patient, 667 279; female surgeon with male patient, 50 269). A total of 189 390 patients (14.9%) experienced 1 or more adverse postoperative outcomes. Sex discordance between surgeon and patient was associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR], 1.07; 95% CI, 1.04-1.09), as well as death (aOR, 1.07; 95% CI, 1.02-1.13), and complications (aOR, 1.09; 95% CI, 1.07-1.11) but not readmission (aOR, 1.02; 95% CI, 0.98-1.07). While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004). Conclusions and Relevance In this study, sex discordance between surgeons and patients negatively affected outcomes following common procedures. Subgroup analyses demonstrate that this is driven by worse outcomes among female patients treated by male surgeons. Further work should seek to understand the underlying mechanism.
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Affiliation(s)
- Christopher J D Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana E Magee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amanda E Hird
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nestor F Esnaola
- Division of Surgical Oncology and Gastrointestinal Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Jonathan C A Guzman
- Department of Urology, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Barbara Bass
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
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Miyahara J, Ohya J, Kawamura N, Ohtomo N, Kunogi J. Adverse effects of surgeon performance after a night shift on the incidence of perioperative complications in elective thoracolumbar spine surgery. J Orthop Sci 2021; 26:948-952. [PMID: 33183941 DOI: 10.1016/j.jos.2020.09.019] [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: 09/26/2019] [Revised: 08/14/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decline in cognitive function after night shift has been well described. However, in the field of spine surgery, the effect of surgeons' sleeplessness on patient outcome is unclear. The purpose of this study was to investigate whether the risk of perioperative complications in elective thoracolumbar spine surgery could be higher if the surgeon had been on a night shift prior to the day of surgery. METHODS We performed a retrospective review of patients who underwent elective posterior thoracolumbar spine surgery, as indicated in medical records, between March 2015 and September 2018. In total, 1189 patients were included and divided into two groups: the post-nighttime (n = 110) and control groups (n = 1079). A post-nighttime case was defined when the operating surgeon was on nighttime duty on the previous night, and other cases were defined as controls. We evaluated the incidence of perioperative complications (surgical site infection, postoperative hematoma, postoperative paralysis, nerve root injury, and dural tear) in both groups. RESULTS Overall, we found no significant difference in the major or minor perioperative complication rates between the two groups, but according to the type of complication, the incidence rate of dural tear tended to be higher in the post-nighttime group (13.6% vs 8.2%, P = 0.074). Multivariate analysis showed that post-nighttime status was an independent risk factor of dural tear (adjusted odds ratio, 2.02; 95% confidence interval [CI], 1.10-3.70; P = 0.023). After stratification by surgical complexity, post-nighttime status was an independent risk factor of dural tear only in the surgeries of 3 levels or more (adjusted odds ratio, 2.81; 95% CI, 1.18-6.67; P = 0.019). CONCLUSIONS Post-nighttime status was generally not a risk factor of perioperative complications in elective posterior thoracolumbar spine surgeries, but was an independent risk factor of dural tear, especially in complex cases.
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Affiliation(s)
- Junya Miyahara
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Junichi Ohya
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Junichi Kunogi
- Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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A MULTIFACTORIAL APPROACH FOR IMPROVING THE SURGICAL PERFORMANCE OF NOVICE VITREORETINAL SURGEONS. Retina 2021; 41:2163-2171. [PMID: 34543245 DOI: 10.1097/iae.0000000000003147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To quantitatively analyze and compare the novice vitreoretinal surgeons' performance after various types of external exposures. METHODS This prospective, self-controlled, cross-sectional study included 15 vitreoretinal fellows with less than 2 years of experience. Surgical performance was assessed using the Eyesi simulator after each exposure: Day 1, placebo, 2.5, and 5 mg/kg caffeine; Day 2, placebo, 0.2, and 0.6 mg/kg propranolol; Day 3, baseline simulation, breathalyzer reading of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentration; Day 4, baseline simulation, push-up sets with 50% and 85% repetition maximum; Day 5, 3-hour sleep deprivation. Eyesi-generated total scores were the main outcome measured (0-700, worst to best). RESULTS Performances worsened after increasing alcohol exposure based on the total score (χ2 = 7; degrees of freedom = 2; P = 0.03). Blood alcohol concentration 0.06% to 0.10% and 0.11% to 0.15% was associated with diminished performance compared with improvements after propranolol 0.6 and 0.2 mg/kg, respectively (∆1 = -22 vs. ∆2 = +13; P = 0.02; ∆1 = -43 vs. ∆2 = +23; P = 0.01). Propranolol 0.6 mg/kg was positively associated with the total score, compared with deterioration after 2.5 mg/kg caffeine (∆1 = +7 vs. ∆2 = -13; P = 0.03). CONCLUSION Surgical performance diminished dose dependently after alcohol. Caffeine 2.5 mg/kg was negatively associated with dexterity, and performance improved after 0.2 mg/kg propranolol. No changes occurred after short-term exercise or acute 3-hour sleep deprivation.
