Procedure Volume Research Articles

The COVID-19 Pandemic Increased the Use of Virtual Fellowship Interviews, Reduced Case Volume, and Limited Sideline Coverage Opportunities During Sports Medicine Surgeon Training

As one-year orthopaedic sports medicine fellowships rely heavily on elective cases and sports coverage, the COVID-19 pandemic necessitated fellowship programs to temporarily transition to virtual mediums for fellow education. Early in the pandemic, there was uncertainty as to how programs would address concerns of trainee readiness, adequate education, and accompanying psychological impact. However, with a return to prepandemic elective procedure volumes and sideline sports coverage responsibilities, sports medicine fellowships have regained some of their traditional education opportunities. Moreover, the implementation of novel training resources, including virtual didactics, augmented reality surgical skills labs, and telehealth medicine training are poised to outlast the current public health crisis and further supplement fellowship education. This article seeks to report on current evidence-based strategies and developments across several critical aspects of sports medicine training during the COVID-19 pandemic.

Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort

ObjectiveTo quantify contemporary outcomes following elective ascending aortic aneurysm repair, to determine risk factors for adverse events and to evaluate difference by institutional surgical volume.MethodsWe included all elective hospitalisations of...

The influence of procedural volume on short-term outcomes for robotic pancreatoduodenectomy—a cohort study and a learning curve analysis

BackgroundAn increasing number of robotic pancreatoduodenectomies (RPD) are reported, however, questions remain on the number of procedures needed for gaining technical proficiency in RPD. Therefore, we aimed to assess the influence of procedure volume on short-term RPD outcomes and assess the learning curve effect.MethodsA retrospective review of consecutive RPD cases was undertaken. Non-adjusted cumulative sum (CUSUM) analysis was performed to identify the procedure volume threshold, following which before-threshold and after-threshold outcomes were compared.ResultsSince May 2017, 60 patients had undergone an RPD at our institution. The median operative time was 360 min (IQR 302.25–442 min). CUSUM analysis of operative time identified 21 cases as proficiency threshold, indicated by curve inflexion. Median operative time was significantly shorter after the threshold of 21 cases (470 vs 320 min, p < 0.001). No significant difference was found between before- and after-threshold groups in major Clavien-Dindo complications (23.8 vs 25.6%, p = 0.876).ConclusionsA decrease in operative time after 21 RPD cases suggests a threshold of technical proficiency potentially associated with an initial adjustment to new instrumentation, port placement and standardisation of operative step sequence. RPD can be safely performed by surgeons with prior laparoscopic surgery experience.

Outcomes of Transcatheter Aortic Valve Replacement in the United Arab Emirates: Real-world, Single-centre Experience from an Emerging Programme.

Data on outcomes of transcatheter aortic valve replacement (TAVR) in the Middle East, particularly in the United Arab Emirates (UAE), are limited. Whether centres with a low volume of patients requiring the procedure can achieve similar outcomes as those reported in pivotal clinical trials remains unclear. This study evaluates procedural outcomes of patients undergoing TAVR in a newly established programme in the UAE. Procedural outcomes of consecutive patients who underwent transfemoral TAVR at a single centre in the UAE between January 2016 and November 2021 were compared with those at centres in the lowest quartile (Q1) of procedural volume in the Transcatheter Valve Therapy Registry, which covers centres in the US. Among the 183 patients included in the study, the median age was 76 years (interquartile range [IQR] 71-82), and 42.1% of patients were women, with a median Society of Thoracic Surgeons predicted risk of mortality score of 4.6 (IQR 2.9-7.5). Most of the patients (93.3%) received a balloon-expandable valve. All-cause death within 30 days, stroke and major vascular complications occurred in 0.6%, 0.6% and 2.2% of patients, respectively, compared with 3.1%, 2.2% and 4% in patients treated at Q1 hospitals. Patients undergoing transfemoral TAVR at an emerging centre in the Middle East had favourable outcomes compared with those performed at Q1 hospitals in the US. These findings suggest that careful patient selection for TAVR is critical and may help optimise patient outcomes, especially when procedural volumes are low.

