Subject(s)
Benchmarking , Cholecystectomy, Laparoscopic/standards , Specialties, Surgical , Acute Disease , Aged , General Surgery , Humans , Middle Aged , Prospective StudiesABSTRACT
Multiple studies have evaluated the effect of anesthesia type on carotid endarterectomy with inconsistent results. Our study compared 30-day postoperative myocardial infarction, stroke, and mortality between carotid endarterectomy under local or regional anesthesia and carotid endarterectomy under general anesthesia utilizing National Surgical Quality Improvement Program database. All patients listed in National Surgical Quality Improvement Program database that underwent carotid endarterectomy under general anesthesia and local or regional anesthesia from 2005 to 2011 were included with the exception of patients undergoing simultaneous carotid endarterectomy and coronary artery bypass grafting. The data revealed substantial differences between the two groups compared, and these were adjusted using multiple logistic regression. Postoperative myocardial infarction, stroke, and death at 30 days were compared between the two groups. A total of 42,265 carotid endarterectomy cases were included. A total of 37,502 (88.7%) were performed under general anesthesia and 4763 (11.3%) under local or regional anesthesia. Carotid endarterectomy under local or regional anesthesia had a significantly decreased risk of 30-day postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia (0.4% vs 0.86%, p = 0.012). No statistically significant differences were found in postoperative stroke or mortality. Carotid endarterectomy under local or regional anesthesia carries a decreased risk of postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia. Therefore, patients at risk of postoperative myocardial infarction undergoing carotid endarterectomy, consideration of local or regional anesthesia may reduce that risk.
Subject(s)
Anesthesia, Conduction , Anesthesia, General , Endarterectomy, Carotid , Myocardial Infarction/etiology , Postoperative Complications/etiology , Quality Improvement/statistics & numerical data , Adult , Aged , Aged, 80 and over , Anesthesia, Conduction/methods , Anesthesia, General/methods , Databases, Factual , Endarterectomy, Carotid/methods , Female , Humans , Male , Middle Aged , Risk Factors , Stroke/complications , Treatment OutcomeABSTRACT
The study objectives were to identify risk factors for surgical patients who develop postoperative urinary tract infections (UTIs) and to characterize urethral catheter practices at the study hospital. Patients from the 2006-2010 institutional National Surgical Quality Improvement Program database were evaluated. Patients with UTIs within 30 postoperative days (n = 116) were compared to patients without UTIs (n = 8685) using multivariable logistic regression. A nested case-control study evaluated the effects of catheter practices on postoperative UTI using conditional logistic regression. Independent predictors of UTI were sex, age, inpatient stay, functional status, renal failure, preoperative transfusion, and preoperative hospital stay. Compared with controls, patients with UTI more often maintained catheters for >2 postoperative days (66% vs 43%, P < .001) and had longer mean catheter duration (11.6 vs 5.1 days, P < .001). Study findings led to institutional recommendations to reduce catheter-associated UTIs. Quality improvement initiatives can increase awareness of performance enhancement opportunities and encourage collaborative, interdisciplinary improvement through shared objectives.
Subject(s)
Cross Infection/etiology , Quality Improvement/statistics & numerical data , Urinary Tract Infections/etiology , Age Factors , Aged , Aged, 80 and over , Case-Control Studies , Catheter-Related Infections/etiology , Female , Humans , Length of Stay , Male , Middle Aged , Postoperative Complications/etiology , Risk Factors , Sex Factors , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/standards , Urinary Catheterization/adverse effects , Urinary Catheterization/standardsABSTRACT
BACKGROUND: The application of evidence-based medicine to patient care requires unique skills of the physician. Advancing residents' abilities to accurately evaluate the quality of evidence is built on understanding of fundamental research concepts. The American Board of Surgery In-Training Examination (ABSITE) provides a relevant measure of surgical residents' knowledge of research design and statistics. OBJECTIVE: We implemented a research education curriculum in an independent academic medical center general residency program, and assessed the effect on ABSITE scores. METHODS: The curriculum consisted of five 1-hour monthly research and statistics lectures. The lectures were presented before the 2012 and 2013 examinations. Forty residents completing ABSITE examinations from 2007 to 2013 were included in the study. Two investigators independently identified research-related item topics from examination summary reports. Correct and incorrect responses were compared precurriculum and postcurriculum. Regression models were calculated to estimate improvement in postcurriculum scores, adjusted for individuals' scores over time and postgraduate year level. RESULTS: Residents demonstrated significant improvement in postcurriculum examination scores for research and statistics items. Correct responses increased 27% (P < .001). Residents were 5 times more likely to achieve a perfect score on research and statistics items postcurriculum (P < .001). CONCLUSIONS: Residents at all levels demonstrated improved research and statistics scores after receiving the curriculum. Because the ABSITE includes a wide spectrum of research topics, sustained improvements suggest a genuine level of understanding that will promote lifelong evaluation and clinical application of the surgical literature.
