Robert S.D. Higgins

Effect of Surgeon and Hospital Volume on Emergency General Surgery Outcomes

BACKGROUNDnEmergency general surgery (EGS) contributes to half of all surgical mortality nationwide, is associated with a 50% complication rate, and has a 15% readmission rate within 30 days. We assessed associations between surgeon and hospital EGS volume with these outcomes.nnnSTUDY DESIGNnUsing Marylands Health Services Cost Review Commission database, we identified nontrauma EGS procedures performed by general surgeons among patients 20 years or older, who were admitted urgently or emergently, from July 2012 to September 2014. We created surgeon and hospital volume categories, stratified EGS procedures into simple (mortality ≤ 0.5%) and complex (>0.5%) procedures, and assessed postoperative mortality, complications, and 30-day readmissions. Multivariable logistic regressions both adjusted for clinical factors and accounted for clustering by individual surgeons.nnnRESULTSnWe identified 14,753 procedures (61.5% simple EGS, 38.5% complex EGS) by 252 (73.3%) low-volume surgeons (≤25 total EGS procedures/year), 63 (18.3%) medium-volume surgeons (26 to 50/year), and 29 (8.4%) high-volume surgeons (>50/year). Low-volume surgeons operated on one-third (33.1%) of all patients. For simple procedures, the very low rate of death (0.2%) prevented a meaningful regression with mortality; however, there were no associations between low-volume surgeons and complications (adjusted odds ratio [aOR] 1.07; 95% CI 0.81 to 1.41) or 30-day readmissions (aOR 0.80; 95% CI 0.64 to 1.01) relative to high-volume surgeons. Among complex procedures, low-volume surgeons were associated with greater mortality (aOR 1.64; 95% CI 1.12 to 2.41) relative to high-volume surgeons, but not complications (aOR 1.06; 95% CI 0.85 to 1.32) or 30-day readmission (aOR 0.99; 95% CI 0.80 to 1.22). Low-volume hospitals (≤125 total EGS procedures/year) relative to high-volume hospitals (>250/year) were not associated with mortality, complications, or 30-day readmissions for simple or complex procedures.nnnCONCLUSIONSnWe found evidence that surgeon EGS volume was associated with outcomes. Developing EGS-specific services, mentorship opportunities, and clinical pathways for less-experienced surgeons may improve outcomes.

Here Comes the Sunshine: Industry’s Payments to Cardiothoracic Surgeons

BACKGROUNDnThe Physician Payment Sunshine Act was implemented to provide transparency to financial transactions between industry and physicians. Under this law, the Open Payments Program (OPP) was created to publicly disclose all transactions and inform patients of potential conflicts of interest. Collaboration between industry and cardiothoracic surgeon-scientists is essential in developing new approaches to treating patients with cardiac disease. The objective of this study is to characterize industry payments to cardiothoracic surgeons as reported by the OPP.nnnMETHODSnWe used the first wave of Physician Payment Sunshine Act data (August 2013 to December 2013) to assess industry payments made to cardiothoracic surgeons.nnnRESULTSnCardiothoracic surgeons (nxa0= 2,495) received a total of

A comprehensive Choosing Wisely quality improvement initiative reduces unnecessary transfusions in an Academic Department of Surgery

4,417,545 during a 5-month period. Cardiothoracic surgeons comprised 0.5% of all persons in the OPP and received 0.9% of total disclosed industry funding. Among cardiothoracic surgeons receiving funding, 34% received payments less than

Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation

100, 43% received payments of

The Cape Town declaration on access to cardiac surgery in the developing world

100 to

Surgical Treatment of Heart Failure

999, 19% received payments of

Mastery of Care-toward Communitarian Regulation

1,000 to

Global Unmet Needs in Cardiac Surgery

9,999, 4% received payments of

The Cape Town Declaration on Access to Cardiac Surgery in the Developing World

10,000 to

Executive Leadership and Surgical Quality: A Guide for Senior Hospital Leaders

99,999, and 0.2% received payments of more than