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Hanyuda A, Sawada N, Uchino M, Kawashima M, Yuki K, Tsubota K, Tanno K, Sakata K, Yamagishi K, Iso H, Yasuda N, Saito I, Kato T, Abe Y, Arima K, Shimazu T, Yamaji T, Goto A, Inoue M, Iwasaki M, Tsugane S. Relationship between unhealthy sleep status and dry eye symptoms in a Japanese population: The JPHC-NEXT study. Ocul Surf 2021; 21:306-312. [PMID: 33845221 DOI: 10.1016/j.jtos.2021.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/31/2021] [Accepted: 04/03/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate whether and how unhealthy sleep habits (i.e., the frequency of difficulty falling or staying asleep, and the frequency of waking up tired) and the duration of sleep are related to the prevalence of dry eye disease (DED) in a general population. METHODS This study included a total of 106,282 subjects aged 40-74 years who participated in a baseline survey of the Japan Public Health Center-based Prospective Study for the Next Generation. DED was defined as the presence of clinically diagnosed DED or severe symptoms. Multivariable-adjusted logistic regression models were used to assess the relationships of various components of sleep status with DED. RESULTS Higher frequencies of having difficulty falling or staying asleep, and waking up tired were significantly related to increased DED in both sexes (Ptrend<0.001). Compared with those with 8 h/day of sleep, shorter sleepers had an increased prevalence of DED in both sexes, although DED was increased among men who slept ≥10 h/day. By comparing participants with the greatest vs. the least difficulty of falling asleep, the multivariable-adjusted odds ratios (95% confidence interval [CI]) were 2.23 (95% CI, 1.99-2.49) for men and 1.91 (95% CI, 1.76-2.07) for women. When analyzed separately, the magnitude of each relationship was stronger with severe DED symptoms than with clinically diagnosed DED. CONCLUSIONS Sleep deprivation and poor sleep quality were significantly related to DED in a Japanese population.
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Affiliation(s)
- Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan; Ibaraki Western Medical Center, Ibaraki, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobufumi Yasuda
- Department of Public Health, Kochi University Medical School, Kochi, Japan
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Tadahiro Kato
- Center for Education and Educational Research, Faculty of Education, Ehime University, Ehime, Japan
| | - Yasuyo Abe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Atsushi Goto
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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Zhang S, Ring J, Methot M, Zevin B. Medication Errors in Surgery: A Classification Taxonomy and a Pilot Study in Postcall Residents. J Surg Res 2021; 264:402-407. [PMID: 33848839 DOI: 10.1016/j.jss.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-call state in postgraduate medical trainees is associated with impaired decision-making and increased medical errors. An association between post-call state and medication prescription errors for surgery residents is yet to be established. Our objective was to determine whether post-call state is associated with increased proportion of medication prescription errors committed by surgery residents in an academic hospital without a computerized physician order entry (CPOE) system. METHODS This prospective observational study was conducted at a tertiary academic hospital between June 28 and August 31, 2017. It compared the proportion of medication prescription errors committed by surgery residents in their post-call (PC) and no-call (NC) states. A novel taxonomy was developed to classify medication prescription errors. RESULTS Sixteen of twenty-one eligible residents (76%) participated in this study. Self-reported hours of sleep per night was significantly higher in the NC group compared to the PC group (6(4-8) vs 2(0-4) hours, P < 0.01). PC residents committed a significantly higher proportion of medication prescription errors versus NC residents (9.2% vs 3.2%; p=0.04). Decision-making and prescription-writing errors comprised 33% and 67% of errors, respectively. CONCLUSIONS The post-call state in surgery residents is associated with a significantly higher proportion of medication prescription errors in a hospital without a CPOE system. Decision-making and prescription-writing errors could potentially be addressed by additional educational interventions.
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Affiliation(s)
- Shannon Zhang
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Justine Ring
- Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Do obstetrics trainees working hours affect caesarean section rates in normal risk women? Eur J Obstet Gynecol Reprod Biol 2021; 258:358-361. [PMID: 33535147 DOI: 10.1016/j.ejogrb.2021.01.036] [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: 12/06/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The rate of caesarean section (CS) is increasing globally. The nulliparous, term, singleton, vertex presentation, spontaneously labouring woman (Robson Group 1/RG1) is considered low risk for CS. It has been hypothesized that more CS occur at nighttime or at weekends due to doctor fatigue. The European Working Time Directive (EWTD) was implemented in our institution in 2013 to limit doctor working hours, which aimed at reducing fatigue but arguably fractures continuity of care. This study aimed to determine the effect of nocturnal hours and weekend on-call as well as the implementation of EWTD on our RG1 CS rates. STUDY DESIGN This was a population-based study in a tertiary referral centre from 2008-2017. The inclusion criteria for our study were limited to RG1. Data were analysed from an established clinical database, including mode and time of delivery. Descriptive statistics are presented as number and percent for categorical variables. Relative frequencies were tested using chi-squared test. All statistical analyses were performed using SPSS Version 26. Statistical significance was defined as p < .05. RESULTS There were 86,473 deliveries over the 10-year study period. There were 18,761 women in RG1. Overall the RG1 CS rate was 12.9 % (n = 2415). Rates of CS in the RG1 were not statistically different between those delivering on weekdays (12.9 %, n = 1726/13,430) and weekends (12.9 %, n = 689/5,331, OR 0.99, 95 % CI = 0.90-1.09, p = .89). During daytime hours the CS rate was 12.1 % (n = 777/6411) and at nighttime was 13.3 % (n = 1638/12,350, OR 1.10, 95 % CI = 1.01-1.21, p = .03). Comparing the time periods pre and post EWTD implementation, there was a significant increase in CS rates (12.1 % n = 1319/10,873 V 13.9 % n = 1096/7,888, OR 1.17, 95 % CI = 1.07-1.27 p < .001). With respect to other modes of delivery in RG1 pre and post EWTD, there was a statistically significant decrease in operative vaginal delivery (OVD) rates (40.1%, n=4,360 V 37.7%, n=2,973, OR 0.90, 95% CI = 0.85-0.95, p = .001) CONCLUSION: This study shows an association between obstetric trainee working practices, RG1 CS and OVD rates; this is most pronounced at night and after the introduction of the EWTD. It is unlikely that obstetric trainee working practices are the only factor related to the increasing CS rate and reduced OVD rate. Consideration should be giving to addressing the needs of obstetric trainees in relation to achieving their competencies with now reduced labour ward exposure. Further study is required to see if alternate arrangements in relation to simulation training could increase the OVD rate and reduce the CS rate.
