A Post-COVID Population-Based Analysis of Mohs Micrographic Surgeon Distribution in the United States.

BACKGROUND: Policy changes to Mohs micrographic surgery board certification eligibility and population shifts in the wake of the COVID-19 pandemic have significant implications for the accessibility of Mohs micrographic surgeons across the United States. OBJECTIVE: To examine the geographic distribution of micrographic surgery providers considering recent population trends and assess the impact of certification eligibility changes and population shifts on accessibility. METHODS AND MATERIALS: Medicare claims data were utilized to identify micrographic surgery providers. Surgeon densities were calculated per 100,000 people by county and state. Population changes were analyzed using US census data. RESULTS: Practicing micrographic surgeons were concentrated in metropolitan and nonmetropolitan areas. Overall, 80.4% of counties lacked micrographic surgery providers, with rural areas being the most underserved. Population changes varied among states. CONCLUSION: Shifts in micrographic surgery certification requirements, US population distribution, and micrographic surgeon location emphasize challenges in accessibility, especially in rural areas across the United States.

Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study.

OBJECTIVE: Multiple comorbidities in hip fracture patients are associated with increased mortality and complications. The goal of this study was to characterize the relationship between specific patient factors including comorbidities and outcomes in geriatric hip fractures, including length of stay, unplanned ICU admission, discharge disposition, complications, and mortality. METHODS: This is a retrospective review of a trauma database from five Level 1 and Level 2 trauma centers of patients with hip fractures of the femoral neck and intertrochanteric region who underwent treatment using hip pinning, hemiarthroplasty, total hip arthroplasty, cephalomedullary nailing, or dynamic hip screw fixation. Mortality was the primary outcome variable (including in-hospital mortality, 30-day mortality, 60-day mortality, and 90-day mortality). Secondary outcome variables included in-hospital adverse events, unplanned transfer to the ICU, postoperative length of stay, and discharge disposition. Regression analyses were used for evaluation of relationships between comorbidities as independent variables and primary and secondary outcomes as dependent variables. RESULTS: Two thousand three hundred patients were included. The mortality was 1.8%, 7.0%, 10.9%, and 14.1% for in-hospital, 30-day, 60-day, and 90-day mortality, respectively. Diabetes and cognitive impairment present on admission were associated with mortality at all-time intervals. COPD was the only comorbidity that signaled in-hospital adverse event with an odds ratio of 1.67 (P = 0.012). No patient factors, time to surgery, or comorbidities signaled unplanned ICU transfer. Patients with renal failure and COPD had longer hospital stays after surgery. CONCLUSION: Geriatric hip fractures continue to have high short-term morbidity and mortality. Identifying patients with increased odds of early mortality and adverse events can help teams optimize care and outcomes. Patients with diabetes, cognitive impairment, renal failure, and COPD may benefit from continued and improved medical optimization during the perioperative period as well as being more closely managed by a medicine team without delaying time to the operating room.

Patient satisfaction in the emergency department and the use of business cards by physicians.

BACKGROUND: Emergency departments (EDs) across the country become increasingly crowded. Methods to improve patient satisfaction are becoming increasingly important. OBJECTIVE: To determine if the use of business cards by emergency physicians improves patient satisfaction. METHODS: A prospective, convenience sample of ED patients were surveyed in a tertiary care, suburban teaching hospital. Inclusion criteria were limited to an understanding of written and spoken English. Excluded patients included those with altered mental status or too ill to complete a survey. Patients were assigned to receive a business card on alternate days in the ED from the treating physician(s) during their patient introductions. The business cards listed the physician's name and position (resident or attending physician) and the institution name and phone number. Before hospital admission or discharge, a research assistant asked patients to complete a questionnaire regarding their ED visit to determine patient satisfaction. RESULTS: Three hundred-twenty patients were approached to complete the questionnaire and 259 patients (81%) completed it. Patient demographics were similar in both the business card and non-business-card groups. There were no statistically significant differences for patient responses to any of the study questions whether or not they received a business card during the physician introduction. CONCLUSION: The use of business cards during physician introduction in the ED does not improve patient satisfaction.