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Concordance of financial disclosures among faculty at the 2018-2020 SAGES annual meetings

Lois, Alex; Schwarz, Erin; Shadduck, Phillip; Denk, Peter; Sinha, Prashant; Lima, Diego L; Scarritt, Thomas; Sylla, Patricia A; Reinke, Caroline
BACKGROUND:Financial relationships with industry may bias educational content delivered by physicians. SAGES strives to mitigate potential bias, relying on physician self-reporting. Retrospective review of relationships is possible using the Open Payments Database (OPD), a public record of industry-reported payments to US physicians. We aimed to evaluate the effectiveness of the SAGES disclosure process by comparing faculty disclosures to SAGES, faculty disclosures within presentations, and OPD records among speakers at the 2018-2020 SAGES meetings. METHODS:We reviewed all presentations from the SAGES 2018-2020 Annual Meetings. For each invited presentation, all slide-disclosed relationships were recorded. For US physicians, we queried the OPD and recorded relationships ≥ $500 USD in the calendar year prior to presentation. We compared the slide-disclosed relationships with OPD-reported relationships and with those provided to SAGES during the faculty disclosure process. We surveyed a sample of the 2020 annual meeting speakers to analyze potential reasons for discordance. RESULTS:From 2018 to 2020, there were 1,355 invited presentations, of which 1,234 (91%) were available for review. Disclosure slides were present in 1,098 (89%), increasing from 86% in 2018 to 93% in 2020. The proportion of speakers with OPD-reported relationships ≥ $500 increased from 54% in 2018 to 66% in 2020. The total value of OPD relationships decreased from $5.9 million (2018) to $3.3 million (2020) with a concomitant decrease in the proportion with high discordance from 9% in 2018 to 5% in 2020. Among the 2020 speakers with high discordance, the most common explanations for discordance were being unaware of payment or payment outside the 12-month timeframe (55%). CONCLUSIONS:Discordance between financial disclosures reported to SAGES and OPD highlight the need for improvements in the faculty disclosure process. SAGES will continue to streamline this process by incorporating faculty review of their OPD disclosures to ensure all educational programs remain free of commercial bias.
PMID: 36151393
ISSN: 1432-2218
CID: 5335812

The SAGES Manual of Quality, Outcomes and Patient Safety, Second Edition

Romanelli, John R.; Kowalski, Rebecca B.; Dort, Jonathan M.; Sinha, Prashant
[S.l.] : Springer International Publishing, 2022
Extent: 1 v.
ISBN: 9783030946098
CID: 5550552

Avoidance of Complications

Chapter by: Sinha, Prashant
in: The SAGES Manual of Quality, Outcomes and Patient Safety, Second Edition by
[S.l.] : Springer International Publishing, 2022
pp. 373-384
ISBN: 9783030946098
CID: 5550562

INCIDENCE AND PREDICTORS OF EARLY AND LATE READMISSION AFTER ACUTE PANCREATITIS [Meeting Abstract]

Richter, Benjamin I.; Tarabanis, Constantine; Khanna, Lauren G.; Haber, Gregory B.; Sinha, Prashant; Wolfgang, Christopher L.; Gonda, Tamas A.
ISI:000826446201301
ISSN: 0016-5085
CID: 5523922

An Ancillary Central Catheter Emergency Support Service Team Staffed by Surgical Personnel Improves Workflow During the Coronavirus Disease 2019 Crisis

Schulberg, Steven P; Jaikaran, Omkaar; Lim, Derek; Robalino, Ryan P; Patel, Ronak; Sirsi, Sandeep; Timoney, Michael; Sinha, Prashant
Background. The SARS-CoV-2 novel coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to urban health centers across the United States. Many hospitals are reallocating resources to best handle the influx of critical patients. Methods. At our New York City hospital, we developed the ancillary central catheter emergency support service (ACCESS), a team for dedicated central access staffed by surgical residents to assist in the care of critical COVID-19 patients. We conducted a retrospective review of all patients for whom the team was activated. Furthermore, we distributed a survey to the critical care department to assess their perceived time saved per patient. Results. The ACCESS team placed 104 invasive catheters over 10 days with a low complication rate of .96%. All critical care providers surveyed found the service useful and felt it saved at least 30 minutes of procedural time per patient, as patient to critical care provider ratios were increased from 12 patients to one provider to 44 patients to one provider. Conclusions. The ACCESS team has helped to effectively redistribute surgical staff, provide a learning experience for residents, and improve efficiency for the critical care team during this pandemic.
PMID: 33153382
ISSN: 1553-3514
CID: 4668652