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Bougie O, McClintock C, Pudwell J, Brogly SB, Velez MP. Short-term outcomes of endometriosis surgery in Ontario: A population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:1140-1147. [PMID: 33368183 DOI: 10.1111/aogs.14071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Our objective was to compare the short-term outcomes by type of surgical management of endometriosis in Ontario, Canada and to characterize the population of women undergoing surgical management of endometriosis. MATERIAL AND METHODS We conducted a population-based cohort study including women aged 18-50 years undergoing same-day or inpatient surgery for endometriosis from 1 April 2002 through 31 March 2018. Surgery was classified as minimally invasive hysterectomy (MIH), total abdominal hysterectomy (TAH) or minor or major conservative (uterus-preserving) surgery. Outcomes examined included length of stay, intraoperative complications, postoperative complications, emergency department visits, ambulatory care visits, and readmission. We estimated the relative risk of these outcomes in minor, major conservative surgery and TAH vs MIH adjusted for age, income quintile, parity, and comorbidities. RESULTS A total of 85 605 patients underwent surgery, 12.9% MIH, 22.1% TAH, 36.3% major conservative, and 28.6% minor conservative. The mean age at index surgery was 37.6 ± 7.7 years. Before surgery, 70.6% of patients had visited a physician for pain at least once (64.7% MIH, 69.5% TAH, 71.1% major conservative and 73.4% minor conservative) and 23.5% of patients had sought infertility consultation (5.7% MIH, 6.6% TAH, 29.3% major conservative and 37.1% minor conservative). The overall risk of intraoperative and postoperative complications was 1.5% and 4.7%, respectively. In adjusted models, compared with those undergoing minor conservative surgery, those having major conservative surgery were 1.77 (95% CI 1.49-2.11) times as likely to experience an intraoperative complication, those having MIH and TAH were 2.55 (95% CI 2.08-3.13) and 2.34 (95% CI 1.93-2.82) times as likely to do so, respectively. Similarly, compared with those undergoing minor conservative surgery, those having major conservative surgery were 2.60 (95% CI 2.30, 2.93) times as likely to experience any postoperative complication, and those having MIH and TAH were 4.69 (95% CI 4.11-5.36) and 5.38 (95% CI 4.76-6.09) times as likely to do so, respectively. CONCLUSIONS Approximately one-third of patients undergoing surgical management for endometriosis in Ontario between 2002 and 2018 had a hysterectomy. Overall, complications following surgery were low, and dependent on extent of surgery. These results should help to inform preoperative counseling for patients and health policy development for providers.
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Affiliation(s)
- Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
| | | | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Susan B Brogly
- ICES Queen's, Kingston, ON, Canada.,Department of Surgery, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
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Satkunasivam R, Klaassen Z, Ravi B, Fok KH, Menser T, Kash B, Miles BJ, Bass B, Detsky AS, Wallis CJD. Relation between surgeon age and postoperative outcomes: a population-based cohort study. CMAJ 2020; 192:E385-E392. [PMID: 32392499 DOI: 10.1503/cmaj.190820] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Aging may detrimentally affect cognitive and motor function. However, age is also associated with experience, and how these factors interplay and affect outcomes following surgery is unclear. We sought to evaluate the effect of surgeon age on postoperative outcomes in patients undergoing common surgical procedures. METHODS We performed a retrospective cohort study of patients undergoing 1 of 25 common surgical procedures in Ontario, Canada, from 2007 to 2015. We evaluated the association between surgeon age and a composite outcome of death, readmission and complications. We used generalized estimating equations for analysis, accounting for relevant patient-, procedure-, surgeon- and hospital-level factors. RESULTS We found 1 159 676 eligible patients who were treated by 3314 surgeons and ranged in age from 27 to 81 years. Modelled as a continuous variable, a 10-year increase in surgeon age was associated with a 5% relative decreased odds of the composite outcome (adjusted odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92 to 0.98, p = 0.002). Considered dichotomously, patients receiving treatment from surgeons who were older than 65 years of age had a 7% lower odds of adverse outcomes (adjusted OR 0.93, 95% CI 0.88-0.97, p = 0.03; crude absolute difference = 3.1%). INTERPRETATION We found that increasing surgeon age was associated with decreasing rates of postoperative death, readmission and complications in a nearly linear fashion after accounting for patient-, procedure-, surgeon- and hospital-level factors. Further evaluation of the mechanisms underlying these findings may help to improve patient safety and outcomes, and inform policy about maintenance of certification and retirement age for surgeons.
