Faculty Bibliography

BACKGROUND:Surgical futility and shared decision-making to proceed with high-risk surgery are challenging for patients and surgeons alike. It is unknown which factors contribute to a patient's decision to undergo high-risk and potentially futile surgery. The clinical perspective, founded in statistical probabilities of survival, could be misaligned with a patient's determination of worthwhile surgery. This study assesses factors most important to patients in pursuing high-risk surgery. STUDY DESIGN:Via anonymous survey, lay participants recruited through Amazon's Mturk were presented high-risk scenarios necessitating emergency surgery. They rated factors (objective risk and quality-of-life domains) in surgical decision-making (0 = not at all, 4 = extremely) and made the decision to pursue surgery based on clinical scenarios. Repeated observations were accounted for via a generalized mixed-effects model and estimated effects of respondent characteristics, scenario factors, and likelihood to recommend surgery. RESULTS:Two hundred thirty-six participants completed the survey. Chance of survival to justify surgery averaged 69.3% (SD = 21.3), ranking as the highest determining factor in electing for surgery. Other factors were also considered important in electing for surgery, including the average number of days the patient lived if surgery were and were not completed, functional and pain status after surgery, family member approval, and surgery cost. Postoperative independence was associated with proceeding with surgery (p < 0.001). Recommendations by patient age was moderated by respondent age (p = 0.002). CONCLUSION:Patients highly value likelihood of survival and postoperative independence in shared decision-making for high-risk surgery. It is important to improve the understanding of surgical futility from a patient's perspective.

BACKGROUND:Recent data based on large databases show that bowel preparation (BP) is associated with improved outcomes in patients undergoing elective colorectal surgery. However, it remains unclear whether BP in elective colectomies would lead to similar results in patients with diverticulitis. The purpose of this study was to investigate whether bowel preparation affected the surgical site infections (SSI) and anastomotic leakage (AL) in patients with diverticulitis undergoing elective colectomies. STUDY DESIGN/METHODS:We identified 16,380 diverticulitis patients who underwent elective colectomies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) colectomy targeted database (2012-2017). Multivariate logistic regression models were employed to investigate the impact of different bowel preparation strategies on postoperative complications, including SSI and AL. RESULTS:In the identified population, a total of 2524 patients (15.4%) received no preparation (NP), 4715 (28.8%) mechanical bowel preparation (MBP) alone, 739 (4.5%) antibiotic bowel preparation (ABP) alone, and 8402 (51.3%) MBP + ABP. Compared to NP, patients who received any type of bowel preparations showed a significantly decreased risk of SSI and AL after adjustment for potential confounders (SSI: MBP [OR = 0.82, 95%CI: 0.70-0.96], ABP [0.69, 95%CI: 0.52-0.92]; AL: MBP [OR = 0.66, 95%CI: 0.51-0.86], ABP [0.56, 95%CI: 0.34-0.93]), where the combination type of MBP + ABP had the strongest effect (SSI:OR = 0.58, 95%CI:0.50-0.67; AL:OR = 0.46, 95%CI:0.36-0.59). The significantly decreased risk of 30-day mortality was observed in the bowel preparation of MBP + ABP only (OR = 0.32, 95%CI: 0.13-0.79). After the further stratification by surgery procedures, patients who received MBP + ABP showed consistently lower risk for both SSI and AL when undergoing open and laparoscopic surgeries (Open: SSI [OR = 0.51, 95%CI: 0.37-0.69], AL [OR = 0.47, 95%CI: 0.25-0.91]; Laparoscopic: SSI [OR = 0.58, 95%CI: 0.47-0.72, AL [OR = 0.49, 95%CI: 0.35-0.68]). CONCLUSIONS:MBP + ABP for diverticulitis patients undergoing elective open or laparoscopic colectomies was associated with decreased risk of SSI, AL, and 30-day mortality. Benefits of MBP + ABP for diverticulitis patients underwent robotic surgeries warrant further investigation.

OBJECTIVE:To identify, categorize, and evaluate the quality of literature, and to provide evidence-based guidelines on virtual surgical education within the cognitive and curricula, psychomotor, and faculty development and mentorship domains. SUMMARY OF BACKGROUND DATA:During the coronavirus disease 2019 pandemic, utilizing virtual learning modalities is expanding rapidly. Although the innovative methods must be considered to bridge the surgical education gap, a framework is needed to avoid expansion of virtual education without proper supporting evidence in some areas. METHODS:The Association for Surgical Education formed an ad-hoc research group to evaluate the quality and methodology of the current literature on virtual education and to build evidence-based guidelines by utilizing the SiGN methodology. We identified patient/problem-intervention-comparison-outcome-style questions, conducted systematic literature reviews using PubMed, EMBASE, and Education Resources information Center databases. Then we formulated evidence-based recommendations, assessed the quality of evidence using Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle-Ottawa Scale for Education, and Kirkpatrick ratings, and conducted Delphi consensus to validate the recommendations. RESULTS:Eleven patient/problem-intervention-comparison-outcome-style questions were designed by the expert committees. After screening 4723 articles by the review committee, 241 articles met inclusion criteria for full article reviews, and 166 studies were included and categorized into 3 domains: cognition and curricula (n = 92), psychomotor, (n = 119), and faculty development and mentorship (n = 119). Sixteen evidence-based recommendations were formulated and validated by an external expert panel. CONCLUSION:The evidence-based guidelines developed using SiGN methodology, provide a set of recommendations for surgical training societies, training programs, and educators on utilizing virtual surgical education and highlights the area of needs for further investigation.

