Surgery Program Research Articles

Readmission after enhanced recovery video-assisted thoracoscopic surgery wedge resection

BackgroundDespite the implementation of Enhanced Recovery After Surgery (ERAS) programs, surgical stress continues to influence postoperative rehabilitation, including the period after discharge. However, there is a lack of data available beyond the point of discharge following video-assisted thoracoscopic surgery (VATS) wedge resection. Therefore, the objective of this study is to investigate incidence and risk factors for readmissions after ERAS VATS wedge resection.MethodsA retrospective analysis was performed on data from prospectively collected consecutive VATS wedge resections from June 2019 to June 2022. We evaluated main reasons related to wedge resection leading to 90-day readmission, early (occurring within 0–30 days postoperatively) and late readmission (occurring within 31–90 days postoperatively). To identify predictors for these readmissions, we utilized a logistic regression model for both univariable and multivariable analyses.ResultsA total of 850 patients (non-small cell lung cancer 21.5%, metastasis 44.7%, benign 31.9%, and other lung cancers 1.9%) were included for the final analysis. Median length of stay was 1 day (IQR 1–2). During the postoperative 90 days, 86 patients (10.1%) were readmitted mostly due to pneumonia and pneumothorax. Among the cohort, 66 patients (7.8%) had early readmissions primarily due to pneumothorax and pneumonia, while 27 patients (3.2%) experienced late readmissions mainly due to pneumonia, with 7 (0.8%) patients experiencing both early and late readmissions. Multivariable analysis demonstrated that male gender, pulmonary complications, and neurological complications were associated with readmission.ConclusionsReadmission after VATS wedge resection remains significant despite an optimal ERAS program, with pneumonia and pneumothorax as the dominant reasons. Early readmission was primarily associated with pneumothorax and pneumonia, while late readmission correlated mainly with pneumonia.

Baseball Injury Prevention Through a Community Outreach Initiative.

Sports-related craniofacial injuries account for 10% to 42% of facial fractures in the US pediatric population, with the incidence of injury peaking at ages 6 to 7 and 12 to 14. The National Survey of Children's Health reported ~5.6 million children between the ages of 6 and 17 participated in baseball in 2021. National Electronic Injury Surveillance System reported 861,456 injuries resulting from baseball and 511,117 injuries resulting from softball in 2021, with ~500,000 of those injuries being to the face/head/neck. While participation in baseball and other youth sports has tremendous physical and mental health benefits, facial and other athletic injuries are concerning beyond the pain and disability caused by the incident itself. Severe injury can result in lost time from school as well as other social activities. Players and their families often experience financial strain as a result of physical trauma as well. The use of protective equipment has decreased the incidence of emergency department visits due to baseball-related trauma, especially mouthguards. However, adherence to using mouthguards is relatively low in baseball, with over 80% of players reporting not being told by a coach to wear mouthpieces. Youth from low-income areas often lack financial means to provide protective equipment and health insurance in the case of injury. The authors, along with the University of Miami Miller School of Medicine Division of Plastic and Reconstructive Surgery and Miami Marlins RBI Program, created an outreach program by which over 400 mouthguards were given to players and caretakers at inner-city baseball and softball programs. Two community outreach events took place in South Florida. One event was held at a University of Miami Men's Baseball Game, and another was held on the opening day of the Miami Marlins RBI Program youth baseball league. In addition to handing out protective equipment and informational pamphlets, a question and answers session was held to discuss injury prevention. In conclusion, our community safety initiative created an interactive dialogue and message to hundreds of youth baseball players about the importance of protective gear to prevent injuries.

