Current Trends in Compensation for Fellowship in Minimally Invasive Gynecologic Surgery Graduates: A 6-Year Follow-Up.

STUDY OBJECTIVE: To present updated information regarding compensation patterns for Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS)-graduated physicians in the United States beginning practice during the last 10 years, focusing on the variables that have an impact on differences in salary, including gender, fellowship duration, geographic region, practice setting, and practice mix. DESIGN: An online survey was sent to FMIGS graduates between March 15, 2019 and April 12, 2019. Information on physicians' demographics, compensation (on the basis of location, practice model, productivity benchmarks, academic rank, and years in practice), and attitudes toward fairness in compensation was collected. SETTING: Online survey. PARTICIPANTS: FMIGS graduates practicing in the United States. INTERVENTION: E-mail survey. MEASUREMENTS AND MAIN RESULTS: We surveyed 298 US FMIGS surgeons who had graduated during the last 10 years (2009-2018). The response rate was 48.7%. Most of the respondents were women (69%). Most of the graduates (84.8%) completed 2- or 3-year fellowship programs. After adjustment for inflation, the median starting salary for the first postfellowship job was $252 074 ($223 986-$279 983) (Table 1). The median time spent in the first job was 2.6 years, and the median total salary at the current year rose to $278 379.4 ($241 437-$350 976). The median salary for respondents entering a second postfellowship job started at $280 945 ($261 409-$329 603). Significantly lower compensation was reported for female FMIGS graduates in their initial postfellowship jobs and was consistently lower than for that of men over time. Most FMIGS graduates (59.7%) reported feeling inadequately compensated for their level of specialization. CONCLUSION: A trend toward higher self-reported salaries is noted for FMIGS graduates in recent years, with significant differences in compensation between men and women. Among obstetrics and gynecology subspecialists, FMIGS graduates earn significantly less than other fellowship-trained physicians, with median salaries that are lower than those of generalist obstetrics and gynecology physicians.

Utility of preoperative laboratory evaluation in low-risk patients undergoing hysterectomy for benign indications.

OBJECTIVE: To evaluate whether preoperative laboratory tests are predictive of surgical complications in the first 30 days after benign hysterectomy. STUDY DESIGN: Data was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) of patients undergoing benign hysterectomy between 2014 and 2016. Patients with significant medical comorbidities were excluded except for current smoking and hypertension. Patients were stratified into those who did and did not undergo preoperative testing. Laboratory results were stratified into normal and abnormal values. The primary outcome was the composite complication rate between groups. Student'st-test, Fisher's exact test, and Wilcoxon Rank-Sum were used for statistical analysis where appropriate. Multivariable regression analysis was used to determine which variables were independently predictive of postoperative complications. RESULTS: A total of 24,752 patients met all inclusion criteria. Of these, 92.5% had at least one preoperative test performed, and out of those 33.5% had an abnormal value. The most common test performed was a complete blood count, 92.5%, and the least common were coagulation studies, 16.1%. Patients who underwent testing were younger (45.9 vs 47.8 years, p < 0.001), more likely to smoke (15.3% vs 12.7%, p = 0.004) and less likely to have hypertension (18.9% vs 21.8%, p = 0.001). The most common abnormality was a low hematocrit, and the least common anomaly was an elevated international normalized ratio. The total complication rate was 9.2%, and there were no differences between groups (p = 0.07). The only lab value associated with an increased risk of complications was a hematocrit less than 34.9% (aOR 2.74, 95%CI 2.92-3.79) and WBC count >11 thousand per microliter (aOR 2.11, 95%CI 1.53-3.09). CONCLUSION: Non-hematologic preoperative laboratory anomalies are uncommon in healthy women undergoing benign hysterectomy by any modality and furthermore non-hematologic abnormalities are not predictive of post-operative complications. On the other hand, hematologic abnormalities are fairly common and a WBC above 11 cells per uL and hematocrit below 34.9% are predictive of postoperative complications.

Preoperative frailty is a risk factor for non-home discharge in patients undergoing surgery for endometrial cancer.

