Pub Date : 2024-04-23DOI: 10.1177/00031348241248807
Jan H. Wong, Ashley E. Burch, Eric J. DeMaria, Walter J Pories, W. Irish
BACKGROUND This study sought to identify factors that contribute to disparities in access to bariatric surgery in North Carolina (NC). METHODS Using the rate of bariatric surgery in the county with the best health outcome as the reference, we calculated the Surgical Equity Index (SEI) in the remaining counties in NC. RESULTS Approximately 2.95 million individuals (29%) were obese in NC. There were 992 (.5%) bariatric procedures performed on a population of 194 209 individuals with obesity in the Reference County (RC). The mean SEI for bariatric surgery in NC was .47 (SD .17, range .15-.95). A statistically significant difference was observed in 89 counties. Univariable analyses identified the following variables to be significantly associated with the SEI: percent of population living in rural areas (% rural) (relative rate change in SEI [RR] = .994, 95% CI .92-.997; <.0001), median household income (RR = 1.0, 95% CI = 1.0-1.0; P = .0002), prevalence of diabetes (RR = .947, 95% CI .917-.977; .0006), the primary care physician ratio (RR = .995, 95% CI .991-.998; P = .006), and percent uninsured adults (RR = .955, 95% CI .927-.985; P = .003). By multivariable hierarchical regression analysis, only the % rural remained statistically associated with a low SEI (RR = .995 per 1% increase in % rural, 95% CI = .992, .998; P = .0002). DISCUSSION The percent rural is the most significant predictor of disparities in access to bariatric surgery. For every 1% increase in % rural, the rate of surgery decreased by .5%. Understanding the characteristics of rurality that are barriers to access is crucial to mitigate disparities in bariatric surgical access in NC.
背景本研究旨在确定造成北卡罗来纳州（NC）减肥手术机会不均等的因素。方法以健康状况最好的县的减肥手术率为参照，计算北卡罗来纳州其余各县的手术公平指数（SEI）。结果北卡罗来纳州约有 295 万人（29%）肥胖。在参照县（RC）194 209 名肥胖症患者中，有 992 例（0.5%）接受了减肥手术。北卡罗来纳州减肥手术的平均 SEI 为 0.47（标准差 0.17，范围 0.15-0.95）。在 89 个县中观察到了具有统计学意义的差异。单变量分析发现以下变量与 SEI 显著相关：农村地区人口百分比（% rural）（SEI 相对变化率 [RR] = .994，95% CI .92-.997；<.0001）、家庭收入中位数（RR = 1.0，95% CI = 1.0-1.0；P = .0002）、糖尿病患病率（RR = .947，95% CI .917-.977；.0006）、初级保健医生比率（RR = .995，95% CI .991-.998；P = .006）和无保险成人百分比（RR = .955，95% CI .927-.985；P = .003）。通过多变量分层回归分析，只有农村人口百分比仍与低 SEI 存在统计学关联（农村人口百分比每增加 1%，RR = .995，95% CI = .992，.998；P = .0002）。农村人口比例每增加 1%，手术率就会下降 0.5%。了解阻碍患者接受手术的农村地区特征对于减少北卡罗来纳州减肥手术的不平等至关重要。
{"title":"Disparities in Access to Bariatric Surgery in North Carolina.","authors":"Jan H. Wong, Ashley E. Burch, Eric J. DeMaria, Walter J Pories, W. Irish","doi":"10.1177/00031348241248807","DOIUrl":"https://doi.org/10.1177/00031348241248807","url":null,"abstract":"BACKGROUND\u0000This study sought to identify factors that contribute to disparities in access to bariatric surgery in North Carolina (NC).\u0000\u0000\u0000METHODS\u0000Using the rate of bariatric surgery in the county with the best health outcome as the reference, we calculated the Surgical Equity Index (SEI) in the remaining counties in NC.\u0000\u0000\u0000RESULTS\u0000Approximately 2.95 million individuals (29%) were obese in NC. There were 992 (.5%) bariatric procedures performed on a population of 194 209 individuals with obesity in the Reference County (RC). The mean SEI for bariatric surgery in NC was .47 (SD .17, range .15-.95). A statistically significant difference was observed in 89 counties. Univariable analyses identified the following variables to be significantly associated with the SEI: percent of population living in rural areas (% rural) (relative rate change in SEI [RR] = .994, 95% CI .92-.997; <.0001), median household income (RR = 1.0, 95% CI = 1.0-1.0; P = .0002), prevalence of diabetes (RR = .947, 95% CI .917-.977; .0006), the primary care physician ratio (RR = .995, 95% CI .991-.998; P = .006), and percent uninsured adults (RR = .955, 95% CI .927-.985; P = .003). By multivariable hierarchical regression analysis, only the % rural remained statistically associated with a low SEI (RR = .995 per 1% increase in % rural, 95% CI = .992, .998; P = .0002).\u0000\u0000\u0000DISCUSSION\u0000The percent rural is the most significant predictor of disparities in access to bariatric surgery. For every 1% increase in % rural, the rate of surgery decreased by .5%. Understanding the characteristics of rurality that are barriers to access is crucial to mitigate disparities in bariatric surgical access in NC.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"44 20","pages":"31348241248807"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/00031348241248816