Enhanced recovery program implementation: an evidence-based review of the art and the science

Aloia, Thomas A; Keller, Deborah S; Kowalski, Rebecca B; Lin, Henry; Luciano, Margaret M; Myers, Jonathan A; Sinha, Prashant; Spaniolas, Konstantinos; Young-Fadok, Tonia M
BACKGROUND:The benefits of enhanced recovery program (ERP) implementation include patient engagement, improved patient outcomes and satisfaction, better team relationships, lower per episode costs of care, lower public consumption of narcotic prescription pills, and the promise of greater access to quality surgical care. Despite these positive attributes, vast numbers of surgical patients are not treated on ERPs, and many of those considered "on pathway" are unlikely to be exposed to a majority of recommended ERP elements. METHODS:To explain the gap between ERP knowledge and action, this manuscript reviewed formal implementation strategies, proposed a novel change adoption model and focused on common barriers (and corollary solutions) that are encountered during the journey to a fully implemented and successful ERP. Given the nature of this review, IRB approval was not required/obtained. RESULTS:The information reviewed indicates that implementation of best practice is both a science and an art. What many surgeons have learned is that the "soft" skills of emotional intelligence, leadership, team dynamics, culture, buy-in, motivation, and sustainability are central to a successful ERP implementation. CONCLUSIONS:To lead teams toward achievement of pervasive and sustained adherence to best practices, surgeons need to learn new strategies, techniques, and skills.
PMID: 31451916
ISSN: 1432-2218
CID: 4054262

Public reporting and transparency: a primer on public outcomes reporting

Romanelli, John R; Fuchshuber, Pascal R; Stulberg, Jonah James; Kowalski, Rebecca Brewer; Sinha, Prashant; Aloia, Thomas A; Orlando, Rocco
INTRODUCTION/BACKGROUND:Healthcare consumers seeking accurate information about where to find quality surgical care face a confusing constellation of rating systems that lack transparency or consistency of opinion. For example, a 2016 report in Health Affairs demonstrated that no hospital was rated as a high performer by all four prominent national ratings systems: Consumer Reports, Leapfrog, Healthgrades and U.S. News & World Report (Austin et al. Health Aff 34:423-430, 2015). Surgeons should have an understanding of the current state of public reporting of quality; hospital ratings and data sources; physician ratings and data sources; and transparency of reporting. METHODS:We conducted a non-systematic review of the literature. RESULTS:Hospital quality ratings remain nebulous and there is not universal opinion on the utility of voluntary participation in ranking systems, leaving the current systems largely opinion-based. Early attempts at physician ranking systems are rudimentary at best and suffer from methodological concerns. Publicly reported metrics should be easily understandable, accessible, clinically relevant, reliable, non-punitive, and shielded from legal discovery. Transparency is increasing within institutions to help align staff to institutional objectives, while specialty specific registries are helping to standardize care pathways and outcomes measures across organizations. Measuring surgical outcomes beyond 30-day morbidity and mortality has been plagued by a lack of understanding on how to create metrics that matter; the four attributes of relevance, scientific soundness, feasibility and comprehensiveness set a high bar for the development of effective and efficient quality measures in surgery. DISCUSSION/CONCLUSIONS:SAGES, via the Quality, Outcomes, and Safety Committee, is committed to learning how to develop meaningful quality metrics in general surgery and will continue to work in other areas that impact quality, such as opioid prescribing, and surgeon wellness.
PMID: 31161288
ISSN: 1432-2218
CID: 3923382

How to manage efferent loop syndrome with endoscopic techniques [Meeting Abstract]

