Surgeon Outcomes Research Articles

"Happy to close?" The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery.

Incisional hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients at 2 years. Given the associated morbidity and high recurrence rates after attempted repair of IH, emphasis should be placed on prevention. There is an association between surgeon volume and outcomes in hernia surgery, yet there is little evidence regarding impact of the seniority of the surgeon performing abdominal wall closure on IH rate. The aim of our study was to assess the rates of IH at 1 year following abdominal wall closure between junior and senior surgeons in patients undergoing elective colorectal surgery. This was an exploratory analysis of patients who underwent elective surgery for colorectal cancer between 2014-2018 as part of the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing abdominal wall closure methods. Grade of surgeon performing abdominal closure was categorised into "trainee" and "consultant" and compared to IH rate at one year. A total of 663 patients were included in this retrospective analysis of patients in the HART trial. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (p=<0.001). When comparing closure methods, IH rates were significantly higher in the Hughes closure arm between trainees and consultants (20% vs. 12%, p=0.032), but not high enough in the mass closure arm to reach statistical significance (21% vs. 13%, p=0.058). On multivariate analysis, age (p=0.036, OR: 1.02, 95% CI: 1.00-1.04), Male sex (p=0.049, OR: 1.61, 95% CI: 1.00-2.59) and closure by a trainee (p=0.006, OR: 1.85, 95% CI: 1.20-2.85) were identified as risk factors for developing IH. Patients who undergo abdominal wall closure by a surgeon in training have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and unsupervised trainees on IH rates, but abdominal wall closure should be regarded as a training opportunity in its own right.

Automatic implant shape design for minimally invasive repair of pectus excavatum using deep learning and shape registration

Minimally invasive repair of pectus excavatum (MIRPE) is an effective method for correcting pectus excavatum (PE), a congenital chest wall deformity characterized by concave depression of the sternum. In MIRPE, a long, thin, curved stainless plate (implant) is placed across the thoracic cage to correct the deformity. However, the implant curvature is difficult to accurately determine during the procedure. This implant depends on the surgeon’s expert knowledge and experience and lacks objective criteria. Moreover, tedious manual input by surgeons is required to estimate the implant shape. In this study, a novel three-step end-to-end automatic framework is proposed to determine the implant shape during preoperative planning: (1) The deepest depression point (DDP) in the sagittal plane of the patient’s CT volume is automatically determined using Sparse R-CNN-R101, and the axial slice containing the point is extracted. (2) Cascade Mask R-CNN-X101 segments the anterior intercostal gristle of the pectus, sternum and rib in the axial slice, and the contour is extracted to generate the PE point set. (3) Robust shape registration is performed to match the PE shape with a healthy thoracic cage, which is then utilized to generate the implant shape. The framework was evaluated on a CT dataset of 90 PE patients and 30 healthy children. The experimental results show that the average error of the DDP extraction was 5.83 mm. The end-to-end output of our framework was compared with surgical outcomes of professional surgeons to clinically validate the effectiveness of our method. The results indicate that the root mean square error (RMSE) between the midline of the real implant and our framework output was less than 2 mm.

Incidence of Complications Associated With Lipectomy Techniques and Patient Body Mass Index: An Institutional and National Analysis Using the Tracking Operations and Outcomes for Plastic Surgeons.

