Private Surgeons Research Articles

Social Media and Digital Footprints in Orthopaedic Trauma: An Analysis of 1465 Orthopaedic Trauma Association Members.

The purpose of this study was to quantify social media usage among Orthopaedic Trauma Association (OTA) members. All active OTA members were searched for involvement among common social media platforms. Surgeons were then classified as "active" on any given social media site if they posted within the last 6 months. Surgeons were also identified by the region they practiced in, gender, and their practice setting (academic vs private). Lastly, a surgeon's score and number of reviews from common physician review websites was examined. A total of 1,465 Orthopaedic Trauma Association (OTA) members were included in the analysis. Most surgeons were male [89.1% (n=1305)] and practiced in a private setting [54.5% (n = 799)]. A total of 590 (40.3%) surgeons had at least 1 form of social media account. Social media sites most used were LinkedIn with 48.7% (n = 713) and ResearchGate with 29.2% (n = 428). Academic surgeons were more likely to have a ResearchGate, LinkedIn, and Twitter account, while private surgeons were more likely to have a personal website (P<0.05). Lastly, there was no correlation between surgeons more active on social media and average scores on Vitals.com or Healthgrade.com (P>0.05). Most orthopaedic trauma surgeons do not have professional social media accounts. While social media may help spread scholarship, having a professional social media account does not correlate with better online physician reviews or increased online reviews among orthopaedic trauma surgeons.

Visual representation of diversity in online patient education materials for reduction mammaplasty

Online patient education materials play an important role in plastic surgery, and surgeons should ensure that materials accurately reflect their patient population. This study compared the skin tone of images in online materials from the American Society of Plastic Surgeons (ASPS), academic plastic surgery programs, and private groups to the demographics of the United States (US) reduction mammaplasty population. Images within patient education materials and embedded photo galleries were assessed and skin tones were categorized using the Fitzpatrick Skin Scale (FSS). Two reviewers evaluated 616 images. Scores of 1-3 were categorized as White, while scores of 4-6 were classified as non-White. The proportion of images categorized as White and non-White were compared to the demographics of the reduction mammaplasty population in the US. Of 616 images, 82% were classified as White, while 18% were non-White. This distribution differed significantly from the racial demographic distribution of patients undergoing reduction mammaplasty in the US in 2020, where 48% identified as White and 52% as non-White (p<0.001). There was also a statistically significant difference in the distribution of FSS scores between the materials from the ASPS, academic programs, and private surgeon groups, with private groups having a lower percentage of non-White images (p=0.028). These findings suggest that implicit bias may impact the creation of patient education materials for reduction mammaplasty and highlights the need for improvement in distributing patient education materials that accurately represent the diverse reduction mammaplasty population.

Social Media Use Among Hand Surgeons.

Recently social media use within healthcare has increased significantly. Today, it is common for patients to browse the Internet, including physicians' social media pages, to learn about their medical conditions and search for providers. The purpose of this study is to analyze the use of social media among hand surgeons, and to compare this use between academic and private surgeons. Using the American Society for Surgery of the Hand's (ASSH) online directory, all active members practicing within the ten most populated U.S. cities were identified. Social media presence was determined by an Internet search of platforms. Members were stratified by practice model (academic vs.private). Chi-square and t-tests were used to compare categorical and continuous variables, and a multivariable logistic regression was performed for the binary variable practice model. Two hundred and fifty-six hand surgeons were identified with 150 (59%) in academic and 106 (41%) in private practice. For ResearchGate accounts, 51 (82%) were academic and 11 (18%) were private. Mean PubMed publications was 38 for academic and 9 for private. YouTube presence was 69 (70%) in academic and 29 (30%) in private. On multivariable analysis, the odds of having ResearchGate and YouTube presence were higher for academic practice. There was no statistically significant difference by practice type for Facebook, Twitter, LinkedIn, and Instagram. With the recent social media expansion, surgeons have adopted social media platforms to reach patients. While the literature has shown that private practices are more active in social media, our results show they are not more active than academic practices in the ten most populated U.S. cities. IV.