Broadening Horizons: a 3-month structured webinar series for undergraduate and postgraduate plastic surgery education

BackgroundWe created a 3-month webinar series, entitled Broadening Horizons, which explored plastic surgery principles from each subspeciality according to the Intercollegiate Surgical Curriculum Programme (ISCP) for plastic surgery. This article reports on our experience of producing a teaching programme, its impact on our delegates, and provides a useful guide to creating future webinar series in plastic surgery and other specialities.MethodsPre- and post-course questionnaires were used to perform a needs analysis, collect feedback and assess our delegates’ career interests and perceptions of plastic surgery. Delegates rated their responses on 5-point Likert scales. Delegates also undertook a 60-question pre- and post-course exam to test their knowledge.ResultsOne thousand eight attendances were recorded for the entire 16-part webinar series. Sixty-three (53–73) delegates, including undergraduate, postgraduate and international students, attended each lecture on average. Seventy-five percent of delegates felt they had previously received inadequate plastic surgery teaching. Ninety-six percent were satisfied or very satisfied with Broadening Horizons. Confidence in their knowledge of plastic surgery increased significantly from 2 (1–3) (not very confident) to 3 (2–5) (somewhat confident) (p = 0.01). Post-course exam scores increased significantly from 49% (32–67) to 56% (23–85) (p = 0.05). Career interest and positive perceptions were maintained.ConclusionsThis is the first webinar series to provide undergraduates and postgraduates plastic surgery teaching based on ISCP learning objectives. The series increased delegates’ knowledge and confidence in their understanding of plastic surgery. This article describes the 5-E-Z step guide to developing future teaching programmes similar to Broadening Horizons.Level of evidence Not ratable

Patient-centered evaluation of an expectation-focused intervention for patients undergoing heart valve surgery: a qualitative study.

Randomized controlled trials demonstrate the effectiveness of expectation-focused interventions in improving recovery outcomes following cardiac surgery. For dissemination in routine health care, it is important to capture the perspective of affected individuals. This qualitative study explores the perceived benefits and intervention-specific needs of patients who received expectation-focused intervention in the context of heart valve surgery. In addition, it explores potential barriers and adverse effects. As part of an Enhanced Recovery After Surgery (ERAS) program within a multicentered randomized controlled trial, patients undergoing minimally invasive heart valve surgery received an intervention focused on their expectations. Six weeks after the intervention, semi-structured interviews were conducted with 18 patients to assess its feasibility, acceptance, barriers, benefits, and side effects. The transcribed interviews were analyzed using qualitative content analysis. The results indicate that both the intervention and the role of the patient and psychologist are key aspects in evaluating the expectation-focused intervention. Five key themes emerged from the patients' perspective: personal needs, expectations and emotions, relationship, communication, and individuality. Patients valued the preparation for surgery and recovery and the space for emotions. Establishing a trustful relationship and addressing stigmatization were identified as primary challenges within the intervention. Overall, patients experienced the expectation-focused intervention as helpful and no adverse effects were reported. Perceived benefits included enhanced personal control throughout the surgery and recovery, while the potential barrier of stigmatization towards a psychologist may complicate establishing a trustful relationship. Addressing personal needs, as a relevant topic to the patients, could be achieved through additional research to identify the specific needs of different patient subgroups. Enhancing the expectation-focused intervention could involve the implementation of a modular concept to address individual needs better.

Our experience with robotic-assisted thymic surgery.

Thoracic surgery is increasingly influenced by the development of minimally invasive approaches which have also influenced surgery in the area of the anterior mediastinum. The previously standard approach to the thymus via partial sternotomy was gradually replaced by the videothoracoscopic approach in most cases. In recent years, robotically assisted surgery has been gaining ground worldwide in this area, as well. The aim of our paper is to provide a comprehensive overview of procedures in the field of the thymus, including their indications, and to share our first experience with robot-assisted thymus surgery. At the 3rd Department of Surgery, since the start of the robot-assisted thymus surgery program, 23 thymectomies have been performed using this approach, of which 17 were performed for thymoma, 3 for myasthenia gravis, and 3 for parathyroid adenoma localized in thymus tissue. From our experience and the available data, it follows that the length of hospitalization, the rate of complications and the resulting effect of robot-assisted procedures is comparable to VTS procedures; however, the robot-assisted surgery also allows for mini-invasive treatment even in significantly obese patients and in patients with advanced thymic tumors who would otherwise be indicated for open thymectomy.

