Surgeon-specific Data Research Articles

Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP-P Database.

Microtia and anotia repair require techniques that consider both aesthetics and function. The outcomes of different reconstructive frameworks such as costal cartilage or a porous polyethylene implant have not been evaluated on a national scale. We aim to understand differences in outcomes/complication rates and operative times between different reconstructive frameworks used in microtia/anotia reconstruction. This was a retrospective review of the National Surgical Quality Improvement Program Pediatric database between 2012-2019. Patients with ICD-9/10 codes for microtia/anotia were isolated. Reconstruction methods were identified using CPT codes for rib graft, ear cartilage graft, and alloplastic implants (biocompatible implants, porous polyethylene, etc). Outcomes included operative-time, wound complications, and unplanned re-operations within 30 days of surgery. Multivariable logistic regression was performed to control for confounders. We included 593 patients for analysis. Reconstruction with rib grafts (N = 506, 85%) was the most common. In 58 patients (9.8%), an implant was used for the auricular framework, whereas in 47 (7.9%) ear cartilage grafts were used. The overall wound complication rate was 3.4%. On univariate analysis, alloplastic implants exhibited a higher rate of wound complications (8.6% vs. 2.8%, p = 0.037) and longer operative times (350 min vs. 235 min, p < 0.001). After controlling for demographics and comorbidities, implants conferred an independently increased risk of wound complications (OR 3.52, 1.10-9.54, p = 0.020). Although the use of alloplastic implants (e.g., porous polyethylene) may confer an increased risk of early complications, the long-term clinical implications of these findings are unclear relative to aesthetic benefits. Multi-institutional studies are needed to validate these findings using patient-specific and surgeon-specific data. 3 Laryngoscope, 134:1214-1219, 2024.

10Years of the German Arthroplasty Registry-EPRD: what has been achieved?

The German Arthroplasty Registry (EPRD) has been accumulating data on hip and knee arthroplasty procedures for 10years. Even though the EPRD is avoluntary registry, it currently includes more than 2million documented surgical procedures in Germany. This ranks the EPRD as the third largest registry in the world. The highly granular classification of the EPRD product database, which currently includes more than 70,000components, is set to become the international standard. The linkage of hospital case data with specific implant component data and routine data from health insurance providers enables robust arthroplasty survival analyses. This provides hospitals, manufacturers, and the specialist community with access to specific results that contribute to improving arthroplasty quality. The registry is gaining increasing international recognition by publishing in peer-reviewed journals. An application procedure also allows "third-party" data access. Furthermore, the EPRD has also established an early warning system to detect anomalies in outcome. Software-based detection of potential implant component mismatches allows notification of hospitals concerned. In 2023, the EPRD will trial extending its data collection to include patient satisfaction surveys (i.e., patient-reported outcome measures), and subsequently to surgeon-specific data.

Impact of PhD Degree Versus Non-PhD Research Fellowship on Future Research Productivity Among Academic Cardiothoracic Surgeons.

A PhD degree can offer significant research experience, but previous studies yielded conflicting conclusions on the relationship between a PhD degree and future research output. We compared the impact of a PhD degree versus research fellowship(RF) training on research productivity in cardiothoracic surgeons, hypothesizing that training pathways may influence potential associations. CT surgeons practicing at all accredited United States CT surgery training programs in 2018 who pursued dedicated time for research (n = 597), including earning a PhD degree (n = 92) or completing a non-PhD RF (n = 505), were included. To control for training pathways, we performed subanalyses of U.S. medical school graduates (n = 466) and international medical school graduates (IMGs) (n = 131). Surgeon-specific data were obtained from publicly available sources (e.g., institutional webpages, Scopus). PhD surgeons published greater total papers (68.5 vs. 52.0, p = 0.0179) and total papers per year as an attending (4.6 vs. 3.0, p = 0.0150). For U.S. medical school graduates, there were 40 PhD surgeons and 426 non-PhD RF surgeons; both groups published a similar number of total papers (64.5 vs. 54.0, p = 0.3738) and total papers per year (3.2 vs. 3.0, p = 0.7909). For IMGs, there were 52 PhD surgeons and 79 non-PhD RF surgeons; the PhD surgeons published greater total papers (80.5 vs. 45.0, p = 0.0101) and total papers per year (5.7 vs. 2.7, p = 0.0037). CT surgeons with dedicated research training are highly academically productive. Although a PhD degree may be associated with enhanced career-long research productivity for IMGs, this association was not observed for U.S. medical school graduates.

