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Surgical leadership in changing times: the American College of Surgeons perspective.

ABSTRACT: Surgeons around the globe are challenged by the rapid evolution of the environment in which they practice their profession. Changes in surgical technologies, the complexity of surgical patient care, and the regulatory and financial environment of surgical care delivery demand that surgeons be supported in their work with access to superb educational offerings and engagement to foster satisfaction and efficacy in their professional activities. The American College of Surgeons (ACS), the largest international surgical professional organization, is committed to supporting surgeons as leaders in the healthcare system to build programs to create the optimal environment for delivery of quality surgical care to our patients. A selected portfolio of the programs of the ACS is presented.

SUBMITTER: Bass BL

PROVIDER: S-EPMC6754053 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Surgical leadership in changing times: the American College of Surgeons perspective.

Bass Barbara Lee BL

Innovative surgical sciences 20190612 2

Surgeons around the globe are challenged by the rapid evolution of the environment in which they practice their profession. Changes in surgical technologies, the complexity of surgical patient care, and the regulatory and financial environment of surgical care delivery demand that surgeons be supported in their work with access to superb educational offerings and engagement to foster satisfaction and efficacy in their professional activities. The American College of Surgeons (ACS), the largest i ...[more]

PMID: 31579807

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Project description:BACKGROUND:Given the rarity of pediatric surgical disease, it is important to consider available large-scale data resources as a means to better study and understand relevant disease-processes and their treatments. The Military Health System Data Repository (MDR) includes claims-based information for >?3 million pediatric patients who are dependents of members and retirees of the United States Armed Services, but has not been externally validated. We hypothesized that demographics and selected outcome metrics would be similar between MDR and the previously validated American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) for several common pediatric surgical operations. METHODS:We selected five commonly performed pediatric surgical operations: appendectomy, pyeloplasty, pyloromyotomy, spinal arthrodesis for scoliosis, and facial reconstruction for cleft palate. Among children who underwent these operations, we compared demographics (age, sex, and race) and clinical outcomes (length of hospital stay [LOS] and mortality) in the MDR and NSQIP-P, including all available overlapping years (2012-2014). RESULTS:Age, sex, and race were generally similar between the NSQIP-P and MDR. Specifically, these demographics were generally similar between the resources for appendectomy (NSQIP-P, n?=?20,602 vs. MDR, n?=?4363; median age 11 vs. 12?years; female 40% vs. 41%; white 75% vs. 84%), pyeloplasty (NSQIP-P, n?=?786 vs. MDR, n?=?112; median age 0.9 vs. 2?years; female 28% vs. 28%; white 71% vs. 80%), pyloromyotomy, (NSQIP-P, n?=?3827 vs. MDR, n?=?227; median age 34 vs. <?1?year, female 17% vs. 16%; white 76% vs. 89%), scoliosis surgery (NSQIP-P, n?=?5743 vs. MDR, n?=?95; median age 14.2 vs. 14?years; female 75% vs. 67%; white 72% vs. 75%), and cleft lip/palate repair (NSQIP-P, n?=?6202 vs. MDR, n?=?749; median age, 1 vs. 1?year; female 42% vs. 45%; white 69% vs. 84%). Length of stay and 30-day mortality were similar between resources. LOS and 30-day mortality were also similar between datasets. CONCLUSION:For the selected common pediatric surgical operations, patients included in the MDR were comparable to those included in the validated NSQIP-P. The MDR may comprise a valuable clinical outcomes research resource, especially for studying infrequent diseases with follow-up beyond the 30-day peri-operative period.

Project description:IntroductionAn overview of the requirements for the head of a surgical department in Germany should be given.Materials and methodsA retrospective literature research on surgical professional policy publications of the last 10 years in Germany was conducted.ResultsSurveys show that commercial influences on medical decisions in German hospitals have today become an everyday, predominantly negative, actuality. Nevertheless, in one survey, 82.9% of surgical chief physicians reported being very satisfied with their profession, compared with 61.5% of senior physicians and only 43.4% of hospital specialists. Here, the chief physician is challenged. Only 70% of those surveyed stated that they could rely on their direct superiors when difficulties arose at work, and only 34.1% regarded feedback on the quality of their work as sufficient. The high distress rate in surgery (58.2% for all respondents) has led to a lack in desirability and is reflected in a shortage of qualified applicants for resident positions. In various position papers, surgical residents (only 35% describe their working conditions as good) demand improved working conditions. Chief physicians are being asked to facilitate a suitable work-life balance with regular working hours and a corporate culture with participative management and collegial cooperation. Appreciation of employee performance must also be expressed. An essential factor contributing to dissatisfaction is that residents fill a large part of their daily working hours with non-physician tasks. In surveys, 70% of respondents stated that they spend up to ≥3 h a day on documentation and secretarial work.DiscussionThe chief physician is expected to relieve his medical staff by employing non-physician assistants to take care of non-physician tasks. Transparent and clearly structured training to achieve specialist status is essential. It has been shown that a balanced work-life balance can be achieved for surgeons. Family and career can be reconciled in appropriately organized departments by making use of part-time and shift models that exclude 24-h shifts and making working hours more flexible.

