Treatment of osteochondrosis dissecans in the stifle and tarsus of juvenile thoroughbred horses.

OBJECTIVES: To determine if arthroscopic surgery performed on weanlings/yearlings with trochlear ridge OCD of the femur (stifle OCD), or intermediate ridge of the tibia (tarsal OCD) detected on routine presale radiographs affects future racing performance. STUDY DESIGN: Retrospective case control study. ANIMALS: Thoroughbred weanlings and yearlings. METHODS: Stifle (N = 37; 22 male, 15 female) and tarsal (N = 35; 22 male, 13 female) OCD cases were identified. Outcome measures relating to racing performance (number of race starts, wins, places, and prize money earned, from races in their 2- and 3-year-old racing careers and in total from the period studied) were defined and then cases were compared to 2 age and sex matched controls using multilevel linear regression models. The effect of horse age at surgery and surgeon experience on the outcomes for cases with stifle OCD were also examined. RESULTS: Stifle OCD cases (N = 37; age 190-563 days at surgery) had significantly lower total earnings (P = .043), fewer total starts (P = .001) and fewer total 1st place finishes (P = .003) than their matched controls. For tarsal OCD cases (N = 35, age 127-470 days at surgery), fewer starts made by cases than controls (P = .018). Younger horse age at time of surgery and reduced surgeon experience were significantly associated with worse outcomes for stifle OCD cases. CONCLUSIONS: Stifle OCD cases appear to perform less successfully as racehorses than matched controls. Horse age at time of surgery has an effect on subsequent racing performance.

Local anesthesia and hydro-distension to facilitate cystic calculus removal in horses.

OBJECTIVE: To report a technique for improving surgical access to the bladder for removal of cystic calculi in male horses. STUDY DESIGN: Retrospective case series. ANIMALS OR SAMPLE POPULATION: Geldings (8) with cystic calculi. METHODS: After catheterization of the bladder through the penis, 100 mL 2% lidocaine hydrochloride solution was instilled. After 10 minutes, the bladder was distended with sterile, warmed Hartmann's solution to a pressure of ≈ 40 cm H(2) O, using gravity feed. This was left in place until abdominal access was gained at surgery, then the fluid siphoned off via the catheter. RESULTS: Calculi were 3-11 cm in diameter (median, 6 cm). Bladder capacity ranged from 1.4 to 2.5 L (median, 1.8 L). Exteriorization time from placing a hand in the abdomen to having the bladder in a surgically accessible position was <5 minutes. CONCLUSION: The described technique facilitates exteriorization of the bladder for removal of cystic calculi.

Special report: suicidal ideation among American surgeons.

BACKGROUND: Suicide is a disproportionate cause of death for US physicians. The prevalence of suicidal ideation (SI) among surgeons and their use of mental health resources are unknown. STUDY DESIGN: Members of the American College of Surgeons were sent an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life. RESULTS: Of 7905 participating surgeons (response rate, 31.7%), 501 (6.3%) reported SI during the previous 12 months. Among individuals 45 years and older, SI was 1.5 to 3.0 times more common among surgeons than the general population (P < .02). Only 130 surgeons (26.0%) with recent SI had sought psychiatric or psychologic help, while 301 (60.1%) were reluctant to seek help due to concern that it could affect their medical license. Recent SI had a large, statistically significant adverse relationship with all 3 domains of burnout (emotional exhaustion, depersonalization, and low personal accomplishment) and symptoms of depression. Burnout (odds ratio, 1.910; P < .001) and depression (odds ratio, 7.012; P < .001) were independently associated with SI after controlling for personal and professional characteristics. Other personal and professional characteristics also related to the prevalence of SI. CONCLUSIONS: Although 1 of 16 surgeons reported SI in the previous year, few sought psychiatric or psychologic help. Recent SI among surgeons was strongly related to symptoms of depression and a surgeon's degree of burnout. Studies are needed to determine how to reduce SI among surgeons and how to eliminate barriers to their use of mental health resources.

Surgical treatment of septic jugular thrombophlebitis in nine horses.

OBJECTIVE: To report a technique for surgical treatment of septic jugular thrombophlebitis unresponsive to medical treatment. STUDY DESIGN: Case series. ANIMALS: Horses (n=9) with septic jugular thrombophlebitis unresponsive to medical treatment. METHODS: Jugular vein thrombectomy was performed under standing sedation and local anesthesia. The contents of the affected portion of vein were removed by multiple incisions in the vein, with the incisions left open to drain and heal by second intention. RESULTS: The technique was curative in all instances, although 2 horses required a 2nd procedure. One horse required ligation of the linguofacial vein to control postsurgical hemorrhage. CONCLUSIONS: The technique is an effective surgical treatment for septic jugular thrombophlebitis unresponsive to medical treatment. CLINICAL RELEVANCE: Jugular vein thrombectomy is a straightforward technique, and has minimal postoperative complications. It allows expedient and cost-effective resolution of medically recalcitrant cases of septic jugular thrombophlebitis.

Burnout and medical errors among American surgeons.

OBJECTIVE: To evaluate the relationship between burnout and perceived major medical errors among American surgeons. BACKGROUND: Despite efforts to improve patient safety, medical errors by physicians remain a common cause of morbidity and mortality. METHODS: Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in June 2008. The survey included self-assessment of major medical errors, a validated depression screening tool, and standardized assessments of burnout and quality of life (QOL). RESULTS: Of 7905 participating surgeons, 700 (8.9%) reported concern they had made a major medical error in the last 3 months. Over 70% of surgeons attributed the error to individual rather than system level factors. Reporting an error during the last 3 months had a large, statistically significant adverse relationship with mental QOL, all 3 domains of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and symptoms of depression. Each one point increase in depersonalization (scale range, 0-33) was associated with an 11% increase in the likelihood of reporting an error while each one point increase in emotional exhaustion (scale range, 0-54) was associated with a 5% increase. Burnout and depression remained independent predictors of reporting a recent major medical error on multivariate analysis that controlled for other personal and professional factors. The frequency of overnight call, practice setting, method of compensation, and number of hours worked were not associated with errors on multivariate analysis. CONCLUSIONS: Major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.

Transpalpebral eye enucleation in 40 standing horses.

OBJECTIVE: To report a technique for eye enucleation in standing sedated horses and to report outcome in 40 horses. STUDY DESIGN: Retrospective study. ANIMALS: Horses (n=40) requiring eye enucleation. METHODS: The eye was enucleated using a transpalpebral technique in 40 horses restrained in stocks and sedated. Anesthesia of orbital structures was provided by local nerve blocks and infiltration of the surgical site with local anesthetic solution. RESULTS: Affected eyes were successfully enucleated with the horse standing. Short-term complications included moderate swelling (5 horses) and wound discharge (1). Long-term complications were not observed. CONCLUSIONS: A diseased eye can be safely enucleated with a horse standing. CLINICAL RELEVANCE: Enucleating an equine eye in the standing position eliminates the risks and costs of general anesthesia.