Management of a large tuberculosis contact investigation related to a contaminated bone graft product used in spinal surgery

Background: In March–April 2021, 23 patients at a 906-bed hospital in Delaware had surgical implantation of a bone graft product contaminated with Mycobacterium tuberculosis; 17 patients were rehospitalized for surgical site infections and 6 developed pulmonary tuberculosis. In May 2021, we investigated this tuberculosis outbreak and conducted a large, multidisciplinary, contact investigation among healthcare personnel (HCP) and patients potentially exposed over an extended period in multiple departments. Methods: Exposed HCP were those identified by their managers as present, without the use of airborne precautions, in operating rooms (ORs) during index spine surgeries or subsequent procedures, the postanesthesia care unit (PACU) when patients had draining wounds, inpatient rooms when wound care was performed, and the sterile processing department (SPD) on the days repeated surgeries were performed. We created and assigned an online education module and symptom screening questionnaire to exposed HCP. Employee health services (EHS) instituted a dedicated phlebotomy station to provide interferon-γ release assay (IGRA) testing for HCP at ≥8 weeks after last known exposure. EHS managed all exposed HCP, including nonemployees (eg, private surgeons) via automated e-mail reminders, which were escalated through supervisory chains as needed until follow-up completion. The infection prevention team notified exposed patients, defined as those who shared semiprivate rooms with case patients with transmissible tuberculosis. The Delaware Division of Public Health performed IGRA testing. Results: There were 506 exposed HCP in ORs (n = 100), the PACU (n = 87), inpatient units (n = 140), the SPD (n = 54), and other locations (n = 122); 83% were employed by the health system. Surgical masks and eye protection were routinely used during patient care. All exposed HCP completed screening by December 17, 2021. Furthermore, 2 HCP had positive IGRAs without symptoms or chest radiograph abnormalities, indicating latent tuberculosis infection, but after further review of records and interviews, we discovered that they had previously tested positive and had been treated for latent tuberculosis infection. In addition, 5 exposed patients tested negative and 2 remain pending. Conclusions: This large investigation demonstrated the need for a systematic process that encompassed all exposed HCP including nonemployees and incorporated administrative controls to ensure complete follow-up. We did not identify any conversions related to this outbreak despite high burden of disease in case patients and multiple exposures to contaminated bone-graft material and infectious bodily fluids without respirator use. Transmission risk was likely reduced by baseline surgical mask use and rapid institution of airborne precautions after outbreak recognition.Funding: NoneDisclosures: None

Analysis of vitreoretinal surgery activity in metropolitan France in 2016: impact on training capacities.

The purpose of the study was to describe vitreoretinal surgery activity and vitreoretinal surgeons in private or public practice in metropolitan France over the year 2016 to anticipate surgical training needs. Patients aged ≥20 years who had undergone vitreoretinal surgery, alone or combined with cataract surgery were included using the French National Healthcare system database. For surgery performed by ophthalmologists carrying out ≥50 procedures during the year, the incidence per 100 000 of population ≥ 20 years of age, the number and mean age of surgeons and the number of surgeons aged >55 years were calculated. Overall, 57 947 posterior segment surgical procedures were included, 40% in the public sector and 49% in the private sector for private surgeons and/or public centres performing ≥50 procedures/year. The remaining 11% of procedures were from private surgeons and/or public centres performing <50 procedures/year. The analysis included 356 surgeons with a mean age of 41 ± 10 years (39% female) in the public sector and 47 ± 10 years (14% female) in the private sector. The majority of urgent surgery was for retinal detachment (n = 30 290 [52% of total surgical procedures]). Scheduled surgery involved surgery for macular holes and epiretinal membranes (n = 16 454 [28% of total surgical procedures]). Combined vitrectomy-phacoemulsification surgery (n = 10 120) represented 17% of all vitreoretinal surgery. University regions with the fewest surgeons and regions with surgeons >55 years of age were identified, to anticipate the training need for new surgeons. This study demonstrated disparities in the geographic distribution of vitreoretinal surgery in France and identified regions that need increased training capacities to ensure a sufficient number of surgeons.