Multimodal prehabilitation program in patients with resectable perihilar cholangiocarcinoma: keypoints for an implementation protocol and literature review.

Postoperative complications after perihilar cholangiocarcinoma surgical procedure are still very high. The implementation of a multimodal prehabilitation program could improve these outcomes. Based on our experience and that of the literature in hepatobiliary and pancreatic surgery, we propose a protocol to promote its implementation. First, we performed a retrospective analysis of the implementation feasibility of a multimodal prehabilitation program in patients' candidates for elective perihilar cholangiocarcinoma surgery in our center. Second, we conducted a literature search of publications in PubMed until December 2022. Relevant data about hepato-pancreato-biliary surgery and prehabilitation programs in features and postoperative outcomes was analyzed. Since October 2020, 11 patients were evaluated for prehabilitation in our hospital. Two of them could not be resected intraoperatively due to disease extension. The median hospital stay was 10days (iqr, 7-11). There were no major complications and 1 patient died. Of a total of 17 articles related to prehabilitation in hepato-biliary-pancreatic surgery, no reports focusing exclusively on perihilar cholangiocarcinoma were found. Six of the studies had nutritional therapies in addition to physical interventions, and 12 studies used home-based exercise therapy. Based on our experience and the data obtained from other studies, a prehabilitation program could be useful to improve perioperative physical and mental fitness in patients' candidates for elective perihilar cholangiocarcinoma surgery. However, more well-designed studies are needed to allow us to obtain more evidence.

Clinical profile and outcomes of endoscopic surgery patients during a mobile gynecological surgery program in low- and middle-income communities in Kenya

Background: Access to quality gynecological surgery in low- and middle-income communities has beengreatly hampered by logistical and socioeconomic challenges. These challenges can be overcomethrough the provision of mobile laparoscopic surgery. Endoscopic surgery reduces the rate of infection,duration of hospital stay, and the need for blood transfusion, which are factors attributable to surgicaldisease burden due to poverty. A team comprising gynecologists, nurses, and theater technicians hasbeen providing laparoscopic surgery to patients in low-income communities in Kiambu, Nairobi, and Merucounties in Kenya. This initiative was undertaken by pooling resources to procure basic laparoscopicequipment, a regional needs assessment for gynecological surgery, and logistical planning for outpatientclinical services. This was followed by the provision of laparoscopic surgery to patients diagnosed withvarious gynecological conditions. We present programmatic data of the clinical profile and outcomes ofpatients who benefited from the program.Results: A total of 175 women benefited from the program from January 2023 to December 2023. Themost common surgery undertaken was laparoscopic hysterectomy due to symptomatic uterine fibroids.Other procedures included diagnostic hysteroscopy and laparoscopy for chronic pelvic pain. Most womenwere under the national health insurance fund scheme.Conclusion: The program has improved the quality of services provided and demonstrated the feasibilityof mobile surgical workshops as an intervention to improve the quality of services in low-incomecommunities.

