Faculty Bibliography

The association between procedure volume at institutions and outcomes of cancer surgeries has been widely published in the medical literature; discussed in the lay press; and, during the past 15 years, incorporated into quality improvement endeavors. In certain cases, institutional volume has become a proxy for quality. Despite the vast amount of retrospective data on this topic, physicians generally have been unsure how to approach the information and interpret it for their patients. Even more challenging to some physicians has been deciding whether the data oblige them to either direct patients with cancer to high-volume centers for care or discuss the data with these patients as part of informed consent. An additional challenge is that physicians must understand laws related to these issues and that these laws are unclear. This article reviews the ethical arguments for including disparities in hospital outcomes as part of informed consent and examines whether legal precedent can shed light on this debate.

BACKGROUND:Mentorship in academic surgery is reflected in part by senior surgeon support of younger individuals with their scholarly contributions to the literature. Scholarship is also reflected in the procurement of extramural funding. This study sought to quantify this process in recent years. STUDY DESIGN/METHODS:All active American Surgical Association and Society of University Surgeons members in the following 2 eras were defined as being mentors (N = 559): 1993 to 1999 (I) and 2000 to 2006 (II). Mentees (N = 7,037) were defined as a primary author associated with the mentor. MEDLINE-cited papers of mentors and mentees were abstracted. Randomly selected mentees from era I and II were examined for academic productivity. The National Institutes of Health (NIH) Computer Retrieval of Information on Scientific Projects database was queried for federal research funding for the mentors and mentees. Continuous categoric and logistical regression was used as appropriate. RESULTS:Combining both eras, mentors published a total of 23,558 articles, of which 3,854 were primary and 9,881 were senior authored. Mentor primary-authored papers were more common in era I than era II (mean = 8 vs 6 articles, P < .01), whereas the number of senior-authored papers was similar in both eras (mean = 18 vs 17 papers, P = .09). Fewer mentors had federal funding in era I compared with era II (42% vs 51%, P = .04). More mentees per mentor existed in era I compared with era II (15 ± 5 vs 9 ± 4, P < .001). Era I mentees examined in era II (n = 187) were primary and senior author of a mean of 2.5 and 5 articles, respectively. Of this group, 14 (7.5%) had federal funding. The number of primary- and senior-authored articles from the mentee but not their prior mentor correlated with federal funding (P < .05). CONCLUSIONS:The number of mentees per mentor has decreased in recent years as has primary-authored authors, whereas federal funding has increased for mentors. Overall NIH funding for mentees was low but is related to their productivity with the mentor.

PURPOSE/OBJECTIVE:To develop and characterize radiopaque embolization microspheres capable of in vivo detection with intraprocedural fluoroscopy and computed tomography (CT) imaging and to evaluate their spatial distribution inside target tissues during and after transcatheter embolization. MATERIALS AND METHODS/METHODS:Polyvinyl alcohol hydrogel microspheres were loaded with Lipiodol and examined for iodine content, stability of loading, and conspicuity with fluoroscopy and CT in vitro. Transcatheter embolization of swine liver and kidney was performed with the radiopaque microspheres and spatial distribution was evaluated with intraprocedural fluoroscopy and CT. Ex vivo evaluation was performed with light microscopy and micro-CT. RESULTS:In vitro analyses demonstrated that radiopaque microspheres could be loaded with sufficient iodine content to be detected with routine fluoroscopy and CT imaging and that such loading was relatively stable. Radiopaque microspheres were visible in vivo with fluoroscopy and CT during transcatheter embolization. CT imaging during embolization procedures demonstrated a dose-dependent relationship in the number and size of visualized embolized arteries. Imaging features of radiopaque microsphere distribution inside target tissues correlated well with ex vivo light microscopic and micro-CT evaluation of microsphere distribution. CONCLUSIONS:Radiopaque embolization microspheres are visualized during transcatheter embolization with routine intraprocedural fluoroscopy and CT. These radiopaque microspheres provided the three-dimensional spatial distribution of embolic material inside target organs during the procedure, and therefore can provide real-time intraprocedural feedback for the interventional radiologist. These microspheres may be useful for demonstrating the influence of material and technical variability in transcatheter embolization in addition to providing intraprocedural identification of tissue at risk of undertreatment.

OBJECTIVE:The perioperative outcomes of open surgical and endovascular repair of intact thoracic aortic aneurysms (TAAs) during the last 3 months of 2005 were compared using a national administrative database. METHODS:The Nationwide Inpatient Sample was used to identify patients undergoing open aneurysm repair (OAR) or endovascular TAA repair (TEVAR) from October 1 to December 31, 2005. Patient demographic data, length of stay, hospital charges, patient disposition, and mortality were examined. Where appropriate, univariate tests of association used the chi(2) test, and multiple logistic regression analysis was used to determine predictors of in-hospital mortality, complications, and discharge status. RESULTS:A total of 1030 patients underwent open TAA repair and 267 underwent TEVAR. There was no significant difference in mortality between OAR and TEVAR (adjusted odds ratio [OR], 1.2; 95% confidence interval [CI], 0.73-2.12), although OAR patients were more likely to have cardiac, respiratory, and hemorrhagic complications. Patients undergoing TEVAR were more likely to be discharged to home (adjusted OR, 6.37; 95% CI, 2.93-13.70) and had a decreased length of stay (5.7 days vs 9.9 days; P = .0015). The differences in hospital charges and costs were not significant. CONCLUSION/CONCLUSIONS:Although further study is warranted, this study of a national sample suggests that endovascular TAA repair is safe in the short-term, associated with fewer cardiac, respiratory, and hemorrhagic complications, and requires a shorter hospital stay.