Practice Patterns Of Surgeons Research Articles

107. Practice patterns of spine surgeons using tranexamic acid for open and hybrid deformity surgery: a survey of spinal deformity surgeons

107. Practice patterns of spine surgeons using tranexamic acid for open and hybrid deformity surgery: a survey of spinal deformity surgeons

Surgeon Gender and Early Complications in Elective Surgery: A Systematic Review and meta-analysis.

To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery. Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes. MEDLINE and Embase were searched in October 2023 for observational studies including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model. Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7,072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95 to 1.00; I2=64.9%; P=0.001). These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, healthcare providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications.

Surgical Management of Achilles Tendon Ruptures in the United States 2006-2020, an ABOS Part II Oral Examination Case List Database Study.

In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume. The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends. The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied. This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period. Level III, retrospective cohort study.

European Pediatric Surgeons' Association Survey on Timing of Inguinal Hernia Repair in Premature Infants.

This article evaluates the practice patterns of European Pediatric Surgeons' Association (EUPSA) members regarding the timing of inguinal hernia (IH) repair in premature infants. Online survey containing 29 questions distributed to EUPSA members during January 2023. A total of 180 responds were received. Overall, IH repair prior to discharge was favored by 60% of respondents when there was a history of incarceration and 56% when there was not. In the case of very/extremely premature infants (< 32 weeks) with no history of incarceration, fewer (43%) respondents postpone the surgery until after discharge. The majority of respondents cited the risk of incarceration as the reason for advocating surgery prior to discharge, whereas a reduced risk of apnea was the most cited reason for respondents who prefer delayed surgery. Open approach under general anesthesia was favored by 54% of respondents, with 27% of them preferring open approach with spinal anesthesia. Laparoscopic surgery for premature infants is used in 11% while 7% of them preferred in all premature infants including extremely/very premature ones. Contralateral side evaluation was never done by 40% of respondents and 29% only performed it only during laparoscopic repair. The majority of respondents (77%) indicated that they have an overnight stay policy for premature infants < 45 weeks of gestation. There is variation in the practice patterns of pediatric surgeons in the treatment of IH in premature infants. Due to the concern for the high risk of incarceration, IH repair before discharge was the most prevalent practice. Lower risk of postoperative apnea was cited as the most common reason for delaying surgery. Randomized studies are required to establish the optimal timing for IH repair in premature infants.

Surgical Margin Definition and Assessment in Head and Neck Oncology: A Cross-Sectional Survey of Canadian Head and Neck Surgeons.

Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method. To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment. A 24-question cross-sectional survey was sent via email through the Canadian Society of Otolaryngology-Head & Neck Surgery (CSOHNS), and responses were gathered from December 19, 2023, to March 12, 2024. Responses were aggregated and reported using descriptive statistics. The survey was conducted in Canada among self-reported staff head and neck oncology surgeons with membership in the CSOHNS. A total of 36 staff head and neck oncology surgeons responded from across Canada. The most common (58.3%) definition of a negative surgical margin for oral cavity HNSCC was ">5 mm formalin fixed paraffin embedded distance." To obtain surgical margins, surgeons were split with 44.1% using only a tumor bed approach and 32.4% using only a specimen-driven approach. A dedicated head and neck pathologist is always available more commonly for final pathological assessment (63.6%) versus intraoperative frozen section assessment (15.5%). Finally, most surgeons reported having a synoptic standardized reporting system for annotating margin status (78.8%). The results of this survey provide a current-state analysis of head and neck surgeons across Canada and set the stage for future efforts to be directed toward standardizing the collection method and reporting criteria for surgical margins in HNSCC.

