RESUMEN
AbstractThe field of surgery has relied on innovation and creativity to improve patient care and propel the field forward. Historically, regulatory oversight of innovative approaches to surgery has been largely inconsistent, rendering surgeons relatively unrestricted creative latitude in the operating room; whether this has proven to be more beneficial or harmful is subject to debate. While innovation plays a crucial role in the advancement of surgical techniques, the potential drawbacks of unregulated innovation must be seriously considered, especially when treating vulnerable populations such as infants and children. This article provides an overview of the ethical aspects surrounding innovation in pediatric surgery, including discussion of relevant considerations, controversies, and pitfalls. The following includes a review of the current and past literature surrounding the topic. The purpose of this review is to heighten awareness of the ethical challenges that surgeons face when considering novel operative techniques on pediatric patients.
Asunto(s)
Pediatría , Humanos , Pediatría/ética , Niño , Procedimientos Quirúrgicos Operativos/ética , Invenciones/ética , Lactante , Cirujanos/ética , Ética MédicaAsunto(s)
Conflicto de Intereses , Revelación , Cirugía Torácica , Revelación/ética , Humanos , Estados Unidos , Cirujanos/psicología , Cirujanos/éticaAsunto(s)
Conflicto de Intereses , Revelación , Cirujanos , Revelación/ética , Humanos , Cirujanos/psicología , Cirujanos/ética , Estados Unidos , Cirugía TorácicaAsunto(s)
Cadáver , Ética Médica , Procedimientos de Cirugía Plástica , Cirujanos , Cirugía Plástica , Humanos , Pueblos del Este de Asia , Procedimientos de Cirugía Plástica/educación , Procedimientos de Cirugía Plástica/ética , Cirujanos/educación , Cirujanos/ética , Cirugía Plástica/educación , Cirugía Plástica/ética , Ética Profesional , JapónRESUMEN
OBJECTIVE: Most of all congenital cardiac surgical programs participate in public outcomes reporting. The primary end point is transparency. In this era, academic programs with surgical residents face the challenge of producing outstanding results while allowing residents to learn by doing. We sought to understand the effect of education on our surgical outcomes. METHODS: We collected data for all American Board of Thoracic Surgery index cases done at our institution over a 10-year period. We identified 3406 cases and categorized them into 2 groups according to primary surgeon: attending (2269) versus resident (1137). In a multivariable logistic regression model we examined the effect of operating surgeon on in-hospital mortality, major morbidity, and length of stay. We used propensity score matching subsequently to balance differences between cohorts, and multivariable logistic regression was repeated. RESULTS: Using the entire cohort, multivariable logistic regression model adjusted for age, sex, weight, lack of preoperative comorbidity, presence of preoperative respiratory failure, The Society of Thoracic Surgeons--European Association for Cardio-Thoracic Surgery category, and need for deep hypothermic circulatory arrest, showed a higher odds of survival in the resident cohort (odds ratio, 1.484; 95% confidence interval, 0.998-2.206; P = .05). Propensity score matching identified 1137 pairs of attending and resident cases with well-balanced preoperative variables. Logistic regression modeling using the matched cohort showed equivalent 30-day mortality, 30-day major morbidity, and length of stay. CONCLUSIONS: There was no difference in mortality, major morbidity, or length of stay when similar cases were compared that were operated on by attendings versus those by a resident. Effectively educating congenital heart surgeons without compromising an operation's quality requires thoughtful approach, including case selection and graded responsibility.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Internado y Residencia , Complicaciones Posoperatorias , Cirujanos , Cirugía Torácica/educación , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/educación , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Competencia Clínica , Mortalidad Hospitalaria , Humanos , Internado y Residencia/ética , Internado y Residencia/métodos , Internado y Residencia/organización & administración , Tiempo de Internación , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Selección de Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Preceptoría/métodos , Responsabilidad Social , Cirujanos/educación , Cirujanos/ética , Cirujanos/estadística & datos numéricosAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Internado y Residencia , Complicaciones Posoperatorias/prevención & control , Preceptoría , Cirujanos , Cirugía Torácica/educación , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/educación , Procedimientos Quirúrgicos Cardíacos/métodos , Humanos , Internado y Residencia/ética , Internado y Residencia/métodos , Preceptoría/ética , Preceptoría/métodos , Cirujanos/educación , Cirujanos/ética , Cirujanos/psicologíaAsunto(s)