How the Shift in Arthroplasty Surgery Location Impacts the Relationship of Private Surgeons, Hospitals, and Ambulatory Surgery Centers

The recent removal of total hip and knee arthroplasty from the Medicare inpatient-only list, COVID-19 pandemic, decreasing reimbursements, and bundled payment programs have all had tremendous impact on the practice of arthroplasty. Surgeons and practices must adapt to these challenges to achieve the ideal triad of quality patient care, low cost to payors, and sustainable financial margins for stakeholders. Here, we review institutional data and present our experience with the changing arthroplasty practice landscape. With the principle of demand matching, arthroplasty surgeons and practices can risk-stratify and shuttle patients in the appropriate operative and rehabilitation setting to optimize quality and efficiency.

Open Aortic Surgery in Endovascular Times: Challenges for Training and Hospital Systems

Endovascular aneurysm repair (EVAR) has surpassed the number of open repairs (OAR) in centers across the country over the last decade. Decreased opportunities for operative OAR training in fellowship programs and the potential for more complicated anatomy may lead to worse patient outcomes. The purpose of this study is to compare OAR outcomes from before (OAR1) and after (OAR2) EVAR surpassed OAR numbers within our institution. A retrospective review of a single prospectively maintained vascular registry of private surgeons who operated across several hospitals including a tertiary care academic hospital was queried for any abdominal aortic aneurysm surgery via OAR or EVAR from January 1997 to December 2009. Data were stratified by years and the point of equipoise where EVAR surpassed OAR was 2003. We also stratified data by care centers in order to compare our tertiary care center to the surrounding community hospitals that we serve. The group OAR1 before 2003 was compared to the group OAR2 after 2003 using standard statistics. Demographics, indications, operative details, and long-term results were retrospectively reviewed and analyzed. 1399 OAR and 191 EVAR were performed between January 1997 and December 2002. January 2003 to December 2019 there were 859 OAR and 1951 EVAR. Indications were significantly different with more ruptures in the OAR2 group (170; 19.8% vs 169, 12.1% P value <00001). Demographics were similar between OAR1 and OAR2 groups, however comorbidities trended more severe in OAR2. Aneurysm size, estimated blood loss, and renal interventions were similar between groups. Ruptured mortality rates were higher in OAR2 (76; 44.7% vs 21, 12.4% P value < .00001) and OAR2 also had higher non-ruptured mortality rates (44; 6.4% vs 7, 0.5% P value < .00001). Subset analysis based on tertiary center versus community hospital demonstrated much worse outcomes for ruptured aneurysm in OAR2. The proliferation of EVAR has decreased the rates of open aortic repair and subsequently selected more complicated aortic anatomy. Consequently, open aortic outcomes have regressed and may prompt a change in vascular training and hospital systems.TableComparison of tertiary care mortality outcomes vs community hospital outcomesAlbany Medical Center MortalityCommunity Hospitals MortalityP valueOAR 1 Elective AAA Repair.74%.22%.2456OAR 2 Elective AAA Repair5.6%6.04%.8201OAR 1 Ruptured AAA Repair5.67%11.95%.0623OAR 2 Ruptured AAA Repair25.6%40.74%.0086OAR 1: Pre-endovascular era defined as open AAA repair prior to 2003.OAR 2: Post-endovascular era defined as open AAA after 2003. Open table in a new tab

Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey.

