The Provision of Acute Pediatric Surgical Care by Adult Acute Care General Surgeons

2020 ◽  
pp. 000313482093325
Author(s):  
Chelsea M. Knotts ◽  
Edward J. Prange ◽  
Krysta Orminski ◽  
Stephanie Thompson ◽  
Bryan K. Richmond
Keyword(s):  
Learning Curve ◽  
Acute Care ◽  
Pediatric Patients ◽  
Surgical Care ◽  
Comfort Level ◽  
General Surgeon ◽  
Published Data ◽  
Common Procedure ◽  
General Surgeons ◽  
Pediatric Laparoscopy

Background At our hospital, acute surgical care of children aged 6 and older is managed by adult acute care surgeons. Previously published data from a 10-year experience with this model demonstrated no differences in outcomes when compared with pediatric surgical benchmark data. This study assesses for the effects of a learning curve in the care of pediatric patients by comparing outcomes of patients treated in the first three years with those treated in the last 3 years during a 10-year experience with this model. Design This was a retrospective study of pediatric patients aged 6 and older who underwent an emergent or urgent, nontrauma surgical procedure by a general surgeon. Data was obtained via chart review and descriptive statistics were compared between patients operated on between January 1, 2009-January 1, 2012 and January 1, 2016-January 1, 2019. Results In all, 208 cases were performed in the early cohort and 192 cases in the late cohort. Appendectomy was the most common procedure in both intervals (88% early, 94.8% late). Although there was a significant decrease in open procedures in the later cohort (22.6% vs 4.7%, P < .001), there was no significant change in disease-specific complications or negative appendectomies. No consults to a fellowship-trained pediatric surgeon were required during either time period, although one was available if needed. Conclusions Our data demonstrated a decrease in the number of open procedures in the later cohort. This may be due to an increased comfort level with pediatric laparoscopy over time. However, no significant changes in outcomes were observed. This study supports that acute care general surgeons can provide comparable care to pediatric patients within this age demographic and that although a learning curve, appears to exist with respect to pediatric laparoscopy, it is insignificant in terms of its effect on overall outcomes.

New Concept for a Thoracic Drainage System Using Magnetic Actuation

2019 ◽  
Vol 26 (6) ◽  
pp. 705-711
Author(s):  
Daisuke Taniguchi ◽  
Keitaro Matsumoto ◽  
Yoshihiro Kondo ◽  
Tomoshi Tsuchiya ◽  
Ikuo Yamamoto ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Drainage System ◽  
Magnetic Actuation ◽  
Thoracic Cavity ◽  
Common Procedure ◽  
Thoracic Drainage ◽  
Drain Fluid ◽  
Laboratory Trial ◽  
General Surgeons ◽  
Effective Drainage

Objectives. Thoracic drainage is a common procedure to drain fluid, blood, or air from the pleural cavity. Some attempts to develop approaches to new thoracic drainage systems have been made; however, a simple tube is often currently used. The existing drain presupposes that it is placed correctly and that the tip does not require moving after insertion into the thoracic cavity. However, in some cases, the drain is not correctly placed and reinsertion of an additional drain is required, resulting in significant invasiveness to the patient. Therefore, a more effective drainage system is needed. This study aimed to develop and assess a new thoracic drain via a collaboration between medical and engineering personnel. Methods. We developed the concept of a controllable drain system using magnetic actuation. A dry laboratory trial and accompanying questionnaire assessment were performed by a group of thoracic and general surgeons. Objective mechanical measurements were obtained. Porcine experiments were also carried out. Results. In a dry laboratory trial, use of the controllable drain required significantly less time than that required by replacing the drain. The average satisfaction score of the new drainage system was 4.07 out of 5, indicating that most of the research participants were satisfied with the quality of the drain with a magnetic actuation. During the porcine experiment, the transfer of the tip of the drain was possible inside the thoracic cavity and abdominal cavity. Conclusion. This controllable thoracic drain could reduce the invasiveness for patients requiring thoracic or abdominal cavity drainage.

scholarly journals Hospital mortality under surgical care

2011 ◽  
Vol 93 (3) ◽  
pp. 193-200 ◽  
Author(s):  
O Aziz ◽  
D Fink ◽  
L Hobbs L ◽  
G Williams ◽  
TC Holme
Keyword(s):  
Surgical Care ◽  
Hospital Performance ◽  
General Surgeon ◽  
Mortality Data ◽  
Co Morbidity ◽  
Specific Mortality ◽  
Mortality Ratio ◽  
Case Mix Adjustment ◽  
Surrogate Measure ◽  
Morbidity Index