An examination of the operative and post-operative management of trapeziometacarpal osteoarthritis in Ireland

BACKGROUND: The trapeziometacarpal or first carpometacarpal (CMC) joint is the second most common joint affected in osteoarthritis (OA) of the hand. Surgical intervention may be required when conservative measures fail to alleviate symptoms. OBJECTIVE: To investigate operative and post-operative management of trapeziometacarpal osteoarthritis in Ireland. METHODS: An on-line Qualtrics survey was used to determine practice patterns of hand surgeons and therapists including surgical technique, patterns of referral to therapy, treatment protocol and perceived pain impact. RESULTS: Twenty surgeon’s responses were received. Trapeziectomy with Ligament Reconstruction and Tendon Interposition (LRTI) was the most common procedure for all stages of arthritis for sedentary and manual patients. Sixty seven percent (n = 18) stated they perform an additional procedure if stage IV arthritis is present. Eighty percent (n = 16) stated they would perform an additional procedure for MCP joint hyperextension. There were 28 therapist responses. Almost all respondents indicated that patients are initially casted post-surgery with 88% (n = 24) indicating they remain casted for 1-2 weeks. A rigid long thumb spica and neoprene splint are most commonly used. The commencement of exercises differed between respondents and surgical procedures. All participants stated that pain is an issue in the rehabilitation of these patients. CONCLUSIONS: There was consistency in the surgical procedure choice. The stage of arthritis and functional level of the patient was not found to be an important factor for choosing this procedure. There is some consensus for post-operative casting and splinting but more variability in terms of exercise prescription. Pain is a factor to consider post-operatively.

Practice Patterns and Perspectives of the Off-Label Use of GLP-1 Agonists for Cosmetic Weight Loss.

The off-label use of glucagon-like peptide 1 (GLP-1) agonists for cosmetic weight loss has captured the interest of the public. However, there is a paucity of published data on their utilization, implications, and management, particularly in the plastic surgery community. This study aims to explore the current practice patterns of aesthetic plastic surgeons regarding the off-label implementation of GLP-1 agonists. A 35-question survey was sent to the 2600 members of The Aesthetic Society in July 2023. The survey collected physician demographics, practice settings, patient population demographics, and the use and management of GLP-1 agonists in their practice. No identifying variables were collected; all responses were anonymous. A total of 368 respondents were included. A quarter of respondents (25.3%) prescribed or utilized GLP-1 agonists in their practice. Nearly a third (29.9%) reported personal use of the medication, of which 71 (70.3%) indicated it was for cosmetic weight loss. Many aspects of the current treatment, counseling, and follow-up practices were similar among prescribing plastic surgeons. However, there were discrepancies in screening, nutrition counseling, and perioperative management. The majority believed that GLP-1 agonists were effective for weight loss (68.9%), profitable for business (57.8%), and would recommend its implementation to other plastic surgeons (68.5%). As leaders in the aesthetic field, it behooves plastic surgeons to take charge of shaping public opinion surrounding the growing off-label use of GLP-1 agonists for cosmetic weight loss. Plastic surgeons' leadership is imperative in establishing safe and ethical guidelines and protocols for proper screening, management, and patient care.

Treatment Trends in Pediatric Trigger Thumb Among Hand Surgeons, Pediatric Orthopedic Surgeons, and Pediatric Hand Surgeons.

The appropriate initial management of pediatric trigger thumb (PTT) remains controversial. Some providers advocate for prolonged nonoperative management, whereas others may offer surgical release to provide a reliable and expedient resolution. The goal of this study was to elucidate the practice patterns of surgeons with different fellowship training who treat patients with PTT. We hypothesized that an association between surgeon specialty training and treatment algorithm would be identified. A cross-sectional survey was sent to mailing lists of 3 professional organizations whose members represent most providers caring for pediatric hand patients. Respondents were asked their training background and treatment recommendations for several clinical scenarios. Responses were compared across subspecialties. Of the respondents, 444 completed a fellowship in hand surgery, 167 completed a pediatric orthopedic fellowship, and 155 completed an additional congenital hand fellowship. Providers with hand fellowship training were more likely to offer surgical intervention as a first-line treatment for a 3-year-old patient with a flexible trigger thumb than those who completed a pediatric orthopedic fellowship (P = .001), and more likely to offer surgical intervention to a 3-year-old patient with an intermittent (P = .007), painful (P = .015), or locked (P = .012) trigger thumb than those providers who completed additional training in congenital hand surgery. No statistically significant differences in practice patterns were appreciated for children aged 6 and 18 months. Variability was appreciated in practice patterns for initial treatment recommendation for a patient presenting with PTT. Subspecialty training does appear to affect treatment recommendations for clinical scenarios involving a 3-year-old patient with PTT, although this trend is not observed when treating younger patients.