An evaluation of complication rates in different abdominal lipectomy techniques with relationship to body mass index (BMI) and other risk factors. We identified patients who underwent an abdominal lipectomy at our institution from January 2015 to July 2020. Those with concurrent hernia repair were excluded. Patients were classified into 2 groups: (1) horizontal lipectomy with or without umbilical translocation and (2) inverted-T lipectomy with translocation. Demographics, operative details, and postoperative complications were collected for 1 year postoperatively. Bivariate analyses were conducted to determine factors associated with type of procedure and complications. Crude and stratum-specific (based on BMI) odds ratios for complications were calculated for the inverted T as compared with the horizontal group. A replicate analysis using the national Tracking Operations and Outcomes for Plastic Surgeons (TOPS) as a single cohort was performed. At our institution, 362 patients (group 1 = 196, group 2 = 166) were included. A total of 40.9% of patients experienced at least one complication at 1 year postoperatively with the complication rate decreasing to 28.0% when analyzed at the 30-day postoperative period. Specifically, wound disruption rates were highest in group 2 (39.8%) compared with group 1 (15.6%; P < 0.0001). The odds of experiencing a complication were greater in the inverted-T group overall and within each stratum of BMI. When dividing the cohort based on BMI class (normal weight, overweight, class I, class II, and class III obesity), the incidence of wound disruption increased as did BMI (2.6%, 22.2%, 27.2%, 48.2%, and 56.3%, respectively; P < 0.0001). The TOPS data set included 23,067 patients and showed an overall complication rate of 13.1% at 30-day postop. Overall, wound disruption rate was 4.6%. Compared with normal weight patients, the odds of experiencing a complication trended higher with each stratum of BMI. Other factors associated with complications included BMI, tobacco use, diabetes, American Society of Anesthesiology, prior massive weight loss, and LOS. The increasing complication rate within each BMI stratum of the large sample size of the TOPS patient cohort, in addition to our similar institutional trends, suggests that a staged procedure may be more appropriate for higher BMI patients. Surgical technique modification with limited flap undermining in patients undergoing inverted-T lipectomy to preserve flap perfusion may also decrease overall complication rates.

Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training.

Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.

Regionalization or Access to Care? A Joint Pediatric Heart Care Program That Achieves Both: One Program-Two Sites.

Background: Regionalization of care for children with congenital heart disease has been proposed as a method to improve outcomes. This has raised concerns about limiting access to care. We present the details of a joint pediatric heart care program (JPHCP) which utilized regionalization and actually improved access to care. Methods: In 2017, Kentucky Children's Hospital (KCH) launched the JPHCP with Cincinnati Children's Hospital Medical Center (CCHMC). This unique satellite model was the product of several years of planning, leading to a comprehensive strategy with shared personnel, conferences, and a robust transfer system; "one program-two sites." Results: Between March 2017 and the end of June 2022, 355 operations were performed at KCH under the auspices of the JPHCP. As of the most recent published Society of Thoracic Surgeons (STS) outcome report (through the end of June 2021), for all STAT categories, the JPHCP at KCH outperformed the STS overall in postoperative length of stay, and the mortality rate was lower than expected for the case mix. Of the 355 operations, there were 131 STAT 1, 148 STAT 2, 40 STAT 3, and 36 STAT 4 operations, with two operative mortalities: an adult undergoing surgery for Ebstein anomaly, and a premature infant who died from severe lung disease many months after aortopexy. Conclusions: With a select case mix, and by affiliating with a large volume congenital heart center, the creation of the JPHCP at KCH was able to achieve excellent congenital heart surgery results. Importantly, access to care was improved for those children at the more remote location utilizing this one program-two sites model.

Higher Surgeon Volume is Associated With a Lower Rate of Subsequent Revision Procedures After Total Shoulder Arthroplasty: A National Analysis.

