The American surgeon
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The American surgeon · Dec 2021
The Fellow's Perspective: The Impact of the COVID-19 Pandemic on Fellowship Training and Job Appointment.
Fellows have been uniquely affected by the widespread changes in educational structure, mandatory limitations in elective procedural volume, and hiring freezes during the COVID-19 global pandemic. ⋯ Almost half of surveyed fellows reported an educational deterioration due to COVID-19 and graduating fellows seeking employment felt hindered by both the virtual interview format and widespread hiring freeze. Fellows are both unique and vulnerable as they balance the solidification of clinical training with securing employment during these tumultuous and unprecedented times.
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The American surgeon · Nov 2021
Outcomes of Trauma Patients with Flail Chest and Surgical Rib Stabilization.
The goal of this project was to describe the current practices of this institution and identify which patients benefit from surgical stabilization of rib fractures (SSRF). A total of 1429 trauma patients admitted to our Level 1 center with rib fractures between January 1, 2014 and June 22, 2020 were retrospectively reviewed. Flail chest was observed in 43 (3.01%) patients. ⋯ Surgical stabilization of rib fractures has shown success in managing flail chest. In intubated patients with flail chest, fixation seems to decrease ICU stays and the duration of ventilation. We believe we need to perform SSRF on more patients with flail chest.
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The American surgeon · Nov 2021
Age as a Barrier to Surgical Stabilization of Rib Fractures in Patients with Flail Chest.
Although randomized trials demonstrate a benefit to surgical stabilization of rib fractures (SSRF), SSRF is rarely performed. We hypothesized older patients were less likely to receive SSRF nationally. ⋯ Despite guideline-based support of SSRF in flail chest, SSRF is performed in <25% of patients. Age ≥70 years is associated with lower rate of SSRF and higher risk of death. Future study should examine barriers to SSRF in older patients.
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Microaggression is an unconscious statement or action regarded as discrimination against a marginalized community. Microaggression coupled with implicit bias (unconscious prejudice in favor or against one person or group) can be psychologically damaging to the targeted community. The difficulty with microaggressions and implicit biases is that they are subjective and unconscious, and the offender may not view them as damaging. ⋯ In either case, repeated direct and indirect exposure of microaggressions and biases through encounters within and outside the workforce are cumulative leading to lasting internalized damage. Awareness that implicit biases and microaggressions exist and recognition that these phenomena are problematic are the first steps toward fostering a more equitable and inclusive culture. As a society and especially as health care workers, we must become increasingly culturally aware and sensitive of all communities for the ultimate good of patient care.
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The American surgeon · Sep 2021
The 5-Factor Modified Frailty Index in the Geriatric Surgical Population.
The modified frailty index (mFI-11) is a National Surgical Quality Improvement Program (NSQIP)-based 11-factor index that has been proven to adequately reflect frailty and predict mortality and morbidity. In the past years, certain NSQIP variables have been removed from the database; as of 2015, only 5 out of the original 11 factors remain. While the predictive power and usefulness of this 5-factor index (mFI-5) has been proven in previous work, it has yet to be studied in the geriatrics population. The goal of our study was to compare the mFI-5 to the mFI-11 in terms of value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission for patients aged 65 years and older. ⋯ The mFI-5 is an equally effective predictor as the mFI-11 in all subspecialties and an effective predictor of mortality and postoperative complication in the geriatric population. This index has credibility for future use to study frailty within NSQIP, within other databases, and for clinical assessment and use.