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1.
Am Surg ; 86(2): 152-157, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106909

RESUMO

The professional use of social media is increasingly prevalent today, particularly in medicine and surgery. Several recent movements have highlighted the strengths of this forum for networking and mentorship for females in surgery who otherwise may lack mentors locally. We sought to describe modern uses for and strengths of social media for women in surgery globally via a systematic review of the literature. Multiple efforts and avenues have promoted gender equality in surgery, while also uniting female surgeons in a collaborative virtual network of colleagues. In particular, movements on Twitter, such as #ILookLikeASurgeon and #NYerORCoverChallenge, as well as other collaborative virtual fora have brought visibility to female surgeons, while drawing the young population of students and trainees toward surgical careers. Social media provides a unique opportunity for female trainees and established surgeons alike to network and establish mentorship relationships, which may aid in fostering interest in surgery and closing the gender gap in our field.


Assuntos
Tutoria , Médicas , Mídias Sociais , Cirurgiões , Escolha da Profissão , Feminino , Humanos , Tutoria/métodos , Mentores/estatística & dados numéricos , Médicas/organização & administração , Médicas/provisão & distribução , Salários e Benefícios/estatística & dados numéricos , Sexismo , Mídias Sociais/organização & administração , Mídias Sociais/estatística & dados numéricos , Mídias Sociais/tendências , Cirurgiões/organização & administração , Cirurgiões/provisão & distribução
2.
Dis Colon Rectum ; 63(2): 190-199, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31914112

