Surgery Attendings Research Articles

Essential Elements in Synoptic Operative Reports for Hepato-Pancreato-Biliary Cancer Surgery: An HPB/CGSO Training Program Survey.

Synoptic operative reports (SORs) are checklists or templates that contain standardized elements of an operation. These elements are associated with standardized inclusion of critical elements of the operative report that translate into numerous potential benefits. Whereas SORs for melanoma, breast, and colorectal cancer surgery have already been widely implemented, similar templates for hepato-pancreato-biliary (HPB) cancer surgery are currently lacking. An anonymous voluntary online survey was distributed to HPB attendings and fellows at HPB and complex general surgical oncology (CGSO) fellowship programs. The 54 participants in this study comprised 31 (57%) HPB surgery attendings, 15 (28%) HPB surgery fellows, and 8 (15%) CGSO fellows. Notably, only six (11%) participants reported consistent use of an HPB SOR. The most commonly reported barriers to SOR uptake were the "lack of a readily available template" (55%) and the "lack of consensus/guidelines" (49%). Despite these limiting factors, a majority of respondents indicated a strong willingness to use a standardized and readily available HPB SOR (mean, 4.13/5 ± 1.23). This interest did not differ between attendings and fellows (p = 0.52) or between the participants stratified by surgical experience (p = 0.58).Finally, the participants were provided a comprehensive list of possible elements to incorporate into a standardized pancreatic and hepatobiliary SOR. After the exclusion of elements with less than 75% agreement, the pancreatic SORs included 17 (57%) of 30 possible elements, and the hepatobiliary SORs included 19 (76%) of 25 possible elements. Broad consensus on several elements of the HPB SOR suggests that uptake should be accelerated in HPB surgery.

Surgical site infection surveillance in knee and hip arthroplasty: optimizing an algorithm to detect high-risk patients based on electronic health records

BackgroundSurgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty.MethodsRetrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated.ResultsIn total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients’ median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation.ConclusionsDifferent algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.

AI Versus MD: Evaluating the surgical decision-making accuracy of ChatGPT-4

BackgroundChatGPT-4 is a large language model with possible applications to surgery education The aim of this study was to investigate the accuracy of ChatGPT-4’s surgical decision-making compared with general surgery residents and attending surgeons. MethodsFive clinical scenarios were created from actual patient data based on common general surgery diagnoses. Scripts were developed to sequentially provide clinical information and ask decision-making questions. Responses to the prompts were scored based on a standardized rubric for a total of 50 points. Each clinical scenario was run through Chat GPT-4 and sent electronically to all general surgery residents and attendings at a single institution. Scores were compared using Wilcoxon rank sum tests. ResultsOn average, ChatGPT-4 scored 39.6 points (79.2%, standard deviation ± 0.89 points). A total of five junior residents, 12 senior residents, and five attendings completed the clinical scenarios (resident response rate = 15.9%; attending response rate = 13.8%). On average, the junior residents scored a total of 33.4 (66.8%, standard deviation ± 3.29), senior residents 38.0 (76.0%, standard deviation ± 4.75), and attendings 38.8 (77.6%, standard deviation ± 5.45). ChatGPT-4 scored significantly better than junior residents (P = .009) but was not significantly different from senior residents or attendings. ChatGPT-4 was significantly better than junior residents at identifying the correct operation to perform (P = .0182) and recommending additional workup for postoperative complications (P = .012). ConclusionChatGPT-4 performed superior to junior residents and equivalent to senior residents and attendings when faced with surgical patient scenarios. Large language models, such as ChatGPT, may have the potential to be an educational resource for junior residents to develop surgical decision-making skills.

The Impact of Financial Education on Stress Among Orthopaedic Surgeons.

Financial stress has been an increasing area of concern for residents and attendings. The primary goal of this study was to determine the financial education level and differentiate financial outcome measures of orthopaedic surgery residents and attendings. A survey of all residents and attendings of the 201 Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs in the United States. Total participation in the study was 118 residents (postgraduate year (PGY) 1-5), three fellows (PGY6), and 57 attending orthopaedic surgeons. A significant difference existed between average current financial stress scores between residents versus attending (2.32 vs 1.17), but not Doctor of Medicine (MD) versus Doctor of Osteopathic Medicine (DO) attendings (0.96 vs 1.67) and MD versus DO residents (2.25 vs 2.50). There was a significant difference in average future financial stress scores between residents and attendings (1.85 vs 1.44) and MD vs DO residents (1.61 vs 2.25) but no difference between MD vs DO attending (1.31 vs 1.63). Residents' confidence in financial knowledge compared to college graduates had a significantly negative Pearson coefficient with current financial stress score, while the attending group was not significant. Orthopaedic residents and attending physicians' financial stress levels are positively correlated with the amount of student debt they hold. Most residents who currently have no personal finance education offered in their residency would likely attend a personal finance course if offered. Decreasing the amount of debt held by residents, increasing their financial knowledge, and helping them develop good financial habits would likely lead to a decrease in financial stress.