Conflicto de Intereses/economía , Bases de Datos Factuales/estadística & datos numéricos , Sector de Atención de Salud/economía , Cirujanos/economía , Cirugía Plástica/economía , Sector de Atención de Salud/estadística & datos numéricos , Humanos , Cirujanos/ética , Cirujanos/estadística & datos numéricos , Cirugía Plástica/ética , Cirugía Plástica/estadística & datos numéricos , Estados UnidosAsunto(s)
Seguridad del Paciente , Procedimientos de Cirugía Plástica/ética , Cirujanos/ética , Competencia Clínica , Toma de Decisiones Clínicas/ética , Humanos , Solución de Problemas , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/educación , Cirujanos/educaciónRESUMEN
BACKGROUND: Women are underrepresented at higher levels of promotion or leadership despite the increasing number of women physicians. In surgery, this has been compounded by historical underrepresentation. With a nation-wide focus on the importance of diversity, our aim was to provide a current snapshot of gender representation in Canadian universities. METHODS: This cross-sectional online website review assessed the current faculty listings for 17 university-affiliated academic surgical training departments across Canada in the 2019/2020 academic year. Gender diversity of academic surgical faculty was assessed across surgical disciplines. Additionally, gender diversity in career advancement, as described by published leadership roles, promotion and faculty appointment, was analyzed. RESULTS: Women surgeons are underrepresented across Canadian surgical specialties (totals: 2,689 men versus 531 women). There are significant differences in the gender representation of surgeons between specialties and between universities, regardless of specialty. Women surgeons had a much lower likelihood of being at the highest levels of promotion (OR: 0.269, 95% CI: 0.179-0.405). Men surgeons were statistically more likely to hold academic leadership positions than women (p = 0.0002). Women surgeons had a much lower likelihood of being at the highest levels of leadership (OR: 0.372, 95% CI: 0.216-0.641). DISCUSSION: This study demonstrates that women surgeons are significantly underrepresented at the highest levels of academic promotion and leadership in Canada. Our findings allow for a direct comparison between Canadian surgical subspecialties and universities. Individual institutions can use these data to critically appraise diversity policies already in place, assess their workforce and apply a metric from which change can be measured.
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Movilidad Laboral , Liderazgo , Sexismo/psicología , Adulto , Canadá/epidemiología , Estudios Transversales , Docentes Médicos/ética , Femenino , Equidad de Género/ética , Equidad de Género/psicología , Humanos , Masculino , Persona de Mediana Edad , Médicos Mujeres/psicología , Sexismo/prevención & control , Especialidades Quirúrgicas , Cirujanos/ética , Cirujanos/psicologíaAsunto(s)
Distinciones y Premios , COVID-19/psicología , Cirugía General/historia , Medicina en la Literatura/historia , Medicina en las Artes/historia , Narrativas Personales como Asunto , Actitud del Personal de Salud , Historia del Siglo XXI , Humanos , Cirujanos/ética , Cirujanos/psicología , Estados UnidosRESUMEN
BACKGROUND: A 2009 systematic review demonstrated that ethical discourse was underrepresented in the plastic surgery literature; approximately one in 1000 articles contained ethical discussions. In the decade since, advances in plastic surgery and continued social progress have created new ethical dilemmas. However, it is unclear whether these developments have augmented the representation of ethics in the plastic surgery literature. A review of publications over the past decade can assess whether progress has been made and identify where deficits persist. METHODS: The authors searched eight bibliographic databases to identify peer-reviewed articles discussing ethical issues in plastic surgery over the past decade. Independent reviewers extracted characteristics and ethical principles from included articles. RESULTS: A total of 7097 articles were identified from the initial search and 531 articles were included for analysis. The principle of autonomy, present in 87.9 percent of articles, had the greatest representation, followed by beneficence (74.4 percent), nonmaleficence (72.3 percent), and justice (51.2 percent). Informed consent and face transplantation were the most prevalent topics discussed. Aesthetic surgery was the subdiscipline of plastic surgery with the greatest ethical discourse, representing 29.8 percent of all included articles. CONCLUSIONS: In the past decade, there was approximately a five-fold increase in plastic surgery publications that include ethical discourse, indicating a growing awareness of ethical implications by the plastic surgery community. However, representation of ethical principles remained uneven, and specific subdisciplines of plastic surgery were substantially underrepresented. Plastic surgeons should adopt a more comprehensive approach when framing ethical implications in clinical and research settings.