Studies assessing the relationship between surgeon volume and outcomes have shown mixed results, depending on the specific procedure analyzed. This volume relationship has not been well studied in patients undergoing total shoulder arthroplasty (TSA), but it should be, because this procedure is common, expensive, and potentially morbid. We performed this study to assess the association between increasing surgeon volume and decreasing rate of revision at 2 years for (1) anatomic TSA (aTSA) and (2) reverse TSA (rTSA) in the United States. In this retrospective study, we used Centers for Medicare and Medicaid Services (CMS) fee-for-service inpatient and outpatient data from 2015 to 2021 to study the association between annual surgeon aTSA and rTSA volume and 2-year revision shoulder procedures after the initial surgery. The CMS database was chosen for this study because it is a national sample and can be used to follow patients over time. We included patients with Diagnosis-related Group code 483 and Current Procedural Terminology code 23472 for TSA (these codes include both aTSA and rTSA). We used International Classification of Diseases, Tenth Revision, procedural codes. Patients who underwent shoulder arthroplasty for fracture (10% [17,524 of 173,242]) were excluded. We studied the variables associated with the subsequent procedure rate through a generalized linear model, controlling for confounders such as patient age, comorbidity risk score, surgeon and hospital volume, surgeon graduation year, hospital size and teaching status, assuming a binomial distribution with the dependent variable being whether an episode had at least one subsequent procedure within 2 years. The regression was fitted with standard errors clustered at the hospital level, combining all TSAs and within the aTSA and rTSA groups, respectively. Hospital and surgeon yearly volumes were calculated by including all TSAs, primary procedure and subsequent, during the study period. Other hospital-level and surgeon-level characteristics were obtained through public files from the CMS. The CMS Hierarchical Condition Category risk score was controlled because it is a measure reflecting the expected future health costs for each patient based on the patient's demographics and chronic illnesses. We then converted regression coefficients to the percentage change in the odds of having a subsequent procedure. After controlling for confounding variables including patient age, comorbidity risk score, surgeon and hospital volume, surgeon graduation year, and hospital size and teaching status, we found that an annual surgeon volume of ≥ 10 aTSAs was associated with a 27% decreased odds of revision within 2 years (95% confidence interval 13% to 39%; p < 0.001), while surgeon volume of ≥ 29 aTSAs was associated with a 33% decreased odds of revision within 2 years (95% CI 18% to 45%; p < 0.001) compared with a volume of fewer than four aTSAs per year. Annual surgeon volume of ≥ 29 rTSAs was associated with a 26% decreased odds of revision within 2 years (95% CI 9% to 39%; p < 0.001). Surgeons should consider modalities such as virtual planning software, templating, or enhanced surgeon training to aid lower-volume surgeons who perform aTSA and rTSA. More research is needed to assess the value of these modalities and their relationship with the rates of subsequent revision. Level III, therapeutic study.

Effective peer review audit and identification of the surgeon outlier.

Surgical audit aims to identify ways to maintain and improve the quality of care for patients, in part by assessment of a surgeon's activities and outcomes. However effective data systems to facilitate audit are uncommon. We aimed to assess the effectiveness of a tool for Peer Review Audit. All General Surgeons in Darwin and the Top End were encouraged to self-record their surgical activity, including procedures and adverse events related to procedures, using the College's Morbidity Audit and Logbook Tool (MALT). A total of 6 surgeons and 3518 operative events were recorded in MALT between 2018 and 2019. De-identified reports of each surgeon's activities, compared directly to the audit group, were created by each surgeon, with correction for complexity of procedures and ASA status. Nine complications Grade 3 and greater were recorded, plus 6 deaths, 25 unplanned returns to theatre (8% failure to rescue rate), 7 unplanned admissions to ICU and 8 unplanned readmissions. One surgeon outlier was identified (>3 standard deviation over group mean) for unplanned returns to theatre. This surgeon's specific cases were reviewed at our morbidity and mortality meeting using the MALT Self Audit Report and changes were implemented as a result, with future progress monitored. The College's MALT system effectively enabled Peer Group Audit. All participating surgeons were readily able to present and validate their own results. A surgeon outlier was reliably identified. This led to effective practice change. The proportion of surgeons who participated was low. Adverse events were likely under-reported.

Managing Borderline Dysplasia: It Can Take More Than Just a Periacetabular Osteotomy: Commentary on an article by Jeffrey J. Nepple, MD, et al.: "Outcomes of Periacetabular Osteotomy for Borderline Acetabular Dysplasia".