Survey of Surgeon-reported Postoperative Protocols for Deep Inferior Epigastric Perforator Flap in Breast Reconstruction.

The use of deep inferior epigastric perforator (DIEP) flaps is a well-established breast reconstruction technique. A 29-question survey was e-mailed to 3186 active American Society of Plastic Surgeons members, aiming to describe postoperative monitoring practice patterns among surgeons performing DIEP flaps. From 255 responses (8%), 79% performing DIEP surgery were analyzed. Among them, 34.8% practiced for more than 20 years, 34.3% for 10-20 years, and 30.9% for less than 10 years. Initial 24-hour post-DIEP monitoring: intensive care unit (39%) and floor (36%). Flap monitoring: external Doppler (71%), tissue oximetry (41%), and implantable Doppler (32%). Postoperative analgesia: acetaminophen (74%), non-steroidal anti-inflammatory drugs (69%), neuromodulators (52%), and opioids (4.4%) were administered on a scheduled basis. On postoperative day 1, 61% halt intravenous fluids, 67% allow ambulation, 70% remove Foley catheter, and 71% start diet. Most surgeons discharged patients from the hospital on postoperative day 3+. Regardless of experience, patients were commonly discharged on day 3. Half of the surgeons are in academic/nonacademic settings and discharge on/after day 3. This study reveals significant heterogeneity among the practice patterns of DIEP surgeons. In light of these findings, it is recommended that a task force be convened to establish standardized monitoring protocols for DIEP flaps. Such protocols have the potential to reduce both the length of hospital stays and overall care costs all while ensuring optimal pain management and vigilant flap monitoring.

Current Clinical Practice Patterns in Total Vaginal Hysterectomy.

There are no data on current surgical practice patterns for benign total vaginal hysterectomy (TVH) despite recently published guidelines. The objective was to determine gynecologic surgeon practice patterns regarding TVH perioperative interventions and to assess adherence to clinical practice guidelines. A survey to assess TVH practice patterns was distributed to gynecologic surgical society members for completion. The primary outcome was to compare adherence to practice guidelines between fellowship-trained and non-fellowship-trained gynecologic surgeons. Secondary outcomes included comparing adherence based on age, practice location, and hysterectomy volume. Of the 204 respondents, there were 163 (80%) fellowship-trained and 41 (20%) non-fellowship-trained gynecologic surgeons. Fellowship-trained surgeons were more likely than non-fellowship-trained surgeons to use vaginal packing (34% vs 15%, P = 0.028), which is contrary to the recommendations. No cohort followed the guideline recommending a circular cervicovaginal incision. Fellowship-trained surgeons also were more likely than non-fellowship-trained surgeons to use the clamp and suture technique for vessel ligation (88% vs 68%, P = 0.004); otherwise, there were no significant differences between cohorts for adherence to any of the other guidelines. Although fellowship-trained surgeons were adherent to fewer of the guidelines as compared with surgeons without fellowship training, both groups generally adhered to a majority of the clinical practice guidelines for benign TVH. This information demonstrates a need for the development of targeted education and interventions to increase the use of evidence-based clinical practice guidelines during TVH for both fellowship-trained and non-fellowship-trained gynecologic surgeons.

