Article

Impact of Surgical Residency Integration on Trauma and Acute Care Surgery Outcomes: A Retrospective Analysis

July 2024
Journal of Surgical Education 81(9)

DOI:10.1016/j.jsurg.2024.06.009

Authors:

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Does implementing a general surgery residency program and resident involvement affect patient outcomes and increase care-associated charges?

Article

Nov 2016

Background: Variable results regarding general surgery residency program (GSRP) impact on patient outcomes and charges are reported. The aim of this study was to determine any significant differences in patient outcomes and cost with a new GSRP. Methods: We analyzed all laparoscopic appendectomies (lap-ap), cholecystectomies (lap-chole), and inguinal hernia repairs (IHR) performed before and after implementing a GRSP. Results: Operative time significantly increased for lap-ap (p < 0.0001), lap-chole (p < 0.0001) and IHR (p = 0.03). Time to close the incision significantly increased for lap-ap (p < 0.0001), lap-chole (p = 0.006) and IHR (p = 0.03). Length of stay only increased for lap-ap (p = 0.04). Complication rates did not increase for any procedure. However, charges significantly increased for lap-ap (p < 0.0001), lap-chole (p < 0.0001), and IHR (p = 0.03). Conclusions: Although a newly implemented GSRP caused increases in overall operative times, times to close incisions, and charges, it did not negatively impact patient outcomes.

Article

Full-text available

Retrospective multi-center study of robotic-assisted cholecystectomy: after-hours surgery and busine...

January 2024 · Journal of Robotic Surgery

The effect of robotic-assisted cholecystectomy (RAC), when performed after hours, on perioperative outcomes has not been evaluated against outcomes achieved during normal business hours. Subjects 18–80 years old who underwent da Vinci robotic-assisted cholecystectomy from August 2018 to February 2021 were included. Baseline and 30-day perioperative outcomes were retrospectively and consecutively ... [Show full abstract] collected and analyzed. Inverse probability treatment weighting (IPTW) was performed to balance patient characteristics between groups. A weighted comparative analysis was followed. Outcomes from 505 patients (after hours, n = 169; business hours, n = 336) undergoing RAC across 5 U.S. medical institutions were analyzed. The higher rates of acute cholecystitis and gallbladder inflammation, gangrene, and intraoperative abnormalities in the after-hours group were associated with higher rates of urgent cases and longer operative times—but not increased complication rates—compared to the business-hours group. There were no significant differences in rates of intraoperative or postoperative complications, readmissions, or reoperations. Integrated da Vinci Firefly fluorescence imaging system was used extensively, and the critical view of safety was achieved in > 96% of cases in both groups. No conversions occurred in the after-hours group compared to four conversions in the business-hours group (p = 0.0266). After-hours patients had shorter outpatient lengths of stay. No mortalities were reported for either group (p = 0.0139). After-hours RAC with integrated da Vinci Firefly imaging performed by surgeons experienced in RAC is associated with similar or improved outcomes than the same procedures during business hours in terms of complications, conversions, readmissions, reoperations, and length of stay. ClinicalTrials.gov identifier: NCT04551820; August 5, 2020.

Article

Full-text available

POST-SURGERY OUTCOMES IN PATIENTS WITH POLYCYTHEMIA VERA AND ESSENTIAL THROMBOCYTHEMIA: A RETROSPECT...

January 1970

Article

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Evaluating Safety and Efficiency of Laparoscopic General Surgery Techniques in Pakistan. A Retrospec...

December 2024

Background: The minimally invasive nature, reduced complications, and quick recovery of laparoscopic general surgery have changed the face of surgical practice around the world. However, the barriers, adoption of the technology is not widespread in low and middle-income countries (LMICs) such as Pakistan. Objectives: The objectives of present study were to assess the safety and efficiency of ... [Show full abstract] laparoscopic general surgery techniques in Pakistan. Methods: This retrospective study comprised 200 patients who were scheduled for elective laparoscopic surgeries (50%) cholecystectomy, (30%) appendectomy, and (20%) hernia repairs at tertiary care hospitals in Lahore, Pakistan from June 2023 to September 2024. Intraoperative and postoperative outcomes and predictors of complications were analyzed, and demographic data were analyzed. Logistic regression was used to identify significant predictors of statistical analysis performed using SPSS version 27. Results: The Patients were 45.6 ± 12.3 years old and had a mean BMI of 28.7 ± 3.4 kg/m². Eighty-five percent of the cases had intraoperative complications; bleeding (4%) was the most common. In 6.5% of cases, conversion to open surgery was noted. In 15%, postoperative complications were found, and wound infection (6%) and seroma formation (5%) were most frequent. Hospital stays were longer in patients with complications (5.5 ± 1.6 days, p<0.001). Logistic regression identified BMI >30 kg/m² (OR: 2. Operative time >90 minutes (OR: 2.6) and 1) as predictors of complications. Conclusion: Safety & efficiency outcomes of laparoscopic general surgery in Pakistan, comparable to global standards, are demonstrated. To further improve access and outcomes, targeted investments in training, infrastructure, and patient optimization are necessary.

Preprint

Full-text available

Cataract surgery outcomes in Australia and New Zealand: A retrospective study of outcomes in 5018 ca...

January 2023

Objectives To report visual and surgical outcomes of phacoemulsification cataract surgery from 5,018 consecutive cases from Western Sydney. A review of the Australian and New Zealand literature was undertaken to provide a benchmark of outcomes from the region. Methods The Electronic Medical Record system was used to retrospectively review three time-points for all phacoemulsification cataract ... [Show full abstract] surgeries at a tertiary-referral centre between May 2017 and August 2020: preoperative, intraoperative and one-month postoperatively. Variables collected included uncorrected (UDVA) and pinhole (PHVA) visual acuities, surgeon seniority, and ocular pathology. Results Of the 5,018 eyes, 37.3% were operated on by consultants, 47.1% by trainees, and 15.6% by fellows. Ocular pathology was seen in 52.5% of eyes (n = 1,709). The mean preoperative and one-month postoperative UDVA was 6/48 and 6/12 respectively. There was an intraoperative complication in 7.6% of eyes (n = 379) and posterior capsular rupture (PCR) occurred in 2.7% (n = 136). Logistic regression analyses demonstrated advanced cataract and use of alpha-2 antagonists to be strongly associated with PCR. Conclusions We present visual and surgical outcomes from the largest study on phacoemulsification cataract surgery in Australia and New Zealand. Our findings were comparable to regional and international benchmarks despite a high rate of ocular pathology and trainee case load. The lack of a regional cataract surgery registry represents a critical need in assessing and claiming key performance indicators, capturing emerging trends, and identifying region-specific risk factors to deliver the best patient outcomes.

Last Updated: 22 Oct 2024