A87 A SURVEY-BASED ASSESSMENT OF ENDOSCOPY CURRICULUM AND EDUCATION IN CANADIAN TRAINING PROGRAMS

Abstract Background Endoscopic training within Canada occurs in programs accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC). Beyond national accreditation, there are no standardized endoscopic training curriculums and each program is responsible for ensuring its trainees achieve competency. There is debate in the literature regarding the minimum number of endoscopic procedures and the role of objective assessment tools in the assessment of trainee competence with no specific recommendations for these by the RCPSC. Aims The goal of our study was to characterize endoscopic training curriculums within Canadian training programs while determining the usage and perceived importance of procedure volume tracking and objective assessment tools. Methods Online surveys were sent to program directors (PD) and trainees within Adult Gastroenterology, Pediatric Gastroenterology, General Surgery and Colorectal Surgery programs within Canada. Surveys contained questions meant to characterize endoscopy training curriculums and perceived effectiveness of the curriculum while highlighting the factors important for feedback and competency assessment. Results Survey responses were obtained from 20 PDs and 83 trainees. Of all programs surveyed 53% (44/83) of trainees reported that they had a formal endoscopy curriculum compared with 75% (15/20) of PDs. PDs assessed endoscopic competence predominantly by EPAs (95%) and verbal feedback (65%) with minimal usage of objective tools (30%). Trainees reported fewer objective tool usage at 2.4% (2/83). When assessed on a 5-point Likert scale, both PDs and trainees felt that verbal feedback was the most important for assessment of competence (3.58 and 4.39 respectively). Seventy-seven percent of trainees report using a procedure log and when asked about procedure volume 37% of trainees expected to complete ampersand:003C250 colonoscopies by the end of their training. Eighty-three percent of PDs felt that all their trainees achieved endoscopic competency with only 50% of adult GI PDs reporting the same. Most PDs and trainees felt that national recommendations for objective tool usage (65% and 57% respectively) and minimum procedure volume (65% and 63% respectively) would be helpful to standardize endoscopic training. Additional results are reported in Figure 1. Conclusions Most training programs reported a standardized curriculum with a majority of trainees tracking their procedure volume, but a minority of programs incorporated objective tools. A significant portion of trainees expected to complete ampersand:003C250 colonoscopies by the end of their training and not all PDs felt that all of their trainees reach endoscopic competence. The majority of trainees and PDs felt national recommendations for procedure tracking and objective tools would be helpful, suggesting the need for more formalized endoscopic curriculums in Canada. Funding Agencies None

Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study

PurposeDespite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023.Materials and MethodsThis was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences.ResultsNine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward.ConclusionThis study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.Graphical

Descriptive Analysis of Vitreoretinal Surgery Fellowship Program Directors.

Purpose: To evaluate the demographic, educational, and scholarly characteristics of Association of University Professors of Ophthalmology-accredited vitreoretinal surgery fellowship program directors in the United States and Canada. Methods: Demographic, educational, and scholarly profiles of identified program directors were collated from online public resources. Characteristics were compared by sex, program size, ranking, and affiliation. Results: Eighty-one program directors (mean age [±SD] 54.7 ± 11.0 years) from 78 fellowship programs were identified. The minority were women (14.8%), who were on average 6 years younger than their male counterparts (P = .07). The majority of program directors had an academic affiliation (90.1%), most commonly professor (54.8%). The mean h-index, 5-year h-index, and m-quotient were 20.9 ± 14.9, 5.9 ± 4.4, and 0.82 ± 0.42, respectively. Compared with their counterparts, program directors of both "top 10" and large programs published more manuscripts (P < .05), accrued more citations (P < .05), and had a higher h-index (P < .05). Fellowship programs with female program directors had a significantly larger proportion of female retina faculty (P = .002). Conclusions: The backgrounds of vitreoretinal surgery program directors are diverse. However, women remain underrepresented in this position, highlighting an area with the potential for greater equity in ophthalmology.