A128 GLOBAL TRENDS IN TRAINING AND CREDENTIALING GUIDELINES FOR GASTROINTESTINAL (GI) ENDOSCOPY: A SYSTEMATIC REVIEW

Abstract Background Credentialing in GI endoscopy is not a universally standardized process. National guidelines may provide a framework for local training, however in certain settings, training committees set minimal competency requirements that must be met before a clinician can be accredited to practice independently. There is a paucity of literature assessing the inter-societal and geographic variability in guidelines and training requirements in endoscopy. Purpose To systematically review the available credentialing guidelines proposed by different GI endoscopy societies and affiliated training committees internationally. Method We conducted a systematic review according to the PRISMA guidelines. A comprehensive literature search was performed for credentialing guidelines for GI endoscopy from inception until January 2022. Two reviewers screened and one reviewer abstracted data using a pre-defined data collection form. Result(s) From the 653 records obtained from our search, 20 credentialing guidelines from 12 different GI societies were ultimately included in the review. These guidelines encompassed the following procedures and outlined the following key-performance indicators; a) Colonoscopy: the recommended minimum number of procedures performed ranged from 150-275 with a minimum cecal intubation and adenoma detection rate of 85-90% and 20-30% respectively; b) EGD: the minimum number of procedures prior to credentialing ranged from 130-1000, the minimum duodenal intubation rate ranged from 95-100%, and the range for minimum number of upper GI bleeds managed was 20-45 (in addition to other procedural KPIs); c) ERCP: the recommended minimum number of procedures prior to credentialing ranged from 100-300 cases with a minimum selective duct cannulation rate of 80-90%. Guidelines for flexible sigmoidoscopy, EUS and capsule endoscopy were also obtained. Image Conclusion(s) There is a general concordance amongst the various international GI societies with regards to minimum procedural volume and performance in key procedural tasks prior to credentialing, however the use of validated education assessment tools was lacking in the majority of guidelines. Additional KPI’s need to be explored for less routinely performed procedures such as EUS and capsule endoscopy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Hospital Procedural Volume Predicts Short-term Outcomes for Patients Undergoing Procedures Requiring Large-bore Access.

Large-bore access procedures (LBP), such as transcatheter aortic valve replacement (TAVR), endovascular aneurysm repair (EVAR), and implantation of mechanical circulatory support (MCS), have been increasing in practice.1 While hospitals with a higher volume of TAVR procedures showed reduced in-hospital mortality and related complications,2 the relationship between procedural volume and outcomes for LBPs, collectively, has not been established, which is the goal of this research letter. This is a retrospective cohort study whereby all hospitalizations with patients undergoing LBP from 1 January 2016 to 31 December 2018, in the United States, were identified using the Nationwide Readmissions Database (NRD).3 LBPs included TAVR, EVAR, balloon aortic valvuloplasty (BAV), and implantation of MCS. Outcomes of interest were in-hospital mortality, vascular complications, major bleeding, and 30-day readmissions. Major bleeding was defined as bleeding requiring blood transfusion. The annualized hospital volume of LBP was analysed as both continuous and categorical variables (in quartiles) for the mentioned outcomes. Quartiles were chosen to ensure an equal number of hospitalizations in each volume category—quartile 1 (Q1), quartile (Q2), quartile 3 (Q3), and quartile 4 (Q4). Q1 was defined as a low-volume hospital and Q4 as a high-volume hospital. Outcomes were compared against Q1 by controlling for age, sex, comorbidities, and the Elixhauser Comorbidity Index, and the related odds ratio (OR) was estimated. Restricted cubic splines with hierarchical models were created to incorporate hospital characteristics as random effects in the model to help assess any nonlinear relationship between the hospital’s volume and outcomes. We also divided LBPs into TAVR and non-TAVR populations to determine if such outcomes also applied to the non-TAVR LBP. The present study did not require the institutional review board approval per institutional policy for de-identified publicly available dataset.

Hepatopancreatic Surgeons Versus Pancreatic Surgeons: Does Surgical Subspecialization Impact Patient Care and Outcomes?