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Affiliation(s)
- Raj Satkunasivam
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Zachary Klaassen
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Bheeshma Ravi
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Kai-Ho Fok
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Terri Menser
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Bita Kash
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Brian J Miles
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Barbara Bass
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Allan S Detsky
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
| | - Christopher J D Wallis
- Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn
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Cusimano MC, Baxter NN, Sutradhar R, Ray JG, Garg AX, McArthur E, Vigod S, Simpson AN. Reproductive patterns, pregnancy outcomes and parental leave practices of women physicians in Ontario, Canada: the Dr Mom Cohort Study protocol. BMJ Open 2020; 10:e041281. [PMID: 33087379 PMCID: PMC7580071 DOI: 10.1136/bmjopen-2020-041281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Surveys and qualitative studies suggest that women physicians may delay childbearing, be at increased risk of adverse peripartum complications when they do become pregnant, and face discrimination and lower earnings as a result of parenthood. Observational studies enrolling large, representative samples of women physicians are needed to accurately evaluate their reproductive patterns, pregnancy outcomes, parental leave practices and earnings. This protocol provides a detailed research plan for such studies. METHODS AND ANALYSIS The Dr Mom Cohort Study encompasses a series of retrospective observational studies of women physicians in Ontario, Canada. All practising physicians in Ontario are registered with the College of Physicians and Surgeons of Ontario (CPSO). By linking a dataset of physicians from the CPSO to existing provincial administrative databases, which hold health data and physician billing records, we will be able to retrospectively assess the healthcare utilisation, work practices and pregnancy outcomes of women physicians at the population level. Specific outcomes of interest include: (1) rates and timing of pregnancy; (2) pregnancy-related care and complications; and (3) duration of parental leave and subsequent earnings, each of which will be evaluated with regression methods appropriate to the form of the outcome. We estimate that, at minimum, 5000 women physicians will be eligible for inclusion. ETHICS AND DISSEMINATION This protocol has been approved by the Research Ethics Board at St. Michael's Hospital in Toronto, Ontario, Canada (#18-248). We will disseminate findings through several peer-reviewed publications, presentations at national and international meetings, and engagement of physicians, residency programmes, department heads and medical societies.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Heath, University of Melbourne, Melbourne, Victoria, Australia
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amit X Garg
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Eric McArthur
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Simone Vigod
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Obstetrics & Gynaecology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Whelehan DF, Alexander M, Ridgway PF. Would you allow a sleepy surgeon operate on you? A narrative review. Sleep Med Rev 2020; 53:101341. [DOI: 10.1016/j.smrv.2020.101341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/22/2023]
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Surgeon fatigue does not affect surgical outcomes: a systematic review and meta-analysis. Surg Today 2020; 51:659-668. [PMID: 32924066 DOI: 10.1007/s00595-020-02138-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To systematically review the effects of surgeon fatigue on postoperative mortality and postoperative complications after elective and non-elective surgeries. METHODS A database search was conducted for original articles published in PubMed between 2000 and 2020 with the keywords: "surgeon," "sleep deprivation," "sleep deprived," "fatigued," "mortality," "morbidity," and "outcomes." We selected articles that disclosed actual numbers of patients who underwent surgery by fatigued or rested surgeons, rates of postoperative mortality, or total postoperative complications. RESULTS Of the 1427 articles identified, 16 met the selection criteria and were included. Eight of the 16 also included total postoperative complications. Analysis revealed no significant differences in the rates of postoperative mortality after elective and non-elective surgeries or total postoperative complications of elective surgeries or non-elective surgeries performed by fatigued vs. rested surgeons. The relative risks were 1.03 [95% confidence interval (CI), 0.86-1.24], 1.08 (95% CI, 0.85-1.38), 0.99 (95% CI, 0.95-1.04), and 0.93 (95% CI, 0.67-1.28), respectively. CONCLUSION Surgeon fatigue does not affect the rates of postoperative mortality or total postoperative complications after elective surgeries and may have little to no effect on the rates of postoperative mortality or total postoperative complications after non-elective surgeries.
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Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery. Spine (Phila Pa 1976) 2020; 45:1171-1177. [PMID: 32355143 DOI: 10.1097/brs.0000000000003516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of a surgical cohort from a single, large academic institution. OBJECTIVE The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission. SUMMARY OF BACKGROUND DATA One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay. No examinations of perioperative outcomes or cost have been performed. METHODS All patients undergoing anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) were queried from a single institution from January 1, 2008 to November 30, 2016. Patients undergoing surgery that started between 12:00 AM and 6:00 AM were excluded due to their likely emergent nature. Cases starting before and after 2:00 PM were compared on the basis of length of stay and cost as the primary outcomes using multivariable logistic regression. RESULT The patients undergoing ACDF and PCDF were both similar on the basis of comorbidity burden, preoperative diagnosis, and number of segments fused. The patients undergoing ACDF starting after 2 PM had longer LOS values (adjusted difference of 0.65 days; 95% confidence interval [CI]: 0.28-1.03; P = 0.0006) and higher costs of hospitalization (adjusted difference of $1177; 95% CI: $549-$1806; P = 0.0002). Patients undergoing PCDF starting after 2 PM also had longer LOS values (adjusted difference of 1.19 days; 95% CI: 0.46-1.91; P = 0.001) and higher costs of hospitalization (adjusted difference of $2305; 95% CI: $826-$3785; P = 0.002). CONCLUSION Later surgical start time is associated with longer LOS and higher cost. These findings should be further confirmed in the spine surgical literature to investigate surgical start time as a potential cost-saving measure. LEVEL OF EVIDENCE 3.
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Alnajashi SS, Alayed SA, Al-Nasher SM, Aldebasi B, Khan MM. Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh. Medicine (Baltimore) 2020; 99:e20273. [PMID: 32769860 PMCID: PMC7593025 DOI: 10.1097/md.0000000000020273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform.A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 AM to 3:59 PM, 4 PM to 11:59 PM, and midnight to 7:59 AM.Participants' mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P-value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries.This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.
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Affiliation(s)
| | | | | | - Bader Aldebasi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Lu Q, Li QS, Zhang W, Liu K, Li T, Yu JW, Lv Y, Zhang XF. Operation start time and long-term outcome of hepatocellular carcinoma after curative hepatic resection. Ann Surg Treat Res 2020; 99:1-7. [PMID: 32676476 PMCID: PMC7332319 DOI: 10.4174/astr.2020.99.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/14/2020] [Accepted: 03/06/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose The objective of the current study was to examine the potential effects of surgery start times (morning vs. afternoon) on the long-term prognosis of patients after hepatic resection (HR) for hepatocellular carcinoma (HCC). Methods All eligible patients were divided into 2 groups according to the start time of surgery: group M (morning surgery, 8 AM–1 PM) and group A (afternoon surgery, 1 PM–6 PM). Clinicopathologic and surgical parameters, as well as oncologic outcomes were compared between the 2 groups. Results In total, 231 patients were included in the study. There was no difference in age, body mass index, comorbidities, tumor size, tumor location, tumor stages, surgical procedures, or surgical margin between morning and afternoon surgery (all P > 0.05). In contrast, patients in group M experienced longer operation duration than those in group A (median, 240 minutes vs. 195 minutes, P = 0.004). However, no differences of overall survival were observed between morning and afternoon surgery groups in the whole cohort or stratified by surgical margin (all P > 0.05). Conclusion Surgery start times during the work day have no measurable influence on patient outcome following curative HR for HCC, indicating good self-regulation and professional judgment of surgeons for progressive fatigue during surgery.