INTRODUCTION:We aimed to assess and quantify recent efforts of surgical departments in achieving diversity, equity and inclusion. METHODS:Chairs of surgery at US hospitals were identified from a database maintained by the Association of Women Surgeons and surveyed to assess diversity, equity and inclusion efforts. RESULTS:A total of 226 surveys were sent out with a 22.6% response rate. Across all survey respondents, only 28.2% of surgeons were female and 24.4% were URiM, with no programs reporting any non-binary surgeons. In the last 3 years, 95.8% programs reported an increase in female surgeons, while only 75.5% programs reported an increase in URiM surgeons. Program size made no difference in diversity across race or gender. DISCUSSION:Recent recruitment efforts are bringing change to departments of surgery. Retaining diverse faculty, ensuring equity in promotions, and giving every faculty the opportunity to thrive is essential to fostering diversity, equity and inclusion in surgery.

BACKGROUND:The COVID-19 pandemic has increased utilization of educational technology for surgical education. Our aim was to determine attitudes and behaviors of surgical education champions towards virtual educational platforms and learner engagement. METHODS:An electronic survey was distributed to all Association of Surgical Education members addressing i) methods of engagement in virtual learning ii) ways to improve engagement and iii) what influences engagement. Stratified analysis was used to evaluate differences in responses by age, gender, level of training and specialty. RESULTS:154 ASE members completed the survey (13% response rate). 88% respondents accessed virtual learning events at home. Most (87%) had joined a virtual learning event and then participated in another activity. 1 in 5 who did this did so "always" or "often". Female respondents were more likely than males to join audio and then participate in another activity (62.3% v 37.7%, p = 0.04). CONCLUSIONS:Virtual platforms do not automatically translate into increased learner engagement. Careful design of educational strategies is essential to increase and maintain learner engagement when utilizing virtual surgical education.

OBJECTIVE:Bullying is defined as the perception of negative actions in which the target has difficulty in defending themself. Bullying can include verbal, physical, and psychological force used to influence the target's behavior. We sought to understand the factors associated with bullying identified in vascular surgery trainees and the barriers to reporting. METHODS:An anonymous electronic survey consisting of demographic information and validated scales for bullying (negative acts questionnaire - revised [NAQ-R]), social support, and grit was sent to vascular surgery trainees in the United States. The respondents who had reported experiencing bullying were compared with those who had not been bullied. RESULTS:Of the 516 trainees invited, 132 (26%) completed the survey. Of these 132 trainees, 63 (48%) reported having been bullied or witnessing a fellow trainee being bullied in the previous 6 months, with 42 (32%) reporting having been bullied. Gender, marital status, paradigm of vascular training, grit level, and social support did not predict for the receipt of bullying, although those in the highest quartile of grit showed a trend toward lower NAQ-R scores (P = .06). As expected, the trainees that reported having experienced bullying had had higher NAQ-R scores (P < .0001). No trainee reported daily bullying; however, 52% reported bullying "now and then" or several times a week. The most common perpetrator was their direct superior surgeon, although 12 (29%) had reported bullying from co-residents and 6 (14%) had reported bullying from patients. Of the 42 trainees who had reported experiencing bullying, 15 (36%) did not address the bullying behavior. The most common barriers to reporting bullying identified were fear of loss of support from their supervisor (48%), loss of reputation (45%), and effect on career choices (43%). Of those who reported addressing the behavior, 56% reported that the behavior had continued. Of the 132 respondents, 70 (53%) reported no knowledge of institution-specific policies to address bullying in their program. The most common reasons identified for why bullying might occur in vascular training programs were "high stress environments" and "learned behavior" from others. CONCLUSIONS:Our results indicate that bullying occurs for a significant number of vascular trainees. However, we did not find any clearly identified factors predictive of who will experience bullying. Trainees with higher grit might experience less bullying or be more likely to have a lower perception of bullying behavior. Further research is needed to determine the effects of bullying on vascular trainees.

Background Abdominal wall reconstruction (AWR) has evolved with the continued advent of new techniques such as component separation (CS). General (GS) and plastics surgeons (PS) are trained to perform this procedure. Differences in patient population and clinical outcomes between specialties are unknown. Methods Using a national database, patients who underwent incisional/ventral hernia repair managed with CS were grouped according to the primary specialty. Patient demographics, perioperative details, and postoperative complications were compared, and the risk factors associated with clinical outcomes were analyzed.  Results A total of 4,088 patients were identified. PS operated more often in the inpatient setting, and patients had a higher prevalence of hypertension and clean-contaminated wounds. Hypertension and being operated by a PS were associated with an increased risk of needing a blood transfusion after CST. Conclusion CS surgical outcomes are similar and comparable specialties. Primary specialty does not affect postoperative complications or 30-day mortality after CS.