Background: Lumbar disc herniation (LDH)/radiculopathy is the most frequent cause of lost workdays in people under 50 years of age. Although there is consensus about how to assess these patients, the optimal management strategy is still debated.Methods: An online survey was sent to spine surgeons who are members of the Iberian-Latin American Spine Society to assess how they treat LDH with radiculopathy.Results: There were 718 surgeons who answered the survey; 66% reported that 76–100% of their monthly clinic work was due to spine issues. The most frequently used conservative treatment modalities included non-opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (90.5%), followed by physical therapy (55.2%) and pregabalin (41.4%). Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6–12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3–6 weeks. Of interest, 78% utilized epidural steroid injections (ESI); 51.7% preferred the transforaminal, 27.2% the interlaminar, and 7.5% the caudal approaches. The most frequent indications for surgery included: cauda equina syndrome, progressive neurological deficits, and intractable pain. Traditional microdiscectomy was the most common technique (68.5%) utilized, followed by 7.5% advocating endoscopic disc resection, and just 6.4% favoring the tubular discectomy.Conclusion: There is considerable heterogeneity among Iberian and Latin American spine surgeons in the treatment of LDH/radiculopathy. Although most begin with the utilization of NSAIDs and non-opioid analgesics, followed by ESI (88%), surgery was recommended for persistent symptoms/signs for those failing between 3 and 6 weeks (private sector) versus 6–12 weeks (public sector) of conservative therapy.

Three months in a high-volume tertiary orthopaedic trauma unit: What is a registrar worth?

South Africa has a high burden of traumatic injuries that is predominantly managed in the public healthcare system, despite the relative disparity in human resources between the public and private sectors. Because of budget and theatre time constraints, the trauma waiting list often exceeds 50 - 60 patients who need urgent and emergent surgery in high-volume orthopaedic trauma centres. This situation is exacerbated by other surgical disciplines using orthopaedic theatre time for life-threatening injuries because of lack of own theatre availability. One of the proposed solutions to this problem is outsourcing of some of the cases to private medical facilities.To establish the volume of work done by an orthopaedic registrar during a 3-month trauma rotation, and to calculate the implant and theatre costs, as well as compare the salary of a registrar with the theoretical private surgeon fees for procedures performed by the registrar in the 3-month period.In a retrospective study, the surgical logbook of a single registrar during a 3-month rotation, from 14 January to 14 April 2019, was reviewed. Surgeon fees were calculated for these procedures, according to current medical aid rates, without additional modifier codes being added.During the 3-month study period, a total of 157 surgical procedures was performed, ranging from total hip arthroplasty to debridement of septic hands. Surgeon fees amounted to ZAR186 565.10 per month ‒ double the gross salary of a registrar. Total implant costs amounted to ZAR1 272 667. Theatre costs were ZAR1 301 976 for the 3-month period.Although this analysis was conducted over a short period, it highlights the significant amount of trauma work done by a single individual at a high-volume tertiary orthopaedic trauma unit. With increasing budget constraints, pressure on theatre time and a growing population, cost-effective expansion of resources is needed. From this study, it appears that increasing capacity in the state sector could be cheaper than private outsourcing, although a more in-depth analysis needs to be conducted.

Online Reviews in a Major City: Who Will Choose You?

A large factor influencing a patient's choice of aesthetic plastic surgeons is online patient reviews. Plastic surgeons whose practices are located in counties within the New York metro area were included. Selected surgeons were divided into private and academic surgeons (defined as having a residency program). For each surgeon, the quantity and quality of their Google reviews were collected. A total of 145 aesthetic surgeons from the New York area were included in the study, both private (n = 126) and academic (n = 19). Given the small size of the latter cohort, 19 private aesthetic surgeons were randomly selected, and compared with the academic surgeons, it was shown that private surgeons had both higher average quality and quantity of online patient Google reviews (confidence interval, 95%; P = 0.0223). Similar results were found when comparing all private American Society for Aesthetic Plastic Surgery (ASAPS) surgeons (n = 126) with all academic ASAPS surgeons (n = 19); private ASAPS surgeons had a higher average rating and number of reviews when compared with academic surgeons, again representing a statistically significant difference for the quality of online reviews between private and academic surgeons (confidence interval, 95%; P = 0.031975). There is a statistically significant difference in both the quality and quantity of online ratings for private and academic aesthetic surgeons.

The growing discrepancy between resident training in colonic surgery and the rising number of general surgery graduates.

