Endocrine surgery

Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
American journal of surgery (Impact Factor: 2.41). 09/2011; 202(3):369-71. DOI: 10.1016/j.amjsurg.2011.06.004
Source: PubMed

ABSTRACT The increasing complexity in the management of surgical disorders of the thyroid, parathyroid, adrenal glands, and neuroendocrine pancreas tumors have led to the emergence of endocrine surgery as a surgical subspecialty. Studies showing the relationship between hospital/surgeon volume and patient outcomes highlight the importance of advanced postgraduate training in this field.

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    ABSTRACT: Endocrine surgery is an evolving subspecialty in general surgery. To determine whether this subspecialty is having an effect on practice patterns of thyroid surgery, we reviewed all thyroidectomies performed in Illinois over an 11-year period. The Illinois COMPdata database from the Illinois Hospital Association was used to retrieve all the thyroid operations performed in the state of Illinois from 1999 to 2009. Univariate and multivariate logistic regression analyses were performed to assess the effects of surgeon and hospital type on practice patterns of thyroidectomies. In the early period (1999-2004), 5,824 operations were identified compared with 8,454 in the late period (2005-2009; P < .001). Total thyroidectomy represented 2,679 (46%) of the thyroid operations done in the early period compared with 4,976 (59%) in the late period (P < .001). Sixty-two percent of all the thyroid operations were done at community hospitals in the early period compared with 56% in the late period. Endocrine surgeons (ES) performed the greatest rate of thyroidectomies, 0.7 and 0.6/10(5) population, in both early and late periods, respectively. In Illinois, the volume of thyroid operations has increased significantly over the past 10 years with a shift toward total thyroidectomy. Although most thyroidectomies are still performed in community hospitals, this percentage has decreased. ES perform a minority of thyroid operations, but they have the greatest volume of thyroidectomies per surgeon. These findings may represent broader trends in thyroid surgery throughout the United States.
    Surgery 09/2013; 154(5). DOI:10.1016/j.surg.2013.04.055 · 3.11 Impact Factor
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    ABSTRACT: General surgery residency training can lead to a rewarding career in general surgery and serve as the foundation for careers in several surgical subspecialties. It offers broad-based training with exposure to the cognitive and technical aspects of several surgical specialties and prepares graduating residents for a wide range of career paths. This career development resource discusses the training aspects of general surgery.
    American journal of surgery 11/2013; 206(5):719-23. DOI:10.1016/j.amjsurg.2013.07.010 · 2.41 Impact Factor
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    ABSTRACT: Surgeon experience has been demonstrated to result in better outcomes after a variety of advanced operations. Less information is available regarding adrenal surgery. We compared the outcomes after adrenalectomy for a variety of indications and determined the effect of surgeon's case volume. Cross-sectional analysis was performed using ICD-9 procedure codes included in the Nationwide Inpatient Sample from 2003 to 2009 to identify all adult patients who underwent unilateral or bilateral adrenalectomy for benign or malignant conditions. Logistic regression was used to test for interaction between surgeon case volume (low = 1, intermediate = 2-5, and high = >5 adrenalectomies per year), diagnosis, type of operation performed, and risk of complications. A total of 7,829 adrenalectomies were included. Risk of complications after bilateral adrenalectomy was 23.4 % compared to 15.0 % for unilateral adrenalectomy (odds ratio 2.165, 95 % confidence interval 1.335, 3.512). Malignancy was associated with higher risk of complication (23.1 %) than benign disease (13.2 %) (odds ratio 1.685, 95 % confidence interval 1.371, 2.072). Complication rates for low- and intermediate-volume surgeons were 18.8 and 14.6 %, respectively, and both were significantly higher than complications by high-volume surgeons (11.6 %, p < 0.05). Length of stay and charges were both significantly less for high-volume surgeons compared to lower-volume groups (p < 0.05). Low surgeon case volumes and adrenal surgery for malignant or bilateral disease are associated with increased risk of postoperative complications. Length of stay and charges were significantly less when high-volume surgeons perform adrenal surgery.
    Annals of Surgical Oncology 05/2014; 22(1). DOI:10.1245/s10434-014-3750-2 · 3.94 Impact Factor
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