Aricia Shen, Galinos Barmparas, Nicolas Melo, R. Chung, Miguel Burch, Umar F Bhatti, D. Margulies, Andrew S Wang
INTRODUCTION The role of robotic surgery in the nonelective setting remains poorly defined. Accessibility, patient acuity, and high turn-over may limit its applicability and utilization. The goal is to characterize the role of robotic cholecystectomy (CCY) in a busy acute care surgery (ACS) practice at a quaternary medical center, and compare surgical outcomes and resource utilization between robotic and laparoscopic CCY. METHODS Adult patients who underwent robotic (Da Vinci Xi) or laparoscopic CCY between 01/2021-12/2022 by an ACS attending within 1 week of admission were included. Primary outcomes included time from admission to surgery, off hour (weekend and 6p-6a) cases, operation time, and hospital costs, to reflect "feasibility" of robotic compared to laparoscopic CCY. Secondary outcomes encompassed surgery-related outcomes and complications. RESULTS The proportion of robotic CCY increased from 5% to 32% within 2 years. In total 361 laparoscopic and 89 robotic CCY were performed. Demographics and gallbladder disease severity were similar. Feasibility measures-operation time, case start time, time from admission to surgery, proportion of off-hour cases, and cost-were comparable between robotic and laparoscopic CCY. There were no differences in surgical complications, common bile duct injury, readmission, or mortality. Conversion to open surgery occurred more often in laparoscopic cases (5% vs 0%, P = .02, OR = 1.05). DISCUSSION Robotic CCY is associated with fewer open conversions and otherwise similar outcomes compared to laparoscopic CCY in the non-elective setting. Incorporation of robotic CCY in a busy ACS practice model is feasible with available resources.
{"title":"Incorporating Robotic Cholecystectomy in an Acute Care Surgery Practice Model is Feasible.","authors":"Aricia Shen, Galinos Barmparas, Nicolas Melo, R. Chung, Miguel Burch, Umar F Bhatti, D. Margulies, Andrew S Wang","doi":"10.1177/00031348241248816","DOIUrl":"https://doi.org/10.1177/00031348241248816","url":null,"abstract":"INTRODUCTION\u0000The role of robotic surgery in the nonelective setting remains poorly defined. Accessibility, patient acuity, and high turn-over may limit its applicability and utilization. The goal is to characterize the role of robotic cholecystectomy (CCY) in a busy acute care surgery (ACS) practice at a quaternary medical center, and compare surgical outcomes and resource utilization between robotic and laparoscopic CCY.\u0000\u0000\u0000METHODS\u0000Adult patients who underwent robotic (Da Vinci Xi) or laparoscopic CCY between 01/2021-12/2022 by an ACS attending within 1 week of admission were included. Primary outcomes included time from admission to surgery, off hour (weekend and 6p-6a) cases, operation time, and hospital costs, to reflect \"feasibility\" of robotic compared to laparoscopic CCY. Secondary outcomes encompassed surgery-related outcomes and complications.\u0000\u0000\u0000RESULTS\u0000The proportion of robotic CCY increased from 5% to 32% within 2 years. In total 361 laparoscopic and 89 robotic CCY were performed. Demographics and gallbladder disease severity were similar. Feasibility measures-operation time, case start time, time from admission to surgery, proportion of off-hour cases, and cost-were comparable between robotic and laparoscopic CCY. There were no differences in surgical complications, common bile duct injury, readmission, or mortality. Conversion to open surgery occurred more often in laparoscopic cases (5% vs 0%, P = .02, OR = 1.05).\u0000\u0000\u0000DISCUSSION\u0000Robotic CCY is associated with fewer open conversions and otherwise similar outcomes compared to laparoscopic CCY in the non-elective setting. Incorporation of robotic CCY in a busy ACS practice model is feasible with available resources.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"126 44","pages":"31348241248816"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140669161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/00031348241248786