RESUMO

BACKGROUND: The National Accreditation Program for Rectal Cancer is a collaborative effort to improve the quality of rectal cancer care, including multidisciplinary assessment, treatment planning, and documentation using synoptic radiology, pathology, and operative reports. OBJECTIVE: The purpose of this study was to examine the implementation and use of a synoptic operative report for rectal cancer. DESIGN: This was a convergent mixed-methods implementation study of electronic medical record data, surveys, and qualitative interviews. SETTINGS: The study was conducted at US medical centers. PARTICIPANTS: Colorectal surgeons were included. INTERVENTION: After development, the synoptic operative report was iteratively revised and ultimately approved by the American Society of Colon and Rectal Surgeons Executive Council and the National Accreditation Program for Rectal Cancer and then implemented into participants' institutional electronic medical record systems. MAIN OUTCOME MEASURES: Change in fidelity to documentation of 19 critical items after implementation of synoptic reports and in-depth details and perspectives about the synoptic operative report were measured. RESULTS: Thirty-seven surgeons from 14 institutions submitted preimplementation operative reports (n = 180); 32 of 37 surgeons submitted postimplementation reports (n = 118). The operation type, approach, and formation of a stoma were present in >70% of preimplementation reports; however, the location of the tumor, the type of reconstruction, and the distal margin were reported in <50%. Each item was present in ≥89% of postimplementation reports. Twenty eight of 37 participants completed the survey, and 21 of 37 participants completed qualitative interviews. Emergent themes included concerns for additional burden and time constraints using the synoptic report themselves, as well as errors or absent information in traditional narrative operative reports of other surgeons. LIMITATIONS: The study was limited by its sample size, cross-sectional nature, specialized centers, and inclusion of colorectal surgeons only. CONCLUSIONS: Although fidelity to the 19 items substantially increased after implementation of the synoptic report, reactions to the synoptic report varied among surgeons. Many indicated concerns that it would hinder workflow or add extra time burden. Others felt the synoptic report could indirectly improve rectal cancer quality of care and provide useful data for quality improvement and research. More work is needed to update and improve the synoptic operative report and streamline the workflow. See Video Abstract at http://links.lww.com/DCR/B100. IMPLEMENTACIÓN DE UN INFORME OPERATIVO SINÓPTICO PARA EL CÁNCER DE RECTO: UN ESTUDIO UTILIZANDO MÉTODOS MIXTOS: El Programa Nacional de Acreditación para el Cáncer Rectal es una iniciativa de colaboración para mejorar la calidad de la atención del cáncer rectal, utilizando evaluación multidisciplinaria, planificación del tratamiento y documentación mediante radiología sinóptica, patología e informes quirúrgicos.Examinar la implementación y el uso de un informe operativo sinóptico para el cáncer de recto.Estudio de implementación de métodos mixtos convergentes de datos de registros médicos electrónicos, encuestas y entrevistas cualitativas.Centros médicos de los Estados Unidos.Cirujanos colorrectales.Después de su formulación, el informe operativo sinóptico fue revisado de forma iterativa y finalmente aprobado por el Consejo Ejecutivo de la Sociedad Americana de Cirujanos de Colon y Rectal y el Programa Nacional de Acreditación para el Cáncer Rectal. Posteriormente, se implementó en los sistemas de registros médicos electrónicos institucionales de los participantes.Cambios en la precisión de documentación de 19 ítems críticos después de la implementación de informes sinópticos; Revisión de detalles y perspectivas en a profundidad sobre el informe operativo sinóptico.Treinta y siete cirujanos de 14 instituciones presentaron informes operativos previos a la implementación (n = 180); 32/37 cirujanos presentaron informes posteriores a la implementación (n = 118). El tipo de operación, el enfoque y la formación de un estoma estuvieron presentes en > 70% de los informes previos a la implementación; sin embargo, la ubicación del tumor, el tipo de reconstrucción y el margen distal se informaron en <50%. Cada ítem estuvo presente en > 89% de los informes posteriores a la implementación. 28/37 participantes completaron la encuesta y 21/37 participantes completaron entrevistas cualitativas. Los temas emergentes incluyeron preocupaciones por la carga adicional y las limitaciones de tiempo usando el informe sinóptico en sí, y errores o información ausente en los informes operativos narrativos tradicionales de otros cirujanos.Tamaño de la muestra, estudio transversal, centros especializados, cirujanos colorrectales solamente.Aunque la fidelidad a los 19 ítems aumentó sustancialmente después de la implementación del informe sinóptico, las reacciones al informe sinóptico variaron entre los cirujanos. Muchos indicaron preocupaciones de que obstaculizaría el flujo de trabajo o agregaría una carga de tiempo adicional. Otros consideraron que el informe sinóptico podría mejorar indirectamente la calidad de la atención del cáncer de recto y proporcionar datos útiles para la mejora de la calidad y la investigación. Se necesita más trabajo para actualizar y mejorar el informe operativo sinóptico y agilizar el flujo de trabajo. Consulte Video Resumen en http://links.lww.com/DCR/B100. (Traducción-Dr. Adrian E. Ortega).


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Neoplasias Retais/cirurgia , Cirurgiões/organização & administração , Estudos Transversais , Documentação/métodos , Registros Eletrônicos de Saúde/normas , Feminino , Humanos , Masculino , Melhoria de Qualidade , Neoplasias Retais/epidemiologia , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
3.
Dis Colon Rectum ; 63(2): 226-232, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31914115