Complications After Inpatient Laparoscopic Cholecystectomy: Effect of Surgeon Experience, Procedure Volume, and Other Surgeon-Based Characteristics.

Previous studies have examined how factors such as gender, education, type of training (MD or DO), and experience of the treating surgeon affect patient outcomes. We investigated patient complications after elective laparoscopic cholecystectomy based on surgeon characteristics. A Medicare database was used to identify surgeon-specific data. The main outcome measure was the adjusted complication rates (ACR) for individual surgeons as reported by the ProPublica Surgeon Scorecard. Surgeon gender, type of training, medical school rank, years since graduation, procedure volume, and teaching status of the primary hospital affiliation were assessed for any association with increased ACR using logistic regression analysis. We explored the associations among procedure volume, years of experience, and ACR using Spearman correlation. 1107 predominantly male (94.6%) surgeons were included. 94.4% were MDs and 34.5% were affiliated with teaching hospitals. Mean length of practice was 24 ± 9years, and median surgeon procedure volume was 28 (IQR = 23, 37). Overall median ACR was 4.3%. Multivariate analysis demonstrated that surgeon gender (P = .71), medical school rank, type of training (P = .68), or hospital affiliation (P = .77) did not have a significant impact on ACR. Increased surgeons' years in practice (r = -.028, P = .35) and increased surgeon procedure volume (r = -.021, P = .49) were negatively associated with increased ACR. Surgeon gender, type of training, medical school rank, or hospital affiliation had no impact on complications after laparoscopic cholecystectomy. Surgeon experience and procedure volume may have clinical implications for patient outcomes. Further studies to elucidate factors associated with surgeon quality and patient outcomes are necessary.

Abstract 17052: Cardiothoracic Surgeons With a PhD Degree Exhibit Greater Research Productivity

Introduction: A PhD degree can offer significant research experience for academic surgeons. Here, we evaluated the impact of a PhD on research productivity and career advancement in cardiothoracic (CT) surgeons. Methods: All CT surgeons practicing at an accredited United States CT surgery training program in 2018 who earned a PhD or completed a research fellowship during training (RF) were included (n=583). To ensure a more consistent training pathway, we performed a sub-analysis of U.S. medical school graduates (n=456). Surgeon-specific data were obtained from publicly available sources (eg. institutional webpages, Scopus). Results: 92 (15.8%) surgeons obtained a PhD while 491 (84.2%) did not but did a RF (Table 1A). Importantly, attending start year was similar (2005 vs 2005, p=0.5202). As of 2018, PhD surgeons published greater first-author (17.0 vs 12.0, p=0.0079), last-author (12.0 vs 6.0, p=0.0462), and total papers (68.5 vs 52.0, p=0.0148), as well as total papers per year as an attending (4.6 vs 3.0, p=0.0148). However, PhD surgeons took a similar amount of time as non-PhD surgeons who did a RF to become a full professor from the start of their first job (12.0 vs 11.0, p=0.6620). No difference was observed in current academic rank neither (p=0.8047). For U.S. medical school graduates, there were 40 PhD surgeons and 416 non-PhD surgeons who did a RF (Table 1B). Both groups published a similar number of first-author (13.0 vs 13.0, p=0.5379), last-author (12.5 vs 6.0, p=0.0981), total papers (64.5 vs 54.0, p=0.3453), and total papers per year as an attending (3.2 vs 3.0, p=0.7546). Years to full professor were also similar between these two groups (12.0 vs 11.0, p=0.6007) as was current academic rank (p=0.3114). Conclusions: A PhD degree is not associated with faster career advancement but may be associated with enhanced research productivity for some surgeons due to the impact of their medical school training environment.

New Attending Surgeons Hired by Their Training Institution Exhibit Greater Research Productivity

A first attending job often sets the tone for academic surgeons' future careers, and many graduating trainees are faced with the decision to begin their career at their training institution or another institution. We hypothesized that surgeons hired as first-time faculty at their cardiothoracic surgery fellowship institution exhibit greater research productivity and career advancement than those hired as first-time faculty at a different institution. Cardiothoracic surgeons who were listed as clinical faculty at all 77 accredited United States cardiothoracic surgery training programs in 2018 and who trained through the general surgery residency and cardiothoracic surgery fellowship pathway were included (n=904). Surgeon-specific data regarding professional history, publications, and grant funding were obtained from publicly available sources. Of the 904 surgeons, 294 (32.5%) were hired as first-time faculty at their cardiothoracic surgery fellowship institution whereas 610 (67.5%) were hired at a different institution (start year 2005 vs 2006; P= .342). Both groups exhibited similar research productivity upon starting their first job (total papers: 7.0 vs 7.0, P= .591). Followed to the present, surgeons hired at their cardiothoracic surgery fellowship institution produced more total papers (64.5 vs 39.0, P < .001) and exhibited a higher H-index (20.0 vs 14.0, P < .001). Surgeons in both groups required a similar amount of time to achieve associate (P= .208) and full professor (P= .593) ranks. Surgeons hired as first-time faculty at their cardiothoracic surgery fellowship institution may experience benefits to research productivity but not career advancement. Trainees may find it advantageous to begin their careers in a familiar environment where they have already formed a robust specialty-specific network.