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Affiliation(s)
- Qiang Lu
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Qing-Shan Li
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Kang Liu
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Tao Li
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Jia-Wei Yu
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
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Simpson AN, Sutradhar R, Ferguson SE, Robertson D, Cheng SY, Li Q, Baxter NN. Perioperative outcomes of women with and without class III obesity undergoing hysterectomy for endometrioid endometrial cancer: A population-based study. Gynecol Oncol 2020; 158:681-688. [PMID: 32571681 DOI: 10.1016/j.ygyno.2020.06.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Population-based data on perioperative complications among women with endometrial cancer and severe obesity are lacking. We evaluated 30-day complication rates among women with and without class III obesity (body mass index ≥ 40 kg/m2) undergoing primary surgical management for endometrioid endometrial cancer (EEC), and how outcomes differed according to surgical approach (open vs. minimally invasive). METHODS We performed a retrospective population-based cohort study of women with EEC undergoing hysterectomy in Ontario, Canada, between 2006 and 2015. We evaluated perioperative complications in the whole cohort, and in a 1:1 matched analysis using hard and propensity score matching to ensure similar distributions of patient, tumour, provider and institution-level factors between women with and without class III obesity (identified using a surgical billing code). The primary outcome of interest was the 30-day perioperative complication rate. RESULTS 12,112 women met inclusion criteria; 2697 (22.3%) had class III obesity. We matched 2320 (86%) women with class III obesity to those without. The composite complication rate was significantly higher among women with class III obesity (23.2% vs. 18.4%, standardized mean difference [SMD] = 0.12), primarily due to wound infection/disruption (12.1% vs. 6.2%). There was no difference in outcomes for women with and without class III obesity when a minimally invasive approach was used. CONCLUSIONS Wound infection/disruption was increased for women with class III obesity compared to women without. Otherwise, perioperative complications were similar between the matched pairs. When minimally invasive approaches were used, women with class III obesity had a similar risk of complications as women without obesity.
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Affiliation(s)
- A N Simpson
- Department of Obstetrics and Gynecology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada.
| | - R Sutradhar
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - S E Ferguson
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, University Health Network/Mount Health Systems, Toronto, ON, Canada
| | - D Robertson
- Department of Obstetrics and Gynecology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Q Li
- ICES, Toronto, ON, Canada
| | - N N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing. Crit Care Med 2020; 47:894-902. [PMID: 30985450 DOI: 10.1097/ccm.0000000000003773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN Prospective observational study. SETTING Medical ICU of a tertiary care academic medical center during a randomized controlled trial of in-hospital nighttime intensivist staffing. PATIENTS Twenty faculty and 13 fellows assigned to rotations in the medical ICU during 2012. INTERVENTIONS As part of the parent study, there was weekly randomization of staffing model, stratified by 2-week faculty rotation. During the standard staffing model, there were in-hospital residents, with a fellow and faculty member available at nighttime by phone. In the intervention, there were in-hospital residents with an in-hospital nighttime intensivist. Fellows and faculty completed diaries detailing their sleep, work, and well-being; wore actigraphs; and performed psychomotor vigilance testing daily. MEASUREMENTS AND MAIN RESULTS Daily sleep time (mean hours [SD]) was increased for fellows and faculty in the intervention versus control (6.7 [0.3] vs 6.0 [0.2]; p < 0.001 and 6.7 [0.1] vs 6.4 [0.2]; p < 0.001, respectively). In-hospital work duration did not differ between the models for fellows or faculty. Total hours of work done at home was different for both fellows and faculty (0.1 [< 0.1] intervention vs 1.0 [0.1] control; p < 0.001 and 0.2 [< 0.1] intervention vs 0.6 [0.1] control; p < 0.001, respectively). Psychomotor vigilance testing did not demonstrate any differences. Measures of well-being including physical exhaustion and alertness were improved in faculty and fellows in the intervention staffing model. CONCLUSIONS Although no differences were measured in patient outcomes between the two staffing models, in-hospital nighttime intensivist staffing was associated with small increases in total sleep duration for faculty and fellows, reductions in total work hours for fellows only, and improvements in subjective well-being for both groups. Staffing models should consider how work duration, sleep, and well-being may impact burnout and sustainability.
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Key Components of the Safe Surgical Ward: International Delphi Consensus Study to Identify Factors for Quality Assessment and Service Improvement. Ann Surg 2020; 269:1064-1072. [PMID: 31082903 DOI: 10.1097/sla.0000000000002718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to prioritize key factors contributing to safety on the surgical ward BACKGROUND:: There is a variation in the quality and safety of postoperative care between institutions. These variations may be attributed to a combination of process-related issues and structural factors. The aim of this study is to reach a consensus, by means of Delphi methodology, on the most influential of these components that may determine safety in this environment. METHODS The Delphi questionnaire was delivered via an online questionnaire platform. The panel were blinded. An international panel of safety experts, both clinical and nonclinical, and safety advocates participated. Individuals were selected according to their expertise and extent of involvement in patient safety research, regulation, or patient advocacy. RESULTS Experts in patient safety from the UK, Europe, North America, and Australia participated. The panel identified the response to a deteriorating patient and the care of outlier patients as error-prone processes. Prioritized structural factors included organizational and environmental considerations such as use of temporary staff, out-of-hours reduction in services, ward cleanliness, and features of layout. The latter includes dedicated areas for medication preparation and adequate space around the patient for care delivery. Potential quality markers for safe care that achieved the highest consensus include leadership, visibility between patients and nurses, and nursing team skill mix and staffing levels. CONCLUSION International consensus was achieved for a number of factors across process-related and structural themes that may influence safety in the postoperative environment. These should be championed and prioritized for future improvements in patient safety at the ward-level.
