Journal of the American College of Surgeons
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Biography Historical Article
Blunt cerebrovascular injuries: anatomic and pathologic heterogeneity create management enigmas.
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Multicenter Study
Factors associated with the frequency of initial total mastectomy: results of a multi-institutional study.
Several previous studies have reported conflicting data on recent trends in use of initial total mastectomy (TM); the factors that contribute to TM variation are not entirely clear. Using a multi-institution database, we analyzed how practice, patient, and tumor characteristics contributed to variation in TM for invasive breast cancer. ⋯ We identified factors associated with initial TM, including preoperative MRI and individual surgeon, that contribute to the current debate about variation in use of TM for the management of breast cancer. Additional evaluation of patient understanding of surgical options and outcomes in breast cancer and the impact of the surgeon provider is warranted.
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Comparative Study
Blood transfusion for lower extremity bypass is associated with increased wound infection and graft thrombosis.
Packed RBC transfusion has been postulated to increase morbidity and mortality after cardiac/general surgical operations, but its effects after lower extremity bypass (LEB) have not been studied extensively. ⋯ Perioperative transfusion in patients undergoing LEB is associated with increased perioperative wound infection and graft thrombosis. From this observational study, it appears transfusion does not have major consequences during mid-term follow-up, but the presumed benefits of blood replacement should be weighed carefully because of the increased risk of perioperative complications with transfusion.
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Comparative Study
A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities.
Our aim was to compare trends in retention of academic surgeons by reviewing surgical faculty attrition rates (leaving academic surgery for any reason) of 3 cohorts at 5-year intervals between 1996 and 2011. ⋯ Greater attrition in the last 5-year cohort, despite the increase in faculty positions, is worrisome. A continuous retention life cycle is critical if academic medical centers hope to compete for talent. Retention planning should include on-boarding programs for enculturation, monitoring of professional satisfaction, formalized mentoring of younger surgeons, retaining academic couples and a part-time workforce, leadership and talent management, exit interviews, and competitive financial packages.
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Effective communication is a critical component of patient care in the operative room (OR). However, the presence of loud equipment, a large number of staff members, and music can contribute to high levels of background noise. In a setting in which crucial tasks are performed continuously, distractions and barriers to communication can result in harm to both patients and OR personnel. The purpose of this investigation was to simulate OR listening conditions and evaluate the effect of operating noise on auditory function. ⋯ Operating room noise can cause a decrease in auditory processing function, particularly in the presence of music. This becomes even more difficult when the communication involves conversations that carry critical information that is unpredictable. To avoid possible miscommunication in the OR, attempts should be made to reduce ambient noise levels.