ABSTRACT
BACKGROUND: Preparation of future general surgeons requires the ongoing assessment of projected case experience. METHODS: Surgical procedures (2005-2008) were abstracted from the Centers for Medicare and Medicaid Services inpatient National Claims History Part A 100% Nearline File for all general surgeons. The most frequent Medicare surgical procedures and physician caseloads were compared by practice population. RESULTS: Over 5 million procedures were evaluated, with procedures decreasing over time in urban and large rural areas. A total of 15 procedures comprised the top 10 for all population/year categories. The most frequent surgical procedures were similar in rural and urban areas. Rural surgeons' caseloads consisted of a higher proportion of endoscopic procedures. CONCLUSIONS: The most common Medicare general surgery procedures are similar across population areas and are required experience for residents. Separate surgical educational programs for urban and rural general surgeons may not be necessary to provide adequate care to rural patients.
Subject(s)
General Surgery/education , Hospitals, High-Volume/statistics & numerical data , Hospitals, Low-Volume/statistics & numerical data , Internship and Residency , Medicare/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Humans , Rural Health Services , United States , Urban Health ServicesABSTRACT
OBJECTIVES: To compare career choices of residency graduates from Independent Academic Medical Center (IAMC) and University Academic Medical Center (UAMC) programs and evaluate program directors' perceptions of residents' motivations for pursuing general surgery or fellowships. DESIGN: From May to August 2011, an electronic survey collected information on program characteristics, graduates' career pursuits, and career motivations. Fisher's exact tests were calculated to compare responses by program type. Multivariate logistic regression was used to identify independent program characteristics associated with graduates pursuing general surgery. SETTING: Data were collected on graduates over 3 years (2009-2011). PARTICIPANTS: Surgery residency program directors. RESULTS: Seventy-four program directors completed the survey; 42% represented IAMCs. IAMCs reported more graduates choosing general surgery. Over one-quarter of graduates pursued general surgery from 52% of IAMC vs 37% of UAMC programs (p = 0.243). Career choices varied significantly by region: over one-quarter of graduates pursue general surgery from 78% of Western, 60% of Midwestern, 40% of Southern, and 24% of Northeastern programs (p = 0.018). On multivariate analysis, IAMC programs were independently associated with more graduates choosing general surgery (p = 0.017), after adjustment for other program characteristics. Seventy-five percent of UAMC programs reported over three-fourths of graduates receive first choice fellowship, compared with only 52% of IAMC programs (p = 0.067). Fellowships were comparable among IAMC and UAMC programs, most commonly MIS/Bariatric (16%), Critical Care/Trauma (16%), and Vascular (14%). IAMC and UAMC program directors cite similar reasons for graduate career choices. CONCLUSIONS: Most general surgery residents undergo fellowship training. Graduates from IAMC and UAMC programs pursue similar specialties, but UAMC programs report more first choice acceptance. IAMC programs may graduate proportionately more general surgeons. Further studies directly evaluating surgical residents' career choices are warranted to understand the influence of independent and university programs in shaping these choices and to develop strategies for reducing the general surgeon shortage.