RESUMO

BACKGROUND: Online physician rating Web sites are used by over half of consumers to select doctors. No studies have examined physician rating Web sites for colon and rectal surgeons. OBJECTIVE: The purpose of this study was to evaluate the accuracy and rating patterns of colon and rectal surgeons on the largest physician rating Web site. DESIGN: Physician characteristics and ratings were collected from a randomly selected sample of 500 from 3043 Healthgrades "colon and rectal surgery specialists." Board certifications were verified with the American Board of Surgery and American Board of Colon and Rectal Surgery Web sites. SETTINGS: Data acquisition was completed on July 18, 2018. PATIENTS: Patients were not directly studied. MAIN OUTCOME MEASURES: The primary outcome was to assess the accuracy of Healthgrades in reporting American Board of Surgery and American Board of Colon and Rectal Surgery certification. The secondary outcome was to identify factors associated with high star ratings. RESULTS: A total of 48 (9.6%) of the 500 sampled were incorrectly identified as practicing US surgeons and excluded from subsequent analysis. Healthgrades showed 80.1% agreement with verified board certifications for American Board of Surgery and 85.4% for American Board of Colon and Rectal Surgery. The mean star rating was 4.2 of 5.0 (SD = 0.9), and 77 (21.6%) had 5-star ratings. In a multivariable logistic model (p < 0.001), 5-star rating was associated with 1 to 9 years (OR = 2.76; p = 0.04) or >40 years in practice (OR = 3.35; p = 0.04) and fewer reviews (OR = 0.88; p < 0.001). There were no significant associations with surgeon sex, age, geographic region, or board certification. LIMITATIONS: Data were limited to a single physician rating Web site. CONCLUSIONS: In the modern age of healthcare consumerism, physician rating Web sites should be used with caution given inaccuracies. More accurate online resources are needed to inform patient decisions in the selection of specialized colon and rectal surgical care. See Video Abstract at http://links.lww.com/DCR/B91. PRECISIÓN DE DATOS Y PREDICTORES DE ALTAS CALIFICACIONES DE CIRUJANOS DE COLON Y RECTO EN UN SITIO WEB DE CALIFICACIÓN MÉDICA EN LÍNEA: Más de la mitad de los consumidores utilizan los sitios web de calificación de médicos en línea para seleccionar médicos. Ningún estudio ha examinado los sitios web de calificación de médicos para cirujanos de colon y recto.Evaluar la precisión y los patrones de calificación de los cirujanos de colon y recto en el sitio web más grande de calificación de médicos.Las características y calificaciones de los médicos se obtuvieron de una muestra seleccionada al azar de 500 de 3,043 "especialistas en cirugía de colon y recto" de Healthgrades. Las certificaciones del Consejo se verificaron en los sitios web del Consejo Americano de Cirugía y del Consejo Americano de Cirugía de Colon y Recto.La adquisición de datos se completó el 18 de julio de 2018.Los pacientes no fueron estudiados directamente.El resultado primario fue evaluar la precisión de Healthgrades al informar la certificación por el Consejo Americano de Cirugía y por el Consejo Americano de Cirugía de Colon y Recto. El resultado secundario fue identificar factores asociados con altas calificaciones en estrellas.Un total de 48 (9.6%) de la muestra de 500 fueron identificados incorrectamente como cirujanos practicantes de EE. UU. y excluidos del análisis subsecuente. Healthgrades mostró un 80.1% de concordancia con las certificaciones verificadas del Consejo Americano de Cirugía y el 85.4% con el Consejo Americano de Cirugía de Colon y Recto. La calificación promedio de estrellas fue 4.2 / 5 (SD 0.9), y 77 (21.6%) tuvieron calificaciones de 5 estrellas. En un modelo logístico multivariable (p <0.001), la calificación de 5 estrellas se asoció con 1-9 años (OR 2.76, p = 0.04) o más de 40 años en la práctica (OR 3.35, p = 0.04) y menos evaluaciones (OR 0.88, p <0.001). No hubo asociaciones significativas con el género, edad, región geográfica o certificación por los Consejos del cirujano.Los datos se limitaron a un solo sitio web de calificación de médicos.En la era moderna del consumismo en atención médica, los sitios web de calificación de los médicos deben usarse con precaución debido a imprecisiones. Se necesitan recursos en línea más precisos para que las decisiones de los pacientes sean informadas en la selección de atención quirúrgica especializada de colon y recto. Consulte Video Resumen en http://links.lww.com/DCR/B91. (Traducción-Dr. Jorge Silva-Velazco).


