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Terry D Amaral - One of the best experts on this subject based on the ideXlab platform.
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a dual team approach benefits standard Volume surgeons but has minimal impact on outcomes for a high Volume surgeon in ais patients
Spine deformity, 2020Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D AmaralAbstract:Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of surgeons, surgeon experience, and surgeon Volume on AIS surgery. Recent literature suggests that utilizing two surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the surgeon’s experience and Surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary surgeon. Analysis was performed for single versus dual surgeons, surgeon experience (≤ 10 years in practice), and Surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 surgeons were included. Two surgeons were highly experienced, 1 of whom was also high Volume. Five cohorts were studied: a single senior high Volume (S1) (n = 302), dual-junior surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and Surgical times were similar (p > 0.05). When the standard-Volume surgeon operated with a second surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, Surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume surgeons have better outcomes with a dual surgeon approach. Junior surgeons benefit operating with an experienced surgeon. A high-Volume surgeon, however, does not benefit from a dual surgeon approach. Level II.
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p100 a dual team approach benefits standard Volume surgeons but has minimal impact on outcomes for a high Volume surgeon in ais patients
The Spine Journal, 2019Co-Authors: Vishal Sarwahi, Jesse M Galina, Aaron M Atlas, Sayyida S Hasan, Yungtai Lo, Terry D AmaralAbstract:BACKGROUND CONTEXT Recent literature suggests that utilizing two surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the surgeon's experience and Surgical Volume are likely just as important. PURPOSE This study seeks to evaluate effect of the dual versus single surgeon approach to Adolescent Idiopathic Scoliosis (AIS) correction through posterior spinal fusion (PSF). STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE AIS patients undergoing PSF from 2012-2018 were included. OUTCOME MEASURES Patient demographics, pre- and postoperative kyphosis, pre- and postoperative Cobb angle, surgery time, anesthesia time, EBL, extubation, transfusion rate, perioperative complication rate, length of hospital stay. METHODS AIS patients undergoing PSF from 2012-2018 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary surgeon. Analysis was performed for single vs dual surgeons, surgeon experience ( 10 years in practice), and Surgical Volume ( 50 cases/year). A sub-analysis was performed for adolescent idiopathic scoliosis patients. Median and IQR values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 520 AIS cases, performed by 4 surgeons were included. Two surgeons were highly experienced, 1 of whom was also high Volume. The five cohorts were a single senior high Volume (S1) (n=302), dual-junior surgeons (DJ) (n=73), dual senior-junior (SJ) (n=36), dual-senior (DS) (n=21) and a single senior, standard Volume surgeon alone (n =87). Radiographic parameters were similar between the groups (p 0.05). S1 had significantly lower EBL (p 0.05) in EBL, operative time, immediate extubation, transfusion rate, perioperative complication rate, and length of hospital stay between SSHV and DS. A dual junior surgeon approach had significantly shorter anesthesia (p CONCLUSIONS Standard Volume surgeons have better outcomes with dual surgeon approach. Junior surgeons benefit operating with an experienced surgeon. A high-Volume surgeon, however, does not benefit from a dual surgeon approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Jason D. Wright - One of the best experts on this subject based on the ideXlab platform.
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hospital Surgical Volume and perioperative mortality of pelvic exenteration for gynecologic malignancies
Journal of Surgical Oncology, 2020Co-Authors: Koji Matsuo, Rachel S Mandelbaum, Lynda D Roman, Shinya Matsuzaki, Maximilian Klar, Brendan H. Grubbs, Kazuhide Matsushima, Jason D. WrightAbstract:BACKGROUND AND OBJECTIVES: To examine the association between hospital Surgical Volume and perioperative mortality of pelvic exenteration performed for gynecologic malignancies. METHODS: A population-based retrospective study utilizing the Nationwide Inpatient Sample was conducted to examine pelvic exenteration for gynecologic malignancies from 2001 to 2011. Annualized hospital Surgical Volume was defined as the average number of procedures a hospital performed per year in which at least one case was performed, and this was correlated to perioperative mortality. RESULTS: A total 1912 exenterations performed at 181 centers were included. Nearly two thirds of exenteration-performing centers had a minimum Surgical Volume of one case per year (121 centers, 66.9%). Perioperative mortality rate was 1.8%. In multivariable analysis Surgical Volume remained an independent factor for perioperative mortality (adjusted-odds ratio 0.21; 95% confidence interval, 0.09-0.49; P 2 exenterations a year), respectively (P < .001). CONCLUSION: Pelvic exenteration for gynecologic malignancy is a rare Surgical procedure with most hospitals performing few cases annually. A higher Surgical Volume of pelvic exenteration was associated with lower perioperative mortality.