The Effect of Feedback on Surgeon Performance: A Narrative Review.

Surgeons play a critical role in the healthcare community and provide a service that can tremendously impact patients' livelihood. However, there are relatively few means for monitoring surgeons' performance quality and seeking improvement. Surgeon-level data provide an important metric for quality improvement and future training. A narrative review was conducted to analyze the utility of providing surgeons direct feedback on their individual performance. The articles selected identified means of collecting surgeon-specific data, suggested ways to report this information, identified pertinent gaps in the field, and concluded the results of giving feedback to surgeons. There is a relative sparsity of data pertaining to the effect of providing surgeons with information regarding their individual performance. However, the literature available does suggest that providing surgeons with individualized feedback can help make meaningful improvements in the quality of practice and can be done in a way that is safe for the surgeons' reputation.

V02-08 SINGLE PORT ROBOTIC ASSISTED LAPAROSCOPIC EXTRAPERITONEAL RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVE: Intuitive introduced Single Port Robotic Assisted Laparoscopic Surgery in 2018. This new technology was a major step forward for single site minimally invasive surgery. It enables multiple instruments with fully wristed motions. The robotic prostatectomy has gained popularity as a minimally invasive surgical technique for the management of prostate cancer due to benefits such as decreased blood loss and patient recovery time. Robotic prostatectomy has been associated with additional cost and time on the operative table. We sought to determine if and how cost and operative time in robotic prostatectomy could be minimized through observation of high-volume surgeons at our institution and present our data in a video format. METHODS: Surgeon specific data provided by the robotic surgery platform at our institution was examined to determine each surgeon`s operative speed, cost per operation, length of stay, and readmission rates following robotic prostatectomy. After determination of high performance in these areas, surgical technique was examined to analyze factors that contributed to the specific surgeon`s high performance. RESULTS: Surgeon specific data is displayed in Figure 1. An observational analysis determined one particular surgeon as an outlier in terms of operative speed and cost while still maintaining excellent outcomes based on length of stay and 30-day readmission rate. Observation of this surgeon`s techniques revealed several time and cost-saving maneuvers. Firstly, multipurpose instruments are utilized to save time and money; for example, the Maryland bipolar forceps are used throughout the case as an electrocautery instrument, grasper, retractor, and needle driver. Specific surgical techniques that reduce operative time were observed, such as forgoing a dorsal vein complex stitch. Additional maneuvers are highlighted in the video. CONCLUSIONS: The techniques documented in our study could benefit the healthcare system by reducing operative costs as well as benefitting patients by reducing time on the operative table while maintaining quality of outcomes, especially as we make the transition to single port robotic surgery.Source of Funding: N/A

How many doctors does it take to manage an elective general surgical patient? Individualised surgeon specific outcomes data misrepresent modern team-centred work practices

Introduction: The recent adoption of publishing surgeon-specific mortality data in some settings has prompted concerns that the complex team working environment is misrepresented. This has led to consideration that outcomes data would be more accurately conveyed if team-based outcomes were published. However, there has been little investigation into what constitutes a clinical team within the surgical setting and if team size increases when providing person-centered care to more complex patients. Here, we seek to address these questions in elective colorectal surgery. Methods: This is a multi-centre retrospective case cohort study. Data were obtained from 3 Scottish sites. All elective colorectal resection procedures within a 2-month period were included. A standardised proforma was used to establish the number of professionals involved in patient care, diagnosis, management and outcome. Data were obtained from referral to discharge from cancer resection. Results: Thirty-eight cases were included. Median age was 69.5, with 63.2% being male. The number of patients with underlying co-morbidities was 15. The mean number of doctors involved in care was 19 (range 26-87). Complications were associated with a larger in-hospital medical team (p <0.001) but there were no differences in team size by co-morbidity status. Conclusion: Our study would suggest that publication of outcomes based upon one named clinician is an oversimplification of modern, person-centered management. The publication of team-based outcomes may both be more transparent with regard to clinical pathways and in turn support individual clinicians. Such reporting may enhance transparency while protecting individuals in an increasing culture of blame.