Amanda Hambrecht, M. Schellenberg, Natthida Owattanapanich, Kelly A Boyle, Chaiss Ugarte, Corey Ambrose, K. Matsushima, Matthew J Martin, Kenji Inaba
INTRODUCTION An increasing proportion of the population identifies as non-binary. This marginalized group may be at differential risk for trauma compared to those who identify as male or female, but physical trauma among non-binary patients has not yet been examined at a national level. METHODS All patients aged ≥ 16 years in the National Trauma Data Bank were included (2021-2022). Demographics, injury characteristics, and outcomes after trauma among non-binary patients were compared to males and females. The goal was to delineate differences between groups to inform the care and future study of non-binary trauma patients. RESULTS In total, 1,012,348 patients were included: 283 (<1%) non-binary, 610,904 (60%) male, and 403,161 (40%) female patients. Non-binary patients were younger than males or females (median age 44 vs 49 vs 67 years, P < .001) and less likely to be White race/ethnicity (58% vs 60% vs 74%, P < .001). Despite non-binary patients having a lower median Injury Severity Score (5 vs 9 vs 9, P < .001), mortality was highest among non-binary and male patients than females (5% vs 5% vs 3%, P < .001). DISCUSSION In this study, non-binary trauma patients were younger and more likely minority races/ethnicities than males or females. Despite having a lower injury severity, non-binary patient mortality rates were comparable to those of males and greater than for females. These disparities identify non-binary trauma patients as doubly marginalized, by gender and race/ethnicity, who experience worse outcomes after trauma than expected based on injury severity. This vulnerable patient population deserves further study to identify areas for improved trauma delivery care.
引言 越来越多的人口认同非二元身份。与男性或女性相比，这一边缘化群体可能面临不同的创伤风险，但目前尚未在全国范围内对非二元患者的身体创伤进行研究。将非二元患者的人口统计学特征、损伤特征和创伤后的结果与男性和女性进行了比较。结果共纳入 1,012,348 名患者：其中非二元患者 283 人（<1%），男性患者 610,904 人（60%），女性患者 403,161 人（40%）。非二元患者比男性或女性更年轻（中位年龄分别为 44 岁 vs 49 岁 vs 67 岁，P < .001），而且不太可能是白人种族/族裔（58% vs 60% vs 74%，P < .001）。尽管非二元患者的受伤严重程度评分中位数较低（5 vs 9 vs 9，P < .001），但非二元患者和男性患者的死亡率却高于女性（5% vs 5% vs 3%，P < .001）。尽管受伤严重程度较低，但非二元患者的死亡率与男性相当，高于女性。这些差异表明，非二元创伤患者在性别和种族/族裔方面被双重边缘化，他们在创伤后的治疗效果比根据受伤严重程度预期的要差。这一弱势患者群体值得进一步研究，以确定需要改进的创伤护理领域。
{"title":"Non-Binary Trauma Patients: Delineating a Vulnerable, At-Risk Population.","authors":"Amanda Hambrecht, M. Schellenberg, Natthida Owattanapanich, Kelly A Boyle, Chaiss Ugarte, Corey Ambrose, K. Matsushima, Matthew J Martin, Kenji Inaba","doi":"10.1177/00031348241248786","DOIUrl":"https://doi.org/10.1177/00031348241248786","url":null,"abstract":"INTRODUCTION\u0000An increasing proportion of the population identifies as non-binary. This marginalized group may be at differential risk for trauma compared to those who identify as male or female, but physical trauma among non-binary patients has not yet been examined at a national level.\u0000\u0000\u0000METHODS\u0000All patients aged ≥ 16 years in the National Trauma Data Bank were included (2021-2022). Demographics, injury characteristics, and outcomes after trauma among non-binary patients were compared to males and females. The goal was to delineate differences between groups to inform the care and future study of non-binary trauma patients.\u0000\u0000\u0000RESULTS\u0000In total, 1,012,348 patients were included: 283 (<1%) non-binary, 610,904 (60%) male, and 403,161 (40%) female patients. Non-binary patients were younger than males or females (median age 44 vs 49 vs 67 years, P < .001) and less likely to be White race/ethnicity (58% vs 60% vs 74%, P < .001). Despite non-binary patients having a lower median Injury Severity Score (5 vs 9 vs 9, P < .001), mortality was highest among non-binary and male patients than females (5% vs 5% vs 3%, P < .001).