BackgroundHepatopancreatic (HP) surgeon and hospital procedural volume may vary relative to liver or pancreas cases. We sought to investigate the impact of surgeon and hospital pancreatic subspecialization on patient outcomes. MethodsPatients who underwent pancreatic surgery between 2013–2017 were identified from the Medicare Standard Analytic Files. The surgery subspecialization index (SSI) was calculated to signify surgeon and hospital pancreatic subspecialization, and categorized as low, intermediate, and high SSI. The association of SSI with Textbook Outcome (TO) and its components, failure to rescue (FTR), discharge to home and index admission expenditures was assessed with mixed-effects multivariable logistic regression. ResultsAmong 19,625 patients, most pancreatic procedures were characterized by high SSI (Low SSI: 27.7%, Intermediate SSI: 34.7%, High SSI: 37.7%). Notably, higher SSI was associated with greater odds of achieving a TO [Intermediate SSI: OR 1.16 (95%CI 1.06–1.27); High SSI: OR 1.23 (95%CI 1.11–1.35)] as well as being discharged home, and lower odds of experiencing FTR. Furthermore, this association persisted in both low-volume [referent: Low SSI; Intermediate SSI: OR 1.14 (95%CI 1.01–1.28); High SSI: OR 1.15 (95%CI 1.02–1.31)] and high-volume hospitals [referent: Low SSI; Intermediate SSI: OR 1.16 (95%CI 1.01–1.32); High SSI: OR 1.26 (95%CI 1.09–1.45)]. ConclusionsGreater pancreatic subspecialization was associated with improved postoperative outcomes following pancreatic resection. Amidst increasing efforts to improve quality of care, surgical subspecialization may play a role in determining patient outcomes regardless of total surgeon or hospital volume.

Application of Green Solvent in Green Chemistry: An overview

Purpose: Generally, conventional or volatile organic solvents are extracted from petroleum resources and other such resources harmful to living species' environment and wellbeing. Because of this severe threat, researchers developed some eco-friendly alternations to circumvent the difficulties associated with traditional solvents. This review paper provides an overview of different alternatives or substitutes to overcome the toxicity of conventional solvents.&#x0D; Methodology: The properties of a green solvent, tools, and techniques used to measure the greenness of solvent, its parameters, classification, and applications in various fields are the factors reviewed in this study.&#x0D; Principal Findings: Chemical and pharmaceutical industries use around 80% of chemical-based solvents out of the total volume for various chemical procedures. The evolution of green chemistry has led to the development of green solvents.&#x0D; Implications: The use of non-conventional solvents also offers prospects for facilitating the recycling and recovery of the solvents.&#x0D; Novelty: The novelty of this work includes its eco-friendliness and sustainability over traditional organic solvents. Along with these, green solvents can be recycled for further use. On a green note, we have discussed various types of solvents, parameters, their properties and applications in different fields in this chapter. And all of them possess some unique characteristics and advantages over conventional organic solvents. Some of them are completely eco-friendly and others in a way require some research and enhancement in techniques to behave like one.

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity among work team members is associated with enhanced success in multiple fields but rarely studied in the operating room. To examine the association between surgeon-anesthesiologist dyad familiarity-as the number of times working together-with short-term postoperative outcomes for complex gastrointestinal cancer surgery. This population-based retrospective cohort study based in Ontario, Canada, included adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer from 2007 through 2018. The data were analyzed January 1, 2007, through December 21, 2018. Dyad familiarity captured as the annual volume of procedures of interest done by the surgeon-anesthesiologist dyad in the 4 years before the index surgery. Ninety-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression. Seven thousand eight hundred ninety-three patients with a median age of 65 years (66.3% men) were included. They were cared for by 737 anesthesiologists and 163 surgeons who were also included. The median surgeon-anesthesiologist dyad volume was 1 (range, 0-12.2) procedures per year. Ninety-day major morbidity occurred in 43.0% of patients. There was a linear association between dyad volume and 90-day major morbidity. After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with an odds ratio of 0.95 (95% CI, 0.92-0.98; P = .01) for each incremental procedure per year, per dyad. The results did not change when examining 30-day major morbidity. Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.

