Career Satisfaction, Gender Bias, and Work-Life Balance: A Contemporary Assessment of General Surgeons.

OBJECTIVE: To identify factors and patterns of career and life satisfaction among general surgery residency graduates who completed all of their general surgery training after the implementation of duty hour restrictions. DESIGN: A 91-point electronic survey was distributed to assess experiences during medical school, residency, current surgical practice and work-life balance. Descriptive statistics and chi-square tests were completed. SETTING: Twenty-nine ACGME-accredited surgery residencies. PARTICIPANTS: Graduates of surgery residencies between 2008 and 2018. RESULTS: Three hundred thirty-six surgeons completed the survey (21% response rate); 42% (n = 141) were female. Seventy-nine percent (n = 81) of female and 92% (n = 138) of male surgeons reported overall career satisfaction (p = 0.004). Overall, 97% and 94% reported feeling competent to practice clinically and operate independently at the conclusion of their training. Thirty-four percent (n = 48) of women experienced gender bias/discrimination while on their medical school surgery rotation, compared to 6% (n = 12) of men (p < 0.001). Sixty-two percent (n = 63) of female surgeons reported gender bias in their practice, compared to 4% (n = 6) of men (p < 0.001). Of respondents with children, female surgeons were more likely to think having a child negatively affected their career advancement (p = 0.004), and 24% of female surgeons and 11% of male surgeons do not think having a family is supported by their practice (p = 0.02). If given the opportunity to choose a career again, 21% of female surgeons and 13% of male surgeons would choose a different profession (p = 0.13). CONCLUSIONS: General surgeons who completed their training after implementation of duty hour regulations are confident in their preparation for clinical practice. Female surgeons were less likely to be satisfied with their career and they report significantly more bias during their professional development and career. Work-life balance challenges were similar among men and women. Efforts are necessary to reduce gender bias across the spectrum of general surgeon training/career and to promote well-being among surgeons in practice.

The effect of laparoscopic gastric bypass on dyslipidemia in severely obese patients: a 5-year follow-up analysis.

BACKGROUND: Dyslipidemia is common in the morbidly obese population. A previous study from our institution demonstrated improved lipid parameters 1 and 2 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) with fewer patients taking lipid-modifying medications postoperatively, suggesting cost-savings over time. Our objective was to evaluate lipid parameters and lipid-modifying medication use at 5 years postoperative. METHODS: The medical records of patients who underwent LRYGB from September 2001 through July 2008 were reviewed. Inclusion criteria consisted of both preoperative and 5-year postoperative lipid values available. RESULTS: Six hundred eighty-two patients underwent LRYGB during the study period; 450 had data available at 5 years postoperative, and 187 patients met the inclusion criteria. Mean age was 46.3 years, and 83 % were women. Mean preoperative body mass index was 47.4 kg/m(2). Total cholesterol was 191.2 ± 35.4 preoperatively and 181.1 ± 33.0 at 5 years postoperative (P = 0.003). Low-density lipoprotein (LDL) was 107.9 ± 30.9 preoperatively and 95.3 ± 29.7 at 5 years postoperative (P < 0.001). High-density lipoprotein (HDL) was 48.7 ± 12.8 preoperatively and 65.1 ± 18.0 at 5 years postoperative (P < 0.001). Triglycerides were 171.3 ± 78.6 preoperatively and 112.9 ± 60.7 5 years postoperative (P < 0.001). Preoperatively, 35 % of patients were on lipid-modifying medications, and at 5 years postoperatively, 26 % required lipid-modifying medications (P = 0.002). CONCLUSIONS: Patients who have undergone LRYGB continue to show favorable change in their lipid profiles at 5 years postoperative. Furthermore, fewer patients were taking lipid-modifying medications at 5 years postoperatively than preoperatively.

Evolution in the management of traumatic diaphragmatic injuries: a multicenter review.

BACKGROUND: Traumatic diaphragmatic injury (TDI) is uncommon and has historically been identified by chest x-ray and repaired by laparotomy with nonabsorbable suture. Blunt TDI was more frequently (90%) detected on the left. With advances in imaging and operative techniques, our objective was to evaluate evolution in incidence, location, and management of TDI. METHODS: The medical records of patients admitted to three Wisconsin regional trauma centers with TDI from 1996 to 2011 were reviewed. Patients were stratified into blunt and penetrating injury and early (1996-2003) and recent (2004-2011) periods. p < 0.05 was significant. RESULTS: A total of 454 patients was included, 87% were men. Median Injury Severity Score (ISS) was 22 and 19 in the early and recent periods, respectively. Diagnostic modality for TDI did not change over time when comparing chest x-ray, computed tomography, or intraoperative diagnosis for blunt (p = 0.214) or penetrating (p = 0.119) TDI. More right-sided penetrating TDI were identified in the recent versus early group (49% vs. 27%). Perihiatal injury was rare (2%). Minimally invasive repairs increased in the recent versus early group of penetrating TDI (5.8% vs. 0.9%, p = 0.040). Complex repairs (mesh, transposition) were required in only three patients. In-hospital mortality was 15% and 4% for blunt and penetrating TDIs, respectively (p < 0.001). CONCLUSION: A large increase in the frequency of both blunt and penetrating TDIs in our region was documented. While no difference was observed regarding diagnosis of blunt TDI during the two study periods, our data show a change from historical reports; more injuries were detected by computed tomography. An increase in right-sided penetrating TDI was also observed. A small but previously unreported incidence of perihiatal/pericardial injury occurred with both blunt and penetrating TDIs. While the majority of injuries were repaired with laparotomy, minimally invasive repairs were used more frequently in the recent period. LEVEL OF EVIDENCE: Epidemiologic study, level III. Therapeutic study, level IV.