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Research paper thumbnail of Blinded intraoperative skill evaluations avoid gender-based bias

Surgical Endoscopy, 2022

Gender bias has been identified consistently in written performance evaluations. Qualitative tool... more Gender bias has been identified consistently in written performance evaluations. Qualitative tools may provide a standardized way to evaluate surgical skill and minimize gender bias. We hypothesized that there is no difference in operative time or GEARS scores in robotic hysterectomy for men vs women surgeons. Patients undergoing robotic hysterectomies performed between June 2019 and March 2020 at 8 hospitals within the same hospital system were captured into a prospective database. GEARS scores were assigned by crowd-sourced evaluators by a third party blinded to any surgeon- or patient-identifying information. One-way ANOVA was used to compare the mean operative time and GEARS scores for each group, and significant variables were included in a one-way ANCOVA to control for confounders. Two-tailed p-value < 0.05 was considered significant. Seventeen women and 13 men performed a total of 188 hysterectomies; women performed 34 (18%) and men performed 153 (81%). Women surgeons had a higher mean operative time (133 ± 58 vs 86.3 ± 46 min, p = 0.024); after adjustment, there were no significant differences in operative time (p = 0.607). There was no significant difference between the genders in total GEARS score (20.0 ± 0.77 vs 20.2 ± 0.70, p = 0.415) or GEARS subcomponent scores: bimanual dexterity (3.98 ± 0.03 vs 4.00 ± 0.03, p = 0.705); depth perception (4.04 ± 0.04 vs 4.05 ± 0.02, p = 0.799); efficiency (3.79 ± 0.02 vs 3.82 ± 0.02, p = 0.437); force sensitivity (4.01 ± 0.04 vs 4.05 ± 0.05, p = 0.533); or robotic control (4.16 ± 0.03 vs 4.26 ± 0.01, p = 0.079). There was no difference in GEARS score between men vs women surgeons performing robotic hysterectomies. Video-based blinded assessment of skills may minimize gender biases when evaluating surgical skill for competency evaluation and credentialing.

Research paper thumbnail of Benchmarking Surgical Incident Reports Using a Database and a Triage System to Reduce Adverse Outcomes

Archives of Surgery, 2008

To study the profile of incidents affecting quality outcomes after surgery by developing a usable... more To study the profile of incidents affecting quality outcomes after surgery by developing a usable operating room and perioperative clinical incident report database and a functional electronic classification, triage, and reporting system. Previously, incident reports after surgery were handled on an individual, episodic basis, which limited the ability to perceive actuarial patterns and meaningfully improve outcomes. Design, Setting, and Participants: Clinical incident reports were experientially generated in the second largest health care system in New York City. Data were entered into a functional classification system organized into 16 categories, and weekly triage meetings were held to electronically review and report summaries on 40 to 60 incident reports per week. System development and deployment reviewed 1041 reports after 19 693 operative procedures. During the next 4 years, 3819 additional reports were generated from 83 988 operative procedures and were reported electronically to the appropriate departments. Main Outcome Measures: Number of incident reports generated annually. Results: A significant decrease in volume-adjusted clinical incident reports occurred (from 53 to 39 reports per 1000 procedures) from 2001 to 2005 (P Ͻ.001). Reductions in incident reports were observed for ambulatory conversions (74% reduction), wasted implants (65%), skin breakdown (64%), complications in the operating room (42%), laparoscopic conversions (32%), and cancellations (23%) as a result of data-focused process and clinical interventions. Six of 16 categories of incident reports accounted for more than 88% of all incident reports. Conclusion: These data suggest that effective review, communication, and summary feedback of clinical incident reports can produce a statistically significant decrease in adverse outcomes.

Research paper thumbnail of Core Competency Self-Assessment Enhances Critical Review of Complications and Entrustable Activities

The Journal of surgical research, 2020

BACKGROUND The Accreditation Council for Graduate Medical Education has defined six core competen... more BACKGROUND The Accreditation Council for Graduate Medical Education has defined six core competencies (CCs) that every successful physician should possess. However, the assessment of CC achievement among trainees is difficult. This project was designed to prospectively evaluate the impact of resident identification of CC as a component of morbidity review on error identification and standard of care (SOC) assessments. The platform was assessed for its reliability as a measure of resident critical analysis of complication causality across postgraduate year (PGY). MATERIALS AND METHODS A total of 1945 general surgery cases with complications were assessed for error identification and SOC management between January 1, 2016, and December 31, 2018. CC identification was additionally assessed between January 1, 2019, and December 31, 2019, and included 708 general surgery cases. Data were evaluated for error assessments and overall SOC management. PGY4 and 5 residents were compared for nu...

