Annals of surgery最新文献

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Association of Prophylactic Antibiotics With Early Infectious Complications in Children With Cancer Undergoing Central Venous Access Device Placement. 预防性抗生素与癌症儿童中心静脉穿刺置管早期感染并发症的相关性。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2023-10-23 DOI: 10.1097/SLA.0000000000006140
Steven T Papastefan, Suhail Zeineddin, Martin L Blakely, Harold N Lovvorn, Lynn Wei Huang, Mehul V Raval, Timothy B Lautz
{"title":"Association of Prophylactic Antibiotics With Early Infectious Complications in Children With Cancer Undergoing Central Venous Access Device Placement.","authors":"Steven T Papastefan, Suhail Zeineddin, Martin L Blakely, Harold N Lovvorn, Lynn Wei Huang, Mehul V Raval, Timothy B Lautz","doi":"10.1097/SLA.0000000000006140","DOIUrl":"10.1097/SLA.0000000000006140","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of prophylactic antibiotics on early infectious complications after central venous access device (VAD) placement in children with cancer.</p><p><strong>Background: </strong>Despite the frequency of VAD procedures in children, the effectiveness of prophylactic antibiotics for reducing infectious complications is unknown.</p><p><strong>Methods: </strong>This was a retrospective cohort study of children with cancer undergoing central VAD placement identified in the Pediatric Health Information System database between 2017 and 2021. The primary outcome was the rate of early infectious complications (composite surgical site infections, central line-associated bloodstream infections, and bacteremia). Multivariable logistic regression was used to evaluate factors associated with early infection, and heterogeneity of treatment effect of prophylactic antibiotics was compared across subgroups.</p><p><strong>Results: </strong>A total of 9216 patients were included (6058 ports and 3158 tunneled lines). Prophylactic antibiotics were associated with lower early infectious complications overall [1.3% vs 2.4%; odds ratio (OR): 0.55 (95% CI: 0.39-0.79), P < 0.001], an effect demonstrated for tunneled lines (OR: 0.59, 95% CI: 0.41-0.84) but not ports (OR: 3.01, 95% CI: 0.66-13.78). On multivariate analysis, prophylactic antibiotics (OR: 0.67, 95% CI: 0.45-0.97) and solid tumors (OR: 0.38, 95% CI: 0.22-0.64) were associated with reduced odds of early infections, whereas tunneled lines (OR: 20.78, 95% CI: 9.83-43.93) and acute myelogenous leukemia (OR: 2.37, 95% CI: 1.58-3.57) had increased odds.</p><p><strong>Conclusions: </strong>Prophylactic antibiotics are associated with reduced early infectious complications after central VAD placement overall. Despite recommendations from multiple national organizations against prophylactic antibiotics, these findings suggest a benefit in children with malignancy undergoing tunneled line placement.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1021-1028"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49688497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Presbyopia in Surgeons: Ergonomic Impact and Tips for Management. 外科医生的老花眼:人体工程学的影响和管理技巧。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-05-08 DOI: 10.1097/SLA.0000000000006323
Amy D Zhang, Brittany Boland, Kristin L Chrouser
{"title":"Presbyopia in Surgeons: Ergonomic Impact and Tips for Management.","authors":"Amy D Zhang, Brittany Boland, Kristin L Chrouser","doi":"10.1097/SLA.0000000000006323","DOIUrl":"10.1097/SLA.0000000000006323","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"935-937"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Environmental Sustainability of Operating Theatres: A Systematic Review of Staff Attitudes, Barriers, and Enablers. 提高经营中剧院的环境可持续性:对员工态度、障碍和推动因素的系统性研究。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-05-10 DOI: 10.1097/SLA.0000000000006337
Siya Lodhia, Victoria Pegna, Ruth Abrams, Daniel Jackson, Timothy A Rockall, Chantelle Rizan
{"title":"Improving Environmental Sustainability of Operating Theatres: A Systematic Review of Staff Attitudes, Barriers, and Enablers.","authors":"Siya Lodhia, Victoria Pegna, Ruth Abrams, Daniel Jackson, Timothy A Rockall, Chantelle Rizan","doi":"10.1097/SLA.0000000000006337","DOIUrl":"10.1097/SLA.0000000000006337","url":null,"abstract":"<p><strong>Objective: </strong>To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres.</p><p><strong>Background: </strong>Global health care sectors are responsible for 4.4% of greenhouse gas emissions. Surgical operating theatres are resource intensive areas and improvements will be important to meet Net-Zero carbon emissions within health care.</p><p><strong>Methods: </strong>Three databases were searched (Web of Science, Ovid, and PubMed), last checked January 2024. We included original manuscripts evaluating staff views regarding sustainable operating theatres. The Mixed Methods Appraisal Tool was used for quality appraisal and data analysed using thematic synthesis.