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effect of Surgical Volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer
Obstetrics & Gynecology, 2011Co-Authors: Jason D. Wright, Sharyn N Lewin, William M Burke, Xuming Sun, Israel Deutsch, Thomas J HerzogAbstract:Objective To estimate the effects of surgeon and hospital Volume on perioperative morbidity and mortality in women who underwent hysterectomy for endometrial cancer. Methods Patients who underwent abdominal hysterectomy for endometrial cancer between 2003 and 2007 and who recorded in an inpatient, acute-care database were examined. Procedure-associated intraoperative, perioperative, and postoperative medical complications, as well as hospital readmission, length of stay, intensive care unit (ICU) use, and mortality were examined. Surgeons and hospitals were stratified into Volume-based tertiles and outcomes analyzed using multivariable, generalized estimating equations. Results A total of 6,015 women were identified. After adjustment for case-mix variables and hospital Volume, perioperative Surgical complications (15.2% compared with 11.7%) (odds ratio [OR] 0.57; 95 confidence interval [CI] 0.38-0.85), medical complications (31.4% compared with 22.0%) (OR 0.57; 95% CI 0.37-0.88), and ICU utilization (8.9% compared with 3.5%) (OR 0.47; 95% CI 0.28-0.80) were lower in patients treated by high-Volume surgeons. Surgeon Volume had no independent effect on the rates of operative injury (OR 0.82; 95% CI 0.32-2.08), transfusion (OR 2.33; 95% CI 0.93-5.36), length of stay (OR 0.60; 95% CI 0.25-1.41), or readmission (OR 1.05; 95% CI 0.51-2.14). Whereas patients treated at high-Volume hospitals were less likely to require ICU care (9.3% compared with 4.3%) (OR 0.44; 95% CI 025-0.77), hospital Volume had no independent effect on any of the other primary outcomes of interest (P>.05 for all). Conclusion Perioperative Surgical complications, medical complications, and ICU requirements are lower in patients treated by high-Volume surgeons. Hospital Volume had little independent effect on outcomes.
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The influence of Surgical Volume on morbidity and mortality of radical hysterectomy for cervical cancer.
American Journal of Obstetrics and Gynecology, 2011Co-Authors: Jason D. Wright, Sharyn N Lewin, William M Burke, Israel Deutsch, Thomas J HerzogAbstract:Objective We examined the influence of physician and hospital Volume on the morbidity and mortality of radical hysterectomy for cervical cancer. Study Design Women who underwent radical hysterectomy for cervical cancer between 2003 and 2007 were examined. The effect of surgeon and hospital Volume on morbidity and mortality was examined using multivariable generalized estimating equations. Results A total of 1536 women who underwent radical hysterectomy were identified. Patients treated by high-Volume surgeons had fewer medical complications (odds ratio, 0.55; 95% confidence interval, 0.34–0.88) and shorter lengths of stay (odds ratio, 0.49; 95% confidence interval, 0.25–0.98). After adjustment for case mix and surgeon Volume, hospital Volume had no independent effect on any of the variables of interest. Conclusion High-Volume surgeons have fewer postoperative medical complications, shorter lengths of stay, and lower transfusion requirements. Hospital Volume appears to have only a minor influence on outcomes after radical hysterectomy.
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the effect of surgeon Volume on outcomes and resource use for vaginal hysterectomy
Obstetrics & Gynecology, 2010Co-Authors: Lisa Rogogupta, Sharyn N Lewin, Jin Hee Kim, William M Burke, Xuming Sun, Thomas J Herzog, Jason D. WrightAbstract:OBJECTIVE:To estimate the effect of Surgical Volume on outcomes and resource use in women undergoing vaginal hysterectomy.METHODS:Women who underwent total vaginal hysterectomy and were registered in the Perspective database were examined. Perspective is a nationwide database developed to measure qu
Vishal Sarwahi - One of the best experts on this subject based on the ideXlab platform.