Lim, D; Bain, K; Sinha, P
Introduction: Efferent loop syndrome (ELS) is defined as a mechanical obstruction of the efferent enteric jejunal limb. ELS can occur after a Whipple, Billroth II gastrectomy, or Roux-en-Y gastric bypass. Gastrojejunal anastomotic stenosis rates in these surgeries range from 0.2-1.7%. However, these documented rates include afferent limb syndrome and roux limb obstruction. Case Presentation: We present the case of a 60 year old female with gastric adenocarcinoma presenting for elective resection. The patient underwent a hemi-gastrectomy with Billroth II reconstruction. On postoperative day (POD) three, the patient was started on a clear liquid diet. On POD four through six, the patient continued to have bowel movements, however, was unable to tolerate oral intake. An UGI series was obtained, with findings suspicious for obstruction of the efferent limb. The patient was taken for esophagogastroduodenoscopy, and there was evidence of a stenosed Billroth II gastrojejunal anastomosis. The anastomosis was transversed, and a covered stent was placed under fluoroscopic guidance. Post procedurally a repeat UGI series confirmed a patent stent. The patient's diet was advanced and tolerated, and the patient was discharged home.
Discussion(s): There are two types of "loop syndromes" which may occur after gastric surgery - afferent and efferent. Efferent loop syndrome is less common of the two. Both syndromes are characterized by a mechanical obstruction of the gastrojejunostomy, causing obstruction of gastric emptying. The gold standard to diagnosing ELS is an upper endoscopy; however, radiographic imaging can aid in the diagnosis. UGI series can demonstrate regurgitation of oral contrast into the afferent limb and gastric pouch. The mainstay treatment of ELS has historically been surgical intervention. However, with recent advancements in endoscopic procedures, there have been published techniques using metal stents, double pigtail stents and naso-jejunal tube stenting to bypass areas of stenosis. In 2016, Chang et al. described the effectiveness of endoscopic stent therapy in the management of postoperative foregut surgery complications (anastomotic leak, lumen stenosis, fistula formation). They reported an 88.9% success rate in treating stenosis with the end point of being able to tolerate a diet. Double pigtail and naso-jejunal tube stenting have also been documented to have success rates as high as 95%.
Conclusion(s): This case describes a rare post-gastrectomy complication which was successfully treated with modern endoscopic technique. With modern advancements in endoscopic techniques, patients suffering from efferent loop syndrome are able to avoid the morbidity associated with operative repairs
EMBASE:627143822
ISSN: 1432-2218
CID: 3811482

[S.l.] : Academic Surgical Congress Abstracts Archive, 2019

91.11 Trends in Treatment of Appendicitis: Analysis of National Inpatient Sample

Chkhikvadze, T; Shi, J; Sinha, P
(Website)
CID: 3942582

Cholecystomegaly: Management and treatment [Meeting Abstract]

Garraud, C; Liu, S; Morin, N; Ferzli, G; Sinha, P
Case Presentation: Patient is a 22 year old female with no significant past medical or surgical history presented to the emergency department with a 2 day history of worsening sharp right upper quadrant pain with associated nausea, vomiting, and PO intolerance. The pain started a few months prior, however it was self-limited with diet modifications. An ultrasound demonstrated a contracted gallbladder with a 15 mm gallbladder wall. White blood cell count was within normal limits and total bilirubin was slightly elevated to 1.8 mg/dL. No palpable mass was noted on physical exam. An MR cholangiopancreatography was performed which demonstrated a dilated gallbladder measuring 11.5 x 2.5 cm, a severely thickened gallbladder with a small intramural collection and multiple gallstones. The patient proceeded with a laparoscopic cholecystectomy. Intraoperatively, the omentum was densely adhered to the gallbladder and needle decompression of the gallbladder was unsuccessful due to the wall thickness. The gallbladder was subsequently removed without any complications. Patient's remaining hospital course was uncomplicated. Surgical pathology returned demonstrating acute on chronic cholecystitis.
Discussion(s): Cholecystomegaly or 'Giant Gallbladder' disease is a rare pathology encountered in the surgical world. There have been few reported cases, most of which occurred in the elderly ([65 years). Kuznetsov et al. defined an enlarged gallbladder to have a volume of 200-300 cc and a giant gallbladder as exceeding 1500 cc (the average weight of the liver). The etiology remains unknown, however certain factors exist to allow the gallbladder to reach this size without life-threatening sequela. Preoperative imaging, such as MR cholangiopancreatography, is important to differentiate biliary pathology and delineate anatomy. Removal of the gallbladder is recommended to prevent the development of complications like cholangitis or bowel obstruction. The cause of cholecystomegaly still remains uncertain and warrants further research. The management and treatment remains similar to acute cholecystitis
EMBASE:632125849
ISSN: 1432-2218
CID: 4550312