(261) Vasovasostomy Surgical Simulation Using En Bloc Orchiectomy Specimen

Abstract Introduction Surgical simulation with use of synthetic materials, animals, or human tissues is an essential part of surgical training. Prior vasovasostomy (VV) simulations have described use of silicone tubules, animal vasa, and vas segments from human prostatectomy specimen. Herein we describe a VV surgical simulation model using benign, en bloc human testicle and spermatic cord specimen acquired via gender-affirming simple orchiectomy. Objective To improve resident confidence in performing VV via a surgical wet lab using benign, en bloc human testicle and spermatic cord specimen acquired via gender-affirming simple orchiectomy. Methods En bloc testicle and spermatic cord specimen from benign orchiectomy procedures were stored in our institution’s tissue bank. After development of a tissue handling protocol, specimens were then transported to our surgical simulation center for use in a VV microsurgical surgical simulation exercise. Participants were asked to complete a six-throw VV anastomosis using specimen. The first three throws were “training naïve,” with no prior instruction and an 8-minute time cap. After the first three throws or 8 minutes of time, participants received 10 minutes of hands-on instruction from a fellowship-trained urologic microsurgeon, then completed the remaining three throws of their six-throw anastomosis. Performance was measured using a microsurgical skills assessment tool for each set of three stitches and compared (figure 1). Pre- exercise and post- exercise surveys (figure 2) were completed in which participants rated their confidence in performing VV. Two months later, the same participants returned for an interval skills assessment in which they were tasked with completing the six-throw anastomosis in a 16-minute time limit. Skills were again evaluated with the microsurgical skills assessment tool; pre- and post- exercise surveys were again completed. Results Four urology trainees participated in our exercise: two PGY2s, one PGY3 and one PGY4. Completed number of knots increased from the first 8-minute session to the final 8-minute session for all participants (table 1). Surgical performance as measured by the skills-assessment tool did not change as a result of the instruction intervention (table 1). Participant confidence in performing microsurgical VV improved between the pre- and post- exercise surveys (table 2). All participants felt the wet lab served as a realistic representation of real-life VV (table 3)). At the two-month reassessment time point, all participants completed a similar number of throws (+/- 1 throw) in an overall equal amount of time (16 consecutive minutes compared to 8 minutes twice) with similar surgical performance compared to initial assessment (table 4). Conclusions A microsurgical VV wet lab using en bloc benign orchiectomy specimen serves a realistic simulation of real-life VV and improves trainee confidence in performing this procedure. Real-time instruction likely provides less value for improving operative skill than does experience and repetitions alone. These findings support not only the use of human specimen for surgical training, but also the value of a gender-affirming surgery program which provides access to these benign specimens. Disclosure No.

Results of robotic liver surgery in association with IWATE criteria — the first 100 cases

BackgroundAim of the current study was to present the results of the implementation phase of a robotic liver surgery program and to assess the validity of the IWATE difficulty score in predicting difficulty and postoperative complications in robotic liver surgery.MethodsBased on the prospective database of the Interdisciplinary Robotic Center of Ulm University Hospital, the first 100 robotic liver surgeries were identified and analyzed. Perioperative parameters (duration of surgery and blood loss) and postoperative parameters including morbidity, mortality, and length of hospital stay were assessed and the results were compared between different IWATE difficulty categories.ResultsFrom November 2020 until January 2023, 100 robotic liver surgeries were performed (41 female, 59 male; median age 60.6 years, median BMI 25.9 kg/m2). Median duration of surgery was 180 min (IQR: 128.7), and median blood loss was 300 ml (IQR: 550). Ninety-day mortality was 2%, and overall morbidity was 21%, with major complications occurring in 13% of patients (≥ grade 3 according to Clavien/Dindo). A clinically relevant postoperative biliary leakage was observed in 3 patients. Posthepatectomy liver failure occurred in 7% (4 Grade A, 3 Grade B). Duration of surgery (p < 0.001), blood loss (p < 0.001), CCI (p = 0.004), overall morbidity (p = 0.004), and length of hospital stay (p < 0.001) were significantly increased in the IWATE ‘expert’ category compared to lower categories.DiscussionRobotic surgery offers a minimally invasive approach for liver surgery with favorable clinical outcomes, even in the implementation phase. In the current study the IWATE difficulty score had the ability to predict both difficulty of surgery as well as postoperative outcomes when assessing the complexity of robotic liver surgery. Therefore, the role of the IWATE score in predicting these outcomes highlights its importance as a tool in surgical planning and decision-making.