\u0000\u0000\u0000DISCUSSION\u0000In this study, non-binary trauma patients were younger and more likely minority races/ethnicities than males or females. Despite having a lower injury severity, non-binary patient mortality rates were comparable to those of males and greater than for females. These disparities identify non-binary trauma patients as doubly marginalized, by gender and race/ethnicity, who experience worse outcomes after trauma than expected based on injury severity. This vulnerable patient population deserves further study to identify areas for improved trauma delivery care.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"52 6","pages":"31348241248786"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1177/00031348241248803
Oluwasegun A. Akinyemi, Terhas A. Weldeslase, Tsion F Andine, M. Fasokun, Yasmin Griffiths, Eunice Odusanya, Mallory Williams, Kakra Hughes, Edward E Cornwell, T. Fullum
The effectiveness of Roux-en-Y gastric bypass (RYGB) might be shadowed by disparities in outcomes related to patient race and insurance type. We determine the influence of patient race/ethnicity and insurance types on complications following RYGB. We performed a retrospective analysis using data sourced from the National Inpatient Sample Database (2010 to 2019). A multivariate analysis was employed to determine the relationship between patient race/ethnicity and insurance type on RYGB complications. The analysis determined the interaction between race/ethnicity and insurance type on RYGB outcomes. We analyzed 277714 patients who underwent RYGB. Most of these patients were White (64.5%) and female (77.3%), with a median age of 46 years (IQR 36-55). Medicaid beneficiaries displayed less favorable outcomes than those under private insurance: Extended hospital stay (OR = 1.68; 95% CI 1.58-1.78), GIT Leak (OR = 1.83; 95% CI 1.35-2.47), postoperative wound infection (OR = 1.88; 95% CI 1.38-2.55), and in-hospital mortality (OR = 2.74; 95% CI 1.90-3.95).
Roux-en-Y 胃旁路术（RYGB）的效果可能会因患者种族和保险类型的不同而受到影响。我们确定了患者种族/民族和保险类型对 RYGB 术后并发症的影响。我们使用来自全国住院患者抽样数据库（2010 年至 2019 年）的数据进行了回顾性分析。我们采用了多变量分析来确定患者种族/民族和保险类型与 RYGB 并发症之间的关系。该分析确定了种族/民族与保险类型对 RYGB 结果的交互作用。我们分析了 277714 名接受 RYGB 的患者。其中大部分患者为白人（64.5%）和女性（77.3%），中位年龄为 46 岁（IQR 36-55）。与私人保险受益人相比，医疗补助受益人的预后较差：住院时间延长（OR = 1.68; 95% CI 1.58-1.78）、胃肠道渗漏（OR = 1.83; 95% CI 1.35-2.47）、术后伤口感染（OR = 1.88; 95% CI 1.38-2.55）和院内死亡率（OR = 2.74; 95% CI 1.90-3.95）。
{"title":"Race, Insurance, and Socioeconomic Influences on Outcomes Following Roux-En-Y Gastric Bypass.","authors":"Oluwasegun A. Akinyemi, Terhas A. Weldeslase, Tsion F Andine, M. Fasokun, Yasmin Griffiths, Eunice Odusanya, Mallory Williams, Kakra Hughes, Edward E Cornwell, T. Fullum","doi":"10.1177/00031348241248803","DOIUrl":"https://doi.org/10.1177/00031348241248803","url":null,"abstract":"The effectiveness of Roux-en-Y gastric bypass (RYGB) might be shadowed by disparities in outcomes related to patient race and insurance type. We determine the influence of patient race/ethnicity and insurance types on complications following RYGB. We performed a retrospective analysis using data sourced from the National Inpatient Sample Database (2010 to 2019). A multivariate analysis was employed to determine the relationship between patient race/ethnicity and insurance type on RYGB complications. The analysis determined the interaction between race/ethnicity and insurance type on RYGB outcomes. We analyzed 277714 patients who underwent RYGB. Most of these patients were White (64.5%) and female (77.3%), with a median age of 46 years (IQR 36-55). Medicaid beneficiaries displayed less favorable outcomes than those under private insurance: Extended hospital stay (OR = 1.68; 95% CI 1.58-1.78), GIT Leak (OR = 1.83; 95% CI 1.35-2.47), postoperative wound infection (OR = 1.88; 95% CI 1.38-2.55), and in-hospital mortality (OR = 2.74; 95% CI 1.90-3.95).","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"78 21","pages":"31348241248803"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1177/00031348241248694
Samantha Larosa, Xander A. Stone, Ashley A. Fenninger, Nathaniel Harshaw, Kathryn M. Hoffman, Katherine Moore, Lindsey L Perea