Deep learning-based preoperative predictive analytics for patient-reported outcomes following lumbar discectomy: feasibility of center-specific modeling

Background ContextThere is considerable variability in patient-reported outcome measures following surgery for lumbar disc herniation. Individualized prediction tools that are derived from center- or even surgeon-specific data could provide valuable insights for shared decision-making. PurposeTo evaluate the feasibility of deriving robust deep learning-based predictive analytics from single-center, single-surgeon data. Study DesignDerivation of predictive models from a prospective registry. Patient SamplePatients who underwent single-level tubular microdiscectomy for lumbar disc herniation. Outcome MeasuresNumeric rating scales for leg and back pain severity and Oswestry Disability Index scores at 12 months postoperatively. MethodsData were derived from a prospective registry. We trained deep neural network-based and logistic regression-based prediction models for patient-reported outcome measures. The primary endpoint was achievement of the minimum clinically important difference (MCID) in numeric rating scales and Oswestry Disability Index, defined as a 30% or greater improvement from baseline. Univariate predictors of MCID were also identified using conventional statistics. ResultsA total of 422 patients were included (mean [SD] age: 48.5 [11.5] years; 207 [49%] female). After 1 year, 337 (80%), 219 (52%), and 337 (80%) patients reported a clinically relevant improvement in leg pain, back pain, and functional disability, respectively. The deep learning models predicted MCID with high area-under-the-curve of 0.87, 0.90, and 0.84, as well as accuracy of 85%, 87%, and 75%. The regression models provided inferior performance measures for each of the outcomes. ConclusionsOur study demonstrates that generating personalized and robust deep learning-based analytics for outcome prediction is feasible even with limited amounts of center-specific data. With prospective validation, the ability to preoperatively and reliably inform patients about the likelihood of symptom improvement could prove useful in patient counselling and shared decision-making.

Identifying Current Trends in the Urologic Oncology Workforce: Does Completion of Fellowship Significantly Change Future Practice?

PurposeTo assess fellowship impact on subsequent practice type and case-mix, we compared urologists who completed a urologic oncology fellowship (OF) to urologists who did not complete a fellowship (NF). Materials and MethodsAnnualized case log data were obtained from the American Board of Urology from 2004 to 2016, including initial certification (C1) and re-certifications 1 (R1) and 2 (R2). We evaluated trends in major urologic oncology case volume using relevant Current Procedural Terminology codes. Surgeon-specific data, including fellowship training, practice type, and practice area population, were analyzed using chi-squared and 2-sample t-tests. ResultsOF (N=338) were more likely than NF (N=7,785) to practice in larger population areas (p<0.001), and practice in academics (p<0.001). OF performed nearly three times as many major oncology cases as NF at each certification cycle (C1: 29.7 vs 12.5, R1: 32.3 vs 13.5, R2: 30.5 vs 11.5; p<0.001 for all), and maintained case volumes over time. OF performed significantly more major cases in kidney, bladder, and prostate cancer across all certification time points than NF, and continued to perform these cases at similar frequency at all certification cycles. Moreover, during the time period studied, OF performed an increasing percentage of overall major oncologic cases (from 8.9% in 2004 to 13.3% by 2016). ConclusionsCompletion of urologic oncology fellowship is associated with performing and maintaining a high volume of major oncology cases over recertification cycles, with academic practice, and with practicing in large population centers. This information may be useful to urology residents considering OF opportunities.

Meta-Analysis of Surgeon Burnout Syndrome and Specialty Differences

Surgeon burnout compromises the quality of life of physicians and the delivery of care to patients. Burnout rates and interpretation of the Maslach Burnout Inventory (MBI) complicates the interpretation of surgeon burnout. The purpose of this study is to apply a standardized interpretation of severe surgeon burnout termed, "burnout syndrome" to analyze inherent variation within surgical specialties. A systematic literature search was performed using MEDLINE, PsycINFO, and EMBASE to identify studies reporting MBI data by surgical specialty. Data extraction was performed to isolate surgeon specific data. A meta-analysis was performed. A total of 16 cross-sectional studies were included in this meta-analysis, totaling 3581 subjects. A random effects model approximated burnout syndrome at 3.0% (95% CI: 2.0%-5.0%; I2 = 78.1%). Subscale analysis of emotional exhaustion, depersonalization, and personal accomplishment indicated subscale burnout in 30.0% (CI: 25.0%-36.0%; I2 = 93.2%), 34.0% (CI: 25.0%-43.0%; I2 = 96.9%), and 25.0% (CI: 18.0%-32.0%; I2 = 96.5%) of surgeons, respectively. Significant differences (p < 0.001) in MBI subscale scoring existed among surgical specialties. Approximately 3% of surgeons suffer from extreme forms of burnout termed "burnout syndrome," although surgeon burnout may occur in up to 34% of surgeons, characterized by high burnout in 1 of 3 subscales. Surgical specialties have significantly different rates of burnout subscales. Future burnout studies should target the specialty-specific level to understand inherent differences in an effort to better understand methods of improving surgeon burnout.