Patient Surgical Outcomes When Surgery Residents Are the Primary Surgeon by Intensity of Surgical Attending Supervision in Veterans Affairs Medical Centers.

Using health records from the Department of Veterans Affairs (VA), the largest healthcare training platform in the United States, we estimated independent associations between the intensity of attending supervision of surgical residents and 30-day postoperation patient outcomes. Academic leaders do not agree on the level of autonomy from supervision to grant surgery residents to best prepare them to enter independent practice without risking patient outcomes. Secondary data came from a national, systematic 1:8 sample of n = 862,425 teaching encounters where residents were listed as primary surgeon at 122 VA medical centers from July 1, 2004, through September 30, 2019. Independent associations between whether attendings had scrubbed or not scrubbed on patient 30-day all-cause mortality, complications, and 30-day readmission were estimated using generalized linear-mixed models. Estimates were tested for any residual confounding biases, robustness to different regression models, stability over time, and validated using moderator and secondary factors analyses. After accounting for potential confounding factors, residents supervised by scrubbed attendings in 733,997 nonemergency surgery encounters had fewer deaths within 30 days of the operation by 14.2% [0.3%, 29.9%], fewer case complications by 7.9% [2.0%, 14.0%], and fewer readmissions by 17.5% [11.2%, 24.2%] than had attendings not scrubbed. Over the 15 study years, scrubbed surgery attendings may have averted an estimated 13,700 deaths, 43,600 cases with complications, and 73,800 readmissions. VA policies on attending surgeon supervision have protected patient safety while allowing residents in selected teaching encounters to have limited autonomy from supervision.

Experiences of LGBTQ + Plastic Surgeons in the US and Canada

Background: The LGBTQ + community faces discrimination within the workplace, with growing evidence emerging about the mistreatment of LGBTQ + surgeon trainees. The purpose of this study was to better understand the experiences of LGBTQ + surgeons in plastic and reconstructive surgery (PRS). Methods: A web-based survey was made available to all plastic surgeons who identified as LGBTQ + across the US and Canada from October 2021 to November 2022. The questionnaire used validated tools assessing “outness” and microaggressions, as well as rates of censorship of speech and/or mannerisms and experiences of discrimination. Outcomes were measured as frequencies and analyzed as a function of location (US vs Canada), gender identity (transgender and gender-diverse (TGD) versus cisgender), and level of training (attending vs in-training). Qualitative responses were also recorded. Results: A total of 43 self-identified LGBTQ + individuals engaged with the survey, 38 of which completed it (88%). Nearly all (96.8%) reported experiencing heteronormative microaggressions, 36.7% reported discrimination from plastic surgery attendings, and 73.3% censor themselves around Plastic Surgery attendings. TGD respondents were more likely to have experienced discrimination than cisgender respondents ( P < .01). One-third (33%) of respondents indicated that they hesitate to be out at their institution for fear of bias and/or discrimination. Conclusion: LGBTQ + plastic and reconstructive surgeons reported a significant amount of microaggressions, self-censorship, and discrimination while at work, and these experiences varied as a function of level of training and gender identity. PRS should strive to eliminate these mistreatments, educate its workforce, and address LGBTQ + underrepresentation within the field.

Working Through the Pain: A Cross-Sectional Survey on Musculoskeletal Pain Among Surgeons and Residents