INTRODUCTION The ‘hospital standardised mortality ratio’ (HSMR) has been used in England since 1999 to measure NHS hospital performance. Large variations in reported HSMR between English hospitals have recently led to heavy criticism of their use as a surrogate measure of hospital performance. This paper aims to review the mortality data for a consultant general surgeon contributed by his NHS trust over a 3-year period as part of the trust's HSMR calculation and evaluate the accuracy of coding the diagnoses and covariates for case mix adjustment. SUBJECTS AND METHODS The Dr Foster Intelligence database was interrogated to extract the NHS trust's HSMR benchmark data on inpatient mortality for the surgeon from 1 April 2006 to 31 March 2009 and compared to the hospital notes. RESULTS 30 patients were identified of whom 12 had no evidence of being managed by the surgeon. This represents a potential 40% inaccuracy rate in designating consultant responsibility. The remaining 18 patients could be separated into ‘operative’ (11 patients) and ‘non-operative’ (7 patients) groups. Only 27% in the operative group and 43% of the non-operative mortality group respectively had a Charlson co-morbidity index recorded despite 94% of the cases having significant co-morbidities CONCLUSIONS Highlighting crude and inaccurate clinician-specific mortality data when only 1-5% of deaths under surgical care may be associated with avoidable adverse events seems potentially irresponsible.

149 Use of Risk Model for Assessment of Residents Perception of Complexity of Surgical Steps

Neurosurgery ◽  
2015 ◽  
Vol 62 (CN_suppl_1) ◽  
pp. 214-214
Author(s):  
Ahmed M. Raslan ◽  
Jeffrey Steven Raskin ◽  
Jesse Jia-Xin Liu
Keyword(s):  
High Risk ◽  
Operative Time ◽  
Resident Education ◽  
Comfort Level ◽  
Matrix Analysis ◽  
Published Data ◽  
Dependent Manner ◽  
Risk Matrix ◽  
Danger Zone ◽  
The Impact

Abstract INTRODUCTION: Quality improvement projects have begun to standardize surgical work flow as a component to optimize operative room (OR) efficiency. Removing special cause variability resulting from nonsurgical waste is an obvious target; however, surgical resident education must be maintained even in the setting of process improvement. There are no published data describing the impact on operative time of resident-identified risky or uncomfortable procedural steps during posterior instrumented fusion (PIF). Self-identification of risk or discomfort in surgical steps may allow for shorter OR time and reduced cost, without sacrificing resident education. METHODS: PIF procedure steps were defined. An 8 two-part question survey regarding surgeon comfort level and perceived risk assessment at each step was developed, and completed by junior (17) and senior residents (10), and faculty (6) from orthopedic and neurological surgeons. A risk matrix was constructed defining 2 zones, a “danger zone” where responses were both high risk (3–5) and low comfort (1–3) and a “safe zone” where responses were low risk (1–2) and high comfort (4–5). One-tailed χ2 with Yates correction was performed. RESULTS: Risk matrix analysis showed a statistical difference among danger zone respondents between junior resident and faculty groups for exposure, pedicle screw placement, neural decompression, interbody placement, posterolateral fusion, and hemostasis (Table 2). Radar graph identifies percentage of respondents who fall within the danger zone (Figure 1). CONCLUSION: Resident perception of surgical complexity can be evaluated for procedural steps using a risk matrix survey. For PIF, residents assign more risk and are less comfortable performing steps in a training-dependent manner. Identification of particular high-risk steps, which are uncomfortable, should prompt strict faculty oversight to improve patient safety, monitor resident education, and reduce operative time.

scholarly journals The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 106
Author(s):  
Miro Jukić ◽  
Ivona Biuk ◽  
Zenon Pogorelić
Keyword(s):  
Postoperative Period ◽  
Quality Indicator ◽  
Pediatric Surgery ◽  
Pediatric Patients ◽  
Length Of Hospital Stay ◽  
Common Procedure ◽  
Asa Score ◽  
Primary Surgery ◽  
Management Of Complications ◽  
Duration Of Surgery

Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

scholarly journals A Retrospective 05 Years Analysis of Operated Surgical Patients in Bangladesh Level II Hospital, UNMIL

2014 ◽  
Vol 9 (1) ◽  
pp. 14-18
Author(s):  
MB Uddin ◽  
MU Ahmed ◽  
MA Haque ◽  
MD Hussain ◽  
SME Hossain
Keyword(s):  
Surgical Care ◽  
Armed Forces ◽  
Published Data ◽  
Optimal Outcome ◽  
Level Ii ◽  
Number Of Patients ◽  
Minor Surgery ◽  
Surgical Conditions ◽  
Logistic Support ◽  
The Impact

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19

scholarly journals Choroidal Neovascularization in Pediatric Patients: Analysis of Etiologic Factors, Clinical Characteristics and Treatment Outcomes

2021 ◽  
Vol 8 ◽  
Author(s):  
Ting Zhang ◽  
You Wang ◽  
Wenjia Yan ◽  
Yafen Liu ◽  
Jinglin Lu ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Choroidal Neovascularization ◽  
Pediatric Patients ◽  
Chinese Patients ◽  
Etiologic Factor ◽  
Published Data ◽  
Demographic Profiles ◽  
Endothelial Growth Factor

Background and Objectives: Choroidal neovascularization (CNV) is a common pathologic lesion that occurs in various chorioretinopathy, but very limited published data have reported in pediatric patients. This study aimed to investigate the etiologic factors, clinical features, and treatment outcomes of choroidal neovascularization (CNV) in children.Methods: In this study, 33 eyes in 30 patients aged 18 years or younger with CNV were included. Comprehensive ophthalmic examination was performed in all the patients. The demographic profiles, laterality, visual acuity, optical coherence tomographic findings, fundus fluorescein angiographic findings, and the underlying pathology were analyzed. The types, locations, treatment outcomes, and recurrences of CNV were noted.Results: The average age was 11.2 ± 4.6 (range, 1–18) years. Most CNVs affecting children were classic and type 2. The most common etiologic factors of CNV in pediatric patients were congenital/developing abnormalities (9/30, 30.0%) and inflammatory retinochoroidopathy (9/30, 30.0%), followed by idiopathic CNV (8/30, 26.7%). Subtype analysis showed that the etiologic factor was inflammatory retinochoroidopathy in children 12 years or older, whereas congenital/developing abnormalities were present in children younger than 12 years. Eyes with active CNVs required a mean of 1.40 ± 0.58 injections. No recurrence was observed during follow-up.Conclusions: The etiologic factors of CNV in young Chinese patients were diverse, with congenital/developing abnormalities, inflammatory retinochoroidopathy and idiopathic CNV being the 3 most common ones. Eyes with active CNVs had good responses to antivascular endothelial growth factor treatment with low recurrence.

Article Commentary: Soft Tissue Sarcoma of the Extremity and Trunk: Issues for the General Surgeon

2006 ◽  
Vol 72 (8) ◽  
pp. 665-671
Author(s):  
Gerame Wells ◽  
Robert C.G. Martin ◽  
Kelly M. Mcmasters ◽  
Charles R. Scoggins
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Current Literature ◽  
Medical Literature ◽  
Malignant Tumors ◽  
Soft Tissue Sarcomas ◽  
Heterogeneous Group ◽  
General Surgeon ◽  
Academic Interest ◽  
General Surgeons

Soft tissue sarcomas represent a heterogeneous group of malignant tumors that arise from mesenchymal tissues. The majority of these tumors arise on the extremity or trunk. Despite their rarity, soft tissue sarcomas continue to generate vigorous academic interest, and as a result, the ever-expanding medical literature dealing with sarcomas continues to grow. Many general surgeons will see few of these tumors during their careers, and a review of the current literature and how it applies to patients afflicted with soft tissue sarcoma of the extremity or trunk is warranted.

scholarly journals The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

2015 ◽  
Vol 81 (9) ◽  
pp. 854-858 ◽  
Author(s):  
Rudy J. Judhan ◽  
Raquel Silhy ◽  
Kristen Statler ◽  
Mija Khan ◽  
Benjamin Dyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Tertiary Care ◽  
Disease Process ◽  
Pediatric Care ◽  
Care Hospital ◽  
Late Night ◽  
General Surgeons ◽  
The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

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