Optimizing the Timeliness of Surgical Therapy in Patients with Breast Cancer Undergoing Immediate Breast Reconstruction.

BACKGROUND: In breast cancer, coordination of surgical therapy with immediate breast reconstruction (IBR) has been found to significantly delay surgical therapy, which in turn can have an adverse effect on patient survival. The objective of this study was to investigate factors that impact the timeliness of surgical therapy in this setting, which may help to optimize the care of patients with breast cancer. PATIENTS AND METHODS: Patients with breast cancer undergoing surgical therapy for breast cancer and immediate reconstruction were reviewed. Patients were divided into two groups: those who underwent surgery ≤ 30 days (group A) and > 30 days (group B) after diagnosis. Multivariate statistical analysis of demographic, disease, surgical, and process of care factors was performed. RESULTS: A total of 348 cases met inclusion criteria, of which 255 (73.2%) were in group A and 93 (26.7%) were in group B. No significant differences were identified in clinical stage, oncologic procedure, or type of reconstruction. On multivariate analysis, an increased likelihood of undergoing surgery ≤ 30 days of diagnosis was observed, with shorter time intervals between surgical oncologist and plastic surgeon consultations [odds ratio (OR) 1.3; 95% confidence interval (CI) 1.1-1.6, p = 0.011]. The number of operating days in common between the surgical oncologist and plastic surgeon nor having the same clinic day impacted timeliness. CONCLUSIONS: Patients may undergo both breast conservation surgery and mastectomy with all major types of immediate reconstruction in a timely manner. Early initiation of plastic surgery referrals and surgeon flexibility to work outside the parameters of institutional schedules may help facilitate the timeliness of surgery.

Efficacy of a Novel Cholangiogram Simulator for Training Laparoscopic Intraoperative Cholangiography.

OBJECTIVE: Determine the efficacy of a novel low-cost, reusable simulator for training fundamental skills associated with safe and effective intraoperative cholangiography (IOC). DESIGN: The simulator uses a balloon and retention suture tubing (representing the gallbladder, cystic duct, common bile duct, and common hepatic duct) attached to a piece of wood and placed in a laparoscopic trainer (representing the abdominal cavity) covered by a piece of simulated skin to obscure it. Following a tutorial on performing a simulated IOC using this, simulation participants independently completed a video-recorded simulated IOC and a post-training survey about the appearance and perceived usefulness of the IOC simulator as a training tool. Two experienced surgeons assessed participants' IOC performance using an IOC procedural checklist developed for this purpose. Procedural time (in seconds) was recorded and used as an additional measure of performance. SETTING: The OhioHealth Learning Center simulation facility in the Department of Surgery at Riverside Methodist Hospital, a large tertiary care independent medical center that is part of the OhioHealth care system. PARTICIPANTS: Eleven attending surgeons and 16 general surgery residents of different levels participated in the simulation. Two experienced surgeons assessed participants' IOC performance. One participated in the simulation along with the other 10 surgeons; the other did not. RESULTS: High-experience participants completed more steps and spent less time than low-experience individuals; however, differences were not statistically significant. There was substantial agreement between the 2 observers regarding participants' performance. Participants scored the simulator as realistic and useful in teaching relevant steps associated with IOC. CONCLUSIONS: Despite differences between high- and low-experience participants in steps completed and time spent, these results did not prove statistically significant. Additional studies to increase sample size are warranted to determine if significant differences exist. However, participants did generally find the simulator to be an effective training tool.