Facteurs de risque de défaut de fixation d’un implant acétabulaire press-fit dans l’arthroplatie totale de hanche

BackgroundSurgeon at primary total hip arthroplasty, sometimes cannot achieve sufficient cementless acetabular press-fit fixation and must resort to other fixation methods. Despite a predominant use of cementless cups, this issue is not fully clarified, therefore we performed a large retrospective study to: (1) identify risk factors related to patient or implant or surgeon for unsuccessful intraoperative press-fit, (2) check for correlation between surgeons’ volume of operated cases and the press-fit success rate. HypothesisUnsuccessful intra-operative press-fit more often occurs in older female patients, particular implants, due to learning curve and low-volume surgeons. Materials and methodsRetrospective observational cohort of prospectively collected intra-operative data (2009–2016) included all primary total hip arthroplasty patients with implant brands that offered acetabular press-fit fixation only. Press-fit was considered successful if acetabulum was of the same implant brand as the femoral component without additional screws or cement. Logistic regression models for unsuccessful acetabular press-fit, included patients’ gender/age/operated side, implant, surgeon approach (posterior n=1206, direct-lateral n=871) and surgery date (i.e. learning curve). ResultsIn 2077 patients (mean 65.5years, 1,093 females, 1,163 right hips) were implanted three different implant brands (973 ABG-II™-Stryker, 646 EcoFit™Implantcast, 458 Procotyl™L-Wright) by eight surgeons. Their unsuccessful press-fit fixation rates ranged from 3.5 % to 23.7 %. Older age (odds ratio 1.01 [95 % CI 0.99–1.02]), female gender (2.87 [95 % CI 2.11–3.91]), right side (1.44 [95 % CI 1.08–1.92]), surgery date (0.90 [95 % CI 1.08–1.92]) and particular implants were significant risk factors only in three surgeons with less successful surgical technique (higher rates of unsuccessful press-fit with Procotyl™-L and EcoFit™ [P=0.01]). Direct-lateral hip approach had a lower rate of unsuccessful press-fit than posterior hip approach (P<0.01) but there was no correlation between surgeons’ volume and rate of successful press-fit (Spearman's rho=0.10, P=0.82). Subcohort of 961 patients with 5–7years, follow-up indicated higher early/late cup revision rates with unsuccessful press-fit. DiscussionSuccess of press-fit fixation depends entirely on the surgeon and surgical approach. With proper operative technique, the unsuccessful press-fit fixation rate should be below 5 % and the impact of patients’ characteristics or implants on press-fit fixation is then insignificant. Findings of huge variability in operative technique between surgeons of the presented study emphasize the need for surgeon-specific data stratification in arthroplasty studies and indicate the possibility of false attribution of clinically observed phenomena to patient-related factors in pooled data of large centres or hip arthroplasty registers. Level of evidenceLevel III, retrospective observational case control study.

Risk factors for unsuccessful acetabular press-fit fixation at primary total hip arthroplasty