Is the learning curve of the urology resident for conventional radical prostatectomy similar to that of staff initiating robot-assisted radical prostatectomy?

The superiority of the functional results of robot-assisted radical prostatectomyis still controversial. Despite this, it is known that minimally invasive surgery obtains better results when analyzing blood loss, blood transfusion and length of stay, for example. Several studies have analyzed the impact of the resident physician's involvement on the results of urological surgeries. The simple learning curve for robot-assisted radical prostate surgery is estimated to be around 10 to 12 cases. Learning curve data for robotic surgeons is heterogeneous, making it difficult to analyze. Rare studies compare the results of a radical prostatectomy of an inexperienced surgeon starting his training in open surgery, with the results of the same surgeon, a few years later, starting training in robotic surgery. to analyze the results of open radical prostatectomy surgeries (ORP) performed by urology residents, comparing them to the results of robot-assisted radical prostatectomy (RARP), performed by these same surgeons, after completing their training in urology. a retrospective analysis of the cases of only 3 surgeons was performed. 50 patients underwent ORP (group A). The surgeons who operated on the ORP patients were in the 3rd and final year of the urology residency program and beginners in ORP surgery, but with at least 4 years of experience in open surgery. The same surgeons, already trained urologists, began their training in robotic surgery and performed 56 RARP surgeries (group B). For the comparative analysis, data were collected on age, number of lymph nodes removed, surgery time, hospitalization time, drain volume, drain permanence time, indwelling bladdercateter (IBC) permanence time, positive surgical margin, biochemical recurrence, risk classification (ISUP), intra and postoperative complications, urinary incontinence (UI) and erectile dysfunction (ED). The console used was the Da Vinci Si, from Intuitive®. For statistical analysis, the Shapiro-Wilk test verified that the data did not follow normality, the Levene test guaranteed homogeneity, and the Mann-Whitney test performed the comparative analysis of the quantitative data. For the analysis of qualitative data, the Chi-square test was used for nominal variables and the Mann-Whitney U test for ordinal variables. Additionally, the Friedman test analyzed whether there was an improvement in the perception of UI or ED over the months, for each group individually (without comparing them), and the post-hoc Durbin-Conover test, for the results with statistically significant difference. We used a p-value < 0.05, and the Jamovi® program (Version 2.0). there was no statistically significant difference between the groups for age, number of lymph nodes removed, positive surgical margin, biochemical recurrence, risk classification and urinary incontinence. Additionally, we observed that the surgical time was longer in group B. On the other hand, the length of stay, drain volume, drain time, IBC time, complication rate and levels of erectile dysfunction in the third and sixth months were higher in group A, when compared to group B. We also observed that there was no evolutionary improvement in ED over the months in both groups, and that there was a perception of improvement in UI from the 1st to the 3rd month in group A, and from the 1st to the 6th month, and from the 3rd to the 12th month, in group B. the learning curve of RARP is equivalent to the curve of ORP. In general, the results for the robotic group were better, however, the functional results were similar between the groups, with a slight tendency of advantage for the robotic arm.