The decrease in resident operative experience due to working-hour directives and sub-specialization within general surgery is the subject of growing debate. This study aims to examine how the numbers of colectomies used for resident training have evolved since the introduction of working-hour directives and to place these results within the context of the number of new general surgeons. Based on the nationwide database of the Swiss association for quality management in surgery, all segmental colectomies performed at 86 centers were analyzed according to the presence or absence of residents and compared to national numbers of surgical graduates. Of 19,485 segmental colectomies between 2006 and 2015, 36% were used for training purposes. Residents performed 4%, junior staff surgeons 31%, senior staff surgeons 55%, and private surgeons 10%. The percentage performed by residents decreased significantly, while the annual number of graduates increased from 36 to 79. Multivariate analysis identified statutory (non-private) health insurance (OR 7.6, CI 4.6-12.5), right colon resection (OR 3.5, CI 2.5-4.7), tertiary referral center (OR 1.9, CI 1.5-2.6), emergency surgery (OR 1.7, CI 1.3-2.3), and earlier date of surgery (OR 1.1, CI 1.0-1.1) as predictors for resident involvement. Only a low and declining percentage of colectomies is used for resident training, despite growing numbers of trainees. These data imply that opportunities to obtain technical proficiency have diminished since the implementation of working-hour directives, indicating the need to better utilize suitable teaching opportunities, to ensure that technical proficiency remains high.

PRIVATE SURGEONS’ ATTITUDE TOWARDS INFORMED CONSENT, KUWAIT

Background: Surgeons ’ role in informed consent is crucial and should know the basic principle of informed consent in collecting and providing information to patients. Surgeons’ attitudes toward informed consent depends on the knowledge they possess . Objectives: Surgeons should become aware of the informed consent guidelines. New guidelines for consent have resulted in changes in health care environment that surgeons must adhere to. This study aims to highlight the way the surgeons in private hospitals view the informed consent for surgery processes. Methods: This study is a cross-sectional survey that was conducted from January to June 2016 in two private hospitals. The sampling unit used in this survey was private hospitals in Kuwait. A custom designed questionnaire about informed consent for surgery was completed by surgeons working at private hospitals in Kuwait. The questionnaire was developed to examine the surgeons' attitudes towards informed consent. The participants, who were surgeons and working in the various surgical specialties in the two hospitals, were made aware that the emphasis was on the verbal or written information about the operation they provide their patients with and not merely about the signing of the consent form which could take place at the same time or later. They were asked to respond to each question by Yes (agreeing) or No (disagreeing) or Unsure. The responses of the surgeons to each statement were calculated, using Statistical analysis SPSS version 21. Results: A high proportion 98.1% of private surgeons considered informed consent routinely achieved in their current practice. They thought that all surgeons should receive formal training on informed consent 81.6%. They have been received formal training on informed consent 76.7%. On the other hand, private surgeons thought that written information leaflets should be provided for patients during informed consent46.6%. However, only 30.1% of private surgeons provide their patients with leaflets during informed consent. A high proportion of private surgeons 86.4% thought that the main purpose of informed consent is to provide the surgeon with greater protection against litigation. Furthermore, 95.1% of private surgeons thought that the main purpose of informed consent is to respect the patient’s right of autonomy. The majority of private surgeons 94.3% thought that the main purpose of informed consent is to improve the doctor patient relationship, and 83.5% of private thought that the main purpose of informed consent is to improve the patient’s compliance with medical care. On other hand, lower percentages 42.7% of private surgeons thought that informed consent may be unnecessary because most patients depend on their doctor to make the decision for them, and 62.1% of private surgeons thought that the doctor who is going to perform the operation, who should do the informed consent. Also, more private surgeons thought that the patients age, complexity and duration of surgery, gender, the patient social class, the timing of surgery, and the need for referral to another doctor or hospital affects the amount of information given during informed consent. Conclusion: Surgeons in private should be more aware of the informed consent guidelines and they should adhere to them. Training on informed consent in both hospitals are recommended, and to provide more leaflet for patient during informed consent is required and important. Keywords: Informed consent, surgical risk, private.