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Encouraging Split Liver Transplantation for Two Adult Recipients to Mitigate the High Incidence of Wait-list Mortality in The Setting of Extreme Shortage of Deceased Donors. J Clin Med 2019; 8:jcm8122095. [PMID: 31805722 PMCID: PMC6947574 DOI: 10.3390/jcm8122095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/03/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Organ demand for liver transplantation (LT) is constantly increasing. Split liver transplantation (SPLT) is an ideal option for increasing the number of available liver grafts for transplantation and ameliorating organ shortage to a certain degree. However, SPLT for two adult recipients is still not broadly applied. Methods: We retrospectively analyzed the outcomes of SPLT for adult recipients at a single center. All donor, recipient, and transplantation factors were thoroughly investigated to clarify factors affecting patient outcomes after LT. Results: One hundred consecutive adult SPLTs were performed during the study period. Early mortality and 1-year mortality occurred in 21 and 31 recipients, respectively. On multivariate analysis, graft weight (p = 0.036, odds ratio = 0.99, 95% confidence interval = 0.98–0.99) was the independent risk factor associated with early mortality; however, no factor was significantly related to 1-year mortality. On receiver operating characteristic curve analysis, a graft weight of 580 g was identified the cutoff for stratifying outcomes. Recipients transplanted with a graft weighing ≥580 g had significantly better outcome as compared with other recipients (p = 0.001). Moreover, SPLT remarkably provided a better survival benefit for recipients than those on the LT wait-list (p < 0.0001). Conclusions: Given the considerable incidence of wait-list mortality, SPLT for two adult recipients should be encouraged whenever possible to increase the donor pool and benefit patients awaiting LT. Nonetheless, caution should be taken with a smaller graft weight owing to the risk of early graft loss.
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Murji A, Lam M, Allen B, Richard L, Shariff SZ, Austin PC, Callum J, Lipscombe L. Risks of preoperative anemia in women undergoing elective hysterectomy and myomectomy. Am J Obstet Gynecol 2019; 221:629.e1-629.e18. [PMID: 31310749 DOI: 10.1016/j.ajog.2019.07.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/07/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hysterectomy is one of the most common surgeries performed worldwide. Identification of modifiable risk factors for complications or readmissions could lead to targeted interventions to improve patient care and reduce health care costs. Preoperative anemia has been identified as a risk factor for adverse postoperative outcomes following noncardiac surgery. However, studies have not focused on young and healthy surgical populations, such as women undergoing gynecologic surgery for benign indications. OBJECTIVE The purpose of this study was to evaluate whether preoperative anemia in women undergoing elective hysterectomy or myomectomy for benign indications was associated with increased 30 day postoperative morbidity and mortality. STUDY DESIGN In this retrospective, population-based cohort study, we followed up adult women (≥18 years of age) who underwent elective hysterectomy or myomectomy (laparoscopic/laparotomy) between the years 2013 and 2015 for benign indications in Ontario, Canada. We used linked administrative data from a government-administered, single-payer provincial health care system using Canadian Classification of Health Interventions intervention codes, International Classification of Diseases, 10th revision, diagnostic codes, physician billing codes, and laboratory data from both community and hospital laboratories across the province. Our exposure of interest was preoperative anemia, defined as a hemoglobin value <12 g/dL on the complete blood count measured closest to the date of surgery. Our primary outcome was the composite of 30 day postoperative morbidity and mortality. Secondary outcomes were 5 individual components of the primary outcome: death, transfusion, surgical site infection, venothromboembolism, and return to the hospital within 30 days. To adjust for confounding, we generated a propensity score using a multiple logistic regression model in which the presence of anemia was regressed on all baseline characteristics. We matched anemic to nonanemic patients on the logit of the propensity score. Using an unadjusted log-binomial model estimated using generalized estimating equations to account for the matched pairs, we calculated the relative risk, 95% confidence intervals, and P values to evaluate the effect of anemia on outcomes. RESULTS Of the 16,218 women in the cohort, 3664 (22.6%) had anemia. After propensity matching, standardized differences in all baseline characteristics (n = 3261 per group) were <0.10. In the matched cohort, the primary outcome (death, complications, or readmission) occurred in 41.2% of anemic patients and 36.2% of nonanemic patients (relative risk, 1.14, 95% confidence interval, 1.07-1.21, P < .0001; absolute risk reduction, 5.03%, 95% confidence interval, 2.70-7.36; (number needed to harm = 20). The risk of transfusion was significantly higher in anemic patients (relative risk, 3.25, 95% confidence interval, 2.67-3.95, P < .0001; absolute risk reduction, 8.34%, 95% confidence interval, 7.06-9.63; number needed to harm = 12). There was no difference in other secondary outcomes. In a subgroup analysis (women >55 years vs ≤55, n = 736), older women were at increased risk of the primary outcome (relative risk, 1.40, 95% confidence interval, 1.12-1.76, P = .004), transfusion (relative risk, 4.20, 95% confidence interval, 1.65-10.72, P = .003), surgical site infection (relative risk, 1.35, 95% confidence interval, 1.01-1.81, P = .04), and return to the hospital (relative risk, 2.36, 95% confidence interval, 1.54-3.62, P < .0001). CONCLUSION Preoperative anemia in women undergoing elective hysterectomy/myomectomy was common and is an independent risk factor for 30 day postoperative adverse outcomes, especially in older women.