Commentary Nepple et al. report the outcomes of a single experienced surgeon treating patients with borderline hip dysplasia from 2010 to 2020. The article correctly points out that a majority of clinical reports of outcomes of treatment for patients with borderline hip dysplasia used arthroscopy without periacetabular osteotomy (PAO)1. This article represents an important contribution documenting the outcomes of treatment correcting structural causes of instability with or without arthroscopy. A previous series of PAOs, including cases from the senior author, used different criteria (lateral center-edge angle [LCEA] of 15° to 25°) to define mild dysplasia2, and those outcomes are not directly comparable with those in the current article, in which an LCEA of 18° to 25° was used to describe borderline dysplasia. The results in the current article demonstrate clinical success in 148 of 156 hips in patients undergoing primary surgery. The article provides important data on radiographic parameters for correction of acetabular dysplasia. The article does not provide a detailed analysis of preoperative femoral neck morphology or femoral torsion. However, several points regarding this clinical series of patients with borderline hip dysplasia are instructive. The authors point out that “A comprehensive assessment of the hip … is critical to informing an accurate diagnosis. Currently, there remain no clear clinical guidelines to differentiate between fundamental mechanical diagnoses (impingement compared with instability) and definitively guide treatment selection.” In other words, the clinical assessment of the patient presentation plays an important role in discriminating between the underlying pathologic mechanisms of impingement or instability. In the entire cohort of 186 hips in 178 patients, only 21 hips underwent an isolated PAO. The majority of treated hips required addition of a concomitant hip arthroscopy to the PAO as treatment for labral or articular cartilage pathology (130 of 186 hips). Similarly, 120 hips required a femoral osteoplasty to treat impingement at the time of the PAO. These 2 important observations emphasize the importance of clinicians and learners who are interested in treating patients with this type of hip pathology gaining experience in evaluating patients with instability as well as patients with impingement. The ability to differentiate instability from impingement depends in part on clinical exposure to the presentation of these types of hip pathology. Of note, neither the evaluation nor treatment of the young adult hip is addressed in the latest iteration of the Accreditation Council for Graduate Medical Education (ACGME) Orthopaedic Surgery Milestones3. This study does not provide an assessment with a control group with similar labral and intra-articular pathology treated without arthroscopy. Therefore, it is unclear whether hip arthroscopy with labral refixation and chondral interventions as performed in this cohort would be required to achieve similar outcomes. A previous study indicated that not treating femoroacetabular impingement at the time of the PAO was associated with poorer long-term outcomes4. However, the reported data in the current study indicate that hip arthroscopy at the time of the PAO has not adversely impacted results. Nepple et al. also point out the adverse impact that a previous unsuccessful hip arthroscopy has on the outcomes in patients with borderline hip dysplasia. The majority of these previous arthroscopies were not performed by the senior author. It is not clear whether these patients had concomitant impingement with borderline dysplasia and developed instability after arthroscopy, or they had clinical instability that had been misdiagnosed as impingement initially. There are many reports detailing successful treatment of femoroacetabular impingement arthroscopically in the setting of borderline dysplasia1. However, clearly a hip arthroscopy that leaves the patient with symptomatic hip instability has an adverse impact on outcome after structural correction with PAO. Finally, the diversity of treatments required to provide successful outcomes in the cohort of patients studied by Nepple et al. provides some evidence for the need for personalized medicine in the care of young patients with hip pathology. As with all such clinical series, the reported results are a benchmark for all clinicians to aspire toward. The results in this article represent the work of an experienced surgeon selectively managing multiple aspects of hip pathology to optimize outcomes in this defined cohort of patients.