Abstract TP50: Ensuring Safe Post-Procedure Throughput for CEA and CAS Patients

Background: A new policy was implemented in November 2021 to reduce the length of post-anesthesia-care-unit (PACU) stay from 6 hours to 4 hours to reduce the nursing care burden and decrease the length of stay, yet how it affected patients’ events after PACU discharge needed close evaluation. Thus, the QI project aimed to retrospectively examine unexpected or safety events of patients who underwent carotid artery stenting or carotid endarterectomy procedures before versus after implementing the new policy. Objective: To compare and examine the rates of unexpected or safety events that occurred before (5/1/2021 - 10/31/2021; PRE) vs. after (2/1/2022 - 7/31/2022; POST) adoption of the new policy. Methods: A determination of IRB review was granted for the retrospective QI project. The unexpected or safety events included patient issues (rapid response calls, STAT calls to service, or bounce back to a higher level of care) and issues with VS or neuro assessment variability. For group comparison, Fisher’s Exact tests were used for dichotomous information, and the Mann-Whitney U tests were performed for continuous data. Results: A total of 145 patients were identified during the study period composing 75 (51.7%) PRE and 70 (48.3%) POST patients. The rates of VS or neuro assessment variability were similar in both groups (PRE: 1.3% vs. POST: 1.3%, p =1.000). Though we saw a lower rate of patient issues within 24 hours on the floor in POST (4.3%), the difference was not statistically significant (PRE: 8.0%, p =0.496). Conclusion: Inefficient patient throughput can impact currently strained hospital resources. Findings of the QI project confirmed that the new policy did not incur a higher rate of instability on the nursing unit. This data lends confidence to Vascular Surgery and Stroke programs as they seek to streamline patient care and manage hospital resources.

The Current State of Plastic Surgery Residency Wellness Programs: Benefits and Barriers.

Wellness programs are especially important in residency. However, the resources available to plastic surgery residents through residency wellness programs have not been described. This study reports current plastic surgery residency wellness programs' organization, leadership, and resources. An anonymous and voluntary e-mail survey was sent to 106 plastic surgery residency program directors through May and June 2022. Features of residency wellness programs were detailed, and program directors' sentiments towards residency wellness programs were evaluated. A 30.2% (32 of 106) complete response rate was achieved. Nearly 90% (87.5%, 28 of 32) of program directors indicated the presence of a wellness program. More than 75% (21 of 28) of programs are supported by the Office of Graduate Medical Education. Wellness events were offered by 92.9% (26 of 28) of programs. More than half of programs offered resources for mental health, physical health, mentorship, and protected time. Several resources were associated with the presence of wellness leadership roles, suggesting residents can positively shape wellness program offerings. Program directors strongly indicated that wellness programs are important, relevant, and effective. Additionally, 75% (24 of 32) report a desire to learn about wellness programs at other plastic surgery residency programs. Resources offered through plastic surgery residency wellness programs are comparable to those in other specialties. However, plastic surgery programs vary in the resources offered to residents and barriers to access exist. Greater involvement of residents in plastic surgery wellness programs may better support physician wellness.

Gender influences resident physicians’ perception of an employee-to-employee recognition program: a mixed methods study

BackgroundBurnout is prevalent in medical training. While some institutions have implemented employee-to-employee recognition programs to promote wellness, it is not known how such programs are perceived by resident physicians, or if the experience differs among residents of different genders.MethodsWe used convergent mixed methods to characterize how residents in internal medicine (IM), pediatrics, and general surgery programs experience our employee-to-employee recognition ("Hi-5″) program. We collected Hi-5s received by residents in these programs from January 1, 2021–December 31, 2021 and coded them for recipient discipline, sex, and PGY level and sender discipline and professional role. We conducted virtual focus groups with residents in each training program.Main measures and approachWe compared Hi-5 receipt between male and female residents; overall and from individual professions. We submitted focus group transcripts to content analysis with codes generated iteratively and emergent themes identified through consensus coding.ResultsOver a 12-month period, residents received 382 Hi-5s. There was no significant difference in receipt of Hi-5s by male and female residents.Five IM, 3 surgery, and 12 pediatric residents participated in focus groups. Residents felt Hi-5s were useful for interprofessional feedback and to mitigate burnout. Residents who identified as women shared concerns about differing expectations of professional behavior and communication based on gender, a fear of backlash when behavior does not align with gender stereotypes, and professional misidentification.ConclusionsThe “Hi-5” program is valuable for interprofessional feedback and promotion of well-being but is experienced differently by men and women residents. This limitation of employee-to-employee recognition should be considered when designing equitable programming to promote well-being and recognition.

Is the h-Index Enough? A Comprehensive Bibliometric Analysis of 871 Academic Plastic Surgeons and Their Departments/Divisions.