Research paper thumbnail of ASSOCIATION FOR ACADEMIC SURGERY, 2008 A Report Card System Using Error Profile Analysis and Concurrent Morbidity and Mortality Review: Surgical Outcome Analysis, Part II

Background. An effective report card system for ad- verse outcome error analysis following surger... more Background. An effective report card system for ad- verse outcome error analysis following surgery is lack- ing. We hypothesized that a memorialized database could be used in conjunction with error analysis and management evaluation at Morbidity & Mortality con- ference to generate individualized report cards for Attending Surgeon and System performance. Study Design. Prospectively collected data from Sep- tember 2000 through April 2005 were reported follow- ing Morbidity & Mortality review on 1618 adverse out- comes, including 219 deaths, following 29,237 operative procedures, in a complete loop to approxi- mately 60 individual surgeons and responsible system personnel. Results. A 40% reduction of gross mortality (P < 0.001) and 43% reduction of age-adjusted mortality were achieved over 4 years at the Academic Center. Quality issues were identified at a rate three times greater than required by New York State regulations and increased from a baseline 4.96% to 32.7% (odds ratio 1...

Research paper thumbnail of Financial Impact of Post-Colectomy Complication and the Value of Administrative Data

Journal of the American College of Surgeons

Research paper thumbnail of Resident and Attending Impressions of a Novel Electronic Tool for the Recording of Surgical Morbidity and Mortality Case Data: the Preparation of Case Presentations and Resident Evaluation

Journal of the American College of Surgeons, Oct 1, 2017

INTRODUCTION: Physicians in procedural specialties are at high risk for work-related musculoskele... more INTRODUCTION: Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (WMSDs). This has been called 'an impending epidemic" in the context of the looming workforce shortage, however prevalence estimates vary by study. This study aimed to estimate the prevalence of disabling WMSDs among at-risk physicians and to determine the scope of preventative efforts. METHODS: A systematic search was conducted on Medline, Embase, Web of Science, PubMed/NCBI, and two clinical trial registries from inception until December 2016 for studies reporting on the prevalence and/or prevention of WMSDs among at-risk physicians. "At-risk physicians" included surgeons and interventionalists. Study estimates were pooled using a random-effects meta-analytic model. RESULTS: The search returned 3,739 unique items. The 126 meeting inclusion criteria were published between 1974 and 2016 in 23 countries. Pooled career prevalence estimates of the most common WMSDs included: degenerative cervical spine disease 17% (457/2,406 physicians), rotator cuff pathology 18% (300/1,513 physicians), degenerative lumbar spine disease 19% (544/2,449 physicians), and carpal tunnel syndrome 9% (256/ 2,449 physicians). From 1997 to 2015, cervical and lumbar spine disease increased by 18.3% and 26.9%, respectively. Of the injured, 15% (391/2,704 physicians) required time away from work, practice modification, or early retirement. Twelve of 14 atrisk specialties described a gross lack of awareness and an unmet need for ergonomics education.

Research paper thumbnail of Percutaneous catheter introducer

Research paper thumbnail of The laparoscopic retrieval of an orthopedic fixation pin from the liver with repair of an associated diaphragmatic laceration

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

We report the successful removal of a shoulder fixation pin from the right lobe of the liver with... more We report the successful removal of a shoulder fixation pin from the right lobe of the liver with intracorporeal repair of a diaphragmatic laceration. An expeditious workup and urgent operative intervention were required. We adhered to the principles of room setup, optical correctness, establishment of the triangle of success, appropriate instrument entry and convergence angles, two-handed surgical skills, and competence in intracorporeal suturing techniques that were all required for successful completion of the case. We also present a review of the significant literature.