IntroductionWhile prior studies have reported that over 80% of surgeons report musculoskeletal pain, to our knowledge, the degree of care required to manage these symptoms has not been discussed. Here, we present granular data on musculoskeletal treatment modalities used by surgeons and residents at a single institution. MethodsWe distributed a survey to assess the prevalence of musculoskeletal pain and treatment utilization to surgery attending and residents at a single institution. ResultsFifty-five out of 115 residents and attending (47.8%) responded to our survey. Among the respondents, 87.3% reported pain within the past week and 76.4% (42/55) of respondents required treatment for musculoskeletal pain and injuries: 63.6% had taken over the counter pain medication, 10.9% had taken prescription pain medication, 25.5% required physical therapy, 14.5% required orthopedic surgery, 23.6% made an appointment with a specialist, and 21.8% required additional testing (i.e., imaging, labs). Interestingly, treatment utilization overall and by modality was similar between residents and attending surgeons. ConclusionsOur study mirrors the high prevalence of musculoskeletal pain in surgeons that has been previously reported in the literature. Among survey respondents, 76.5% of surgeons and 76.2% of residents required some form of treatment. These findings suggest a significant burden of musculoskeletal disorders of likely multifactorial etiologies including operating room ergonomics. Therefore, comprehensive ergonomics programs to measure, prevent, and treat musculoskeletal injury may help to fulfill a compelling need to ensure health and career longevity of the surgical workforce.

Chest X-Ray Remains a Vital Component Prior to Tube Thoracostomy.

The identification and treatment of traumatic pneumothorax (PTX) has long been a focus of bedside imaging in the trauma patient. While the emergence of bedside ultrasound (BUS) provides an opportunity for earlier detection, the need for tube thoracostomy (TT) based on bedside imaging, including BUS and supine AP chest X-ray (CXR) is less established in the medical literature. Retrospective data from 2017 to 2020 were collected of all adult trauma activations at a level 1 rural trauma facility. Every adult patient included in this study received a CXR and BUS (eFast) upon arrival. The need for TT was determined by the emergency medicine attending or the trauma surgery attending evaluating the patient. McNemar's chi-squared test and conditional logistic regression analysis were performed comparing BUS, CXR, and the combination of BUS and CXR findings for the need for TT. Subgroup analyses were performed comparing BUS, CXR, and the combination of BUS and CXR for the detection of PTX compared to CT scan. Of the 12,244 patients who underwent trauma activation during this timeframe, 602 were included in the study. 74.9% were males with an age range of 36-63years. Of the 602 patients, 210 received TT. Positive PTX was recorded with BUS in 128 (21%) patients with 16 false negatives (FNs) and 98 false positives (FPs), 100 (17%) PTX were identified with CXR with 114 FNs and 4 FPs, and 72 (11.9%) were noted on both CXR and BUS with 140 FNs and 2 FPs. The odds ratio of TT placement was 22 times with positive BUS alone (P < .0001, 95% CI: 10.9-43.47), 47 times with positive CXR alone (P < .0001, 95% CI: 16.99-127.5), and 70 times with both positive CXR and BUS (P < .0001, 95% CI: 17.08-288.4). A positive finding of PTX on BUS combined with CXR is more indicative of the need for TT in the trauma patient when compared with BUS or CXR alone.

Individual and Program-Related Predictors of Academic Vascular Surgery Practice

Several studies have explored factors affecting academic employment in surgical subspecialties; however, vascular surgery has not yet been investigated. We examined which elements of surgical training predict future academic productivity and studied characteristics of NIH-funded vascular surgery attendings. With approval from the APDVS, the database of recent vascular surgery fellowship (VSF) and integrated vascular surgery residency (IVSR) graduates was obtained, and public resources (Doximity, Scopus, PubMed, NIH, etc.) were queried for research output during and after training, completion of dedicated research years, individual and program NIH funding, current practice setting and academic rank. Adjusted multivariate regression analyses were conducted for postgraduate academic productivity. From 2013-2017, there were 734 graduates. 603 completed VSF and 131 IVSR; 220 (29%) were female. Academic employment was predicted by MD degree, advanced degree, training at a top NIH-funded program, number publications by end of training, and H-index. Dedicated research time before or during vascular training, advanced degree, or graduating from a top NIH-funded program were predictors of publishing >1 paper/year. Number of publications by end of training and years in practice were predictive of H-index ≥5. VSF vs. IVSR pathway did not have an impact on future academic employment, annual publication rate as an attending, or H-index. Characterization of NIH-funded attendings showed that they often completed dedicated research time (72%) and trained at a top NIH-funded program (79%). Mean publications by graduation among this group was 15.82±11.3, and they averaged 4.31±4.2 publications/year as attendings. Research output during training, advanced degrees, and training at a top NIH funded program predict an academic vascular surgery career. VSF and IVSR constitute equally valid paths to productive academic careers.