Project description:BACKGROUND:In October 2012, The Centers for Medicare and Medicaid Services (CMS) began publicly reporting American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical outcomes on its public reporting website, Hospital Compare. Participation in this CMS-NSQIP initiative is voluntary. Our objective was to compare CMS-NSQIP participating hospitals with ACS NSQIP hospitals that elected not to participate. STUDY DESIGN:Hospital Compare and American Hospital Association Annual Survey data were merged to compare CMS-NSQIP participants with nonparticipants. Regression models were developed to assess predictors of participation and to assess if hospitals differed on 32 process, 10 patient experience (Hospital Consumer Assessment of HealthCare Providers and Systems [HCAHPS]), and 16 outcomes (Hospital Compare and Agency for Healthcare Research Quality) measures. Additionally, performance on 2 waves of publicly reported ACS NSQIP surgical outcomes measures was compared. RESULTS:Of the 452 ACS NSQIP hospitals, 80 (18%) participated in CMS-NSQIP public reporting. Participating hospitals had more beds, admissions, operations, and were more often accredited (Commission on Cancer and the Council of Teaching Hospitals [COTH] [p < 0.05]). Only COTH membership remained significant in adjusted analyses (odds ratio 2.45, 95% CI 1.12 to 5.35). Hospital performance on process, HCAHPS, and outcomes measures were not associated with CMS-NSQIP participation for 54 of 58 measures examined. Hospitals with "better-than-average" performance were more likely to publicly report the Elderly Surgery measure (p < 0.05). In wave 2, an increased proportion of new participants reported "worse-than-average" outcomes. CONCLUSIONS:There were few measurable differences between CMS-NSQIP participating and nonparticipating hospitals. The decision to voluntarily publicly report may be related to the hospital's culture of quality improvement and transparency.

Project description:Surgical wound classification has been used in risk-adjustment models. However, it can be subjective and could potentially improperly bias hospital quality comparisons. The objective is to examine the effect of wound classification on hospital performance risk-adjustment models.Retrospective review of the 2011 American College of Surgeons NSQIP database was conducted for the following wound classification categories: clean, clean-contaminated, contaminated, and dirty-infected. To assess the influence of wound classification on risk adjustment, 2 models were developed for all outcomes: 1 including and 1 excluding wound classification. For each model, hospital postoperative complications were estimated using hierarchical multivariable regression methods. Absolute changes in hospital rank, correlations of odds ratios, and outlier status agreement between models were examined.Of the 442,149 cases performed in 315 hospitals: 53.6% were classified as clean; 34.2% as clean-contaminated; 6.7% as contaminated; and 5.5% as dirty-infected. The surgical site infection rate was highest in dirty-infected (8.5%) and lowest in clean (1.8%) cases. For overall surgical site infection, the absolute change in risk-adjusted hospital performance rank between models, including vs excluding wound classification, was minimal (mean 4.5 of 315 positions). The correlations between odds ratios of the 2 performance models were nearly perfect (R = 0.9976, p < 0.0001), and outlier status agreement was excellent (? = 0.95ss08, p < 0.0001). Similar findings were observed in models of subgroups of surgical site infections and other postoperative outcomes.In circumstances where alternate information is available for risk adjustment, there appear to be minimal differences in performance models that include vs exclude wound classification. Therefore, the American College of Surgeons NSQIP is critically evaluating the continued use of wound classification in hospital performance risk-adjustment models.

Project description:BACKGROUND:There is significant morbidity after diverting ileostomy closure, so identifying predictors of complications could be of great benefit. The aim of our study was to evaluate the incidence and risk factors for postoperative morbidity after elective ileostomy closure. METHODS:The ACS-NSQIP dataset was evaluated for elective ileostomy closures from 1/1/2015 to 12/31/2016. Demographic characteristics, operative, and postoperative outcomes were evaluated. The primary outcome was 30-day major morbidity (Clavien class III and greater). Secondary outcomes were rates and predictors of major morbidity, superficial site infection (SSI), reoperation, and readmission from multivariate logistic regression modeling. RESULTS:We retrospectively evaluated 1885 patients. The median operative time was 65 (IQR 50-90) minutes and median length of stay was 3 (IQR 2-5) days. Major morbidity was recorded in 6.7%, including mortality (1.0%), deep/organ space SSI (2.6%), dehiscence (0.8%), reintubation (0.5%), sepsis (1.7%), septic shock (0.8%), and reoperation (3.7%). Readmission was recorded in 9.7% and 6.2% had SSI. Multivariate logistic regression showed male sex (OR 1.584; 95% CI 1.068-2.347; p?=?0.022) and longer operative time (OR 1.004; 95% CI 1.001-1.007; p?=?0.009) were among those variables associated with increased odds of major morbidity. Dyspnea (OR 2.431; 95% CI 1.139-5.094; p?=?0.021) and longer operative time (OR 1.003; 95% CI 1.001-1.007; p?=?0.034) were among the independent risk factors for SSI. Male sex (OR 2.246; 95% CI 1.297-3.892; p?=?0.004, chronic obstructive pulmonary disease (OR 2.959; 95% CI 1.153-7.591; p?=?0.024), and longer operative time (OR 1.005; 95% CI 1.001-1.009; p?=?0.011) were associated with increased odds of reoperation. Chronic obstructive pulmonary disease (OR 2.578; 95% CI 1.338-4.968; p?=?0.005), wound infection (OR 2.680; 95% CI 1.043-6.890; p?=?0.041), and inflammatory bowel disease (OR 2.565; 95% CI 1.203-5.463; p?=?0.015) were associated with increased odds of readmission. CONCLUSIONS:Elective stoma closure has significant risk of morbidity. Patients with longer operative times were at increased risk for major morbidity, overall SSI, and reoperation. From the analysis, factors specifically associated with major morbidity, overall infectious complications, readmissions, and reoperations were identified. This information can be used to prospectively prepare for these high-risk patients, potentially improving postoperative outcomes.

Dataset Information

Surgical leadership in changing times: the American College of Surgeons perspective.

Publications

Surgical leadership in changing times: the American College of Surgeons perspective.

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