722 Select Survey of Human Cadaver Skin Allograft Utilization by 21 Senior Academic Burn Surgeons

Abstract Introduction As of 2022, cryopreserved human cadaver skin allograft remains the gold standard by which all other skin substitutes used for burn care are compared. The 2015 Taiwan Color Dust Explosion burn mass casualty engendered the transfer of emergency tranches of skin allograft from reserves in both the US and EU to Taiwan. HHS/ASPR/BARDA/CBRN led an after-action fact-finding mission to Taiwan and concluded that skin allograft would still play a central role as a safety net in US national burn care preparedness, even as BARDA invested in the development of other burn medical countermeasures that would be part of the preparedness strategy. However, before investments in a skin allograft based national strategy could be built, it was critical that the leaders of the Disaster Committee and Organization and Delivery of Burn Care (ODBC) Committee of the American Burn Association (ABA) commission a survey to verify current practice patterns of senior academic burn surgeons on the use of skin allograft. Methods The committee chairs curated a list of 21 leading academic burn surgeons in North America. These surgeons’ credentials included having been an ABA president, a member of the ABA Board of Trustees, or having chaired a standing committee of the ABA. All 21 surgeons were actively practicing burn care daily. The survey contained 18 questions and was intentionally kept brief (Survey to be provided as Appendix). Results Of the 21 surgeons selected, there was 100% participation and completion of the survey. Most were in practice &amp;gt;15 years (62%) and manage &amp;gt;200 patients surgically per year (71%). The predominant use of allograft is to temporize the wound bed when there are inadequate donor sites (48% “Almost Always”). It is “Often” (48%) used to temporize wound beds prior to autografting. However, most are looking for alternatives to allograft (43% “Sometimes”, 43% “Often”). With ongoing development of skin substitutes, most indicated their allograft use will likely decrease, with only 19% indicating “Probably Not”. Conclusions Human skin allograft continues to play a central role in surgical burn care management. For the foreseeable future, new technologies are not likely to displace allograft use but rather blend with its use. This brief, select survey is not powered but provides a snapshot of the current role of skin allograft. In the future, we may conduct a broader survey to obtain a validated and more granular view of the use of allograft in modern burn care. Applicability of Research to Practice Armed with this information, the US Federal Government acted to increase preparedness after a burn mass casualty. In February 2022, a Request for Proposals for a large vendor-managed inventory of human cryopreserved skin allograft was answered by two separate tissue banks. As of September 2022, $38M was awarded to two partners for procurement and expansion of a vendor managed inventory of cryopreserved human skin allograft to ensure preparedness for rapid response to a burn mass casualty incident.

Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability.

To determine the practice patterns of Canadian orthopedic surgeons in the management of patients with anterior glenohumeral instability (AGHI). Cross-sectional survey. Canada. Canadian orthopedic surgeons with membership in the Canadian Orthopedic Association or Canadian Shoulder and Elbow Surgeon group who had managed at least 1 patient with AGHI in the previous year. A survey including demographics and questions on the management of patients with AGHI was completed. Statistical comparisons (χ 2 ) were completed with responses stratified using the instability severity index score (ISIS) in practice, years of practice, and surgical volumes. Summary statistics were compiled, and response frequencies were considered for consensus (75%). Case series responses were stratified on use of the ISIS in practice, years of experience, and annual procedure volumes (χ 2 , P < 0.05). Eighty orthopedic surgeons responded, with consensus on areas of diagnostic workup of AGHI, nonoperative management, and operative techniques. There was no consensus on indications for soft tissue and bony augmentation or postoperative management. There was no difference in practices based on the use of ISIS, years in practice, or surgical volumes. Canadian orthopedic surgeons manage AGHI consistently with consensus achieved in preoperative diagnostics and operative techniques, although debate remains as to the indications for soft tissue and bony augmentation procedures.

MP64-10 DUELING ACTIVE SURVEILLANCE: DOES UTILIZATION OF ACTIVE SURVEILLANCE FOR LOW RISK PROSTATE CANCER CORRESPOND WITH UTILIZATION OF ACTIVE SURVEILLANCE FOR SMALL RENAL MASSES?

