Brenessa Lindeman

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

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 < .001). High‐volume surgeons had significantly lower mortality compared with low‐volume surgeons (0.56% vs 1.25%, P = .004) and a lower rate of complications (10.2% vs 16.4%, P = < .001). Endocrine surgeons were more likely to perform laparoscopic procedures (34.8% vs 22.4% general surgeons and 27.7% US, P < .001) and had the lowest median hospital duration of stay (2 days vs 4 days general surgeons and 3 days urologists, P < .001). After risk adjustment, low surgeon volume was an independent predictor of inpatient complications (odds ratio = 0.96, P = .002). Conclusion. Patients with adrenal disease should be referred to surgeons based on adrenalectomy volume regardless of specialty, but most endocrine surgeons that perform adrenalectomy are high‐volume for the procedure.

Association of Burnout With Emotional Intelligence and Personality in Surgical Residents: Can We Predict Who Is Most at Risk?

OBJECTIVESnBurnout is common among surgical residents and may be related to personality characteristics, emotional intelligence (EI), or work experiences.nnnDESIGNnLongitudinal cohort study over 1 year.nnnSETTINGnTertiary academic medical centers in the Northeast.nnnPARTICIPANTSnAll general surgery residents in 2 programs (n = 143) were invited to complete an electronic survey at 3 time points; 88, 64, and 69 residents completed the survey (overall response rate 52%).nnnRESULTSnSevere burnout was observed in 51% of residents (n = 41). Higher scores were associated with female sex (p = 0.02). Burnout scores were highest at the beginning and end of the academic year; EI and personality scores remained stable. On bivariate analysis, high EI score (p < 0.001), agreeableness and emotional stability personality features (p = 0.003), and positive job experiences (p < 0.01) were protective against burnout. Higher EI and positive work experiences were independent predictors of lower burnout (p < 0.01) after multivariable adjustment.nnnCONCLUSIONSnSurgical residents have high levels of burnout. Higher EI and positive work experiences are associated with lower burnout. Focused interventions to improve EI and optimize the work environment may prevent or lessen burnout.

Impact of near-peer teaching rounds on student satisfaction in the basic surgical clerkship.

BACKGROUNDnTeaching rounds are rarely featured in the surgery clerkship. Senior students interested in surgery are suited to precept teaching rounds. Near-peer teaching can provide benefits to both learners and preceptors.nnnMETHODSnNear-peer teaching rounds consisted of senior student-precetors leading groups of 3 clerkship students on teaching rounds once during the clerkship. We prospectively surveyed student satisfaction before and after instituting near-peer teaching rounds. We retrospectively gathered qualitative narratives from student-preceptors.nnnRESULTSnThe survey response rate was 93% before near-peer teaching rounds were instituted and 85% after. Satisfaction with the learning environment and the quality and amount of small-group teaching were significantly higher after the institution of near-peer teaching rounds (P ≤ .001 for all 3). Satisfaction with the overall clerkship and baseline interest in surgery were not significantly different. Student-preceptors reported gaining valuable experience for future roles in academia as residents and attending surgeons.nnnCONCLUSIONSnStudent satisfaction with small-group teaching and the learning environment increased after the institution of near-peer teaching rounds in the surgery clerkship. Student-preceptors gained early experience for careers in academic surgery.

International Residency Program Evaluation: Assessing the Reliability and Initial Validity of the ACGME-I Resident Survey in Abu Dhabi, United Arab Emirates

BACKGROUNDnEducators agree on the importance of assessing the quality of graduate medical education. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) resident survey is an important part of the accreditation process, yet some studies have questioned its validity.nnnOBJECTIVEnWe assessed the reliability and acceptance of the ACGME-International (ACGME-I) resident survey in the culturally distinct, nonnative English-speaking resident population of Abu Dhabi in the United Arab Emirates.nnnMETHODSnA total of 158 residents in ACGME-I accredited institutions in Abu Dhabi received an online link to the ACGME-I survey. Reliability analysis was conducted using the Cronbach α. A focus group was then held with a convenience sample of 25 residents from different institutions and specialties to understand potential challenges encountered by survey participants.nnnRESULTSnCompleted surveys were received from 116 residents (73.4%). The 39 items in the survey demonstrated high reliability, with a Cronbach α of 0.918. Of the 5 subscales, 4 demonstrated acceptable to very good reliability, ranging from 0.72 to 0.888. The subscale resources had lower reliability at 0.584. Removal of a single item increased the Cronbach α to a near-acceptable score of 0.670. Focus group results indicated that the survey met standards for readability, length, and time for completion.nnnCONCLUSIONSnThe ACGME-I resident survey demonstrates acceptable reliability and validity for measuring the perceptions of residents in an international residency program. The data derived from the survey can offer an important set of metrics for educational quality improvement in the United Arab Emirates.