HINDI TRANSLATION, CROSS CULTURALADAPTATION AND DETERMINED ITS PSYCHOMETRIC PROPERTIES OF SPINAL CORD INDEPENDENT MEASURE – SELF REPORTED VERSION (SCIM-SR) – A METHODOLOGICAL STUDY

Study design: Methodological study Objective: To Hindi translate spinal cord independent measure -self reported scale into Hindi language; perform cross cultural adaptation and determined its psychometric properties in Hindi speaking population. Setting: ISIC Institute of Health and Rehabilitation Sciences, New Delhi, India. Methods: Hindi translation and cross cultural adaptation of the SCIM SR was performed using standardizing guidelines described by American academy of orthopedic surgeons (AAOS) Outcome Committee. This procedure involved six stages which consist of forward translation, synthesis of translation, backward translation, expert committee review, pretesting of prenal version of scale on 30 SCI subjects and nal submission. The content validity was determined by using content validity ratio formula given by C H Lawshe (1975). The reliability was determined by Cronbach's alpha consistency coefcient formula (IC), Interclass correlation coefcient (ICC) and Pearson correlation (test-retest reliability). Result: The translation undertaking six step processes provided with nalized version of SCIM SR in Hindi version. The nalize version of SCIM SR was cross culturally adapted and approved by all the translators, expert panel members, subject with spinal cord injury and by the developer of original version SCIM SR. The result of psychometric properties showed excellent content validity (0.96), the internal consistency (cronbach's alpha–0.928 and the intra-class correlation coefcient–0.405 for single measures and 0.928 for average measure) and test-retest reliability (Pearson correlation – 0.999). Conclusion: The SCIM–SR scale is an instrument for assessing functional independence of person with spinal cord injury. SCIM SR is a well translated, adapted, content wise valid and reliable tool and can be used in subjects with SCI.

Seniority of the assistant surgeon and perioperative outcomes in robotic-assisted proctectomy for rectal cancer.

The background of this study is to evaluate the impact of the assistant surgeon's in robotic-assisted proctectomy (RAP) on perioperative outcomes. A retrospective analysis of all patients who underwent RAP for rectal adenocarcinoma between 2011 and 2020 was conducted. Patient cohort was divided into three groups based on the assistant surgeon's training level: post-graduate years (PGY) 1-3 surgical residents (Group 1), PGY 4-5 surgical residents (Group 2), and board-certified general surgeons (Group 3). Overall, 175 patients were included in the study: 29 patients (17%) in Group 1, 84 (48%) in Group 2, and 62 (35%) in Group 3. The median tumor distance from the anal verge was 8cm in all groups (p = 0.73). The median operative time was similar across all groups: 290, 291, and 281min in Groups 1, 2, and 3, respectively (p = 0.69). In a multivariable analysis, the lack of association between assistant training level and procedure time maintained when adjusting for the year of operation (p = 0.84). Patients operated with junior residents as assistant surgeons (Group 1) had a more postoperative complications (p = 0.01) and a slightly longer hospital length of stay [7days, interquartile range (IQR) 3], compared to those operated by assistant surgeons that were senior residents or attendings (6 IQR 2.5, and 6 IQR 2 in Groups 2 and 3, respectively; p = 0.02). Conversion rates (p = 0.12), intraoperative complications (p = 0.39), major postoperative complications (Clavien-Dindo ≥ 3; p = 0.32), 30-day readmission (p = 0.45), and mortality (p = 0.99) were similar between the groups. Robotic-assisted proctectomy performed with the assistance of a junior resident was found to be correlated with worse postoperative outcomes compared to more experienced assistants. No difference was seen in intraoperative outcomes.

Canadian Spine Society

# Abstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments? {#article-title-2} Cobb angle measurement is the standard method for quantification of scoliosis in adolescent idiopathic scoliosis (AIS),

Reliability and validity of an adapted Saudi Arabic version of scoliosis research society outcomes questionnaire (SRS-30) in Saudi Arabia.