Assuntos
Colo/cirurgia , Sistemas On-Line/instrumentação , Reto/cirurgia , Cirurgiões/estatística & dados numéricos , Confiabilidade dos Dados , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Conselhos de Especialidade Profissional/organização & administração , Cirurgiões/organização & administração
5.
Keio J Med ; 68(3): 68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31554774

RESUMO

In contrast to many other countries, training of medical specialists is funded by the Department of Health. The curriculum of medical specialist training including general surgery is well structured and lasts 6 years. Specialist (trainers) and hospitals involved in surgical training have been accredited by the Dutch Association of Surgeons. Surgical training includes 4 years of general surgery followed by two years of differentiation in one of the sub-specialities. These are gastrointestinal, oncological, vascular, pediatric and trauma surgery. The training program is competency based: there are key procedures and so called EPA (entrusted professional activities) that are defined to monitor the progress of an individual. Unique in the Dutch system is the quality control and governance of surgical training that will be discussed in my lecture.The number of positions available for surgical trainees is limited and determined by the government each year. Hence, to enter surgical training has always been very competitive and not easy for young doctors. This is one of the reasons why many students start a PhD program after medical school and to gain experience in basic or clinical research. These young and talented students usually work for 3-4 years full time and are well capable of coordinating trials. This is just one of the reasons that many clinical (randomised) studies come from the Netherlands. Besides this strong academic environment, lack of private practice, strong multidisciplinary working parties and the geographical situation in our small country facilitates multicenter studies. Some more crucial factors for success will be discussed in the lecture.(Presented at the 1983th Meeting, July 10, 2019).


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Especialidades Cirúrgicas/organização & administração , Cirurgiões/organização & administração , Competência Clínica/normas , Currículo , Humanos , Países Baixos , Controle de Qualidade , Especialidades Cirúrgicas/educação , Conselhos de Especialidade Profissional/organização & administração , Cirurgiões/educação
6.
BMC Surg ; 19(1): 112, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412843

RESUMO

BACKGROUND: Many surgeons report passion for their work, but not all tasks are likely to be satisfying. Little is known about how hospital surgeons spend their days, how they like specific tasks, and the role of core tasks (i.e. surgery-related tasks) versus tasks that may keep them from core tasks (e.g., administrative work). This study aimed at a more detailed picture of hospital surgeons' daily work - how much time they spend with different tasks, how they like them, and associations with satisfaction. METHODS: Hospital surgeons (N = 105) responded to a general survey, and 81 of these provided up to five daily questionnaires concerning daily activities and their attractiveness, as well as their job satisfaction. The data were analyzed using t-tests, analysis of variance, as well as analysis of covariance and repeated measures analysis of variance for comparing means across tasks. RESULTS: Among 14 tasks, surgery-related tasks took 21.2%, patient-related tasks 21.7% of the surgeons' time; 10.4% entailed meetings and communicating about patients, and 18.6% documentation and administration. The remaining time was spent with teaching, research, leadership and management, and not task-related activities (e.g. walking between rooms). Surgery was rated as most (4.25; SD = .66), administration as least attractive (2.63; SD = .78). A higher percentage of administration predicted lower perceived legitimacy; perceived legitimacy of administrative work predicted job satisfaction (r = .47). Residents were least satisfied; there were few gender differences. CONCLUSIONS: Surgeons seem to thrive on their core tasks, most notably surgery. By contrast, administrative duties are likely perceived as keeping them from their core medical tasks. Increasing the percentage of medical tasks proper, notably surgery, and reducing administrative duties may contribute to hospital surgeons' job satisfaction.