Public and private surgeon attitude towards informed consent

BackgroundInformed consent ranks as one of the most prominent issues in the recent bioethics literature due to increasing number of medico-legal cases and, the introduction of new national guidelines. ObjectivesThe aim of this study is to examine the attitude of surgeons working in public and private hospitals towards informed consent. Subjects and methodsThis study is a cross-sectional survey that was conducted from January to June 2016 in all five governmental general hospitals, and two private hospitals in Kuwait. A self-administered questionnaire was used to collect data from the surgeons working in the selected hospitals including six domains related to informed consent. ResultsThe majority of surgeons believed that informed consent routinely achieved in their current practice and that all doctors should receive formal training on informed consent, though only 35.7% of public surgeon received training compared to 76.7% of private surgeons. Although 82.7% of public surgeons believed that written information leaflets should be provided for patients, only 41.1% provide their patients with these type of leaflets. There was no significant difference between public and private surgeons regarding the purpose of informed consent except that higher proportion of private surgeons believed that informed consent improves the doctor-patient relationship. There was an agreement between public and private surgeons that junior doctors should not conduct the informed consent. Higher proportion of private than public surgeons stated that the content of informed consent was affected by patient’s age, gender, and social class whereas level of education was thought by public surgeons. ConclusionPrivate surgeons differ from those in the public hospitals in that they tend to look at informed consent as not only an ethical and legal obligation, but also of benefit to patients. The introduction of formal training on informed consent in both types of hospitals are recommended.

Remodelling care for low back pain: tripartite partnership among general practitioners, physiotherapists and hospital specialists

Introduction : Government-run primary healthcare polyclinics in Singapore are often overcrowded and overloaded due to the high fee-for-service (cost gradient) when patients visit private general practitioners (GP: USD22 vs. USD6) and physiotherapists (PT: USD91 vs. USD36). Moreover, patients often experience long wait time before receiving care due in part to limited physiotherapy services in the polyclinics. As a result, patients suffering from low back pain (LBP) and require physiotherapy are often referred to specialist doctors sited at government-run tertiary hospitals, complemented with acute physiotherapy services. However, patients are reluctant to receive follow-up care at the overcrowded polyclinics when their condition was assessed to be stable. There is a need to decongest acute care services for more deserving complex patients. Practice Change Implemented : A tripartite relationship among private GP, PT and public hospital-based orthopaedic surgeons was forged [Delivering-on-Target GP – Allied Health Partnership Programme (DOT GP – AHPP)] to narrow the cost gradient. Stable patients can now be right-sited to less crowded privately-run primary care facilities for follow-up. Aim : We aim to demonstrate that patients receiving care from this new model are satisfied with the cost, quality, and effectiveness of services provided by the DOT-AHPP liaison officers (DALO) and private partners. Methods : Seventy-seven patients suffering from LBP, suitable for conservative treatment, and assessed to be stable by orthopaedic surgeons from Singapore General Hospital (SGH) participated in this new model of care from August 2015 to April 2016. Patient satisfaction with our DALO and AHPP PT were described. Visual analogue pain scores (VAS) were evaluated before and after physiotherapy at AHPP using Wilcoxon signed-rank test. Results : Forty-two (54.6%) and Forty-five (58.5%) patients are very/extremely satisfied with the clarity of information and helpfulness presented by the DALO respectively. Twenty-two (28.6%) patients were referred for physiotherapy at AHPP but only 16 (20.8%) actualised the visit; Twelve (75.0%) patients were either satisfied or very satisfied with the overall affordability, friendliness, knowledge and ambience of the AHPP clinics. Significant improvement in VAS was observed after AHPP physiotherapy [n=9; before: 6.3(1.7); after: 4.0(1.6); P=.007]. Discussion : Patients receiving care from this new model are generally satisfied with the right-siting process. Overall, patients receiving care from AHPP PT reported improvement in their condition and were satisfied with the cost gradient reduction. Further strategies can be implemented to increase the enrolment. These include deepening the AHPP and specialists relationship by governing the care provision, regular case discussion and building trust. Further cost reduction, for example, with government subvention may increase patient enrolment. Limitations : The number of AHPP physiotherapy clinics is limited and most of them are geographically located in central Singapore. This may prohibit patients from enrolling into the new care model. More partners can be co-opted, especially in the northern and western parts of Singapore. These partners should be located close to Mass Rapid Transit (MRT) stations in order to reduce travel inconveniences to patients. Conclusions : The tripartite public-private partnership model has proven useful to decongest acute care services. However, more strategies to increase uptake by patients are needed.