BackgroundSurgeon at primary total hip arthroplasty sometimes cannot achieve sufficient cementless acetabular press-fit fixation and must resort to other fixation methods. Despite a predominant use of cementless cups, this issue is not fully clarified, therefore we performed a large retrospective study to: (1) identify risk factors related to patient or implant or surgeon for unsuccessful intraoperative press-fit; (2) check for correlation between surgeons’ volume of operated cases and the press-fit success rate. HypothesisUnsuccessful intra-operative press-fit more often occurs in older female patients, particular implants, due to learning curve and low-volume surgeons. Materials and methodsRetrospective observational cohort of prospectively collected intraoperative data (2009–2016) included all primary total hip arthroplasty patients with implant brands that offered acetabular press-fit fixation only. Press-fit was considered successful if acetabulum was of the same implant brand as the femoral component without additional screws or cement. Logistic regression models for unsuccessful acetabular press-fit included patients’ gender/age/operated side, implant, surgeon, approach (posterior n=1206, direct-lateral n=871) and surgery date (i.e. learning curve). ResultsIn 2077 patients (mean 65.5 years, 1093 females, 1163 right hips), three different implant brands (973 ABG-II™-Stryker, 646 EcoFit™ Implantcast, 458 Procotyl™ L-Wright) were implanted by eight surgeons. Their unsuccessful press-fit fixation rates ranged from 3.5% to 23.7%. Older age (odds ratio 1.01 [95% CI: 0.99–1.02]), female gender (2.87 [95% CI: 2.11–3.91]), right side (1.44 [95% CI: 1.08–1.92]), surgery date (0.90 [95% CI: 1.08–1.92]) and particular implants were significant risk factors only in three surgeons with less successful surgical technique (higher rates of unsuccessful press-fit with Procotyl™-L and EcoFit™ [P=0.01]). Direct-lateral hip approach had a lower rate of unsuccessful press-fit than posterior hip approach (P<0.01), but there was no correlation between surgeons’ volume and rate of successful press-fit (Spearman's rho=0.10, P=0.82). Subcohort of 961 patients with 5–7-years follow-up indicated higher early/late cup revision rates with unsuccessful press-fit. DiscussionSuccess of press-fit fixation depends entirely on the surgeon and surgical approach. With proper operative technique, the unsuccessful press-fit fixation rate should be below 5% and the impact of patients’ characteristics or implants on press-fit fixation is then insignificant. Findings of huge variability in operative technique between surgeons of the presented study emphasize the need for surgeon-specific data stratification in arthroplasty studies and indicate the possibility of false attribution of clinically observed phenomena to patient-related factors in pooled data of large centers or hip arthroplasty registers. Level of evidenceLevel III, retrospective observational case control study.

PD32-10 DATA FEEDBACK AFFORDS MODEST EFFECT IN DRIVING PHYSICIAN BEHAVIOR TOWARD VALUE-BASED CARE FOR BPH SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures III1 Apr 2017PD32-10 DATA FEEDBACK AFFORDS MODEST EFFECT IN DRIVING PHYSICIAN BEHAVIOR TOWARD VALUE-BASED CARE FOR BPH SURGERY Alan L Kaplan, Vishnukamal Golla, Catherine M. Crespi, Jamal Nabhani, Mark S. Litwin, and Christopher Saigal Alan L KaplanAlan L Kaplan More articles by this author , Vishnukamal GollaVishnukamal Golla More articles by this author , Catherine M. CrespiCatherine M. Crespi More articles by this author , Jamal NabhaniJamal Nabhani More articles by this author , Mark S. LitwinMark S. Litwin More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For provider organizations transitioning to value-based care models, physician engagement and support in testing new models is critical. Little is known about how to optimally engage physicians in these activities, which simultaneously target cost and quality of care. To test whether individualized physician feedback would improve adherence to a value-based care pathway, we gave quarterly surgeon-specific feedback on outcomes, practice patterns, and cost data. We hypothesized that value-based care pathway (VBCP) adherence would modestly increase. METHODS We studied men undergoing surgery for uncomplicated BPH at our institution between March 1, 2013 and December 17, 2015. In April 2014, we defined and introduced a value-based care pathway (VBCP) for BPH to surgeons in our department. Physicians confidentially received their outcomes, cost, and practice pattern data compared to de-identified colleague data in a quarterly email from the Department leadership. Rates of pathway adherence were measured pre- and post-intervention. We used t-tests for physician-level evaluation using the physician as the unit of analysis. A multilevel logistic regression model was fit for patient-level analyses using random intercepts for the physician. RESULTS There were 225 patients with complete data available representing 18 treating urologists. Two value-based pathways were used for analysis. The AUA recommended pathway requires PSA testing when indicated, urinalysis, and post-void residual (PVR) measurement, but is silent on surgery type or preoperative invasive testing. The VBCP requires in addition that cystoscopy or urodynamics are not performed preoperatively and bipolar transurethral resection/vaporization is the operation of choice. In the physician-level analysis, AUA recommended compliance increased from 1.8% to 9.2% (p=0.02) while increasing from 3.5% to 11.8% (p=0.03) in the patient-level analysis. VBCP compliance increased from 0% to 5% in physician-level (p=0.002) and patient-level (p=0.03) analyses. CONCLUSIONS Surgeon-specific data feedback, in isolation, very modestly drove physician behavior toward value-based care models for BPH surgery. VBCP adherence remained low throughout the study period. Further studies are needed to better understand whether physician-identified reporting of data or financial incentives might facilitate the transition to value-based care in urologic surgery. © 2017FiguresReferencesRelatedDetailsCited byAksenov L, Fairchild R, Kaplan S, Scales C and Routh J (2022) Behavioral Economics in Urology: A Scoping ReviewJournal of Urology, VOL. 207, NO. 6, (1193-1199), Online publication date: 1-Jun-2022. Volume 197Issue 4SApril 2017Page: e592 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alan L Kaplan More articles by this author Vishnukamal Golla More articles by this author Catherine M. Crespi More articles by this author Jamal Nabhani More articles by this author Mark S. Litwin More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The value of surgeon-specific outcome data: results of a questionnaire.