BACKGROUND Arriving during "off hours" to the hospital can put patients at greater risk of complications or mortality given lesser staff. Our goal was to investigate this in trauma patients with an Injury Severity Score (ISS) of >15. We hypothesized that the patients admitted late at night and/or during the weekend, would have worse outcomes, delays to the operating room (OR), and longer lengths of stay (LOS) compared to those who arrive on a weekday during the day. METHODS We performed a retrospective study from 8/1/2019 to 8/1/2022 of all trauma patients with an ISS >15 at our Level 1 Trauma Center. Patients <18 years, dead on arrival, or transferred out were excluded. Univariate and multivariable analysis were performed comparing weekday vs weekend arrivals, day vs night shift arrivals, and with patients grouped as weekday day, weekday night, weekend day, and weekend night. The primary outcome was mortality. RESULTS 953 patients met inclusion criteria. The patients that arrived on the weekend and at night were significantly younger than their counterparts. A significantly greater percentage of Black patients arrived during night shift. Mortality, hospital LOS, and ICU LOS did not differ based on day or time of arrival. CONCLUSION Contrary to our hypothesis, our study did not find a significant difference in outcomes when evaluating based on a patient's time of arrival. This gives credence that our mature trauma center can provide the same level of care despite the time of a severely injured patient's time of arrival.
{"title":"Effects of Time of Arrival on Trauma Patient Outcomes.","authors":"Samantha Larosa, Xander A. Stone, Ashley A. Fenninger, Nathaniel Harshaw, Kathryn M. Hoffman, Katherine Moore, Lindsey L Perea","doi":"10.1177/00031348241248694","DOIUrl":"https://doi.org/10.1177/00031348241248694","url":null,"abstract":"BACKGROUND\u0000Arriving during \"off hours\" to the hospital can put patients at greater risk of complications or mortality given lesser staff. Our goal was to investigate this in trauma patients with an Injury Severity Score (ISS) of >15. We hypothesized that the patients admitted late at night and/or during the weekend, would have worse outcomes, delays to the operating room (OR), and longer lengths of stay (LOS) compared to those who arrive on a weekday during the day.\u0000\u0000\u0000METHODS\u0000We performed a retrospective study from 8/1/2019 to 8/1/2022 of all trauma patients with an ISS >15 at our Level 1 Trauma Center. Patients <18 years, dead on arrival, or transferred out were excluded. Univariate and multivariable analysis were performed comparing weekday vs weekend arrivals, day vs night shift arrivals, and with patients grouped as weekday day, weekday night, weekend day, and weekend night. The primary outcome was mortality.\u0000\u0000\u0000RESULTS\u0000953 patients met inclusion criteria. The patients that arrived on the weekend and at night were significantly younger than their counterparts. A significantly greater percentage of Black patients arrived during night shift. Mortality, hospital LOS, and ICU LOS did not differ based on day or time of arrival.\u0000\u0000\u0000CONCLUSION\u0000Contrary to our hypothesis, our study did not find a significant difference in outcomes when evaluating based on a patient's time of arrival. This gives credence that our mature trauma center can provide the same level of care despite the time of a severely injured patient's time of arrival.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"39 13","pages":"31348241248694"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1177/00031348241244643
Amelia Grover, Sally A. Santen, Kelly Lockeman, Dana Burns, K. Akuamoah-Boateng, Cynthia Siner, Sarah Miller, Brian K Sparkman, Lisa Ellis, Carla Nye
OBJECTIVES Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths. METHODS In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally "lead". RESULTS Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they "lead with" a specific domain. Mapped from the providers' top 10 strengths, the most common "lead with" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians. CONCLUSION A majority of surgical providers "lead with" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.