Assuntos
Satisfação no Emprego , Cirurgiões/psicologia , Adulto , Pesquisa Biomédica , Comunicação , Documentação , Feminino , Administração Hospitalar , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Cirurgiões/organização & administração , Inquéritos e Questionários , Ensino , Carga de Trabalho
8.
Surgery ; 166(5): 744-751, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31303324

RESUMO

BACKGROUND: Persistent opioid use is common after surgical procedures, and postoperative opioid prescribing often transitions from surgeons to primary care physicians in the months after surgery. It is unknown how surgeons currently transition these patients or the preferred approach to successful coordination of care. This qualitative study aimed to describe transitions of care for postoperative opioid prescribing and identify barriers and facilitators of ideal transitions for potential intervention targets. METHODS: We conducted a qualitative study of surgeons and primary care physicians at a large academic healthcare system using a semi-structured interview guide. Transcripts were independently coded using the Theoretical Domains Framework to identify underlying determinants of physician behaviors. We mapped dominant themes to the Behavior Change Wheel to propose potential interventions targeting these behaiors. RESULTS: Physicians were interviewed between July 2017 and December 2017 beyond thematic saturation (n = 20). Surgeons report passive transitions to primary care physicians after ruling out surgical complications, and these patients often bounce back to the surgeon when primary care physicians are uncertain of the cause of ongoing pain. Ideal practices were identified as setting preoperative expectations and engaging in active transition for postoperative opioid prescribing. We identified 3 behavioral targets for multidisciplinary intervention: knowledge (guidelines for coordination of care), barriers (utilizing support staff for active transition), and professional role (incentive for multidisciplinary collaboration). CONCLUSION: This qualitative study identifies potential interventions aimed at changing physician behaviors regarding transitions of care for postoperative opioid prescribing. Implementation of these interventions could improve coordination of care for patients with persistent postoperative opioid use.


Assuntos
Analgésicos Opioides/uso terapêutico , Atitude do Pessoal de Saúde , Dor Pós-Operatória/tratamento farmacológico , Transferência de Pacientes/organização & administração , Papel Profissional , Adulto , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Médicos de Atenção Primária/organização & administração , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica/organização & administração , Pesquisa Qualitativa , Cirurgiões/organização & administração , Cirurgiões/psicologia
9.
Medicine (Baltimore) ; 98(25): e16133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232965

RESUMO

The American College of Surgeons (ACS) Committee on Trauma (COT) verification and State designation of trauma centers (TCs) into Level 1 or 2 establishes a distinction based on resources, trauma volume, and educational commitment. The ACS COT and individual states each verify TCs to differentiate performance levels. We aim to determine the relationship between ACS and State Level 1 versus 2, and injury-adjusted, all-cause mortality in a national sampling.TCs were identified by review of the National Sample Program (NSP) from the National Trauma Data Bank (NTDB)-the largest validated trauma database in the nation-of the year 2013. TCs were categorized by ACS or State Level 1 or 2 status, all others were excluded. Adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived by trauma and injury severity score (TRISS) methodology. Chi-squared and t test analyses were used for categorical variables, with a statistical significance defined as P-value <.05.Of the 94 TCs in the NSP, 67 had ACS and 80 had State designations. There were 38 ACS Level 1 TCs and 29 ACS Level 2. For State designations, there were 45 as State Level 1 and 35 State Level 2. ACS Level 1 TCs had a similar O/E compared with ACS Level 2 verified centers (0.73 vs 0.75, chi-square, P = .36). Level 1 TCs designated by their state, had a similar O/E compared with State Level 2 centers (0.70 vs 0.74, chi-square, P = .08).Both ACS and State Level 1 and 2 trauma centers performed similarly on injury adjusted, all-cause mortality.


Assuntos
/estatística & dados numéricos , Cirurgiões/organização & administração , Centros de Traumatologia/normas , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Jurisprudência , Qualidade da Assistência à Saúde , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Sociedades Médicas/normas , Sociedades Médicas/tendências , Cirurgiões/tendências , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
10.
World J Emerg Surg ; 14: 30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236130

RESUMO

Background: The World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management. Methods: Multicenter prospective observational study on adult patients with blunt splenic trauma managed between 2014 and 2016 in two Italian trauma centers (ASST Papa Giovanni XXIII in Bergamo and Sant'Anna University Hospital in Ferrara). Risk factors for operative management at the arrival of the patient and as a definitive treatment were analyzed. Moreover, the association between the different WSES grades of injury and the definitive management was analyzed. Results: One hundred twenty-four patients were included. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. WSES splenic injury grade III is a risk factor for angioembolization. Conclusions: The WSES classification is a good and reliable tool in the decision-making process in splenic trauma management.