</p><p><strong>Results: </strong>A total of 2933 articles were screened and 14 fulfilled inclusion criteria, using qualitative (1), quantitative (2), and mixed methods (11). Studies were undertaken in a variety of clinical (Department of Anaesthesia, Surgery, Otolaryngology, Obstetrics and Gynaecology and Ophthalmology) and geographical settings (Australia, Canada, France, Germany, New Zealand, United States, United Kingdom, and Ireland). Across studies there was a lack of evidence exploring enablers to implementation, but barriers mainly related to the following themes: education and awareness, leadership, resistance to change, facilities and equipment, time, and incentive.</p><p><strong>Conclusions: </strong>This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. In addition, implementation studies should be carried out to examine whether barriers do change in practice.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"954-959"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Shared Decision-making in Situations of Uncertainty: Adopting Lessons From "The Equipoise Ruler". 改善不确定情况下的共同决策:从 "等价交换尺 "中吸取经验教训。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-07-22 DOI: 10.1097/SLA.0000000000006456
Mary E Brindle
{"title":"Improving Shared Decision-making in Situations of Uncertainty: Adopting Lessons From \"The Equipoise Ruler\".","authors":"Mary E Brindle","doi":"10.1097/SLA.0000000000006456","DOIUrl":"10.1097/SLA.0000000000006456","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"914-915"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association With Mortality. 创伤中的全血和血液成分复苏:与死亡率的相互作用和关联。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-05-06 DOI: 10.1097/SLA.0000000000006316
Ander Dorken-Gallastegi, Phillip C Spinella, Matthew D Neal, Christine Leeper, Jason Sperry, Andrew B Peitzman, Joshua B Brown
{"title":"Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association With Mortality.","authors":"Ander Dorken-Gallastegi, Phillip C Spinella, Matthew D Neal, Christine Leeper, Jason Sperry, Andrew B Peitzman, Joshua B Brown","doi":"10.1097/SLA.0000000000006316","DOIUrl":"10.1097/SLA.0000000000006316","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the interaction between whole blood (WB) and blood component resuscitation in relation to mortality after trauma.</p><p><strong>Background: </strong>WB is increasingly available in civilian trauma resuscitation, and it is typically transfused concomitantly with blood components. The interaction between WB and blood component transfusions is unclear.</p><p><strong>Methods: </strong>Adult patients with trauma with a shock index >1 who received ≥4 combined units of red blood cells and/or WB within 4 hours across 501 U.S. trauma centers were included using the American College of Surgeons Trauma Quality Improvement Program database. The associations between (1) WB resuscitation and mortality, (2) WB to total transfusion volume ratio (WB:TTV) and mortality, and (3) balanced blood component transfusion in the setting of combined WB and component resuscitation and mortality were evaluated with multivariable analysis.</p><p><strong>Results: </strong>A total of 12,275 patients were included (WB: 2884 vs component-only: 9391). WB resuscitation was associated with lower odds of 4-hour [adjusted odds ratio: 0.81 (0.68-0.97)], 24-hour, and 30-day mortality compared with component-only. Higher WB:TTV ratios were significantly associated with lower 4-hour, 24-hour, and 30-day mortality, with a 13% decrease in odds of 4-hour mortality for each 10% increase in the WB:TTV ratio [0.87 (95% CI: 0.80-0.94)]. Balanced blood component transfusion was associated with significantly lower odds of 4-hour [adjusted odds ratio: 0.45 (95% CI: 0.29-0.68)], 24-hour, and 30-day mortality in the setting of combined WB and blood component resuscitation.</p><p><strong>Conclusions: </strong>WB resuscitation, higher WB:TTV ratios, and balanced blood component transfusion in conjunction with WB were associated with lower mortality in patients with trauma presenting in shock requiring at least 4 units of red blood cells and/or WB transfusion within 4 hours of arrival.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1014-1020"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk Factors for Major Pregnancy Complications in Female Cardiothoracic Surgeons. 心胸外科女医生主要妊娠并发症的风险因素。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-05-24 DOI: 10.1097/SLA.0000000000006364
Anna Olds, Sameer Hirji, Manuel Castillo-Angeles, Lauren Kane, Jennifer Romano, Cynthia Herrington, Erika Rangel
