Effects of preoperative pulmonary function on perioperative outcomes after robotic-assisted pulmonary lobectomy.

INTRODUCTION: Effects of pulmonary function test (PFT) results on perioperative outcomes were investigated after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy. METHODS: We retrospectively analyzed 706 consecutive patients who underwent RAVT lobectomy by one surgeon over 10.8 years. Preoperative (preop) forced expiratory volume in 1 s as a percent of predicted (FEV1%) was used to group patients as having normal FEV1% (≥80%) versus reduced FEV1% (<80%). Demographics, preop comorbidities, intraoperative (intraop) and postoperative (postop) complications, perioperative outcomes, and median survival time (MST) were compared across patients with normal vs. reduced FEV1% using Chi-Square (X2), Fisher's Exact test, Student's t-test, Kruskal-Wallis test, or Kaplan-Meier analysis respectively, with significance at p ≤ 0.05. Multivariable analysis was performed for perioperative outcomes to investigate the differences across patients in the FEV1% groups. RESULTS: There were 470 patients with normal FEV1% and 236 patients with reduced FEV1%. The two FEV1% groups did not differ in intraop or postop complication rates, except for higher postop other arrhythmia requiring intervention (p = 0.004), prolonged air leak >5 days (p = 0.002), mucous plug formation (p = 0.009), hypoxia (p < 0.001), and pneumonia (p = 0.002), and total postop complications (p < 0.001) in reduced-FEV1% patients. Reduced FEV1% correlated with increased intraop estimated blood loss (p < 0.0001) and skin-to-skin operative time (p < 0.0001). Median overall survival in patients with normal FEV1% was 93.20 months (95% CI: 76.5-126.0) versus 58.9 months (95% CI: 50.4-68.4) in patients with reduced FEV1% (p = 0.0004). CONCLUSION: Patients should have PFTs conducted before surgery to determine at-risk patients. However, RAVT pulmonary lobectomy is feasible and safe even in patients with reduced FEV1%.

Academic Productivity in Orthopaedic Traumatology Correlates Positively With Industry Compensation.

OBJECTIVE: To determine the association between academic productivity and industry compensation among Orthopaedic Traumatologists. DESIGN: Retrospective cohort study. SETTING: Review of the Centers for Medicaid and Medicare Services Open Payments program from 2016 to 2020. PARTICIPANTS: 1120 Orthopaedic Traumatologists. MAIN OUTCOME MEASUREMENTS: To determine if an Orthopaedic Traumatologist's h-index and m-index, as generated from Web of Science, Scopus, and Google Scholar User Profile databases, correlate with total payments from medical industry in 7 categories, including Royalties and Licensing Fees, Consulting Fees, Gifts, Honoraria, and 3 unique Speaking Fee delineations. RESULTS: Of 30,343 Orthopaedic Surgeons in the Open Payments program, 1120 self-identified with the Orthopaedic Trauma taxonomy. From 2016 to 2020, 499 surgeons (44.6%) received compensation in one of the eligible categories, most commonly from Consulting Fees (67.3%), though payments from Royalties provided the greatest gross income (70.4%). Overall, for all 1120 surgeons, h-index (r = 0.253, P < 0.001) and m-index (r = 0.136, P < 0.01) correlated positively with mean annual total industry compensation. The highest annual compensation group had higher h-index ($0 vs. $1-$1k vs. $1k-$10k vs. >$10k: 5.0 vs. 6.6 vs. 9.6 vs. 16.8, P < 0.001) and m-index ($0 vs. $1-$1k vs. $1k-$10k vs. >$10k: 0.48 vs. 0.60 vs. 0.65 vs. 0.89, P < 0.001) scores than either the intermediate or the no compensation groups. Multivariable analysis of factors associated with increased industry compensation, including H-index and years active, identified both as having significant associations with physician payments [H-index (B = 0.073, P < 0.001); years active (B = 0.059, P < 0.001)]. Subgroup analysis of the highest annual earner group (>$250k/year) also demonstrated the highest overall h-index (27.6, P < 0.001) and m-index (1.23, P = 0.047) scores, even when compared with other high-earners ($10k-$50k, $50k-$250k). Overall, each increase in h-index above an h-index of 3 was associated with an additional $1722 (95% CI: $1298-2146) of annual industry compensation. CONCLUSIONS: Academic productivity metrics have a positive association with industry compensation for Orthopaedic Traumatologists. This may highlight a potential ancillary benefit to scholarly efforts.