Assuntos
Baço/lesões , Ferimentos e Lesões/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Baço/anormalidades , Baço/fisiopatologia , Esplenectomia/métodos , Cirurgiões/organização & administração , Cirurgiões/estatística & dados numéricos
12.
J Surg Res ; 242: 258-263, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31108343

RESUMO

BACKGROUND: Inflammatory bowel disease encompasses relapsing gastrointestinal disorders commonly presenting in pediatric patients, with 25% of diagnoses made before age 20 and 4% before age 5. Considering the need for life-long surgical follow-up, a collaborative system involving both pediatric and colorectal surgeons could improve overall patient experiences. We hypothesized that cases performed in collaboration with both pediatric and adult colorectal surgeons may lead to better outcomes. METHODS: Data were gathered retrospectively for 116 patients 18 y old or younger who underwent colorectal resections for inflammatory bowel disease between 2010 and 2017 at our institution. Data included patient demographics, type of procedure, surgical approach, specimen extraction site, surgeon involvement (pediatric, colorectal, or collaborative), operative time, and estimated blood loss. We analyzed days until passage of flatus and bowel movement, length of stay, type of surgical procedure, and surgical complications. RESULTS: Our data showed that days until flatus (2.27 ± 0.47, P = 0.049), first bowel movement (2.64 ± 0.67, P = 0.006), and length of stay (4.45 ± 1.51, P = 0.006) were the shortest in the collaborative group. We also found that single-incision laparoscopic surgery was significantly more common in the collaborative group (77.8%, P = 0.002). We did not see a difference in surgical complication rates among any of the groups. CONCLUSIONS: Our study showed short-term beneficial outcomes in a single institution associated with the collaboration of pediatric surgeons and colorectal surgeons on pediatric colorectal cases in comparison to those performed by pediatric surgeons or adult colorectal surgeons alone.


Assuntos
Colectomia/efeitos adversos , Doenças Inflamatórias Intestinais/cirurgia , Colaboração Intersetorial , Equipe de Assistência ao Paciente/organização & administração , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Colectomia/métodos , Cirurgia Colorretal/organização & administração , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Pediatria/organização & administração , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgiões/organização & administração , Resultado do Tratamento
13.
Am Surg ; 85(4): 420-430, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043205

RESUMO

The aim of this study was to review and analyze all of the "concurrent surgery" (CS) and "overlapping surgery" (OS) literature with the goal of: standardizing terminology, defining discrepancies in the literature and proposing solutions for the current challenges of regulating surgery to achieve maximal safety and efficiency. The CS and OS literature has grown exponentially over the past two years. Before this, there were no significant publications addressing this topic. There is an extremely wide variance on how "running two rooms" is defined and whether it should be permitted. These differences affect our patients' perception of this practice. The literature lacks any comprehensive review of the topic and terminology. We performed a PubMed search to identify studies that considered the issue of OS. The terms "overlapping surgery", "concurrent surgery", and "simultaneous surgery" (SS) were used in the query. We then analyzed the publications identified. The literature contained 18 published studies analyzing OS safety between November 2016 and June 2018. Eight were neurosurgical studies, three were orthopedic, and the remaining seven articles were in other surgical specialties. A total of 1,207,155 surgical cases (range 250->500,000 patients) were analyzed among the 18 studies. There were 57,880 (5.04%) OS cases. The OS rates in the individual studies ranged from 1.2 to 68 per cent (Table 1). Neurosurgical studies had the highest average OS rate of 54 per cent (range 37-68%), whereas the average OS rate in orthopedic surgery was 43 per cent (range 2.7-68%). Approximately one-third of the studies were multicenter investigations (27.7%). The studies measured more than 20 distinct outcomes, but there were only five outcomes that were included in the majority of the studies: mortality rates, reoperation rates, procedure length of time, readmission rates, and hospital length of stay. The current body of literature repeatedly demonstrates that OS is a safe and effective option when undertaken by experienced surgeons who practice it frequently. For successful OS, the Mandatory Attending Portion for two surgeries must not overlap and Unnecessary Anesthesia Time must be prohibited. Hospitals and surgical specialty organizations must implement policies to assure the safe practice of OS.