You have accessJournal of UrologyCME1 Apr 2023MP64-10 DUELING ACTIVE SURVEILLANCE: DOES UTILIZATION OF ACTIVE SURVEILLANCE FOR LOW RISK PROSTATE CANCER CORRESPOND WITH UTILIZATION OF ACTIVE SURVEILLANCE FOR SMALL RENAL MASSES? Michael Wang, Sophie Wittenberg, Michael Cher, JI Qi, Stephanie Ferrante, Mahin Mirza, Anna Johnson, Alice Semerjian, Arvin George, Craig Rogers, Samantha Wilder, Richard Sarle, Khurshid Ghani, Brian Lane, Kevin Ginsburg, and For The Michigan Urological Surgery IMPROVEMENT Collaborative Michael WangMichael Wang More articles by this author , Sophie WittenbergSophie Wittenberg More articles by this author , Michael CherMichael Cher More articles by this author , JI QiJI Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Arvin GeorgeArvin George More articles by this author , Craig RogersCraig Rogers More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Richard SarleRichard Sarle More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Brian LaneBrian Lane More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the recommended management strategy for men with low-risk prostate cancer (CaP). Similarly, AS has been shown to be safe for patients with renal masses <4 cm (cT1aRM). Here, we assessed surgeon-level practice patterns for the use of AS in patients with GG1 CaP and cT1aRM. We hypothesized that the proportion of a urologist’s patients with CaP managed with AS will correlate with the use of AS for their patients with cT1aRM. METHODS: We reviewed practice patterns of surgeons in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Urologists were included if they managed at least 10 GG1 CaP and 10 cT1aRM patients between 2017 and 2021. Using the Chi-squared test, we compared the proportions of cT1aRM patients managed with AS among surgeons in the lowest and highest quartile of AS use for those with GG1 CaP. We fit separate multivariable mixed-effects logistic regression models to obtain risk-adjusted proportions of a urologist’s patients with GG1 CaP and cT1aRM managed with AS. Correlation between a surgeon’s risk-adjusted use of AS for the two groups was assessed with Pearson’s correlation coefficient. RESULTS: 27 urologists met the inclusion criteria. 82% of men with GG1 CaP were managed on AS compared with 49% of men with cT1aRM. Among the surgeons in the lowest quartile of AS use for CaP (<71% of men with GG1 CaP managed on AS), 33% of men with cT1aRMs were managed with AS compared to 49% of men with cT1aRMs managed by the surgeons in the highest quartile of CaP AS use (>89% of men with GG1 CaP managed with AS, p<0.001, Figure 1). There was a modest positive correlation between the proportion of a surgeon’s men with GG1 prostate cancer and cT1aRM managed with AS (correlation coefficient: 0.47, p=0.014). CONCLUSIONS: There is marked variability in the use of AS for patients with GG1 CaP and cT1aRMs by surgeons. Those that are low utilizers of AS for men with GG1 CaP used less AS for patients with cT1aRM compared with surgeons that are high utilizers of AS for GG1 CaP. Thus, urologists who use AS for GG1 CaP are more likely to use AS for patients cT1aRM, while those that are more likely to operatively manage one low risk malignancy are likely to also operate on a second low risk malignancy. Source of Funding: funding from Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e884 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Wang More articles by this author Sophie Wittenberg More articles by this author Michael Cher More articles by this author JI Qi More articles by this author Stephanie Ferrante More articles by this author Mahin Mirza More articles by this author Anna Johnson More articles by this author Alice Semerjian More articles by this author Arvin George More articles by this author Craig Rogers More articles by this author Samantha Wilder More articles by this author Richard Sarle More articles by this author Khurshid Ghani More articles by this author Brian Lane More articles by this author Kevin Ginsburg More articles by this author For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Predictors of Intraoperative Echocardiography: Analysis of The Society of Thoracic Surgeons Database

BackgroundIntraoperative transesophageal echocardiography (TEE) is associated with improved outcomes after cardiac surgery, but unexplained practice pattern variation exists. This study aimed to identify and quantify the predictors of intraoperative TEE use among patients undergoing isolated coronary artery bypass graft surgery (CABG) or cardiac valve surgery. MethodsThis observational cohort study used The Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database data to identify and quantify the predictors of intraoperative TEE use among adult patients aged 18 years or more undergoing either isolated CABG or open cardiac valve repair or replacement surgery between January 1, 2011, and December 31, 2019. Generalized linear mixed models were used to measure the relationship between intraoperative TEE and patient characteristics, surgical volume, and geographic location, while accounting for clustering within hospitals (primary analysis) or surgeons (secondary analysis). ResultsOf 1,973,655 patients, 1,365,708 underwent isolated CABG and 607,947 underwent cardiac valve surgery. Overall, intraoperative TEE was used in 62% of surgeries. The primary hospital-level generalized linear mixed models analysis demonstrated that the strongest predictor of intraoperative TEE use was the hospital where the surgery occurred—with a median odds ratio for TEE of 10.13 in isolated CABG and 5.30 in cardiac valve surgery. The secondary surgeon-level generalized linear mixed models analysis demonstrated similar findings. ConclusionsIntraoperative TEE use (vs lack of use) during surgery was more strongly associated with hospital and surgeon practice patterns than with any patient-level factor, surgical volume, or geographic location.