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Bibliometría , Bases de Datos Bibliográficas/estadística & datos numéricos , Ética Médica , Relaciones Médico-Paciente/ética , Cirugía Plástica/ética , Beneficencia , Humanos , Autonomía Profesional , Justicia Social , Cirujanos/éticaRESUMEN
BACKGROUND: Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. METHODS: Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating surgeon/nonsurgeon pairs within 2 years before the operation) were regressed on cardiopulmonary bypass duration (primary-an intraoperative measure of care efficiency) and postoperative complication outcomes (major morbidity, mortality), adjusting for provider experience, surgeon 2-year case volume before the surgery, case start time, weekday, and perioperative risk factors. The relationship between team familiarity and outcomes was assessed across predicted risk strata. RESULTS: Median (interquartile range) cardiopulmonary bypass duration was 132 (91-192) minutes, and 698 (15.7%) patients developed major postoperative morbidity. The relationship between team familiarity and cardiopulmonary bypass duration significantly differed across predicted risk strata (P = .0001). High (relative to low) team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk (-24 minutes) and high-risk (-27 minutes) patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. CONCLUSION: Team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
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Procedimientos Quirúrgicos Cardíacos/ética , Cardiopatías/cirugía , Complicaciones Posoperatorias/prevención & control , Reconocimiento en Psicología , Cirujanos/ética , Anciano , Procedimientos Quirúrgicos Cardíacos/psicología , Humanos , Persona de Mediana Edad , Morbilidad/tendencias , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/psicología , Estudios Retrospectivos , Factores de Riesgo , Cirujanos/psicología , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE/BACKGROUND: With increased collaboration between surgeons and industry, there has been a push towards improving transparency of conflicts of interest (COIs). This study aims to determine the accuracy of reporting of COIs among studies in major vascular surgery journals. METHODS: A literature search identified all comparative studies published from January 2018 through December 2018 from three major United States vascular surgery journals (Journal of Vascular Surgery, Vascular and Endovascular Surgery, and Annals of Vascular Surgery). Industry payments were collected using the Centers for Medicare and Medicaid Services Open Payments database. COI discrepancies were identified by comparing author declaration statements with payments found for the year of publication and year prior. RESULTS: A total of 239 studies (1642 authors) were identified. Two hundred twenty-one studies (92%) and 669 authors (63%) received undisclosed payments when utilizing a cut-off payment amount of $250. In 2018, 10,778 payments (totaling $22,174,578) were made by 145 companies. Food and beverage payments were the most commonly reported transaction (42%), but accounted for only 3% of total reported monetary values. Authors who accurately disclosed payments received significantly higher median general payments compared with authors who did not accurately disclose payments ($56,581 [interquartile range, $2441-$100,551] vs $2361 [interquartile range, $525-$9,699]; P < .001). When stratifying by dollar-amount discrepancy, the proportions of authors receiving undisclosed payments decreased with increasing payment thresholds. Multivariate analysis demonstrated that first and senior authors were both significantly more likely to have undisclosed payments (odds ratio, 2.0; 95% confidence interval, 1.1-3.6 and odds ratio, 2.9; 95% confidence interval, 1.6-5.2, respectively). CONCLUSIONS: There is a significant discordance between self-reported COI in vascular surgery studies compared with payments received in the Centers for Medicare and Medicaid Services Open Payments database. This study highlights the need for increased efforts to both improve definitions of what constitutes a relevant COI and encourage a standardized reporting process for vascular surgery studies.