OBJECTIVE: Our objective was to examine the association of the modified frailty index (mFI) and non-home discharge in patients undergoing surgery for endometrial cancer (EMCA). METHODS: Patients who underwent surgery for EMCA from 2011 to 2012 were identified from the American College of Surgeons - Nastional Surigical Quality Improvement Project (ACS-NSQIP) database. Current Procedural Terminology (CPT) codes were used to identify surgical characteristics. We excluded patients who were already living in a non-home facility. To determine frailty, we used the NSQIP frailty index. For analysis purposes, patients with an mFI score ≥0.18 were defined as frail. Patients were divided into groups based on discharge destination. Logistic regression were used to identify predictors of post-operative non-home discharge. RESULTS: 1216 patients were identified. 26 (2.1%) were discharged to a non-home facility. On multivariate analysis, patients who were discharged to a non-home facility were older (OR 1.09, 95% CI 1.04-1.14, p < 0.001), had a higher Body Mass Index (BMI) (OR 1.08, 95% CI 1.04-1.12, p < 0.001), were more likely to have disseminated cancer (OR 10.02, 95% CI 2.28-44.1, p = 0.002), and were frail (OR 1.95, 95% CI 1.91-5.01, p = 0.008). Undergoing minimally-invasive surgery was independently associated with discharge to home (OR 0.165, 95% CI 0.059-0.458, p = 0.001). CONCLUSION: Frailty is associated with increased risk of non-home discharge in patients undergoing surgery for EMCA. The mFI can be easily calculated using patient characteristics that are readily available pre-operatively. This information can be used for pre-op counseling and to facilitate appropriate and timely discharge planning.

Compliance of camps in the United States with guidelines for health and safety practices.

OBJECTIVE: To determine the compliance of US camps with guidelines for health and safety practices as set forth by the American Academy of Pediatrics and the US Department of Homeland Security. METHODS: An electronic questionnaire was distributed to US camps during the summer of 2012 as identified by 3 online summer camp directories. RESULTS: Analysis was performed on 433 completed questionnaires. Fourteen percent of camps were considered medically related. Ninety-three percent of camps have established relationships with community emergency medical services, 34% with local orthodontists, and 37% with local mental health professionals. Camps reported the immediate availability of the following: automated external defibrillators (75%), respiratory rescue inhalers (44%), epinephrine autoinjectors (64%), cervical spine collars (62%), and backboard with restraints (76%). Camps reported the presence of the following written health policies: dehydration (91%), asthma and anaphylaxis (88%), head injuries (90%), seizures (78%), cardiac arrest (76%), and drowning (73%). Although 93% of camps have a disaster response plan, 15% never practice the plan. Sixty-eight percent of camps are familiar with community evacuation plans, and 67% have access to vehicles for transport. Camps reported the presence of the following written disaster policies: fire (96%), tornadoes (68%), arrival of suspicious individuals (84%), hostage situations (18%). CONCLUSIONS: Areas for improvement in the compliance of US camps with specific recommendations for health and safety practices were identified, such as medically preparing campers before their attendance, developing relationships with community health providers, increasing the immediate availability of several emergency medications and equipment, and developing policies and protocols for medical and disaster emergencies.

Impact of Pulsatile Flow Settings on Hemodynamic Energy Levels Using the Novel Diagonal Medos DP3 Pump in a Simulated Pediatric Extracorporeal Life Support System.

BACKGROUND: The objective of this study was to evaluate the pump performance of the novel diagonal Medos Deltastream DP3 diagonal pump (MEDOS Medizintechnik AG, , Stolberg, Germany) under nonpulsatile to pulsatile mode with varying differential speed values in a simulated pediatric extracorporeal life support system. METHODS: The experimental circuit consisted of a Medos Deltastream DP3 pump head and console, a Medos Hilite 2400 LT hollow fiber membrane oxygenator (MEDOS Medizintechnik AG), a 14F Medtronic DLP arterial cannula (Medtronic Inc, Minnesota), and a 20F Terumo TenderFlow Pediatric venous return cannula (Terumo Corporation, Michigan). Trials were conducted at flow rates ranging from 500 mL/min to 2,000 mL/min (500 mL/min increments) and pulsatile differential speed values ranging from 500 rpm to 2,500 rpm (500 rpm increments) using human blood (hematocrit 35%). The postcannula pressure was maintained constantly at 60 mm Hg. Real-time pressure and flow data were recorded using a custom-made data acquisition system and Labview software. RESULTS: Under all experimental conditions, pulsatile flow (P) generated significantly greater energy equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE) than those of nonpulsatile flow (NP). Under NP, SHE was zero. Higher differential speed values generated greater EEP, SHE, and THE values. There was little variation in the oxygenator pressure drop and the cannula pressure drop in P, compared to NP. CONCLUSIONS: The novel Medos Deltastream DP3 diagonal pump is able to generate physiological quality of P, without backflow. With increased differential rpm, the pump generated greater EEP, SHE, and THE. Physiological quality of pulsatility may be associated with better microcirculation because of greater EEP, SHE, and THE.