Monitoring Resident Surgical Performance Through Dictated Feedback

BACKGROUND: We rely on 3 faculty for most feedback about resident surgical performance. However, more than half the resident surgical experience involves private surgeons from whom we were not receiving case-specific feedback. We needed a system to capture this feedback. METHODS: We implemented a phone dictation system distributed to all surgeons participating in resident education in May 2015. We consented 17 gynecologists who were asked to use telephone dictation cards to provide feedback after each case involving a resident. We compared number of dictations with number of resident cases that could have been dictated each month using resident logs of cases scrubbed. We also tracked how many different surgeons provided dictations. RESULTS: Not all gynecologists used the dictation system. Despite initial promising results, there was a time dependent trail-off in both number of surgeons using the system and number of dictations received. In total, out of 205 cases performed, we received 50 dictations—24% feedback rate. DISCUSSION: It is difficult to get resident surgical performance feedback from private surgeons, even when you provide structure and accessibility. However, a 24% feedback rate is still improved from no surgical case feedback.

Factors in the Selection and Management of Chest Tubes After Pulmonary Lobectomy: Results of a National Survey of Thoracic Surgeons

This study determined patterns of chest tube (CT) selection and management after open lobectomy and minimally invasive lobectomy by thoracic surgeons. Surveys were sent electronically to 5,175 thoracic surgeons, and 475 were completed. Responses, blinded so individuals could not be identified, were analyzed and compared according to surgeon characteristics (academic/private practice, years in practice, lobectomy volume, and geographic region). All indicated differences were statistically significant (p < 0.05 by χ(2) tests). CT selection: Most surgeons prefer rigid tubes, and the size most commonly used was 28F. Most place 2 CTs after open lobectomy and 1 CT after minimally invasive lobectomy. Academic surgeons are more likely than private surgeons to use 1 tube after open lobectomy, but both prefer 1 tube after minimally invasive lobectomy. Younger surgeons and high-volume surgeons are more likely to use 1 CT than senior surgeons and low-volume surgeons after both open lobectomy and minimally invasive lobectomy. CT management: Academic and younger surgeons remove the CT sooner after open lobectomy. Younger and high-volume surgeons remove the CT with greater drainage amounts. All groups remove CTs sooner after minimally invasive lobectomy than after open lobectomy. Approximately half of surgeons get a daily chest roentgenogram. Younger and low-volume surgeons are most likely to discharge patients with Heimlich valves, although overall use was in less than 5% (49 of 475) of respondents. Most surgeons believe clinical experience rather than training or the literature determined their CT strategy. This survey determined the difference in CT management among various groups of surgeons. Clinical experience was the most important factor in determining their CT strategy.

Type of surgery for early breast cancer and predictive factors an institutional review: A regression model.