Outpatient Attendance in COVID Pandemic Lockdown: An Observational Study

Objectives: The objectives of this study were to analyze the profile of outpatient department (OPD) attendance of a tertiary care hospital during pre- and post-pandemic lockdown period. Materials and Methods: All consecutive patients presenting to OPD from August 1, 2019 to November 23, 2020 were included in the study. The sample was divided into Zone R (Regular domain) and Zone L (Lockdown domain). Zone L was divided into three groups A, B, and C; representing attendance to be &lt;30%, 30–60%, and &gt;60% of previous (i.e., Zone R), respectively. The patient gender, intradepartmental, and inter departmental OPD attendance data were collected and analyzed. Results: n = 428,322 patients attended the OPD in the study period. 301,586 patients presented in Zone R and 126,736 presented in Zone L (P = 0.000). Zone L recorded an OPD attendance drop to 42% of Zone R. The least attended an OPD (Group A) was ophthalmology, ENT, dermatology, surgery, and orthopedics versus highest attendance (Group C) was noticed in emergency OPD and oncology with a moderate decline in the rest (P = −0.00, 0.00, and 0.00, respectively). Both male and female attendance in the OPD showed a decline; however, the gender divide was apparent with significantly low women attendance in all the departments (P = 0.00). Conclusion: OPD attendance showed a significant reduction in COVID lockdown era hitting the non-emergent medical branches the most. The gender divide significantly widened with less female attendance recorded in most OPDs in pandemic lockdown. Apt administrative measures could prove fruitful by an improved OPD attendance and its psychosocial implications to a society with less disease burden.

The low sensitivity of direct smears limit the utility of intraoperative gram stains for predicting culture-positivity in acute surgical settings

The role of intraoperative Gram stains in acute surgery decision-making is unclear. Our retrospective chart review of microbiology results for specimens submitted by acute surgery attendings showed Gram stain performs with a sensitivity ranging from 18% to 65% compared to culture, depending on organism type, thus limiting its utility.

Current state of female pediatric urologists at Societies for Pediatric Urology fellowship accredited programs

PurposeGender inequities in medicine exist. Urology is a male dominated surgical specialty, with recent census data showing females represent only 10.9% of the workforce. We aimed to characterize the composition of female pediatric urologists across the Societies for Pediatric Urology (SPU) pediatric urology fellowship accredited programs, with particular attention to academic promotion and leadership positions.MethodsIn January 2023, we reviewed the official websites of the 27 pediatric urology programs listed on the SPU website as fellowship accredited programs. We identified pediatric urology surgery attendings, their gender, academic title, and if they were named a director of an internal program or had a hospital leadership position. We identified the program chief and fellow/resident program director. This data was associated with years in practice.ResultsFemales represented 27.4% of pediatric urology surgical attendings. Four programs (14.8%) had no female attendings. Female staff were in practice a median shorter time than that of males (6 vs. 16 years, p&amp;lt;0.0001). A significantly higher proportion of females were assistant professors (62.2 vs. 35.2%; p=0.0041) while a significantly higher proportion of men were professors (37.0 vs. 18.9%; p=0.0421). Only one program (3.7%) had a female department/division chief. There was no difference between genders regarding being named a director of a program and/or having an identified hospital position of leadership. Female professors had been in practice a significantly shorter time than male professors (p=0.0003); women with an internal or hospital leadership position had also been in practice a significantly shorter time than males (p&amp;lt;0.001).ConclusionsFemales are represented more in SPU pediatric urology fellowship accredited programs than the overall urology workforce. Fewer female attendings are professors compared to male attendings; however, differences in promotion could be impacted by female attendings being earlier in their career. Hopefully with time, we will see more equal representation amongst genders in pediatric urology programs overall, but especially where we are training the next generation.

Trauma team on call: Why are we all so stressed?

BackgroundAcute stress is a known contributor to surgical outcomes. While trauma care is widely acknowledged to be stressful, understanding of specific sources of practitioner stress across learner levels is currently limited. Implementing tailored stress mitigation techniques is not possible without an increased understanding of the specific stress triggers. The objective of this study was to explore sources of acute stress for trauma care providers across various learner levels. MethodsSemi-structured interviews were undertaken following major trauma activations at a Level 1 urban trauma center. Interviews were conducted with medical students, surgical residents, and surgical attendings, exploring their perception of acute stress during the preceding event. Interviews were transcribed, coded and analyzed for emerging themes. Results38 trauma team shifts were observed including major trauma activations. 58 interviews were conducted with 4 medical students, 7 junior residents, 4 senior residents, and 7 trauma surgery attendings. Three predominant themes related to sources of acute stress where identified: “performance”, “stress contagion” and “fear of the unknown”. While all three themes were identified across all learner levels, emphasis and context for a given theme varied based on an individual's position within the team hierarchy. ConclusionsThree recurring sources of stress identified amongst all learner levels within the trauma team: “performance”, “stress contagion” and “fear of the unknown”. These themes offer concrete targets for future development of stress mitigation efforts.