The publication of surgeon-specific data has been controversial. To assess the profession's opinion, a forum was organized at the 2015 EACTS meeting followed by a questionnaire of the value of surgeon-specific outcome and its impact. A series of presentations were made including assessments of quality and safety in one major European country, the relationship between volume and outcome, the role of guidelines, the effect of publication of results on training, and discussion for and against publication of surgeon-specific data. A questionnaire was given to all attendees at the forum on the value of surgeon-specific data and their impact on the specialty. The questionnaire was completed by 118 attendees. Of the total, 69% felt that mortality is a surrogate for quality and that it should be reported at the hospital and unit level as opposed to the individual surgeon level, but 81% wished there were different criteria for quality outcome. Of the total, 91% felt that the individual surgeons' data should be collected but not published in public portals, and that publication produces risk-averse behaviour; 65% felt that it hinders innovation; 86% felt that EuroSCORE II is not reliable in identifying high-risk patients and the same number felt that it has affected entry into the specialty. The information that is collectable will be published, but we can control the way in which it is published and presented.

Online Patient Ratings of Hand Surgeons: N/A - Not a clinical study

The primary aim of this study was to evaluate online patient ratings (OPRs) of hand surgeons. We hypothesized that (1Kadry B. Chu L.F. Kadry B. Gammas D. Macario A. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating.J Med Internet Res. 2011; 13: e95Crossref PubMed Scopus (191) Google Scholar) the majority of hand surgeons would be rated online, (2Emmert M. Meier F. Heider A.K. Durr C. Sander U. What do patients say about their physicians? An analysis of 3000 narrative comments posted on a German physician rating website.Health Policy. 2014; 118: 66-73Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar) surgeons with greater online presence would have higher OPRs, and (3Hanauer D.A. Zheng K. Singer D.C. Gebremariam A. Davis M.M. Public awareness, perception, and use of online physician rating sites.JAMA. 2014; 311: 734-735Crossref PubMed Scopus (265) Google Scholar) positive comments posted on rating websites would more likely reflect surgeon-dependent factors, while negative comments would more likely reflect surgeon-independent factors. 250 US hand surgeons were randomly selected from the ASSH online member directory. We reviewed surgeon profiles on three of the most commonly visited OPR websites: HealthGrades.com, Vitals.com and RateMDs.com [1]. Written comments were categorized into 6 groups: professional competence, communication, cost, overall assessment, staff and office practice [2]. Surgeon-specific data were also collected from Google, Facebook and Twitter. Independent sample t tests were used to compare OPRs between surgeons who had a website, Facebook or Twitter page. One way ANOVA was used to analyze the mean number of written comments between groups. Analyses were conducted with SPSS version 22.0. 250 hand surgeons from 43 states were included in this study. 245 hand surgeons (98%) had at least one OPR among the three websites. The number and magnitude of OPRs are presented in Figure 1. When Google searching hand surgeons, the mean number of top 10 results dedicated to OPR websites was 3.4. 220 hand surgeons (88%) had a professional website. Links to professional Facebook and Twitter pages were listed on 113 (45%) and 50 (20%) surgeon websites, respectively. Surgeons with an increased online presence (i.e. website, Facebook or Twitter pages) had significantly higher OPRs on RateMDs.com (P < 0.01, 0.02, 0.02, respectively) and Vitals.com (P < 0.01, 0.80, 0.08, respectively). Positive online comments were found to be more likely associated with surgeon-dependent factors (i.e. clinical outcomes), while negative comments more likely reflected surgeon-independent factors (e.g. wait time, office staff, cost) (Figure 2). •OPR websites are increasingly utilized by patients to inform decision-making, despite potential concerns regarding validity [3-6].•OPR websites feature prominently on Google and 98% of hand surgeons are reviewed online.•This is the first study to evaluate hand surgeon OPRs, assess factors associated with positive OPRs in orthopedic surgeons, and/or correlate physician online presence with OPRs.•This is the first study to distinguish between physician-dependent and physician-independent factors with respect to positive and negative written OPRs, respectively. This finding highlights a fundamental difference in how patients and physicians assess care quality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