Assuntos
Salas Cirúrgicas/organização & administração , Cirurgiões/organização & administração , Procedimentos Cirúrgicos Operatórios/métodos , Humanos
14.
Clin Ter ; 170(2): e148-e161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30993312

RESUMO

OBJECTIVES: To explore the interaction between surgeon volumes (SVs) and hospital volumes (HVs) on health outcomes. MATERIALS AND METHODS: We searched MEDLINE, Embase, CINAHL, Web of Science as of May 2017. We included studies investigating the interaction between high or low SVs operating in high or low HVs. Review process follows the PRISMA guidelines. We assessed the methodological quality of the included studies using validated critical appraisal checklists. RESULTS: Sixteen studies were included. Due to the heterogeneity of studies, it was not possible to perform a quantitative analysis. Heath outcome are worse when high SV operating in low HV vs high HV, for the majority of the conditions (colorectal cancer, cystectomy, liver resection, mitral valve surgery, pancreatico-duodenectomy). Results for low SV are better when operating in high HV vs low HV for patients undergoing pancreatic-duodenectomy for mortality, 30 days complications and length of stay. Results for low SV are worse vs high SV when operating in high HV for most considered conditions. Results were in favour of higher SV vs low SV when operating in low HV for digital replantation success after injuries, 30 days mortality and complications after pancreatic-duodenectomy. CONCLUSIONS: The available evidence is limited. It is necessary to increase the monitoring of the association between surgeons volumes and hospitals volumes in which they operate, to ensure fairness and accuracy of care for better health outcomes.


Assuntos
Assistência à Saúde/organização & administração , Cirurgiões/organização & administração , Hospitais com Alto Volume de Atendimentos , Humanos
16.
Can J Surg ; 62(2): 139-141, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907994

RESUMO

Summary: Comparisons with other high-income countries suggest that Canada has been slower to adopt laparoscopic colectomy (LC). The Canadian Association of General Surgeons sought to evaluate the barriers to adoption of laparoscopic colon surgery and to propose potential intervention strategies to enhance the use of the procedure. Given the clinical benefits of laparoscopic surgery for patients, the increasing needs for surgical care and the desire of Canadian general surgeons to advance their specialty and enhance the care of their patients, it is an important priority to improve the utilization of LC.


Assuntos
Colectomia/tendências , Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/tendências , Implementação de Plano de Saúde/tendências , Laparoscopia/tendências , Canadá , Competência Clínica , Colectomia/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Laparoscopia/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cirurgiões/organização & administração
17.
J Pediatr Surg ; 54(9): 1872-1877, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30765152

RESUMO

INTRODUCTION: Peer-review endeavors represent the continual learning environment critical for a culture of patient safety. Morbidity and mortality (M&M) conferences are designed to review adverse events to prevent future similar events. The extent to which pediatric surgeons participate in M&M, and believe M&M improves patient safety, is unknown. METHODS: A cross-sectional survey of the American Pediatric Surgical Association membership was conducted to evaluate participation in and perception of M&M conferences. Closed and open-ended questions were provided to gauge participation and perceptions of M&M effectiveness. Standard frequency analyses and tests of associations between M&M program attributes and surgeons' perceptions of effectiveness were performed. RESULTS: The response rate was 38% (353/928). Most surgeons (85%) reported that they always participate in M&M, but only 64% believe M&M is effective in changing practice or prevention of future adverse events. Effective M&Ms were more likely to emphasize loop closure, multidisciplinary participation, standardized assessment of events, and connection to quality improvement efforts. CONCLUSIONS: Most pediatric surgeons participate in M&M, but many doubt its effectiveness. We identified attributes of M&M conferences that are perceived to be effective. Further investigation is needed to identify how to optimally utilize peer-review programs to prevent adverse events and improve patient safety. LEVEL OF EVIDENCE: V.