To perform a cross-cultural adaptation and validation of Saudi Arabic (SA) version of SRS-30 and test it on Saudi patients with adolescent idiopathic scoliosis (AIS). A retrospective analysis of prospective collected data of 322 patients with AIS. The cross-cultural adaptation process was performed using the American Association of Orthopedic Surgeons (AAOS) Outcomes Committee method. A pre-test analysis was conducted on 30 patients. All patients had completed the SRS-22r and SF-12 preoperatively and 198 patients had completed the SA version of SRS-30 and SF-12 postoperatively twice at six weeks interval. The validity and internal consistency were tested using the interclass correlation coefficient (ICC), Cronbach alpha, person correlation coefficient, and confidence interval (CI). There are 288 (89.4%) girls and 34 (10.6%) boys and the average age is 15 ± 2.3years (range from 10-21years). The majority of patients have a Lenke type 1 curve (41%) and only 14% have a Lenke type 5 and 6. The overall Cronbach alpha (CA) of all SRS-30 domains is 0.87. However, the Cronbach alpha for the satisfaction, and function domains slightly lower than the original English questionnaire. The Saudi Arabic version of SRS-30 is a reliable and valid instrument and can be applied to evaluate the quality of life in patients with AIS.

Online Patient Reviews of Breast Reconstruction: RealSelf Analysis.

The breast reconstruction category from RealSelf.com was analyzed using a web crawler-based application built from Python and Selenium. Reviews were collected from May 2009 to November 2021. Information including RealSelf's inherent "worth it" ranking system, review text, the number of submitted photographs, and the number of readers who found the review helpful was captured. The content of the review was then independently reviewed by the authors and was categorized with key factors that determined positive or negative reviews. A total of 3451 breast reconstruction reviews were collected. After the authors analyzed each review, 3225 (94.33%) were identified as positive reviews. The most common factors associated with positive reviews were physician demeanor (n = 2600, 31.7%), aesthetic outcome (n = 1955, 23.8%), or staff (n = 1543, 18.8%), while negative reviews were associated with unfavorable aesthetic outcome (n = 94, 28.9%), physician demeanor (n = 82, 25.2%), or postoperative complications (n = 75, 23.1%). Although there are surveys that analyze patient satisfaction for breast reconstruction, there has not been a study that analyzed a large online review database. Predominating factors in both positive and negative reviews were physician demeanor and aesthetic outcome.

Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients

BackgroundRobot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. ObjectiveTo assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design, setting, and participantsIn this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon’s experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. InterventionTransperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysisThe impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitationsBMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p < 0.001) and WIT (p < 0.001) and improved the MIC rate (p = 0.022). A greater number of prior robotic pelvic interventions decreased WIT (p = 0.011) and the rate of major complications (p < 0.001) and increased the MIC rate (p = 0.011), while prior experience in open kidney surgery did not. One limitation is the short-term follow-up. ConclusionsMastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. Patient summaryIn this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.

Assessment of Adverse Event Risk in Combined Plastic Surgery Procedures Utilizing the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) Database

