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Fifteen years of adrenalectomies: impact of specialty training and operative volume.

ABSTRACT: BACKGROUND:Previous associations between surgeon volume with adrenalectomy outcomes examined only a sample of procedures. We performed an analysis of all adrenalectomies performed in New York state to assess the effect of surgeon volume and specialty on clinical outcomes. METHODS:Adrenalectomies performed in adults were identified from the New York Statewide Planning and Research Cooperative System from 2000-2014. Surgeon specialty, volume, and patient demographics were assessed. High volume was defined using a significance threshold at ?4 adrenalectomies per year. Outcome variables included in-hospital mortality, duration of stay, and in-hospital complications. RESULTS:A total of 6,054 adrenalectomies were included. Median patient age was 56 years; 41.9% were men and 68.3% were white. Urologists (n?=?462) performed 46.8% of adrenalectomies, general surgeons (n?=?599) performed 35.0%, and endocrine surgeons (n?=?23) performed 18.1%. Significantly more endocrine surgeons were high-volume compared with urologists and general surgeons (65.2% vs 10.2% and 6.7%, respectively, P?

SUBMITTER: Lindeman B

PROVIDER: S-EPMC5903575 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Fifteen years of adrenalectomies: impact of specialty training and operative volume.

Lindeman Brenessa B Hashimoto Daniel A DA Bababekov Yanik J YJ Stapleton Sahael M SM Chang David C DC Hodin Richard A RA Phitayakorn Roy R

Surgery 20171108 1

<h4>Background</h4>Previous associations between surgeon volume with adrenalectomy outcomes examined only a sample of procedures. We performed an analysis of all adrenalectomies performed in New York state to assess the effect of surgeon volume and specialty on clinical outcomes.<h4>Methods</h4>Adrenalectomies performed in adults were identified from the New York Statewide Planning and Research Cooperative System from 2000-2014. Surgeon specialty, volume, and patient demographics were assessed. ...[more]

PMID: 29128168

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Project description:BackgroundWhile surgical simulation is regularly used in surgical training in high-income country settings, it is uncommon in low- and middle-income countries, particularly for surgical training that primarily occurs in rural areas. We designed and evaluated a novel surgical simulator for improving trachomatous trichiasis (TT) surgery training, given that trichiasis is mostly found among the poorest individuals in rural areas.Methodology/principal findingsTT surgery programs were invited to incorporate surgical simulation with a new, high fidelity, low-cost simulator into their training. Trainees completed standard TT-surgery training following World Health Organization guidelines. A subset of trainees received three hours of supplemental training with the simulator between classroom and live-surgery training. We recorded the time required to complete each surgery and the number of times the trainer intervened to correct surgical steps. Participants completed questionnaires regarding their perceptions. We also assessed trainer and trainee perceptions of surgical simulation training as part of trichiasis surgery training. 22 surgeons completed standard training and 26 completed standard training plus simulation. We observed 1,394 live-training surgeries. Average time to first live-training surgery completion was nearly 20% shorter the simulation versus the standard group (28.3 vs 34.4 minutes; p = 0.02). Trainers intervened significantly fewer times during initial live-training surgeries in the simulation group (2.7 vs. 4.8; p = 0.005). All trainers indicated the simulator significantly improved training by allowing trainees to practice safely and to identify problem areas before performing live-training surgeries. Trainees reported that simulation practice improved their confidence and skills prior to performing live-training surgeries.ConclusionsA single high-fidelity surgical simulation session can significantly improve critical aspects of initial TT surgeries.

Dataset Information

Fifteen years of adrenalectomies: impact of specialty training and operative volume.

Publications

Fifteen years of adrenalectomies: impact of specialty training and operative volume.

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