Assuntos
Dano ao Paciente/prevenção & controle , Segurança do Paciente/normas , Pediatras , Cirurgiões , Estudos Transversais , Humanos , Morbidade , Pediatras/organização & administração , Pediatras/estatística & dados numéricos , Melhoria de Qualidade , Cirurgiões/organização & administração , Cirurgiões/estatística & dados numéricos
19.
Healthc (Amst) ; 7(2): 7-9, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30709795

RESUMO

In India, 90% of the rural population is estimated to lack access to safe, affordable, and timely surgical care. Surgical care in these settings is often characterized by limited resources. Provision of rural surgical care often requires novel approaches as compared to those in higher income urban sectors, specifically in areas of infrastructure, workforce, and blood. This consensus statement draws upon the wealth of experience held by India's rural surgeons to identify key problems and lay forth actionable solutions in the areas of surgical infrastructure, workforce, and blood supply.


Assuntos
Serviços de Saúde Rural/organização & administração , Cirurgiões/organização & administração , Consenso , Recursos em Saúde/economia , Recursos em Saúde/provisão & distribução , Humanos , Índia , Serviços de Saúde Rural/tendências , Cirurgiões/provisão & distribução , Cirurgiões/tendências
20.
J Surg Res ; 236: 110-118, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30694743

RESUMO

BACKGROUND: Surgical supplies occupy a large portion of health care expenditures but is often under the surgeon's control. We sought to assess whether an automated, surgeon-directed, cost feedback system can decrease supply expenditures for five common general surgery procedures. MATERIALS AND METHODS: An automated "surgical receipt" detailing intraoperative supply costs was generated and emailed to surgeons after each case. We compared the median cost per case for 18 mo before and after implementation of the surgical receipt. We controlled for price fluctuations by applying common per-unit prices in both periods. We also compared the incision time, case length booking accuracy, length of stay, and postoperative occurrences. RESULTS: Median costs decreased significantly for open inguinal hernia ($433.45 to $385.49, P < 0.001), laparoscopic cholecystectomy ($886.77 to $816.13, P = 0.002), and thyroidectomy ($861.21 to $825.90, P = 0.034). Median costs were unchanged for laparoscopic appendectomy and increased significantly for lumpectomy ($325.67 to $420.53, P < 0.001). There was an increase in incision-to-closure minutes for open inguinal hernia (71 to 75 min, P < 0.001) and laparoscopic cholecystectomy (75 to 96 min, P < 0.001), but a decrease in thyroidectomy (79 to 73 min, P < 0.001). There was an increase in booking accuracy for laparoscopic appendectomy (38.6% to 55.0%, P = 0.001) and thyroidectomy (32.5% to 48.1%, P = 0.001). There were no differences in postoperative occurrence rates and length of stay duration. CONCLUSIONS: An automated surgeon-directed surgical receipt may be a useful tool to decrease supply costs for certain procedures. However, curtailing surgical supply costs with surgeon-directed cost feedback alone is challenging and a multimodal approach may be necessary.


Assuntos
Equipamentos e Provisões Hospitalares/economia , Custos Hospitalares/organização & administração , Salas Cirúrgicas/economia , Cirurgiões/organização & administração , Procedimentos Cirúrgicos Operatórios/economia , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício , Correio Eletrônico , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Estudos de Viabilidade , Retroalimentação , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Salas Cirúrgicas/organização & administração , Duração da Cirurgia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Cirurgiões/economia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
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