PURPOSE: Combining several surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. There are several benefits that should be taken into consideration when deciding whether to combine plastic surgery procedures. First, combining procedures reduces the number of times a patient must undergo anesthesia. Additionally, the patient benefits from a lower cost burden and single postoperative recovery. However, these benefits must be weighed against any potential increased risk for the patient. This study aimed to evaluate the rates and characteristics of adverse events associated with combining plastic surgery procedures in a single session as compared with similar outcomes of index procedures alone. METHOD: A retrospective cohort analysis was performed utilizing data between January 2016 and December 2020 from the TOPS database. The three most frequent combinations for each of the five most commonly performed plastic surgery procedures (augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty) were selected for analysis. The rate of 30-day adverse events, as defined by the TOPS database, served as the primary outcome. Chi-square analyses were to compare adverse event percentages. Chi-square, Kruskal-Wallis and Fisher’s exact tests were used as appropriate to compare patient characteristics. RESULTS: Of the total 35,157 patients analyzed, 12,373 (35%) underwent multiple concurrent procedures. Double or triple procedure combinations were found to have higher rates of 30-day adverse events compared to index procedures (8.7% and 7.7% compared to 4.2%, p<0.001, respectively). Rates of adverse events for double and triple procedure combinations remained elevated compared to index procedures throughout the five-year analysis (p<0.05). The 30-day adverse event rates were significantly higher for the three most common combinations for augmentation mammaplasty compared to index (4.3% and 2.3%, respectively, p<0.001), trunk liposuction combinations compared to index (13% and 2%, respectively, p<0.001), and reduction mammaplasty combinations compared to index (14% and 7.1%, respectively, p<0.001). Adverse events were not significantly different for the three most common combinations for mastopexy compared to index (4.7% and 4.5%, respectively, p=0.8), and abdominoplasty combinations compared to index (11% and 8.7%, respectively, p=0.066). A sub-analysis comparing patients coded for abdominoplasty, panniculectomy, or both was performed. Patients coded for both procedures had a higher rate of adverse events (12%) compared to abdominoplasty or panniculectomy alone (8.7% and 9.1%, respectively p=0.012). However, patients coded for panniculectomy alone were found to have the highest rates of diabetes (10%), hypertension (16%), and ASA class 5 status (9.2%) compared to patients coded for abdominoplasty alone or both procedures. CONCLUSION: The findings from this study help elucidate the impact of combining procedures. These results serve to inform shared surgical decision making in multi-procedure planning and contribute to patient safety.

OC-050 “HAPPY TO CLOSE?”: THE RELATIONSHIP BETWEEN SURGICAL EXPERIENCE AND INCISIONAL HERNIA RATES FOLLOWING ABDOMINAL WALL CLOSURE IN COLORECTAL SURGERY

Abstract Introduction Incisional Hernia (IH) is a common complication of colorectal surgery. Given high recurrence rates and associated morbidity, emphasis must be on prevention of IH. There is an association between surgeon volume and outcomes in hernia surgery, yet little evidence regarding impact of the experience of the surgeon performing abdominal wall closure (AWC) on IH rate. Our aim was to assess the rates of IH at 1 year following surgery between Registrar and Consultant surgeons in patients undergoing elective colorectal surgery. Methods Patients undergoing elective surgery for colorectal cancer between 2014–2018 were identified through the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial. Grade of surgeon performing AWC was categorised into “Registrar” and “Consultant” and compared with IH detected at clinical examination at 1 year following surgery. Results 663 patients were suitable for inclusion. 44% were closed by registrars (n=289). Groups were comparable in BMI, previous surgery and pre-operative IH. The rate of IH in patients closed by registrars was significantly higher than those closed by consultants (20% vs 12%, p&amp;lt;0.01). Patients who underwent AWC by a registrar were 88% more likely to develop IH at 1 year (OR 1.88, 95%CI 1.23–2.86, p&amp;lt;0.01). Conclusion Patients who undergo AWC by a registrar have an increased risk of developing IH compared to those closed by a consultant. Further work is needed to determine the impact of supervised and un-supervised trainees on IH rates, but AWC should be treated as training time rather than coffee time.

Impact of a new teaching model on the fine cosmetic suturing operation and quantitative assessment of the training effect on plastic surgeons