Non-Renal Factors Associated with Simultaneous Liver-Kidney Transplant in Patients with End-Stage Liver Disease and Stage 3-5 Chronic Kidney Disease Not Requiring Dialysis

We aimed to identify the non-renal risk factors for simultaneous liver-kidney transplantation (SLKT) vs. liver transplantation alone (LTA) in end-stage liver disease (ESLD) patients with estimated glomerular filtration rate (eGFR) &lt;60 ml/min, not on dialysis. Using organ procurement and transplantation network data, we studied adult ESLD patients who received deceased-donor SLKT or LTA in July 2002-Mar 2016 with a 4-point modification of renal disease (MDRD) equation-estimated glomerular filtration rate (eGFR) stratified into chronic kidney disease stage 3 (CKD-3): 30-59 ml/min, CKD stage 4 (CKD-4): 15-29 ml/min, and CKD stage 5 (CKD-5): &lt;15 ml/min) and not on maintenance dialysis (NOD). The outcome of the study was identification of non-renal risk factors predicting likelihood of SLKT vs. LTA. We reported the odds ratio (OR) and 95% confidence interval (CI) for SLKT vs. LTA associated with important clinical variables. Strong non-renal (non-creatinine-associated) risk factors for SLKT were WL-time &gt;2 yrs. and 1-2 yrs. (OR = 3.80, CI = 2.94-4.91; OR = 3.20, CI = 2.58-3.97; respectively), African American or Hispanic recipient race/ethnicity (OR = 2.93, CI = 2.45-3.51; OR = 1.46, CI = 1.24-1.72; respectively), liver repeat transplant (OR = 1.66, CI = 1.39-1.99), and diabetes (OR = 1.53, CI = 1.36-1.72). Factors associated with lower likelihood of SLKT were donor age &gt;60 years (OR = 0.25, CI = 0.19-0.32), female recipient sex (OR = 0.48, CI = 0.43-0.54), hepatocellular carcinoma (OR = 0.53, CI = 0.35-0.81), and transplant center procedure volume tercile ranks 3&lt;sup&gt;rd&lt;/sup&gt; (OR = 0.74, CI = 0.62-0.89) and 2&lt;sup&gt;nd&lt;/sup&gt; (OR = 0.78, CI = 0.64-0.95). Model for end-stage liver disease scores have varying associations with SLKT vs. LTA, depending on calculation time: at wait listing or transplant. CKD-5 and -4 at wait listing (WL) and transplant were the risk factors with highest point estimates for SLKT vs. LTA. In patients with ESLD and CKD stage 3-5, not on dialysis, strong non-renal risk factors favoring SLKT versus LTA include: prolonged waitlist time, African American or Hispanic race/ethnicity, previous liver transplant, and diabetes. Some novel associations found between risk factors and likelihood of SLKT need further study for confirmation. Lack of uniform criteria for SLK allocation during the period studied is a major limitation of the study.

A National Survey of the Infrastructure and Scope of Practice for Gastroenterology Hospitalists.

Hospital-based specialty-trained physicians have become more prevalent with emerging data suggesting benefit in consult and procedure volume, reduced complication rates, and increased practice productivity. Interest in gastroenterology (GI) hospitalist programs has increased in recent years. However, little is known regarding the types of GI hospitalist models that currently exist. To characterize the infrastructure of GI hospitalist models across the USA. A 50-question survey was distributed to the GI Hospitalist Special Interest Group of the American Society for Gastrointestinal Endoscopy. Information on demographics, hospital infrastructure, and compensation were collected. 31 of 33 (94%) GI hospitalists completed the questionnaire. Respondents were mostly male (65%), white (48%) or Asian (42%). Most GI hospitalists spent at least half of their clinical time dedicated to the inpatient consultation service (73%), during which they had no other clinical duties. Most services had endoscopy suites with dedicated inpatient endoscopy rooms (66%), over 4h allotted for procedures (83%), and were available on weekends (62%). Over half of GI hospitalists reported having outpatient duties, the most common being performance of direct access endoscopy (69%). Outside of clinical responsibilities, GI hospitalists were most frequently involved in clinical education or fellowship program leadership (48%). Most GI hospitalists were salaried with an incentive-based bonus based on work relative value units. GI hospitalist programs are varied throughout the USA but key commonalities exist between most programs.