e12016 Background: Breast conserving surgery (BCS) is the preferred surgical management for most early-stage breast cancer, given the equivalent survival after BCS plus radiation and mastectomy (M). Clinical reports of an increasing trend in mastectomy from some institutional reviews have been published. The aim of this study was to assess correlation of type of surgery with different factors in our cancer registry database. Methods: We retrospectively reviewed the cancer registry data at UTMC for early breast cancer stage I/II from 2006-2010. Patient demographics, tumor characteristics, institution of surgery, academic versus private surgeon were identified and compared. We used univariate analysis to select factors for entry into a multivariate analysis. Multinomial logistic regression analysis was performed to predict the type of surgery (cancer side mastectomy (CSM) versus BCS, bilateral mastectomy (BM) versus BCS based on the above variables. A p-value of &lt; 0.05 was significant and comparisons were two tailed. Results: We identified 506 eligible patients with stage I/II breast cancer. 306(60.5%) had undergone breast conservative surgery (BCS), 91 (18%) patients had cancer side mastectomy (CSM) and 109 (21.5%) patients had bilateral mastectomy (BM). 298 (59%) patients were stage I and 208 (41%) had stage II, 218 (42%) had undergone surgery at academic center versus 298 (58%) at nonacademic institution. Predictors o CSM were stage II (p =0.0193), high-grade tumor (p=0.015), surgeon from academic institution (p=0.64), age (p=0.61). Predictors of BM were surgeon from academic institution (p=0.060), age (p=0.07). Conclusions: This study confirms some known factors like stage, surgeon expertise, as influencing factors in type of local surgery, while at the same time did not show impact of race and other tumor characteristics. Further research of these factors need to confirm the influence on decision making prospectively.

Imparting Surgical Training in Private Practice

Imparting Surgical Training in Private Practice

Necrotizing Fasciitis Following Calf Augmentation

We are writing to present a short case that we believe might be of interest to the Aesthetic Surgery Journal readership. Necrotizing fasciitis remains one of the most life-threatening soft tissue infections, and a patient presented to us with this infection following calf augmentation.1 In 2011, a 26-year-old man presented to our hospital 2 days after cosmetic calf augmentation with implants, complaining of a fever and pain when standing or walking. He had no allergies and no significant past medical history. The initial augmentation procedure was performed by a private surgeon in an accredited center; 105-mL, symmetrical-base, smooth-surface silicone implants were placed in the retromuscular plane. No other procedures were performed concurrently. The patient did not provide information about which antibiotic …

Creation of an emergency surgery service concentrates resident training in general surgical procedures

Emergency general surgery (EGS) is increasingly being provided by academic trauma surgeons in an acute care surgery model. Our tertiary care hospital recently changed from a model where all staff surgeons (private, subspecialty academic, and trauma academic) were assigned EGS call to one in which an emergency surgery service (ESS), staffed by academic trauma faculty, cares for all EGS patients. In the previous model, many surgeries were "not covered" by residents because of work-hour restrictions, conflicting needs, or private surgeon preference. The ESS was separate from the trauma service. We hypothesize that by creating a separate ESS, residents can accumulate needed and concentrated operative experience in a well-supervised academic environment. A prospectively accrued EGS database was retrospectively queried for the 18-month period: July 2010 to June 2011. The Accreditation Council for Graduate Medical Education (ACGME) databases were queried for operative numbers for our residency program and for national resident data for 2 years before and after creating the ESS. The ACGME operative requirements were tabulated from online sources. ACGME requirements were compared with surgical cases performed. During the 18-month period, 816 ESS operations were performed. Of these, 307 (38%) were laparoscopy. Laparoscopic cholecystectomy and appendectomy were most common (138 and 145, respectively) plus 24 additional laparoscopic surgeries. Each resident performed, on average, 34 basic laparoscopic cases during their 2-month rotation, which is 56% of their ACGME basic laparoscopic requirement. A diverse mixture of 70 other general surgical operations was recorded for the remaining 509 surgical cases, including reoperative surgery, complex laparoscopy, multispecialty procedures, and seldom-performed operations such as surgery for perforated ulcer disease. Before the ESS, the classes of 2008 and 2009 reported that only 48% and 50% of cases were performed at the main academic institution, respectively. This improved for the classes of 2010 and 2011 to 63% and 68%, respectively, after ESS creation. An ESS rotation is becoming essential in large teaching hospitals by helping to fulfill ACGME requirements and by providing emergent general surgical skills an efficient and well-supervised academic environment. Movement toward concentrating EGS on a single service can enhance resident education and may decrease the need to supplement certain aspects of general surgery education with away rotations.