OC-058 A survey of surgeon specific outcome data and their potential impact on surgical training

Introduction The publication of surgeon specific data (SSD) for general surgeons at the end of 2013 started a new era in surgery in the UK. It is not known if and how this will impact surgical practice and training particularly with respect to high-risk cases. We aimed to explore the consultants’ perception and their potential changes in their practice as a result of SSD publication. Method A cross sectional on-line survey was sent to a sample of General Surgeons with an interest in Upper GI surgery. Details of their current surgical practice and their opinions on the changes they would make in clinical practice and training were collected. Questions were themed and data analysed both qualitatively and quantitatively. Results Eighty nine surgeons responded to the questionnaire. Of those 61 (68.5%) were cancer surgeons and 28 (31.5%) described themselves as a benign (including bariatric) surgeon. Thirty six (40%) surgeons considered SSD to be of no benefit at all to surgical training while 21 (23.5%) thought there will be some useful effect. Asked whether there was any negative effect on training, 33 surgeons (37%) thought there will be a detrimental effect on surgical training in general, and 25 (75%) of those thought this effect will be mainly on complex cases. However, when asked to specify the negative effects on surgical training 55 (73%) of the group said the number of complex operations done by trainees will drop and 35 (46%) thought the number of all operation done by trainees will drop. A significant point was the attitude toward trainees where 32 (36%) surgeons said they will perform major or complex cases themselves with 13 (14%) choosing the option of performing all cases themself. Upon asking about any general changes to practice, 11 (12.5%) said they will give up or reduce high risk surgery and 32 (36%) thought their practice will not change. Regarding the patients’ outcome 49 (55%) thought that SSD will improve outcomes while 40 (45%) answered that they will not change outcomes. Qualitative assessment, using content analysis technique, showed a minority of the surgeons will either avoid training their trainees in high risk patients and/or avoid high risk cases in order to maintain their SSD data reputation. Conclusion The publication of surgeons’ specific data will result in some changes to general surgical practice. It is too early to decide whether these effects are good for training, however, if these initial opinions are applied to routine practice then trainees may be faced with large scale reductions in training cases particularly those of a complex nature that would have major ramifications on surgical training. As the shape of surgical training continues to be developed it is important that the implications of SSD on surgical training are considered. Disclosure of interest None Declared.

PWE-267 Has the publication of surgeon specific data adversely affected older patients?

Introduction The Association of Coloproctology first published surgeon specific outcome data in September 2013. There has been some concern this may lead to surgeons refusing to operate on higher risk patients. Furthermore, Published by the Royal College of Surgeons of England, “Access Ages 2” suggests that there is a marked decline in rates of elective surgery in over 65s. It described a 9 fold difference in the rate of colorectal cancer excision for over 75s depending on where the patient lives. We hypothesised that concern over poor outcomes may lead to a reduction in the age of patients offered elective colorectal cancer excision. Method Data was prospectively collected on all patients undergoing elective colorectal cancer resections in our unit. We compared the patient selection for one year before and after publication of surgeon specific data. Results In the 12 months prior to publication of surgeon specific data, our Unit (4 Consultant Colorectal Surgeons) operated on 114 patients with a median age of 71 (IQR 63–77.5), compared to 84 patients with a median age of 72.5 (65–77) for the subsequent 12 months (p = 0.351, Mann-Whitney). There were more patients in the 75–85 age range than in the 65–75 range. The comorbidities identified in both groups were comparable. Conclusion There was no difference in the age group of patients offered elective surgery following the publication of surgeon specific outcome data. Fears that the publication may lead to older patients being denied surgery were unfounded. Disclosure of interest None Declared. Reference http://www.rcseng.ac.uk/news/docs/access-all-ages-2

Delivering individual surgeon performance data through a statewide surgical quality improvement collaborative

METHODS: An established collaborative generated a surgeon specific data set based on four quarters data from 2012 to 2013. There were 470 surgeons, 394 with sufficient data (>10 cases, expected risk >0) to analyze. Data was reported as exemplars (significantly lower observed to expected adverse occurrences) or outliers (significantly higher observed to expected occurrences). Prospective analysis verified this approach would be sufficiently powered and Poisson distributions were assumed. The model sufficiently accounts for procedure risk with breast surgery as below par risk and esophagectomy at highest.