BackgroundTraditional lecture-based teaching (TLT) has long been the primary method of teaching plastic suturing techniques and even surgical education. It has been challenging to adapt this approach to fit the educational objectives of plastic surgery, which is a very practical science. Additionally, it is mainly teacher-led, and the course content is teacher-driven, which has disadvantages such as difficulty in motivating students and disconnection from clinical practice. Therefore, we developed a video point-to-point teaching (VPT) method and teamwork-based teaching (TBT) to study the effect of the new teaching model on fine cosmetic suturing operation (FCSO) and training outcomes for plastic surgeons. MethodsWe selected 30 junior doctors from the Department of Plastic and Reconstructive Surgery of the Chinese PLA General Hospital. All trainees were randomly assigned to three groups: TLT, VPT, and TBT. All trainees had their performances photographed, and a senior attending physician was appointed as a rater. We rated the process and results of FCSO according to a uniform rubric following the double-blind principle to compare the effects of different teaching modes on the trainees’ FCSO and differences in training outcomes. ResultsThere was no significant effect of video recording on trainees’ FCSO (P>0.05). The total scores of the first suturing in the three groups were as follows: TLT group (13.18 ​± ​1.66), VPT group (13.63 ​± ​1.97), and TBT group (13.50 ​± ​2.26), with no significant difference among the groups (P>0.05), indicating that the starting level of the trainees in the three groups was basically the same. There was no significant difference (P>0.05) between the VPT (20.30 ​± ​2.17) and TBT (20.38 ​± ​2.29) groups, but both of these groups were significantly better than the TLT group (16.43 ​± ​1.86, P<0.01). ConclusionThe TBT and VPT methods are significantly better than TLT. However, the TBT method is more economical and optimal for teachers and better utilizes students’ initiative in learning and operation, which improves the teaching level and training efficiency.

Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study

ObjectiveTo compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan.DesignRetrospective cohort study.SettingData from the Japanese National Clinical Database (includes data on >95% of surgeries performed in...

Fertility & childbearing outcomes of female plastic surgeons: How far have we come in 25 years?

BackgroundTo understand whether the fertility and childbearing outcomes of female plastic surgeons have changed, this study compares current data to historical data from 25 years ago. MethodsAn IRB-approved survey was sent to female plastic surgery residents, fellows, and members of the American Society of Plastic Surgeons in 2018–2020. The results were compared to historical data from 1995. ResultsThere were 351 respondents with a response rate of 26%. Fifty-four percent of women had children, which was similar to 1995 (54% vs. 51%, p = 0.45). Miscarriage affected 40% of women, a rate twice as high as 1995 (18.9%, p = n/a). The prevalence of abortion was 13%, significantly lower than 1995 (26%, p < 0.005). The rate of infertility was 54%, significantly higher than 1995 (33%, p < 0.005). Obstetrical complications were slightly higher than in 1995 (61% vs. 57%, p = n/a). ConclusionsThere is a disappointing lack of progress in fertility and childbearing outcomes among female plastic surgeons.

Modified turn-up technique for proximal anastomosis in acute aortic dissection type A has potential to facilitate stable outcomes for low-volume early-career surgeons.

ObjectiveSecure proximal anastomosis is an essential part of surgical treatment for acute aortic dissection type A (AADA). This study aimed to investigate the effectiveness of the modified turn-up technique for proximal anastomosis in AADA and compare this technique with other techniques.MethodsWe divided 57 patients who underwent ascending aorta replacement for AADA into the modified turn-up technique group (group A: 36 patients) and the other technique group (group B: 21 patients). Intraoperative and postoperative course data were compared between groups A and B. In group A, we also compared early-career surgeons (practicing for <10 years after graduation) and aged surgeons (practicing for ≥10 years after graduation).ResultsPreoperative patient characteristics did not differ between groups. There was a tendency toward shorter operation time in group A than in group B without statistical significance (p = 0.12), and the length of intensive care unit stay was significantly shorter (p < 0.01); the occurrence of cerebral infarction was lower (p < 0.01) in group A than in group B, whereas mortality and major complications other than the cerebral infarction rate did not differ between the groups. In group A, 13 patients were operated on by early-career surgeons, while 23 patients were operated on by surgeons with more than 10 years of experience. Aortic clamp time and circulatory arrest time were significantly longer in patients operated on by early-career surgeons, but outcomes were comparable.ConclusionsThe modified turn-up technique was comparable to other techniques. Even for less skilled surgeons (e.g., early-career surgeons), the use of this technique may lead to stable outcomes.