Vanita Ahuja

Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery

IMPORTANCE As robotic-assisted cardiac surgical procedures increase nationwide, surgeons need to be educated on the safety of the new modality compared with that of open technique. OBJECTIVE To compare complications, length of stay (LOS), actual cost, and mortality between nonrobotic and robotic-assisted cardiac surgical procedures. DESIGN, SETTING, AND PARTICIPANTS Weighted data on cardiac patients who had undergone operations involving the valves or septa and vessels, as well as other heart and pericardium procedures, from January 1, 2008, to December 31, 2011, were obtained from the Nationwide Inpatient Sample via the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Propensity score matching was used to match each robotic-assisted case to 2 nonrobotic cases on 14 characteristics. MAIN OUTCOMES AND MEASURES Complications, median LOS, actual cost, and mortality. RESULTS Exploratory analysis found a total of 1,374,653 cardiac cases (1,369,454 [99.6%] nonrobotic and 5199 [0.4%] robotic-assisted cases). After propensity score matching, there were 10,331 (66.5%) nonrobotic cases and 5199 (33.5%) robotic-assisted cases. Cardiac operations included 1630 (10.5%) involving the valves or septa, 6616 (42.6%) involving the vessels, and 7284 (46.9%) other heart and pericardium procedures. Robotic-assisted compared with nonrobotic surgery had a higher median cost (

Simulation as an adjunct to didactics to increase acquired knowledge retention of learning how to avoid a “never event” of unintended retained foreign objects: 6-month and 1-year follow-up study

39,030 vs

Quantification of Resident Work in Colorectal Surgery

36,340; P < .001) but lower LOS (5 vs 6 days; P < .001) and lower mortality (1.0% vs 1.9%; P < .001). Robotic-assisted surgery had significantly fewer complications for all operation types (30.3% vs 27.2%; P < .001). CONCLUSIONS AND RELEVANCE Overall, robotic-assisted surgery has significantly reduced median LOS, complications, and mortality compared with nonrobotic surgery. Results of this study support the contention that robotic-assisted surgery is as safe as nonrobotic surgery and offers the surgeon an additional technique for performing cardiac surgery.

Changing Demographics in Laparoscopic Cholecystectomy Performed in the United States Hospitalizations from 1998-2010

Purpose: Previous research has identified multiple risk factors implicated in unintended retained foreign objects (URFOs), which were incorporated into our community hospital’s URFO policy. The purpose of this quality improvement study was to use simulation along with didactics to improve retention of learned knowledge and implementation of the policy changes. Methods: An initial didactic session was performed followed by a survey at 3 months. Results indicated the need for improvement in retention of learned information. In addition to didactics, a multidisciplinary simulation curriculum with scenarios susceptible to URFO of an emergency operation was performed followed by debriefing. A survey was performed at 6 months and 1 year to measure follow-up retention of acquired knowledge. Results: Survey results showed that knowledge retention improved significantly, with 96.7% correct identification of URFOs as a sentinel event and 100% choosing crew resource management as an important strategy in preventing URFOs. Furthermore, at 6 months, 93.5% indicated that “finding the individual responsible for the mistake” was not the goal, and 91.9% correctly identified the primary root cause analysis for this scenario was failure of appropriate “system design.” Conclusions: Simulation provides the opportunity to learn the concept of root cause analysis and identification of factors that lead to URFOs. Simulation as an adjunct to didactics can help increase retention of patient safety policies.

The impact of seatbelt use and airbag deployment on blunt thoracic aortic injury.

OBJECTIVE To examine resident intraoperative participation, perceived autonomy, and communication patterns between residents and attending surgeons using a novel survey tool. DESIGN This was a prospective multi-institutional study. Operative residents completed the survey tool immediately after each colorectal resection performed during the study period. Resident intraoperative participation was quantified including degree of involvement in the technical aspects of the case, self-perception of autonomy, and communication strategies between the resident and attending. SETTING This study was conducted at 7 general surgery residency programs: 5 academic medical centers, and 2 independent training programs. PARTICIPANTS Residents and fellows rotating on a colorectal surgery service or general surgery service. RESULTS Sixty-three residents participated in this study with 417 surveys completed (range 19-79 per institution) representing a 95.4% response rate across all sites. Respondents ranged from clinical year 1 (CY1) to fellows. CY3s (35.7%) and CY5s (34.7%) were most heavily represented. Residents completed ≥50% of the skin closure in 88.7% of cases, ≥50% of the fascial closure in 87.1%, and t ≥ 50% of the anastomosis in 78.4% of the cases. Increasing resident participation was associated with advancing resident CY across all technical aspects of the case. This trend remained significant when controlling for site (p < 0.001). Resident self-perception of autonomy revealed learners of all stages: Observer (11.5%, n = 48), Assistant (53.7%, n = 224), Surgeon (33.8%, n = 141), and Teacher (0.96%, n = 4). Level of perceived autonomy increased with resident CY when controlling for site (p < 0.001). Residents who discussed the case before the day of surgery were twice as likely to rate themselves as Surgeon or Teacher (OR = 2.01) when controlling for CY (p = 0.011). CONCLUSIONS Brief surveys can easily capture resident work in the operating room. Resident intraoperative involvement and perceived autonomy are associated with CY. Early communication with the attending is significantly associated with increased perception of autonomy regardless of CY.