The posterior adiposity index: a quantitative selection tool for adrenalectomy approach

BACKGROUNDnObjective criteria are lacking to determine whether a laparoscopic transabdominal (LA) or retroperitoneoscopic (RP) approach to adrenalectomy is optimal. We hypothesized that imaging characteristics could predict patients for whom RP adrenalectomy is the optimal approach.nnnMATERIALS AND METHODSnRetrospective cohort study of all patients undergoing minimally invasive adrenalectomy between 2014 and 2016 (nxa0=xa0113) at one institution. Imaging measurements included distances between the skin and Gerotas fascia (S-GF), upper borders of adrenal and kidney (A-K), adrenal and 12th rib (A-R), 12th rib and iliac crest (R-IC), and perinephric fat (PNF). These characteristics plus patient body mass index, gender, age, tumor size, and diagnosis were compared with operative time and estimated blood loss using Pearsons correlation or ANOVA. Multivariable linear regression also identified independent predictors of operative time.nnnRESULTSnHalf of patients underwent LA (nxa0=xa057) and RP adrenalectomy (nxa0=xa056). Median age was 57xa0y; 60% were female. Mean tumor size was 3.2xa0cm. Higher body mass index patients were more likely to undergo LA (Pxa0=xa00.03). Increasing lesion size modestly correlated with longer operative time (rxa0=xa00.341). On bivariate analysis, S-GF and PNF distances moderately correlated with operative time (rxa0=xa00.464 and 0.494) for RP procedures. The sum of S-GF and PNF generated a Posterior Adiposity Index (PAI). The PAI strongly correlated with operative time for RP (rxa0=xa00.590). Nothing was significantly associated with estimated blood loss. Multivariate analysis revealed larger lesions (Pxa0=xa00.025) and increasing PAI (Pxa0=xa00.019) were predictive of longer operative time, with PAI ≥9 conferring the greatest risk (Pxa0=xa00.004).nnnCONCLUSIONSnSmaller tumors and PAI <9 are associated with shorter operative times in RP adrenalectomy. Surgeons can utilize preoperative images to calculate the PAI and determine whether an RP approach would be favorable.

Reducing cost and improving operating room efficiency: examination of surgical instrument processing

BACKGROUNDnOperating room efficiency can be compromised because of surgical instrument processing delays. We observed that many instruments in a standardized tray were not routinely used during thyroid and parathyroid surgery at our institution. Our objective was to create a streamlined instrument tray to optimize operative efficiency and cost.nnnMATERIALS AND METHODSnHead and neck surgical instrument trays were evaluated by operating room team leaders. Instruments were identified as either necessary or unnecessary based on use during thyroidectomies and parathyroidectomies. The operating room preparation time, tray weights, number of trays, and number of instruments were recorded for the original and new surgical trays. Cost savings were calculated using estimated reprocessing cost of

Characterization and Perceptions of Surgical Clinician Educators: An International Survey

0.51 per instrument.nnnRESULTSnThree of 13 head and neck trays were converted to thyroidectomy and parathyroidectomy trays. The starting head and neck surgical set was reduced from two trays with 98 total instruments to one tray with 36 instruments. Tray weight decreased from 27 pounds to 10 pounds. Tray preparation time decreased from 8xa0min to 3xa0min. The new tray saved

Effect of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Malignancy Rates in Thyroid Nodules: How to Counsel Patients on Extent of Surgery

31.62 (

To admit or not to admit? Experience with outpatient thyroidectomy for Graves’ disease in a high-volume tertiary care center

49.98 to

Strategic surgical planning for resection of a large adrenal cortical carcinoma

18.36) per operation in reprocessing costs. Projected annual savings with hospitalwide implementation is over