The Effect of Duty Hour Regulation on Resident Surgical Case Volume in Otolaryngology

Objective: Wide variation exists in cardiac arrest survival. Historically cardiac arrest research has focused upon clinical pre-arrest and intra-arrest factors to explain this variation in outcomes. In-hospital post-arrest care is increasingly recognized as an important aspect of survival. We sought to identify hospital characteristics associated with improved cardiac arrest survival. Methods: We examined all participating hospitals in the University Hospital Consortium (UHC) clinical database with more than 25 adult cardiac arrests in 2012. Cases were identified using International Classification of Diseases, 9th Edition, code 427.5 (cardiac arrest) or 99.60 (CPR), excluding prisoners, pregnant patients, transfers, and hospice patients. We estimated hospital-specific risk-standardized survival rates (RSSRs) using hierarchical logistic regression, adjusting for individual risk of mortality. Institutions in the highest RSSR quartile were compared with those in the lowest three quartiles using Pearson chi-square tests of association. Results: UHC institutions admitted 3,686,296 patients in 2012, of which 33,700 patients experienced cardiac arrest. Overall survival was 42.3% (95% CI 41.8-42.9) with median RSSR of 42.7% (IQR 35.5-50.8). Hospitals in the highest quartile of RSSR had higher cardiac arrest volume (median 193 vs. 150, p-value 0.019), higher annual surgical operation volume (21,177 vs. 14,122, 0.007), cared for patients from catchment areas with higher household income ($60,753 vs. $56,424, 0.027), and were more likely to be a trauma (79% vs 59%, 0.024) or cardiac surgery center (91% vs 70%, 0.007). In addition, hospital size (477 vs 415 beds, 0.060) and teaching status (77% vs. 62%, 0.067) demonstrated a trend toward association with higher RSSR. Conclusion: Among hospitals in the UHC, those with higher cardiac arrest and surgical case volume, patient household income, and availability of trauma and cardiac surgery were associated with improved RSSR.

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Correlation of Surgical Case Volume and Fellowship Training with Simulated Procedural Tasks

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2019.09.636 ◽

2019 ◽

Vol 26 (7) ◽

pp. S58-S59

Author(s):

V Palvia ◽

JA Doneza ◽

SS Mathews ◽

CJ Ascher-Walsh

Keyword(s):

Fellowship Training ◽

Case Volume ◽

Surgical Case ◽

Procedural Tasks

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Do Orthopaedic Resident and Fellow Case Logs Accurately Reflect Surgical Case Volume?

Journal of Surgical Education ◽

10.1016/j.jsurg.2017.12.002 ◽

2018 ◽

Vol 75 (4) ◽

pp. 1052-1057 ◽

Cited By ~ 6

Author(s):

Kanu Okike ◽

Peter Z. Berger ◽

Carrie Schoonover ◽

Robert V. O′Toole

Keyword(s):

Case Volume ◽

Surgical Case ◽

Orthopaedic Resident ◽

Case Logs

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The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm

Gynecologic Oncology ◽

10.1016/j.ygyno.2010.05.025 ◽

2010 ◽

Vol 118 (3) ◽

pp. 262-267 ◽

Cited By ~ 142

Author(s):

Robert E. Bristow ◽

Bryan E. Palis ◽

Dennis S. Chi ◽

William A. Cliby

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Surgical Treatment ◽

Epithelial Ovarian Cancer ◽

National Cancer Database ◽

Advanced Stage ◽

Case Volume ◽

Surgical Case ◽

Treatment Paradigm

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Modelling and forecasting daily surgical case volume using time series analysis

Health Systems ◽

10.1080/20476965.2017.1390185 ◽

2018 ◽

Vol 7 (2) ◽

pp. 111-119 ◽

Cited By ~ 2

Author(s):

Nazanin Zinouri ◽

Kevin M. Taaffe ◽

David M. Neyens

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Case Volume ◽

Surgical Case ◽

Series Analysis ◽

Modelling And Forecasting

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Real-time assessment of COVID-19 impact on global surgical case volumes

10.1101/2020.05.03.20086819 ◽

2020 ◽

Author(s):

Vikas N. O’Reilly-Shah ◽

Wil Van Cleve ◽

Dustin R. Long ◽

Vanessa Moll ◽

Faye M. Evans ◽

...

Keyword(s):

Real Time ◽

Low Income ◽

Mobile Application ◽

Surgical Care ◽

Low Income Countries ◽

Surgical Volume ◽

Case Volume ◽

Surgical Case ◽

The Impact ◽

Usage Data

AbstractImportanceThe COVID-19 pandemic has disrupted global surgical capacity. The impact of the pandemic in low and middle income countries has the potential to worsen already strained access to surgical care. Timely assessment of surgical volumes in these countries remains challenging.ObjectiveTo determine whether usage data from a globally used anesthesiology calculator mobile application can serve as a proxy for global surgical case volume and contribute to monitoring of the impact of the COVID-19 pandemic, particularly in World Bank low income countries where official data collection is not currently practical.DesignSubset of data from an ongoing observational cohort study of users of the application collected from October 1, 2018 to April 18, 2020.SettingThe mobile application is available from public sources; users download and use the application per their own clinical needs on personal mobile devices.ParticipantsNo user data was excluded from the study.Exposure(s)Events with impacts on surgical case volumes, including weekends, holidays, and the COVID-19 pandemic.Main Outcome(s) and Measure(s)It was previously noted that application usage was decreased on weekends and during winter holidays. We subsequently hypothesized that more detailed analysis would reveal impacts of country-specific or region-specific holidays on the volume of app use.Results4,300,975 data points from 92,878 unique users were analyzed. Physicians and other anesthesia providers comprised 85.8% of the study population. Application use was reduced on holidays and weekends and correlated with fluctuations in surgical volume. The COVID-19 pandemic was associated with substantial reductions in app use globally and regionally. There was strong cross correlation between COVID-19 case count and reductions in app use. By country, there was a median global reduction in app use to 58% of baseline (interquartile range, 46%-75%). Application use in low-income continues to decline but in high-income countries has stabilized.Conclusions and RelevanceApplication usage metadata provides a real-time indicator of surgical volume. This data may be used to identify impacted regions where disruptions to surgical care are disproportionate or prolonged. A dashboard for continuous visualization of these data has been deployed.Key PointsQuestionCan usage data from a globally used anesthesiology calculator mobile application contribute to monitoring of the impacts to global surgical case volume caused by the COVID-19 pandemic, particularly in resource-limited environments such as World Bank low income countries?FindingsIn this ongoing observational cohort study, application usage data from 92,878 unique users in 221 countries was found to serve well as a qualitative proxy for surgical case volume, with clear impacts to app use during weekend, holidays, and during the COVID-19 pandemic.MeaningThis proxy of surgical volume will provide insight into the impact of and recovery from the COVID-19 pandemic where official data collection is not currently practical. A real time dashboard tracking this proxy of global surgical volume is live and under continued development.

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Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy

Military Medicine ◽

10.1093/milmed/usab500 ◽

2021 ◽

Author(s):

Alicia G Sykes ◽

Jason B Brill ◽

James D Wallace ◽

Clara Lee ◽

Paul R Lewis ◽

...

Keyword(s):

General Surgery ◽

Medical Center ◽

Case Volume ◽

Surgical Specialty ◽

Average Case ◽

Patient Demographics ◽

Surgical Case ◽

Institutional Review ◽

Included Patient ◽

The U.S

ABSTRACT Introduction Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. Materials and Methods Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. Results A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician–gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. Conclusions Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.

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