In plastic surgery academia, research output is heavily used as a metric of accreditation, from assessing residency applicants to evaluating faculty for promotion. The h index, defined as an author's h papers with at least h citations, is commonly used as a measure of academic success. However, the index itself disfavors junior researchers, favors publication quantity, and discounts highly cited works. Given the importance of bibliometrics within plastic surgery, there is a paramount need to adopt additional metrics to measure research productivity. The authors sought to validate the use of time-independent bibliometrics to complement the h index in measuring citation impact. The genders and academic titles of plastic surgeons affiliated with US plastic surgery programs were recorded. Author publications were retrieved from Scopus. Bibliometrics software was used to calculate the following metrics per surgeon: h index, e index, and g index. Time-adjusted versions of these indices were used to correct for the number of years since first publication. Medians and interquartile ranges (IQRs) are reported. Departmental ranks were determined using the cumulative sum of time-corrected indices and compared with Doximity departmental research rankings. P < 0.05 was deemed significant. Indices were calculated for 871 academic plastic surgeons in 85 departments/divisions. Men had statistically greater h index (median, 13.0 [IQR, 7.0-21.0] vs 6.0 [IQR, 3.0-13]; P < 0.001), e index (18.3 [IQR, 10.0-28.7] vs 11.1 [IQR, 5.5-18.4]; P < 0.001), and g index (23.0 [IQR, 11.0-39.0] vs 11.0 [IQR, 5.0-22.0]; P < 0.001) than women. Professors had the highest median time-uncorrected indices. After adjusting for the number of years since an author's first publication, there were no significant differences in m quotient (men: 0.66 [IQR, 0.40-0.98] vs women: 0.57 [IQR, 0.33-0.90]; P = 0.05) and ec index (men: 0.93 [IQR, 0.62-1.3] vs women: 0.87 [IQR, 0.50-1.3]; P = 0.08) between genders. Departmental chairs had significantly higher indices than other faculty after correcting for time. The calculated program rankings were low to moderately correlated with that of Doximity (correlation coefficient τ = 0.49 [95% confidence interval, 0.37-0.59; P < 0.001]). Men and women have statistically similar citation patterns after correcting for the time. Citation differences between academic levels are less pronounced when controlling for time, suggesting comparable research quality between academic roles.

Challenging issues of implementing enhanced recovery after surgery programs in South Korea.

This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea's unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.

Why it is difficult to establish enhanced recovery after surgery (eras) programs in surgical units? Narrative review

Approximately 234.2 million major surgeries are performed worldwide every year, which is equivalent to one in 25 people [1]. In Australia, 662,000 patients underwent elective surgeries in public hospitals in 2011. Majority of these surgeries are essential and lifesaving procedures [2]. Growing population and increasing available management options increase demand for surgical procedures. Health care costs consume significant amount of the national income in both developed and developing countries [3]. At the same time population is aging and demonstrates upsurge in number of associated co-morbidities [4]. As a result, the incidence of perioperative complications is enhanced and length of stay and consumption of rehabilitation requirements are dramatically amplified [4]. There is a need for innovative pathways to improve perioperative outcomes in older and co-morbid patients undergoing surgical procedures. Several models were trialled in many centres and “enhanced recovery after surgery” (ERAS) is the most successful programme amongst them. Aim of this article is to assess the role of ERAS in major surgical procedures and challenges in implementing ERAS in a surgical setting.

Thirteen Years of Impactful, Minimally Invasive Coronary Surgery: Short- and Long-Term Results for Single and Multi-Vessel Disease

Objectives: Minimally invasive coronary surgery (MICS) via lateral thoracotomy is a less invasive alternative to the traditional median full sternotomy approach for coronary surgery. This study investigates its effectiveness for short- and long-term revascularization in cases of single and multi-vessel diseases. Methods: A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints. Results: A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4). Conclusions: Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.