Rising vasectomy volume following reversal of federal protections for abortion rights in the United States.

In June 2022 the United States Supreme Court issued a ruling in the case Dobbs v. Jackson that overturned Roe v. Wade, the 1973 ruling establishing a federally protected right to abortion in the United States. Anecdotal reports suggested increased vasectomy volume following this event; however, no published data exist. We sought to describe trends in vasectomy consultation before and after the Dobbs v. Jackson ruling (referred to as pre- and post-Dobbs herein). Following IRB approval, we reviewed charts of all adults seeking vasectomy consultation in July-August 2021 and July-August 2022 at a large healthcare organization. We then aggregated vasectomy procedural billing data from 2018 to present. The primary outcome was volume of vasectomy consultation appointments and the secondary outcome was number of vasectomies performed. In July-August 2021 (Pre-Dobbs), 116 men attended vasectomy consultation versus 142 men in July-August 2022 (Post-Dobbs). Median age Post-Dobbs was significantly younger than Pre-Dobbs (35 vs 38 years, respectively, p = 0.01) with a significant increase in Post-Dobbs men under 30 seeking vasectomy (p = 0.005). A total of 16.9% (24/142) of Post-Dobbs men were childless, compared to 8.6% (10/116) of Pre-Dobbs men (p = 0.05). Of those with children, median number of offspring was unchanged at 2. Billing data showed a significant increase in vasectomy procedural volumes Post-Dobbs. While overturning Roe v Wade directly impacted female reproductive rights, number of vasectomy consultations and procedures increased significantly following this decision. Younger men, especially those under 30, as well as childless men were significantly more likely to seek consultation Post-Dobbs compared to the prior reproductive legal climate. While longer-term data are needed, findings indicate that men are invested in maintaining reproductive autonomy for themselves and their partners.

Gender Disparities in Critical Care Procedure Training of Internal Medicine Residents.

Procedural training is a required competency in internal medicine (IM) residency, yet limited data exist on residents' experience of procedural training. We sought to understand how gender impacts access to procedural training among IM residents. A mixed-methods, explanatory sequential study was performed. Procedure volume for IM residents between 2016 and 2020 was assessed at two large academic residencies (Program A and Program B: 399 residents and 4,020 procedures). Procedural rates and actual versus expected procedure volume by gender were compared, with separate analyses by clinical environment (intensive care unit [ICU] or structured procedural service). Semistructured gender-congruent focus groups were conducted. Topics included identity formation as a proceduralist and the resident procedural learning experience, including perceived gender bias in procedure allocation. Compared with men, women residents performed disproportionately fewer ICU procedures per month at Program A (1.4 vs. 2.7; P < 0.05) but not at Program B (0.36 vs. 0.54; P = 0.23). At Program A, women performed only 47% of ICU procedures, significantly fewer than the 54% they were expected to perform on the basis of their time on ICU rotations (P < 0.001). For equal gender distribution of procedural volume at Program A, 11% of the procedures performed by men would have needed to have been performed by women instead. Gender was not associated with differences in the Program A structured procedural service (53% observed vs. 52% expected; P = 0.935), Program B structured procedural service (40% observed vs. 43% expected; P = 0.174), or in Program B ICUs (33% observed vs. 34% expected; P = 0.656). Focus group analysis identified that women from both residencies perceived that assertiveness was required for procedural training in unstructured learning environments. Residents felt that gender influenced access to procedural opportunities, ability to self-advocate for procedural experience, identity formation as a proceduralist, and confidence in acquiring procedural skills. Gender disparities in access to procedural training during ICU rotations were seen at one institution but not another. There were ubiquitous perceptions that assertiveness was important to access procedural opportunities. We hypothesize that structured allocation of procedures would mitigate disparities by allowing all residents to access procedural training regardless of self-advocacy. Residency programs should adopt structured procedural training programs to counteract inequities.

Correlation of Relative Value Units With Surgical Complexity and Physician Workload: A Contemporary Nationwide Analysis of Orthopaedic Procedures.