Research paper thumbnail of Management of the Exposed Saphenous Vein Graft

Research paper thumbnail of Impact of Timing of Tocilizumab Use in Hospitalized Patients With SARS-CoV-2 Infection

Research paper thumbnail of Cognitive Bias, Harm Severity and Debiasing Strategies

Journal of the American College of Surgeons

Research paper thumbnail of Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications

Research paper thumbnail of Correlation between operative time and crowd-sourced skills assessment for robotic bariatric surgery

Research paper thumbnail of Cognitive Bias Impact on Management of Postoperative Complications, Medical Error, and Standard of Care

Journal of Surgical Research

Research paper thumbnail of Impact of Timing of Tocilizumab Use in Hospitalized SARS-CoV-2 Infected Patients

Research paper thumbnail of 86A surgeon report card system developed using a standardized classification of adverse outcomes, error profile analysis and concurrent morbidity and mortality review: A three-year experience

Research paper thumbnail of Laparoscopic transperitoneal anterior lumbar interbody fusion with cylindrical threaded cortical allograft bone dowels

Research paper thumbnail of Natural killer and antibody-dependent cytotoxicity following thermal injury in humans

Research paper thumbnail of Pathophysiologic glucocorticoid elevations promote bacterial translocation after thermal injury

Infection and immunity, 1990

Thermal injury results in transient elevations of plasma glucocorticoids and promotes translocati... more Thermal injury results in transient elevations of plasma glucocorticoids and promotes translocation of bacteria from the gut to the mesenteric lymph nodes (MLN) in rats. Translocated organisms are quickly cleared following uncomplicated thermal injury. However, subsequent burn wound infection, in temporal association with sustained pathophysiologic elevations of plasma corticosterone, results in the continued presence of enteric bacteria in the MLN. To study the role of sustained pathophysiologic steroid elevations in the mediation of this prolonged bacterial translocation, Wistar rats were randomly placed in groups receiving one of the following: (i) a 30% total body surface area scald injury with placement of a subcutaneous corticosterone pellet, (ii) a 30% total body surface area scald and a sham pellet implantation, (iii) a sham burn and a corticosterone pellet implantation, or (iv) a sham burn and a sham pellet implantation. The animals were sacrificed on days 1 and 4 after inj...

Research paper thumbnail of Management of the Exposed Saphenous Vein Graft

Perspectives in Vascular Surgery and Endovascular Therapy, 1991

Research paper thumbnail of Blinded intraoperative skill evaluations avoid gender-based bias

Surgical Endoscopy, 2022

Gender bias has been identified consistently in written performance evaluations. Qualitative tool... more Gender bias has been identified consistently in written performance evaluations. Qualitative tools may provide a standardized way to evaluate surgical skill and minimize gender bias. We hypothesized that there is no difference in operative time or GEARS scores in robotic hysterectomy for men vs women surgeons. Patients undergoing robotic hysterectomies performed between June 2019 and March 2020 at 8 hospitals within the same hospital system were captured into a prospective database. GEARS scores were assigned by crowd-sourced evaluators by a third party blinded to any surgeon- or patient-identifying information. One-way ANOVA was used to compare the mean operative time and GEARS scores for each group, and significant variables were included in a one-way ANCOVA to control for confounders. Two-tailed p-value < 0.05 was considered significant. Seventeen women and 13 men performed a total of 188 hysterectomies; women performed 34 (18%) and men performed 153 (81%). Women surgeons had a higher mean operative time (133 ± 58 vs 86.3 ± 46 min, p = 0.024); after adjustment, there were no significant differences in operative time (p = 0.607). There was no significant difference between the genders in total GEARS score (20.0 ± 0.77 vs 20.2 ± 0.70, p = 0.415) or GEARS subcomponent scores: bimanual dexterity (3.98 ± 0.03 vs 4.00 ± 0.03, p = 0.705); depth perception (4.04 ± 0.04 vs 4.05 ± 0.02, p = 0.799); efficiency (3.79 ± 0.02 vs 3.82 ± 0.02, p = 0.437); force sensitivity (4.01 ± 0.04 vs 4.05 ± 0.05, p = 0.533); or robotic control (4.16 ± 0.03 vs 4.26 ± 0.01, p = 0.079). There was no difference in GEARS score between men vs women surgeons performing robotic hysterectomies. Video-based blinded assessment of skills may minimize gender biases when evaluating surgical skill for competency evaluation and credentialing.