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a dual team approach benefits standard Volume surgeons but has minimal impact on outcomes for a high Volume surgeon in ais patients
Spine deformity, 2020Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D AmaralAbstract:Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of surgeons, surgeon experience, and surgeon Volume on AIS surgery. Recent literature suggests that utilizing two surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the surgeon’s experience and Surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary surgeon. Analysis was performed for single versus dual surgeons, surgeon experience (≤ 10 years in practice), and Surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 surgeons were included. Two surgeons were highly experienced, 1 of whom was also high Volume. Five cohorts were studied: a single senior high Volume (S1) (n = 302), dual-junior surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and Surgical times were similar (p > 0.05). When the standard-Volume surgeon operated with a second surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, Surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume surgeons have better outcomes with a dual surgeon approach. Junior surgeons benefit operating with an experienced surgeon. A high-Volume surgeon, however, does not benefit from a dual surgeon approach. Level II.
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p100 a dual team approach benefits standard Volume surgeons but has minimal impact on outcomes for a high Volume surgeon in ais patients
The Spine Journal, 2019Co-Authors: Vishal Sarwahi, Jesse M Galina, Aaron M Atlas, Sayyida S Hasan, Yungtai Lo, Terry D AmaralAbstract:BACKGROUND CONTEXT Recent literature suggests that utilizing two surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the surgeon's experience and Surgical Volume are likely just as important. PURPOSE This study seeks to evaluate effect of the dual versus single surgeon approach to Adolescent Idiopathic Scoliosis (AIS) correction through posterior spinal fusion (PSF). STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE AIS patients undergoing PSF from 2012-2018 were included. OUTCOME MEASURES Patient demographics, pre- and postoperative kyphosis, pre- and postoperative Cobb angle, surgery time, anesthesia time, EBL, extubation, transfusion rate, perioperative complication rate, length of hospital stay. METHODS AIS patients undergoing PSF from 2012-2018 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary surgeon. Analysis was performed for single vs dual surgeons, surgeon experience ( 10 years in practice), and Surgical Volume ( 50 cases/year). A sub-analysis was performed for adolescent idiopathic scoliosis patients. Median and IQR values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 520 AIS cases, performed by 4 surgeons were included. Two surgeons were highly experienced, 1 of whom was also high Volume. The five cohorts were a single senior high Volume (S1) (n=302), dual-junior surgeons (DJ) (n=73), dual senior-junior (SJ) (n=36), dual-senior (DS) (n=21) and a single senior, standard Volume surgeon alone (n =87). Radiographic parameters were similar between the groups (p 0.05). S1 had significantly lower EBL (p 0.05) in EBL, operative time, immediate extubation, transfusion rate, perioperative complication rate, and length of hospital stay between SSHV and DS. A dual junior surgeon approach had significantly shorter anesthesia (p CONCLUSIONS Standard Volume surgeons have better outcomes with dual surgeon approach. Junior surgeons benefit operating with an experienced surgeon. A high-Volume surgeon, however, does not benefit from a dual surgeon approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Thomas J Herzog - One of the best experts on this subject based on the ideXlab platform.
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effect of Surgical Volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer
Obstetrics & Gynecology, 2011Co-Authors: Jason D. Wright, Sharyn N Lewin, William M Burke, Xuming Sun, Israel Deutsch, Thomas J HerzogAbstract:Objective To estimate the effects of surgeon and hospital Volume on perioperative morbidity and mortality in women who underwent hysterectomy for endometrial cancer. Methods Patients who underwent abdominal hysterectomy for endometrial cancer between 2003 and 2007 and who recorded in an inpatient, acute-care database were examined. Procedure-associated intraoperative, perioperative, and postoperative medical complications, as well as hospital readmission, length of stay, intensive care unit (ICU) use, and mortality were examined. Surgeons and hospitals were stratified into Volume-based tertiles and outcomes analyzed using multivariable, generalized estimating equations. Results A total of 6,015 women were identified. After adjustment for case-mix variables and hospital Volume, perioperative Surgical complications (15.2% compared with 11.7%) (odds ratio [OR] 0.57; 95 confidence interval [CI] 0.38-0.85), medical complications (31.4% compared with 22.0%) (OR 0.57; 95% CI 0.37-0.88), and ICU utilization (8.9% compared with 3.5%) (OR 0.47; 95% CI 0.28-0.80) were lower in patients treated by high-Volume surgeons. Surgeon Volume had no independent effect on the rates of operative injury (OR 0.82; 95% CI 0.32-2.08), transfusion (OR 2.33; 95% CI 0.93-5.36), length of stay (OR 0.60; 95% CI 0.25-1.41), or readmission (OR 1.05; 95% CI 0.51-2.14). Whereas patients treated at high-Volume hospitals were less likely to require ICU care (9.3% compared with 4.3%) (OR 0.44; 95% CI 025-0.77), hospital Volume had no independent effect on any of the other primary outcomes of interest (P>.05 for all). Conclusion Perioperative Surgical complications, medical complications, and ICU requirements are lower in patients treated by high-Volume surgeons. Hospital Volume had little independent effect on outcomes.