Although previous studies have demonstrated inconsistencies between surgeon work and reimbursement, no previous study has calculated expected relative value units (RVUs) based on procedure-specific variables. Our study aimed to evaluate how measures of physician workload and surgical complexity correlate with the work RVUs (wRVUs) assigned to orthopaedic procedures and compare our predicted wRVUs with actual wRVUs. The National Surgical Quality Improvement Program was used to identify orthopaedic surgeries with the highest procedural volume in 2019. For each Current Procedural Terminology (CPT) code, variables related to surgical complexity and postoperative management were retrieved. A multivariable linear regression was conducted, and R 2 values were calculated. A total of 229,792 cases from the top 20 CPT codes by frequency in 2019 were identified. Base RVU values ranged from 7.03 mRVUs for arthroscopic meniscectomy to 30.28 mRVUs for revision total hip arthroplasty. A total of 15 (75%) of the projected mRVUs were lower than the actual mRVU of the procedure. For the 5 (25%) procedures with mRVU projections higher than actual values, the largest differences were seen for CPT codes 29,888 (arthroscopic anterior cruciate ligament [ACL] repair; difference: 7.81), 22,630 (posterior arthrodesis of the lumbar interbody; difference: 7.75), and 27,487 (revision total knee arthroplasty; difference: 4.04). Our analysis demonstrates that current orthopaedic wRVUs do not appropriately compensate for objective measures of overall complexity as it relates to each procedure. Significant undercompensation in projected RVUs was noted for several high-volume orthopaedic procedures including arthroscopic ACL repair and revision total knee arthroplasty.

Surgical Trends for Managing Knee Osteonecrosis: A 2010 to 2020 United States Nationwide Study

BackgroundKnee osteonecrosis (ON) is rare, with an estimated incidence of 0.01-0.17 per 1,000 person years. Our study aimed to do the following: 1) quantify total operative procedures with rates normalized to the United States population; 2) compare arthroplasty versus joint-preserving procedural trends; and 3) determine rates of specific operative techniques/demographics in patients aged <50 versus >50 years. MethodsUsing a nationwide database, 8,269 patients diagnosed with knee ON underwent surgical treatment from 2010 to 2020. Documented surgical procedures included total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and core decompression. Primary outcomes included procedural utilization with subanalyses comparing arthroplasty versus joint-preserving procedures, and age-stratified by under/over 50 years. Linear regressions were evaluated for trends in procedural volumes over time. ResultsFrom 2010 to 2014, 0.54% of all knee procedures were to treat ON compared to 0.71% from 2015 to 2020 (P < .001). Overall rates of TKA (85.4%) and UKA (10.3%) far exceeded rates of joint preserving procedures (4.3%). Comparing 2010-2014 with 2015-2019, joint-preserving procedures proportionally increased (0.7 to 5.0%, P < .001). Patients <50 years had significantly more joint-preserving procedures (19.5 versus 2.7%). Overall, TKA was the most common procedure (7,062; 85.40%), following by UKA 853; 10.32%) and core decompression (354; 4.28%). ConclusionTo our knowledge, this is the first study to characterize surgical trends in management of knee ON. Overall surgical volume for knee ON has continued to increase, outpacing population growth. Patients who have knee ON are most commonly managed with arthroplasty procedures, specifically TKA. Younger aged patients (<50 years) are more likely to undergo joint-preserving procedures, namely core decompression.

Met and Unmet Need for Pediatric Surgical Access in Uganda: A Country-Wide Prospective Analysis