The Impact of the Maritime Deployment Cycle on the Surgeon's Knowledge, Skills, and Abilities.

The U.S. Navy routinely deploys aircraft carriers and amphibious assault ships throughout the world in support of U.S. strategic interests, each with an embarked single surgeon team. Surgeons and their teams are required to participate in lengthy pre-deployment shipboard certifications before each deployment. Given the well-established relationship of surgeon volume to patient outcome, we aim to compare the impact of land vs. maritime deployments on Navy general surgeon practice patterns. Case logs and pre-deployment training initiation of land-based (n = 8) vs. maritime-based (n = 7) U.S. Navy general surgeons over a 3-year period (2017-2020) were compared. Average cases per week were plotted over 26 weeks before deployment. Student's t-test was utilized for all comparisons. Cases declined for both groups in the weeks before deployment. At 6 months (26 weeks) before deployment, land-based surgeons performed significantly more cases than their maritime colleagues (50.3 vs. 14.0, P = .009). This difference persisted at 16 weeks (13.1 vs. 1.9, P = .011) and 12 weeks (13.1 vs. 1.9, P = .011). Overall, surgeon operative volume fell off earlier for maritime surgeons (16 weeks) than land-based surgeons (8 weeks). Within 8 weeks of deployment, both groups performed a similarly low number of cases as they completed final deployment preparations. Surgeons are a critical component of combat causality care teams. In this analysis, we have demonstrated that both land- and maritime-based U.S. Navy surgeons have prolonged periods away from clinical care before and during deployments; for shipboard surgeons, this deficit is large and may negatively impact patient outcomes in the deployed maritime environment. The authors describe this discrepancy and provide practical doctrinal solutions to close this readiness gap.

Impact of Fellowship Training on Practice Patterns of Glaucoma Surgeons Treating Medicare fee-for-service Beneficiaries

ABSTRACT Purpose Analyze practice patterns of glaucoma surgeons with and without fellowship training. Materials and Methods Physician-specific 2017 Medicare data were obtained from the Centers for Medicare & Medicaid Services website. Current Procedural Terminology codes identified procedures including iStent, tube shunts, trabeculectomy, complicated trabeculectomy, endoscopic cyclophotocoagulation, internal Xen Implant, external Xen or Express shunt, Gonioscopy-Assisted Transluminal Trabeculotomy, and Kahook Dual Blade Goniotomy. Physicians with fellowship training were identified via the American Glaucoma Society website. Results A total of 1547 glaucoma surgeons were identified, of which 319 had completed fellowship training. Overall, fellowship-trained glaucoma surgeons performed more services (50.4 ± 47.0 vs 40.5 ± 35.3, P < .001) with a larger variety of procedures (1.8 ± 1.0 vs 1.3 ± 0.6, P < .001) than those without fellowship training. Surgeons without fellowship training were more likely to perform iStent and endoscopic cyclophotocoagulation and less likely to perform the remaining procedures than their fellowship-trained counterparts. Medicare payments did not differ between groups and the number of Medicare beneficiaries only differed for internal Xen implant (P = .03). Patient comorbidity burden was similar between groups with about one-third of patients being diagnosed with ischemic heart disease. Conclusions Surgeons without fellowship training can treat a similar volume of glaucoma patients as those with fellowship training. However, based on surgical procedures employed, their practices are skewed towards mild and moderate glaucoma and they are more limited in their breadth of procedures. In addition, ischemic heart disease was prevalent in the glaucoma patient population.