{"title":"Risk Factors for Major Pregnancy Complications in Female Cardiothoracic Surgeons.","authors":"Anna Olds, Sameer Hirji, Manuel Castillo-Angeles, Lauren Kane, Jennifer Romano, Cynthia Herrington, Erika Rangel","doi":"10.1097/SLA.0000000000006364","DOIUrl":"10.1097/SLA.0000000000006364","url":null,"abstract":"<p><strong>Objective: </strong>To describe the incidence of and risk factors for pregnancy complications in female cardiothoracic surgeons compared with women of similar sociodemographic profiles.</p><p><strong>Background: </strong>Female cardiothoracic surgeons often postpone childbearing, but little is known about their pregnancy outcomes.</p><p><strong>Methods: </strong>In 2023, a self-administered survey was distributed to US cardiothoracic surgeons/trainees. Surgeons with ≥1 live birth were queried on maternal work hours during pregnancy and major antenatal pregnancy complications. Male surgeons answered on behalf of non-surgeon childbearing partners (female non-surgeons).</p><p><strong>Results: </strong>The study included 255 surgeons (63.53% male; 36.47% female). Compared with female surgeons, male surgeons more often had partners who were not employed outside the home (25.64% vs 13.33%, P <0.001). Female surgeons were older than female non-surgeons at first live birth (34.49±4.41 vs 31.45±4.16, P <0.001), more often worked >60 h/wk during pregnancy (70.33% vs 14.08%, P <0.001), and more often had pregnancy complications (45.16% vs 27.16%, P =0.003; operating room (OR): 1.78, 95% CI: 1.01-3.13). Among female surgeons, 18.28% reduced work hours during pregnancy. During their third trimester, 54.84% worked >6 overnight calls/mo, and 72.04% operated >12 h/wk. Age ≥35 years (OR: 3.28, 95% CI: 1.27-8.45) and operating >12 h/wk during the third trimester (OR: 3.72, 95% CI: 1.04-13.30) were associated with pregnancy complications.</p><p><strong>Conclusions: </strong>Female cardiothoracic surgeons are more likely to experience major pregnancy complications than non-surgeon partners of their male peers. Long operative hours during pregnancy and older maternal age are significant risk factors for pregnancy complications. To advance gender equity, policies to protect maternal-fetal health and facilitate childbearing during training and early career are needed.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"966-972"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pancreatic Cancer: An Exocrine Tumor With Endocrine Characteristics. 胰腺癌:具有内分泌特征的外分泌肿瘤。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2023-12-05 DOI: 10.1097/SLA.0000000000006168
Xinzhe Zhu, Zhiwen Xiao, He Liu, Pin Zhang, Shengming Deng, Lei Ding, Jingjing Feng, Jianfeng Luo, Quanxing Ni, Guopei Luo, Xianjun Yu
{"title":"Pancreatic Cancer: An Exocrine Tumor With Endocrine Characteristics.","authors":"Xinzhe Zhu, Zhiwen Xiao, He Liu, Pin Zhang, Shengming Deng, Lei Ding, Jingjing Feng, Jianfeng Luo, Quanxing Ni, Guopei Luo, Xianjun Yu","doi":"10.1097/SLA.0000000000006168","DOIUrl":"10.1097/SLA.0000000000006168","url":null,"abstract":"<p><strong>Objective: </strong>To examine the characteristics of patients with pancreatic cancer with long-term survival.</p><p><strong>Background: </strong>Although pancreatic cancer is a highly lethal malignancy, a minority of patients experience long-term survival. The characteristics of these patients remain largely unidentified.</p><p><strong>Methods: </strong>An indolent subgroup was established using carbohydrate antigen 19-9 (CA19-9), which is the best-validated biomarker for pancreatic cancer. Of 1558 patients, 13.9% were included in the CA19-9-normal (≤37 U/mL) subgroup.</p><p><strong>Results: </strong>A normal CA19-9 level was an independent variable for overall survival (median survival, 18.1 vs 9.7 months, hazard ratio = 0.53, P < 0.001). The 5-year survival of patients with stage IV CA19-9-normal cancer was higher than that of patients with stage I-IV CA19-9-high cancer (22.4% vs 6.8%, P = 0.034). The CA19-9-normal subgroup exhibited reduced levels of circulating glucose ( P < 0.001) and increased expression of insulin ( P < 0.001) compared with the CA19-9-high subgroup. Glucose was a substrate for CA19-9 biosynthesis through the hexosamine biosynthesis pathway. In addition, in pancreatic cancer animal models of diabetes, glucose control decreased CA19-9 levels and improved overall survival. In a clinical trial (NCT05306028) of patients before undergoing major anticancer treatments, glucose control decreased CA19-9 levels in 90.9% of the patients.</p><p><strong>Conclusions: </strong>CA19-9-normal pancreatic cancer is a strikingly indolent subgroup with low glucose and high insulin. Glucose control is a promising therapeutic strategy for pancreatic cancer.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e17-e25"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138481819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Association Between Pediatric Readiness and Mortality for Injured Children Treated at US Trauma Centers. 在美国创伤中心接受治疗的受伤儿童的儿科准备情况与死亡率之间的关系。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2023-10-26 DOI: 10.1097/SLA.0000000000006126
Caroline Melhado, Katherine Remick, Amy Miskovic, Bhavin Patel, Hilary A Hewes, Craig D Newgard, Avery B Nathens, Charles Macias, Lisa Gray, Brian K Yorkgitis, Michael W Dingeldein, Aaron R Jensen