Research paper thumbnail of Benchmarking Surgical Incident Reports Using a Database and a Triage System to Reduce Adverse Outcomes

Archives of Surgery, 2008

To study the profile of incidents affecting quality outcomes after surgery by developing a usable... more To study the profile of incidents affecting quality outcomes after surgery by developing a usable operating room and perioperative clinical incident report database and a functional electronic classification, triage, and reporting system. Previously, incident reports after surgery were handled on an individual, episodic basis, which limited the ability to perceive actuarial patterns and meaningfully improve outcomes. Design, Setting, and Participants: Clinical incident reports were experientially generated in the second largest health care system in New York City. Data were entered into a functional classification system organized into 16 categories, and weekly triage meetings were held to electronically review and report summaries on 40 to 60 incident reports per week. System development and deployment reviewed 1041 reports after 19 693 operative procedures. During the next 4 years, 3819 additional reports were generated from 83 988 operative procedures and were reported electronically to the appropriate departments. Main Outcome Measures: Number of incident reports generated annually. Results: A significant decrease in volume-adjusted clinical incident reports occurred (from 53 to 39 reports per 1000 procedures) from 2001 to 2005 (P Ͻ.001). Reductions in incident reports were observed for ambulatory conversions (74% reduction), wasted implants (65%), skin breakdown (64%), complications in the operating room (42%), laparoscopic conversions (32%), and cancellations (23%) as a result of data-focused process and clinical interventions. Six of 16 categories of incident reports accounted for more than 88% of all incident reports. Conclusion: These data suggest that effective review, communication, and summary feedback of clinical incident reports can produce a statistically significant decrease in adverse outcomes.

Research paper thumbnail of Core Competency Self-Assessment Enhances Critical Review of Complications and Entrustable Activities

The Journal of surgical research, 2020

BACKGROUND The Accreditation Council for Graduate Medical Education has defined six core competen... more BACKGROUND The Accreditation Council for Graduate Medical Education has defined six core competencies (CCs) that every successful physician should possess. However, the assessment of CC achievement among trainees is difficult. This project was designed to prospectively evaluate the impact of resident identification of CC as a component of morbidity review on error identification and standard of care (SOC) assessments. The platform was assessed for its reliability as a measure of resident critical analysis of complication causality across postgraduate year (PGY). MATERIALS AND METHODS A total of 1945 general surgery cases with complications were assessed for error identification and SOC management between January 1, 2016, and December 31, 2018. CC identification was additionally assessed between January 1, 2019, and December 31, 2019, and included 708 general surgery cases. Data were evaluated for error assessments and overall SOC management. PGY4 and 5 residents were compared for nu...

Research paper thumbnail of ASSOCIATION FOR ACADEMIC SURGERY, 2008 A Report Card System Using Error Profile Analysis and Concurrent Morbidity and Mortality Review: Surgical Outcome Analysis, Part II

Background. An effective report card system for ad- verse outcome error analysis following surger... more Background. An effective report card system for ad- verse outcome error analysis following surgery is lack- ing. We hypothesized that a memorialized database could be used in conjunction with error analysis and management evaluation at Morbidity & Mortality con- ference to generate individualized report cards for Attending Surgeon and System performance. Study Design. Prospectively collected data from Sep- tember 2000 through April 2005 were reported follow- ing Morbidity & Mortality review on 1618 adverse out- comes, including 219 deaths, following 29,237 operative procedures, in a complete loop to approxi- mately 60 individual surgeons and responsible system personnel. Results. A 40% reduction of gross mortality (P < 0.001) and 43% reduction of age-adjusted mortality were achieved over 4 years at the Academic Center. Quality issues were identified at a rate three times greater than required by New York State regulations and increased from a baseline 4.96% to 32.7% (odds ratio 1...

Research paper thumbnail of Financial Impact of Post-Colectomy Complication and the Value of Administrative Data

Journal of the American College of Surgeons

Research paper thumbnail of Resident and Attending Impressions of a Novel Electronic Tool for the Recording of Surgical Morbidity and Mortality Case Data: the Preparation of Case Presentations and Resident Evaluation