Orthopaedic Surgery Pediatric Sports Medicine: Characterizing Practice Patterns and Subspecialization.

Pediatric sports medicine is a new and rapidly growing subspecialty within orthopaedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America. Therefore, the purpose of this study was to evaluate and describe the current practice patterns of orthopaedic surgeons specializing in pediatric sports medicine. An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through the Pediatric Research in Sports Medicine Society. The purpose of the survey was to characterize (1) surgeon demographics, (2) the breakdown of different joint specialization, and (3) the specific procedures for joints that the surgeons specialize in. Responses from 55 orthopaedic surgeons were collected and analyzed. Most respondents considered pediatric sports medicine as the primary focus of their practice (89.1%, n=49/55). The number of fellowships completed was almost evenly split between either a single fellowship (52.7%, n=29/55) or 2 or more (47.3%, n=26/55). The most common combination of fellowships was pediatric orthopaedics and adult sports medicine (32.7%, n=18/55). Most survey respondents had been in practice for <10 years (69.0%, n=38/55) and were affiliated with an academic center (61.8%, n=34/55). On average, 77.5% of the patients treated were <18 years old. The knee joint was the most specialized joint, with 98.2% (n=54/55) respondents reporting that the knee joint constituted ≥25% of their practice. The knee joint constituted a mean of 52.1% of the respondents' overall practice, followed by the shoulder (15.2%), hip (13.9%), ankle (7.5%), elbow (7.1%), and wrist (4.2%). Pediatric sports medicine practices are variable and have distinct practice patterns in pediatric, orthopaedic, and adult sports practices. In the current study, most surgeons are less than 10 years into practice, affiliated with academic centers, and have typically completed either 1 or 2 fellowships after residency. Surgeons were most commonly specialized in the knee joint and cared for patients <18 years old. Level of evidence IV.

The association between surgeon subspecialty training and postoperative outcomes following surgery for pelvic organ prolapse

Symptomatic pelvic organ prolapse is common and affects 25% to 35% of women worldwide. As this growing patient need is being met by surgeons from diverse training backgrounds, it is important to both characterize the differences in surgeon practice patterns and examine postoperative outcomes to ensure optimal patient care. To determine the association between surgeon specialty and postoperative outcomes following surgery for pelvic organ prolapse. This was a retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program Gynecologic reconstructive surgery targeted database between 2014 and 2018. Pelvic organ prolapse surgeries were identified using Current Procedural Terminology codes, and surgical cases performed by urogynecologists or obstetrician-gynecologists were included for analysis. The primary outcome was any 30-day postoperative complication following prolapse surgery. The secondary outcomes were any major or minor postoperative complications, genitourinary complications, reoperation, or readmission within 30-days following surgery. Descriptive statistics were used to characterize the cohort, and pairwise analyses were used to describe the differences between the cases performed by the surgeon specialties. Multivariable logistic regression was used to control for potential confounders. A total of 3358 women underwent prolapse surgery-68% performed by urogynecologists and 32% by obstetrician-gynecologists. The 30-day postoperative complication rate was higher for surgeries performed by obstetrician-gynecologists than for surgeries performed by urogynecologists (10.7% vs 7.0%, respectively; P<.001). There was no difference in the readmission rates between the 2 groups (2.1% vs 2.0%; P=1.000). However, the reoperation rates were higher for surgeries performed by obstetrician-gynecologists (1.8% vs 1.0%; P=.040). In a multivariable logistic regression model controlling for age, body mass index, American Society of Anesthesiology class, smoking, and type of concomitant surgery (hysterectomy, apical suspension, other prolapse surgery, obliterative procedure, or sling), prolapse surgery performed by a urogynecologist remained associated with nearly 40% lower odds of any 30-day postoperative complication (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80). Prolapse surgery performed by a urogynecologist is associated with lower odds of any 30-day postoperative complication than that performed by an obstetrician-gynecologist.

Surgeon Attitudes Toward Concurrent Urogynecologic and Gynecologic Oncology Procedures: A Cross-sectional Survey.