{"title":"Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout.","authors":"Amelia Grover, Sally A. Santen, Kelly Lockeman, Dana Burns, K. Akuamoah-Boateng, Cynthia Siner, Sarah Miller, Brian K Sparkman, Lisa Ellis, Carla Nye","doi":"10.1177/00031348241244643","DOIUrl":"https://doi.org/10.1177/00031348241244643","url":null,"abstract":"OBJECTIVES\u0000Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths.\u0000\u0000\u0000METHODS\u0000In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally \"lead\".\u0000\u0000\u0000RESULTS\u0000Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they \"lead with\" a specific domain. Mapped from the providers' top 10 strengths, the most common \"lead with\" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians.\u0000\u0000\u0000CONCLUSION\u0000A majority of surgical providers \"lead with\" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"48 14","pages":"31348241244643"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1177/00031348241248690
Alexis Webber, Shruthi R. Perati, Emily M Su, A. Ata, Todd D Beyer, Megan K Applewhite, J. Canete, Edward C. Lee
BACKGROUND Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited. METHODS We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission. RESULTS From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]). DISCUSSION Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients.
{"title":"Psychiatric Diagnoses Are Associated With Postoperative Disparities in Patients Undergoing Major Colorectal Operations.","authors":"Alexis Webber, Shruthi R. Perati, Emily M Su, A. Ata, Todd D Beyer, Megan K Applewhite, J. Canete, Edward C. Lee","doi":"10.1177/00031348241248690","DOIUrl":"https://doi.org/10.1177/00031348241248690","url":null,"abstract":"BACKGROUND\u0000Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited.\u0000\u0000\u0000METHODS\u0000We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission.\u0000\u0000\u0000RESULTS\u0000From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]).\u0000\u0000\u0000DISCUSSION\u0000Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"60 10","pages":"31348241248690"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1177/00031348241248792
Zoltán Németh, Satyam K Ghodasara, Patricia B. Stopper, Renay Durling-Grover, L. Difazio
{"title":"Letter re: \"Opioid Use, Disposition, and Parent Satisfaction Following Common Pediatric Surgical Procedures\".","authors":"Zoltán Németh, Satyam K Ghodasara, Patricia B. Stopper, Renay Durling-Grover, L. Difazio","doi":"10.1177/00031348241248792","DOIUrl":"https://doi.org/10.1177/00031348241248792","url":null,"abstract":"","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"84 23","pages":"31348241248792"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1177/00031348241248788
William G. Lee, MaKayla L. O’Guinn, Olivia A. Keane, Vikram Krishna, Shale J. Mack, Antoine Soliman, Dean M. Anselmo, Nam X Nguyen, Christopher P. Gayer, Eugene S. Kim, Eveline H. Shue
BACKGROUND The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants. METHODS We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications. RESULTS Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032). CONCLUSION Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.
{"title":"Evaluation of Postoperative Outcomes After Enterostomy Closure in Low Body Weight Infants: A Multi-Center Retrospective Analysis.","authors":"William G. Lee, MaKayla L. O’Guinn, Olivia A. Keane, Vikram Krishna, Shale J. Mack, Antoine Soliman, Dean M. Anselmo, Nam X Nguyen, Christopher P. Gayer, Eugene S. Kim, Eveline H. Shue","doi":"10.1177/00031348241248788","DOIUrl":"https://doi.org/10.1177/00031348241248788","url":null,"abstract":"BACKGROUND\u0000The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants.\u0000\u0000\u0000METHODS\u0000We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications.\u0000\u0000\u0000RESULTS\u0000Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032).\u0000\u0000\u0000CONCLUSION\u0000Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"21 26","pages":"31348241248788"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-21DOI: 10.1177/00031348241248797
Umar F Bhatti, Aricia Shen, Nicolas Melo, Galinos Barmparas, Andrew S Wang, D. Margulies, R. Alban
Introduction: Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes. Methods: We implemented an institution-wide intervention (INT) to encourage early SC (<1 day of diagnosis) for SBO patients in July 2022. A retrospective analysis was performed on all patients with SBO requiring NOM from January 2021 to June 2023, categorized into pre- and post-INT groups. The primary outcome was the number of SC's and secondary outcomes were early SC (<1 day of diagnosis), utilization of SBFT, LOS, 30-day readmission, and costs of admission. Results: A total of 670 patients were included, 438 in the pre-INT and 232 in the post-INT group. Overall, SBFT utilization was significantly higher in cases with SC (17.2% vs 41.4%, P < .001). Post-INT patients were more likely to receive SC (94.0% vs 83.3%, P < .001) and increased SBFT utilization (47.0% vs 33.6%, P = .001). Additionally, early SC improved significantly in the post-INT group (74.3% vs 65.7%, P = .03). There was no difference in LOS between groups (4.0 vs 3.8 days, P = .48). There was a trend toward decreased readmission rates in the INT group at 30 days (7.3% vs 11.0%, P = .13) and reduced direct costs in the INT group (US$/admission = 8467 vs 8708, P = .1). Conclusion: Hospital-wide interventions to increase early surgical involvement proved effective by improving early SC, increased SBFT utilization, and showed a trend towards decreased readmission rates and direct costs.