Individual And Program-related Predictors Of Academic Vascular Surgery Practice

Several studies have explored factors affecting academic employment in surgical subspecialties; however, vascular surgery has not yet been investigated. We examined which elements of surgical training predict future academic productivity and studied characteristics of NIH-funded vascular surgery attendings.

Interprofessional Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation Simulations Aimed at Decreasing Actual Cannulation Times: A Longitudinal Study.

Since 2013, the cardiac intensive care unit (CICU) at Children's National has conducted annual extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) simulations that focus on team dynamics, room setup, and high-quality CPR. In 2019 and 2020, the simulations were expanded to include the surgical and extracorporeal membrane oxygenation (ECMO) teams in an effort to better understand and improve this process. During a 4-week period in 2019, 7 peripheral ECPR simulations were conducted, and through a 3-week period in 2020, 7 central ECPR simulations were conducted. Participants in each session included: 8 to 10 CICU nurses, 1 CICU attending, 1 to 2 ICU or cardiology fellows, 1 cardiovascular surgery fellow or attending, and 1 ECMO specialist. For each session, the scenario continued until the simulated patient was on full cardiopulmonary bypass. An ECMO trainer was used for peripheral simulations and a 3-dimensionally-printed heart was used for central cannulations. An ECMO checklist was used to objectively determine when the patient and room were fully prepared for surgical intervention, and simulated cannulation times were recorded for both groups. A retrospective chart review was conducted to compare actual cannulation times before and after the intervention period, and video was used to review the events and assist in dividing them into medical versus surgical phases. Control charts were used to trend the total ECPR times before and after the intervention period, and mean and P values were calculated for both ECPR times and for all other categorical data. Mean peripheral ECPR times decreased significantly from 71.7 to 45.1 minutes ( P = 0.036) after the intervention period, and this was reflected by a centerline shift. Although we could not describe a similar decrease in central ECPR times because there were only 6 postintervention events, the times for each of these events were shorter than the historical mean of 37.8 minutes. There was a trend in improved survival, which did not meet significance both among patients undergoing peripheral ECPR (15.4% ± 10% to 43.8% ± 12.4%, P = 0.10) and central ECPR (36.4% ± 8.4% to 50% ± 25%, P = 0.60). The percentage of time dedicated to the medical phases of the actual versus simulated procedures was very consistent among both peripheral (33.0% vs. 31.9%) and central (39.6% vs. 39.8%) cannulations. We observed a significant decrease in peripheral cannulation times at our institution after conducting interprofessional ECPR simulations taken to the establishment of full cardiopulmonary bypass. The use of an ECMO trainer and a 3-dimensionally-printed heart allowed for both the medical and surgical phases of the procedure to be studied in detail, providing opportunities to streamline and improve this complex process. Larger multisite studies will be needed in the future to assess the effect of efforts like these on patient survival.

Surgery and Anesthesia Preoperative “Virtual Huddle”: Enhancing Communication Across the Drape

INTRODUCTION: Teamwork and interdisciplinary communication in the operating room (OR) can facilitate efficiency, promote patient safety, and improve provider wellness. To enhance team communication and foster collegiality, we conducted a feasibility pilot trial of a simple, “virtual huddle” between anesthesiologists and surgeons on the eve of surgery. METHODS: Participants who would be working in the same OR the next day were connected via electronic medical records (EMR)-based secure chat message and could use the platform to communicate directly about case(s) or anticipated patient issues. After the study period, a survey was administered to evaluate the usability of the platform and its potential to improve communication. RESULTS: A total of 51 unique secure chat connections were created between 11 anesthesiologists and 13 surgeons over 99 operations. Survey response rate was 79% (11 surgeons, 8 anesthesiologists). All questions received positive ratings, as the virtual huddle was deemed to be easy to use (4.47/5.00), to improve attending-to-attending communication (4.29/5.00), and to improve patient care (4.22/5.00). There were no statistically significant differences in ratings between surgery and anesthesia (Table).TableCONCLUSION: This project demonstrated the utility of an electronic text–based chat for surgery and anesthesia attendings. Secure chat messaging is basic technology that offers an intuitive mechanism of connecting across the drapes. The direct line of communication can aid in preparation for cases to enhance OR efficiency and promote patient safety. Although there are limitations to this pilot study, there is clear evidence that implementation of EMR-based secure chat messaging among team members offers a simple adjunct to enhance a vital aspect of surgical care.