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The influence of Surgical Volume on morbidity and mortality of radical hysterectomy for cervical cancer.
American Journal of Obstetrics and Gynecology, 2011Co-Authors: Jason D. Wright, Sharyn N Lewin, William M Burke, Israel Deutsch, Thomas J HerzogAbstract:Objective We examined the influence of physician and hospital Volume on the morbidity and mortality of radical hysterectomy for cervical cancer. Study Design Women who underwent radical hysterectomy for cervical cancer between 2003 and 2007 were examined. The effect of surgeon and hospital Volume on morbidity and mortality was examined using multivariable generalized estimating equations. Results A total of 1536 women who underwent radical hysterectomy were identified. Patients treated by high-Volume surgeons had fewer medical complications (odds ratio, 0.55; 95% confidence interval, 0.34–0.88) and shorter lengths of stay (odds ratio, 0.49; 95% confidence interval, 0.25–0.98). After adjustment for case mix and surgeon Volume, hospital Volume had no independent effect on any of the variables of interest. Conclusion High-Volume surgeons have fewer postoperative medical complications, shorter lengths of stay, and lower transfusion requirements. Hospital Volume appears to have only a minor influence on outcomes after radical hysterectomy.
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the effect of surgeon Volume on outcomes and resource use for vaginal hysterectomy
Obstetrics & Gynecology, 2010Co-Authors: Lisa Rogogupta, Sharyn N Lewin, Jin Hee Kim, William M Burke, Xuming Sun, Thomas J Herzog, Jason D. WrightAbstract:OBJECTIVE:To estimate the effect of Surgical Volume on outcomes and resource use in women undergoing vaginal hysterectomy.METHODS:Women who underwent total vaginal hysterectomy and were registered in the Perspective database were examined. Perspective is a nationwide database developed to measure qu
Nimesh D Desai - One of the best experts on this subject based on the ideXlab platform.
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Volume of frail patients predicts outcome in frail patients after cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Nicholas J Goel, A Iyengar, John J Kelly, Jason J Han, Chase R Brown, Nimesh D DesaiAbstract:Abstract Objective Recent data from major noncardiac surgery suggest that outcomes in frail patients are better predicted by a hospital's Volume of frail patients specifically, rather than overall Surgical Volume. We sought to evaluate this “frailty Volume-frailty outcome relationship” in patients undergoing cardiac surgery. Methods We studied 72,818 frail patients undergoing coronary artery bypass grafting or valve replacement surgery from 2010 to 2014 using the Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multilevel logistic regression was used to assess the independent effect of frailty Volume by quartile on mortality, Surgical complications, failure to rescue, nonhome discharge, 30-day readmissions, length of stay, and hospital costs in frail patients. Results In comparing the highest Volume quartiles with the lowest, both overall cardiac Surgical Volume and Volume for frail patients were significantly associated with shorter length of stay and reduced costs. However, frailty Volume was also independently associated with significantly reduced in-hospital mortality (odds ratio, 0.79; 95% confidence interval, 0.67-0.94; P = .006) and failure to rescue (odds ratio, 0.83; 95% confidence interval, 0.70-0.98; P = .03), whereas no such association was seen between overall Volume and either mortality (odds ratio, 0.94; 95% confidence interval, 0.74-1.10; P = .43) or failure to rescue (odds ratio, 0.98; 95% confidence interval, 0.83-1.17; P = .85). Neither frailty Volume nor overall Volume showed any significant relationship with the rate of 30-day readmissions. Conclusions In frail patients undergoing cardiac surgery, Surgical Volume of frail patients was a significant independent of predictor of in-hospital mortality and failure to rescue, whereas overall Surgical Volume was not. Thus, the “frailty Volume-outcome relationship” superseded the traditional “Volume-outcome relationship” in frail patients with cardiac disease.