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Affiliation(s)
- Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | | | | | | | | | - Peter C Austin
- Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada; ICES Toronto, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine Lipscombe
- Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada; ICES Toronto, Toronto, Ontario, Canada; Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
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Bekelis K, Missios S, MacKenzie TA. Outcomes of Elective Cerebral Aneurysm Treatment Performed by Attending Neurosurgeons after Night Work. Neurosurgery 2019; 82:329-334. [PMID: 28575518 DOI: 10.1093/neuros/nyx174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 05/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association between long work hours and outcomes among attending surgeons remains an issue of debate. OBJECTIVE To investigate whether operating emergently the night before an elective case was associated with inferior outcomes among attending neurosurgeons. METHODS We executed a cohort study with unruptured cerebral aneurysm patients, who underwent endovascular coiling or surgical clipping from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System database. We investigated the association of treatment by surgeons performing emergency procedures the night before with outcomes of elective cerebral aneurysm treatment using an instrumental variable analysis. RESULTS Overall, 4700 patients underwent treatment for unruptured cerebral aneurysms. There was no difference in inpatient mortality (adjusted difference, -0.7%; 95% confidence interval [CI], -1.4% to 0.02%), discharge to a facility (adjusted difference, -0.1%; 95% CI, -1.2% to 1.2%), or length of stay (adjusted difference, -0.58; 95% CI, -1.66 to 0.50) between patients undergoing elective cerebral aneurysm treatment by surgeons who performed emergency procedures the night before, and those who did not. CONCLUSION Using a comprehensive patient cohort in New York State for elective treatment of unruptured cerebral aneurysms, we did not identify an association of treatment by surgeons performing emergency procedures the night before, with mortality, discharge to a facility, or length of stay. Our study had 80% power to detect differences in mortality (our primary outcome), as small as 4.1%. The results of the present study do not support the argument for regulation of attending work hours.
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Affiliation(s)
- Kimon Bekelis
- Department of Neurosurgery, Jefferson Hospital for the Neurosciences, Philadel-phia, Pennsylvania.,The Dartmouth In-stitute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Symeon Missios
- Neu-roscience Institute, Cleveland Clinic/Akron General Hospital, Akron, Ohio
| | - Todd A MacKenzie
- The Dartmouth In-stitute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Gupta V, Bubis L, Kidane B, Mahar AL, Ringash J, Sutradhar R, Darling GE, Coburn NG. Readmission rates following esophageal cancer resection are similar at regionalized and non-regionalized centers: A population-based cohort study. J Thorac Cardiovasc Surg 2019; 158:934-942.e2. [DOI: 10.1016/j.jtcvs.2019.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
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Abstract
Abstract
Over the past decade, failure to rescue—defined as the death of a patient after one or more potentially treatable complications—has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient’s postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is an increasing appreciation of the key role of microsystem factors. Although failure to rescue is believed to contribute to observed hospital-level variation in both surgical outcomes and costs, further work is needed to delineate the underlying patient-level and system-level factors preventing the timely identification and treatment of postoperative complications. Therefore, the goals of this narrative review are to provide a conceptual framework for understanding failure to rescue, to discuss various associated patient- and system-level factors, to delineate the reasons it has become recognized as an important quality indicator, and to propose future directions of scientific inquiry for developing effective interventions that can be broadly implemented to improve postoperative outcomes across all hospitals.
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Zepeda ED, Nyaga GN, Young GJ. The Effect of Hospital‐Physician Integration on Operational Performance: Evaluating Physician Employment for Cardiovascular Services. DECISION SCIENCES 2019. [DOI: 10.1111/deci.12401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. David Zepeda
- Department of Health LawPolicy and ManagementBoston University School of Public Health 715 Albany Street Boston MA 02118
| | - Gilbert N. Nyaga
- Supply Chain and Information Management Group, and Center for Health Policy and Healthcare ResearchD'Amore‐McKim School of BusinessNortheastern University 360 Huntington Avenue Boston MA 02115
| | - Gary J. Young
- Strategic Management and Healthcare Systems, and Center for Health Policy and Healthcare ResearchD'Amore‐McKim School of Business, and Bouvé College of Health SciencesNortheastern University 360 Huntington Avenue Boston MA 02115
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Emergency glioma resection but not hours of operation predicts perioperative complications: A single center study. Clin Neurol Neurosurg 2019; 182:11-16. [PMID: 31054423 DOI: 10.1016/j.clineuro.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Physical and mental status of neurosurgeons may vary with emergency status and hours of operation, which may impact the outcome of patients undergoing surgery. This study aims to clarify the influence of these parameters on outcome after surgery in glioma patients. PATIENTS AND METHODS A total of 477 nonemergency surgery (NES) and 30 emergency surgery (ES) were enrolled in this study. Using propensity score matching (PSM) analysis, 97 pairs of procedures from NES group were generated and then classified as group M (morning procedures, 8:00 a.m-1:00 p.m) or group A (afternoon or night procedures, 1:00 p.m-8:00 p.m). 30 emergency procedures were classified into group ESa (daytime emergency surgery, 8:00 a.m-6:00 p.m) and group ESb (nighttime surgery procedures, 6:00 p.m-8:00 a.m the next day). Differences in intraoperative risk factors and postoperative complications were analyzed. RESULTS Postoperative complications, including death within 30 days (p = 0.004), neurological function deficit (p = 0.012), systemic infection (p < 0.001) were significant higher in emergency procedures. Intraoperative risk factors including blood loss (p < 0.001), blood transfusion (p = 0.036) were also higher in emergency procedures than nonemergency procedures, although both procedures had comparable time duration (p = 0.337). By PSM analysis, patients in group M and group A were well matched and no significant difference of intraoperative risk factors and postoperative complications (all p > 0.05) were found. Furthermore, incidence of intraoperative risk factors and postoperative complications were similar in both groups ESa and ESb (all p > 0.05). CONCLUSION Emergency glioma resection is a very important risk factors of perioperative mortality and morbidity for patients. However, hours of operation did not necessarily predict postoperative mortality or morbidity, either in emergency or nonemergency glioma resection.