Journal of the American College of Surgeons, Oct 1, 2017

INTRODUCTION: Physicians in procedural specialties are at high risk for work-related musculoskele... more INTRODUCTION: Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (WMSDs). This has been called 'an impending epidemic" in the context of the looming workforce shortage, however prevalence estimates vary by study. This study aimed to estimate the prevalence of disabling WMSDs among at-risk physicians and to determine the scope of preventative efforts. METHODS: A systematic search was conducted on Medline, Embase, Web of Science, PubMed/NCBI, and two clinical trial registries from inception until December 2016 for studies reporting on the prevalence and/or prevention of WMSDs among at-risk physicians. "At-risk physicians" included surgeons and interventionalists. Study estimates were pooled using a random-effects meta-analytic model. RESULTS: The search returned 3,739 unique items. The 126 meeting inclusion criteria were published between 1974 and 2016 in 23 countries. Pooled career prevalence estimates of the most common WMSDs included: degenerative cervical spine disease 17% (457/2,406 physicians), rotator cuff pathology 18% (300/1,513 physicians), degenerative lumbar spine disease 19% (544/2,449 physicians), and carpal tunnel syndrome 9% (256/ 2,449 physicians). From 1997 to 2015, cervical and lumbar spine disease increased by 18.3% and 26.9%, respectively. Of the injured, 15% (391/2,704 physicians) required time away from work, practice modification, or early retirement. Twelve of 14 atrisk specialties described a gross lack of awareness and an unmet need for ergonomics education.

Research paper thumbnail of Percutaneous catheter introducer

Research paper thumbnail of The laparoscopic retrieval of an orthopedic fixation pin from the liver with repair of an associated diaphragmatic laceration

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

We report the successful removal of a shoulder fixation pin from the right lobe of the liver with... more We report the successful removal of a shoulder fixation pin from the right lobe of the liver with intracorporeal repair of a diaphragmatic laceration. An expeditious workup and urgent operative intervention were required. We adhered to the principles of room setup, optical correctness, establishment of the triangle of success, appropriate instrument entry and convergence angles, two-handed surgical skills, and competence in intracorporeal suturing techniques that were all required for successful completion of the case. We also present a review of the significant literature.

Research paper thumbnail of Management of the Exposed Saphenous Vein Graft

Research paper thumbnail of Impact of Timing of Tocilizumab Use in Hospitalized Patients With SARS-CoV-2 Infection

Research paper thumbnail of Cognitive Bias, Harm Severity and Debiasing Strategies

Journal of the American College of Surgeons

Research paper thumbnail of Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications

Research paper thumbnail of Correlation between operative time and crowd-sourced skills assessment for robotic bariatric surgery

Research paper thumbnail of Cognitive Bias Impact on Management of Postoperative Complications, Medical Error, and Standard of Care

Journal of Surgical Research

Research paper thumbnail of Impact of Timing of Tocilizumab Use in Hospitalized SARS-CoV-2 Infected Patients

Research paper thumbnail of 86A surgeon report card system developed using a standardized classification of adverse outcomes, error profile analysis and concurrent morbidity and mortality review: A three-year experience

Research paper thumbnail of Laparoscopic transperitoneal anterior lumbar interbody fusion with cylindrical threaded cortical allograft bone dowels

Research paper thumbnail of Natural killer and antibody-dependent cytotoxicity following thermal injury in humans

Research paper thumbnail of Pathophysiologic glucocorticoid elevations promote bacterial translocation after thermal injury

Infection and immunity, 1990

Thermal injury results in transient elevations of plasma glucocorticoids and promotes translocati... more Thermal injury results in transient elevations of plasma glucocorticoids and promotes translocation of bacteria from the gut to the mesenteric lymph nodes (MLN) in rats. Translocated organisms are quickly cleared following uncomplicated thermal injury. However, subsequent burn wound infection, in temporal association with sustained pathophysiologic elevations of plasma corticosterone, results in the continued presence of enteric bacteria in the MLN. To study the role of sustained pathophysiologic steroid elevations in the mediation of this prolonged bacterial translocation, Wistar rats were randomly placed in groups receiving one of the following: (i) a 30% total body surface area scald injury with placement of a subcutaneous corticosterone pellet, (ii) a 30% total body surface area scald and a sham pellet implantation, (iii) a sham burn and a corticosterone pellet implantation, or (iv) a sham burn and a sham pellet implantation. The animals were sacrificed on days 1 and 4 after inj...

Research paper thumbnail of Management of the Exposed Saphenous Vein Graft

Perspectives in Vascular Surgery and Endovascular Therapy, 1991