IntroductionChildren's surgical access in low and low-middle income countries is severely limited. Investigations detailing met and unmet surgical access are necessary to inform appropriate resource allocation. Materials and methodsSurgical volume, outcomes, and distribution of pediatric general surgical procedures were analyzed using prospective pediatric surgical databases from four separate regional hospitals in Uganda. The current averted burden of surgical disease through pediatric surgical delivery in Uganda and the unmet surgical need based on estimates from high-income country data was calculated. ResultsA total of 8514 patients were treated at the four hospitals over a 6-year period corresponding to 1350 pediatric surgical cases per year in Uganda or six surgical cases per 100,000 children per year. The majority of complex congenital anomalies and surgical oncology cases were performed at Mulago and Mbarara Hospitals, which have dedicated pediatric surgical teams (P < 0.0001). The averted burden of pediatric surgical disease was 27,000 disability adjusted life years per year, which resulted in an economic benefit of approximately 23 million USD per year. However, the average case volume performed at the four regional hospitals currently represents 1% of the total projected pediatric surgical need. ConclusionsThis investigation is one of the first to demonstrate the distribution of pediatric surgical procedures at a country level through the use of a prospective locally created database. Significant disease burden was averted by local pediatric and adult surgical teams, demonstrating the economic benefit of pediatric surgical care delivery. These findings support several ongoing strategies to increase pediatric surgical access in Uganda.

Retina Procedure Volume Changes during the COVID-19 Pandemic

Retina Procedure Volume Changes during the COVID-19 Pandemic

Global trends in training and credentialing guidelines for gastrointestinal endoscopy: a systematic review.

Background and study aims Credentialing, the process through which an institution assesses and validates an endoscopist's qualifications to independently perform a procedure, can vary by region and country. Little is known about these inter-societal and geographic differences. We aimed to systematically characterize credentialing recommendations and requirements worldwide. Methods We conducted a systematic review of credentialing practices among gastrointestinal and endoscopy societies worldwide. An electronic search as well as hand-search of World Endoscopy Organization members' websites was performed for credentialing documents. Abstracts were screened in duplicate and independently. Data were collected on procedures included in each document (e. g. colonoscopy, ERCP) and types of credentialing statements (procedural volume, key performance indicators (KPIs), and competency assessments). The primary objective was to qualitatively describe and compare the available credentialing recommendations and requirements from the included studies. Descriptive statistics were used to summarize data when appropriate. Results We screened 653 records and included 20 credentialing documents from 12 societies. Guidelines most commonly included credentialing statements for colonoscopy, esophagogastroduodenoscopy (EGD), and ERCP. For colonoscopy, minimum procedural volumes ranged from 150 to 275 and adenoma detection rate (ADR) from 20 % to 30%. For EGD, minimum procedural volumes ranged from 130 to 1000, and duodenal intubation rate of 95 % to 100%. For ERCP, minimum procedural volumes ranged from 100 to 300 with selective duct cannulation success rate of 80 % to 90 %. Guidelines also reported on flexible sigmoidoscopy, capsule endoscopy, and endoscopic ultrasound. Conclusions While some metrics such as ADR were relatively consistent among societies, there was substantial variation among societies with respect to procedural volume and KPI statements.

TRENDS IN THE SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURE OVER THE LAST 20 YEARS

Proximal humerus fractures (PHF) are common, accounting for approximately 5% of all fractures. Approximately 30% require surgical intervention which can range from open reduction with internal fixation (ORIF) to shoulder arthroplasty (including hemiarthroplasty, total shoulder arthroplasty, (TSA) or reverse total shoulder arthroplasty (RTSA)). The aim of this study was to assess trends in operative interventions for PHF in an Australian population.Data was retrospectively collected for patients diagnosed with a PHF and requiring surgical intervention between January 2001 and December 2020. Data for patients undergoing ORIF were extracted from the Medicare database, while data for patients receiving arthroplasty for PHF were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).Across the study period, ORIF was the most common surgical procedure for management of PHFs. However, since 2019, RTSA has surpassed ORIF as the most common surgical procedure to treat PHFs, accounting for 51% of operations. While the number of RTSA procedures for PHF has increased, ORIF and shoulder hemiarthroplasty has significantly reduced since 2007 (p &lt; 0.001). TSA has remained uncommon across the follow-up period, accounting for less than 1% of all operations. Patients younger than 65 years were more likely to receive ORIF, while those aged 65 years or greater were more likely to receive hemiarthroplasty or RTSA.While the number of ORIF procedures has increased during the period of interest, it has diminished as a proportion of overall procedure volume. RTSA is becoming increasingly popular, with decreasing utilization of hemiarthroplasty, and TSA for fracture remaining uncommon. These trends provide information that can be used to guide resource allocation and health provision in the future. A comparison to similar data from other nations would be useful.