AI-based chest CT semantic segmentation algorithm enables semi-automated lung cancer surgery planning by recognizing anatomical variants of pulmonary vessels.

The recognition of anatomical variants is essential in preoperative planning for lung cancer surgery. Although three-dimensional (3-D) reconstruction provided an intuitive demonstration of the anatomical structure, the recognition process remains fully manual. To render a semiautomated approach for surgery planning, we developed an artificial intelligence (AI)-based chest CT semantic segmentation algorithm that recognizes pulmonary vessels on lobular or segmental levels. Hereby, we present a retrospective validation of the algorithm comparing surgeons' performance. The semantic segmentation algorithm to be validated was trained on non-contrast CT scans from a single center. A retrospective pilot study was performed. An independent validation dataset was constituted by an arbitrary selection from patients who underwent lobectomy or segmentectomy in three institutions during Apr. 2020 to Jun. 2021. The golden standard of anatomical variants of each enrolled case was obtained via expert surgeons' judgments based on chest CT, 3-D reconstruction, and surgical observation. The performance of the algorithm is compared against the performance of two junior thoracic surgery attendings based on chest CT. A total of 27 cases were included in this study. The overall case-wise accuracy of the AI model was 82.8% in pulmonary vessels compared to 78.8% and 77.0% for the two surgeons, respectively. Segmental artery accuracy was 79.7%, 73.6%, and 72.7%; lobular vein accuracy was 96.3%, 96.3%, and 92.6% by the AI model and two surgeons, respectively. No statistical significance was found. In subgroup analysis, the anatomic structure-wise analysis of the AI algorithm showed a significant difference in accuracies between different lobes (p = 0.012). Higher AI accuracy in the right-upper lobe (RUL) and left-lower lobe (LLL) arteries was shown. A trend of better performance in non-contrast CT was also detected. Most recognition errors by the algorithm were the misclassification of LA1+2 and LA3. Radiological parameters did not exhibit a significant impact on the performance of both AI and surgeons. The semantic segmentation algorithm achieves the recognition of the segmental pulmonary artery and the lobular pulmonary vein. The performance of the model approximates that of junior thoracic surgery attendings. Our work provides a novel semiautomated surgery planning approach that is potentially beneficial to lung cancer patients.

Quality of life and barriers to undergo cataract surgery

Cataract is the major cause of blindness and visual impairment in most cases worldwide. Measuring the QOL of patients with Cataract and assessing the Barriers to undergo Cataract surgery among patients will highlight the importance of the vision related needs of elderly population, which in turn will be an eye opener for the health care professionals to focus on the vision needs of the elderly. Aim: The study aims to assess the Quality of life and the barriers to undergo cataract surgery. Objectives: 1. Assess the Quality of Life among patients with Cataract. 2. Assess the barriers to undergo cataract surgery among patients with Cataract. 3. Find association between Quality of life and barriers with the selected demographic variables.Methods: Descriptive non experimental research design was used. The conceptual framework was based on Roy’s adaptation model. A total of 100 patients with cataract advised for surgery attending OPD in DRR Eye care and Oculoplasty Hospital, Chennai were selected by purposive sampling technique. The investigator collected data using interview technique. The Quality of Life was measured using Indian Vision Function Questionnaire (IVFQ)-33 and barriers was measured using checklist. The data was analyzed using descriptive statistics (frequency distribution, mean and standard deviation) and inferential statistics (chi-square test). Results: The overall quality of life revealed that 84(84%) had good quality of life and 16(16%) had moderate quality of life. The mean score of quality of life was 59.36±10.81 with minimum score of 41.0 and maximum score of 92.0. With regard to barriers, all 100(100%) had mild level of barrier to undergo cataract surgery among patients with cataract and the mean score of barriers was 2.77±1.29 with minimum score of 0 and maximum score of 7.0. The demographic variable occupation (2=10.361, p=0.035) had shown statistically significant association with quality of life at p

P30. Grit, Resilience, and Burnout Among Plastic Surgery Residents, Fellows, and Attendings

P30. Grit, Resilience, and Burnout Among Plastic Surgery Residents, Fellows, and Attendings

Value of robotic surgery simulation for training surgical residents and attendings: a systematic review protocol

IntroductionRobotic surgery is a method of minimally invasive surgery performed through small incisions using a remote robotic console. Surgical residents and attendings participate in simulation training to be able to...