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Coleman JJ, Robinson CK, Zarzaur BL, Timsina L, Rozycki GS, Feliciano DV. To Sleep, Perchance to Dream: Acute and Chronic Sleep Deprivation in Acute Care Surgeons. J Am Coll Surg 2019; 229:166-174. [PMID: 30959105 DOI: 10.1016/j.jamcollsurg.2019.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute and chronic sleep deprivation are significantly associated with depressive symptoms and are thought to be contributors to the development of burnout. In-house call inherently includes frequent periods of disrupted sleep and is common among acute care surgeons. The relationship between in-house call and sleep deprivation among acute care surgeons has not been previously studied. The goal of this study was to determine prevalence and patterns of sleep deprivation in acute care surgeons. STUDY DESIGN A prospective study of acute care surgeons with in-house call responsibilities from 2 level I trauma centers was performed. Participants wore a sleep-tracking device continuously over a 3-month period. Data collected included age, sex, schedule of in-house call, hours and pattern of each sleep stage (light, slow wave, and rapid eye movement [REM]), and total hours of sleep. Sleep patterns were analyzed for each night, excluding in-house call, and categorized as normal, acute sleep deprivation, or chronic sleep deprivation. RESULTS There were 1,421 nights recorded among 17 acute care surgeons (35.3% female; ages 37 to 65 years, mean 45.5 years). Excluding in-house call, the average amount of sleep was 6.54 hours, with 64.8% of sleep patterns categorized as acute sleep deprivation or chronic sleep deprivation. Average amount of sleep was significantly higher on post-call day 1 (6.96 hours, p = 0.0016), but decreased significantly on post-call day 2 (6.33 hours, p = 0.0006). Sleep patterns with acute and chronic sleep deprivation peaked on post-call day 2, and returned to baseline on post-call day 3 (p = 0.046). CONCLUSIONS Sleep patterns consistent with acute and chronic sleep deprivation are common among acute care surgeons and worsen on post-call day 2. Baseline sleep patterns were not recovered until post-call day 3. Future study is needed to identify factors that affect physiologic recovery after in-house call and further elucidate the relationship between sleep deprivation and burnout.
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Affiliation(s)
| | | | - Ben L Zarzaur
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Lava Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Grace S Rozycki
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David V Feliciano
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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Mendelsohn D, Despot I, Gooderham PA, Singhal A, Redekop GJ, Toyota BD. Impact of work hours and sleep on well-being and burnout for physicians-in-training: the Resident Activity Tracker Evaluation Study. MEDICAL EDUCATION 2019; 53:306-315. [PMID: 30485496 DOI: 10.1111/medu.13757] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/09/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Resident Activity Tracker Evaluation (RATE) is a prospective observational study evaluating the impact of work hours, sleep and physical activity on resident well-being, burnout and job satisfaction. BACKGROUND Physician burnout is common and its incidence is increasing. The impact of work hours and sleep on resident well-being and burnout remains elusive. Activity trackers are an innovative tool for measuring sleep and physical activity. METHODS Residents were recruited from (i) general surgery and orthopaedics (SURG), (ii) internal medicine and neurology (MED) and (iii) anaesthesia and radiology (RCD). Groups 1 and 2 do not enforce restrictions on the duration of being on-call, and group 3 had restricted the duration of being on-call to 12 hours. Participants wore FitBit trackers for 14 days. Total hours worked, daily sleep, sleep on-call and daily steps were recorded. Participants completed validated surveys assessing self-reported well-being (Short-Form Health Survey), burnout (Maslach Burnout Inventory), and satisfaction with medicine. RESULTS Surgical residents worked the most hours per week, followed by medical and RCD residents (SURG, 84.3 hours, 95% CI, 80.2-88.5; MED, 69.2 hours, 95% CI, 65.3-73.2; RCD, 52.2 hours, 95% CI, 48.2-56.1; p < 0.001). Surgical residents obtained fewer hours of sleep per day (SURG, 5.9 hours, 95% CI, 5.5-6.3; MED, 6.9 hours, 95% CI, 6.5-7.3; RCD, 6.8 hours, 95% CI, 5.6-7.2; p < 0.001). Nearly two-thirds of participants (61%) scored high burnout on the Maslach depersonalisation subscore. Total steps per day and well-being, burnout and job satisfaction were comparable between groups. Total hours worked, daily sleep and steps per day did not predict burnout or well-being. CONCLUSIONS Work hours and average daily sleep did not affect burnout. Physical activity did not prevent burnout. Work hour restrictions may lead to increased sleep but may not affect resident burnout or well-being.
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Affiliation(s)
- Daniel Mendelsohn
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ivan Despot
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter A Gooderham
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashtush Singhal
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gary J Redekop
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian D Toyota
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Tam DY, Fang J, Tran A, Tu JV, Ko DT, Deb S, Fremes SE. A Clinical Risk Scoring Tool to Predict Readmission After Cardiac Surgery: An Ontario Administrative and Clinical Population Database Study. Can J Cardiol 2018; 34:1655-1664. [DOI: 10.1016/j.cjca.2018.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022] Open
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