There is increasing overlap in the urogynecologic and gynecologic oncologic patient populations. To improve patient advocacy and access to care, a collaborative surgical approach may benefit this cohort. The aim of the study was to evaluate surgeon attitudes toward performing concurrent urogynecologic and gynecologic oncology procedures. We hypothesized that most surgeons are amenable to collaboration. We conducted a cross-sectional questionnaire of members of the Society of Gynecologic Oncology and the American Urogynecologic Society from August to November 2020. A 23-item online survey was created to assess surgeon demographics, practice and screening patterns, and attitudes toward surgical collaboration. We also evaluated obstacles to performing joint procedures and assessed whether attitudes could be influenced by new information. A total of 338 surveys were included in the analysis, including 158 urogynecologists and 226 gynecologic oncologists (GOs). Most surgeons (77.8%) will recommend concurrent procedures with another specialty, and 97.8% of urogynecologists and 95.7% of oncologists currently perform joint surgical procedures. Male surgeons, regardless of specialty, were more likely to recommend staged procedures (44% vs 31%, P < 0.001), as were GOs (28% vs 10.1%, P < 0.001). However, oncologists were more likely than urogynecologists to initiate referrals for surgical collaboration (33.3% vs 14.4%, P < 0.001). A total of 22.2% of urogynecologists and oncologists prefer staging surgical procedures. The most common barrier to a combined procedure was logistics. Urogynecologists were more concerned about the effects of cancer treatments on healing, the use of mesh implants, and financial reimbursements as compared with GOs. Treatment delay was a significantly greater concern for the oncologists.

Variable Practice Patterns and Variation Among Orthopaedic Surgeons Specializing in Pediatric Sports Medicine

Introduction:Pediatric sports medicine is a growing subspecialty within orthopedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America.Purpose:To evaluate and describe the current practice patterns of orthopedic surgeons specializing in pediatric sports medicine via survey of PRiSM (Pediatric Research in Sports Medicine Society) members.Methods:An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through PRiSM in April 2021. The survey was designed to (1) characterize respondent demographics (practice focus on pediatric vs. adult, fellowship training, years in practice, location), (2) characterize the breakdown of different joint specialization, and (3) determine the most common procedures across different joints that the respondent specializes in. Specialization was defined as composing ≥ 25% of a respondent’s practice. Commonly operated joints were defined as composing ≥5% of their practice.Results:Responses from 55 orthopedic surgeons were collected and analyzed. The majority of respondents considered pediatric sports medicine as the primary focus of their practice (89.1%, n=49/55). The number of fellowships completed was almost evenly split between either a single fellowship (52.7%, 29/55) or two or more (47.3%, 26/55). The most common combination of fellowships was pediatric orthopaedics and adult sports medicine (32.7%, 18/55). The majority of survey respondents have been in practice for <10 years (69.0%, 38/55), were affiliated with an academic center (61.8%, 34/55), and utilized non-operative providers as a part of their practice (66.6%, 36/54). On average, 77.5% of patients treated were skeletally immature. Overall, 54.5% of respondents reported specializing in one joint and 41.8% specialized in two. Surgeons commonly operated on a mean of 3 joints. The knee was the most commonly specialized joint (composing a mean of 52.1% of an overall practice), followed by the shoulder (15.2%), hip (13.9%), ankle (7.5%), elbow (7.1%), and wrist (4.2%) (Table 1). Interestingly, 87.3% (48/55) commonly operate on the shoulder but only 21.8% (12/55) were specialists. Conversely, the hip had a similar amount of specialization (23.6%, 13/55) but 56.3% (31/55) reported that they rarely operated on the hip.Conclusions:Pediatric sports medicine practices in orthopaedic surgery are quite variable. The majority of surgeons are <10 years into practice, affiliated with academic centers and have typically completed either 1 or 2 fellowships after residency. The majority of patients are skeletally immature. Most surgeons specialize in one or two joints, most commonly the knee, followed by hip and then shoulder.Table 1.Distribution of joints that make up individuals’ practice (n=55).Figure 1:Number of joints commonly operated on. Joint options were the knee, shoulder, hip, andkle, elbow and wrist. Commonly operated on was defined as composing >5% of total practice.