简介小肠梗阻（SBO）是导致资源使用的常见入院原因。大多数患者需要进行非手术治疗（NOM），这会导致住院时间（LOS）延长、再次入院、资源利用和吞吐延误。针对 SBO 的早期手术会诊（SC）可提高效率并改善预后。方法：2022 年 7 月，我们在全院范围内实施了一项干预措施（INT），鼓励 SBO 患者尽早（诊断后 1 天内）进行手术会诊。我们对 2021 年 1 月至 2023 年 6 月期间所有需要 NOM 的 SBO 患者进行了回顾性分析，并将其分为 INT 前和 INT 后两组。主要结果是SC的数量，次要结果是早期SC（诊断时间小于1天）、SBFT的使用、LOS、30天再入院和入院费用。结果：共纳入了 670 名患者，其中 438 人在INT 前组，232 人在INT 后组。总体而言，SC 患者使用 SBFT 的比例明显更高（17.2% vs 41.4%，P < .001）。干预后患者更有可能接受 SC（94.0% vs 83.3%，P < .001），SBFT 的使用率也有所提高（47.0% vs 33.6%，P = .001）。此外，INT 后组的早期 SC 显著改善（74.3% vs 65.7%，P = .03）。两组患者的住院时间没有差异（4.0 对 3.8 天，P = .48）。INT 组在 30 天后的再入院率呈下降趋势（7.3% vs 11.0%，P = .13），INT 组的直接费用也有所降低（每入院 = 8467 美元 vs 8708 美元，P = .1）。结论事实证明，全院范围内增加早期手术参与的干预措施通过改善早期 SC、提高 SBFT 利用率而取得了成效，并呈现出降低再入院率和直接费用的趋势。
{"title":"Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management Pathways.","authors":"Umar F Bhatti, Aricia Shen, Nicolas Melo, Galinos Barmparas, Andrew S Wang, D. Margulies, R. Alban","doi":"10.1177/00031348241248797","DOIUrl":"https://doi.org/10.1177/00031348241248797","url":null,"abstract":"Introduction: Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes. Methods: We implemented an institution-wide intervention (INT) to encourage early SC (<1 day of diagnosis) for SBO patients in July 2022. A retrospective analysis was performed on all patients with SBO requiring NOM from January 2021 to June 2023, categorized into pre- and post-INT groups. The primary outcome was the number of SC's and secondary outcomes were early SC (<1 day of diagnosis), utilization of SBFT, LOS, 30-day readmission, and costs of admission. Results: A total of 670 patients were included, 438 in the pre-INT and 232 in the post-INT group. Overall, SBFT utilization was significantly higher in cases with SC (17.2% vs 41.4%, P < .001). Post-INT patients were more likely to receive SC (94.0% vs 83.3%, P < .001) and increased SBFT utilization (47.0% vs 33.6%, P = .001). Additionally, early SC improved significantly in the post-INT group (74.3% vs 65.7%, P = .03). There was no difference in LOS between groups (4.0 vs 3.8 days, P = .48). There was a trend toward decreased readmission rates in the INT group at 30 days (7.3% vs 11.0%, P = .13) and reduced direct costs in the INT group (US$/admission = 8467 vs 8708, P = .1). Conclusion: Hospital-wide interventions to increase early surgical involvement proved effective by improving early SC, increased SBFT utilization, and showed a trend towards decreased readmission rates and direct costs.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"110 12","pages":"31348241248797"},"PeriodicalIF":0.0,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：