{"title":"The Association Between Pediatric Readiness and Mortality for Injured Children Treated at US Trauma Centers.","authors":"Caroline Melhado, Katherine Remick, Amy Miskovic, Bhavin Patel, Hilary A Hewes, Craig D Newgard, Avery B Nathens, Charles Macias, Lisa Gray, Brian K Yorkgitis, Michael W Dingeldein, Aaron R Jensen","doi":"10.1097/SLA.0000000000006126","DOIUrl":"10.1097/SLA.0000000000006126","url":null,"abstract":"<p><strong>Objective: </strong>To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness.</p><p><strong>Background: </strong>Most children in the United States receive initial trauma care at nonpediatric centers. The aim of the National Pediatric Readiness Project (NPRP) was to ensure that all EDs are prepared to provide quality care for children. Trauma centers reporting the highest quartile of wPRS on the 2013 national assessment have been shown to have lower mortality. Significant efforts have been invested to improve pediatric readiness in the past decade.</p><p><strong>Study design: </strong>A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) from 2019 to 2021 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15 y) were calculated using Pediatric Trauma Quality Improvement Program models. Deterministic linkage was used for transferred patients to account for wPRS at the initial receiving center. Center-specific mortality odds ratios were then compared across quartiles of wPRS.</p><p><strong>Results: </strong>A total of 66,588 children from 630 centers with a median (interquartile range) wPRS of 79 (66-93) were analyzed. The average observed-to-expected odds of mortality [1.02 (0.97-1.06)] for centers in the highest quartile (wPRS≥93) was lower than any of the lowest 3 wPRS quartiles [1.19 (1.14-1.23) (Q1), 1.29 (1.24-1.33) (Q2), and 1.28 (1.19-1.36) (Q3), all P <0.05). The presence of a pediatric-specific quality improvement plan was the domain with the strongest independent association with mortality [standardized beta -0.095 (-0.146 to -0.044)].</p><p><strong>Conclusion: </strong>Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e26-e33"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41189268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Looking Across the Drape: A Novel Quality Improvement Approach to Understanding Surgeon and Anesthesiologist Burnout. 透过窗帘看世界:了解外科医生和麻醉师职业倦怠的新颖质量改进方法。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-02-20 DOI: 10.1097/SLA.0000000000006241
Jina L Sinskey, Rachel Schwartz, Christy K Boscardin, Joyce M Chang, Sandhya B Kumar, Carter C Lebares
{"title":"Looking Across the Drape: A Novel Quality Improvement Approach to Understanding Surgeon and Anesthesiologist Burnout.","authors":"Jina L Sinskey, Rachel Schwartz, Christy K Boscardin, Joyce M Chang, Sandhya B Kumar, Carter C Lebares","doi":"10.1097/SLA.0000000000006241","DOIUrl":"10.1097/SLA.0000000000006241","url":null,"abstract":"<p><strong>Objective: </strong>To identify well-being threats for surgeons and anesthesiologists and develop interventions using the quality of life improvement (QOLI) approach.</p><p><strong>Background: </strong>Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs.</p><p><strong>Methods: </strong>Anesthesia and surgery faculty in 8 perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live voting to identify well-being priorities.</p><p><strong>Results: </strong>One hundred four perioperative faculty completed the survey. Across specialties, higher Mental Health Continuum-Short Form scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded 5 areas for intervention: (1) work culture, (2) work environment/resources, (3) sources of fulfillment, (4) work/life harmony, and (5) financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were operating room inefficiencies/delays and excessive workload, whereas anesthesiologists cited understaffing and unpredictable work hours.</p><p><strong>Conclusions: </strong>Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e2-e7"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139904858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complex Problems Require Complex Solutions: A Comprehensive Approach to Cancer Treatment Disparities. 复杂的问题需要复杂的解决方案:解决癌症治疗差异的综合方法》。
IF 7.5 1区 医学
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-06-11 DOI: 10.1097/SLA.0000000000006395
Richard S Hoehn, Kurt C Stange, Aleece Caron, Patrick Runnels, Peter J Pronovost
{"title":"Complex Problems Require Complex Solutions: A Comprehensive Approach to Cancer Treatment Disparities.","authors":"Richard S Hoehn, Kurt C Stange, Aleece Caron, Patrick Runnels, Peter J Pronovost","doi":"10.1097/SLA.0000000000006395","DOIUrl":"10.1097/SLA.0000000000006395","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"928-930"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141299854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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