Faculty Bibliography

Purpose of Review: Intimate partner homicide (IPH), the lethal consequence of intimate partner violence (IPV), continues to account for a significant proportion of homicides worldwide. This review will highlight known risk factors of IPH, the state of risk assessment in healthcare settings, and examples of public policies that have impacted IPH risk. Recent Findings: Studies have identified risk factors unique to IPH, which include female and transgender identities, a larger age gap between victim and perpetrator, race and ethnic minority identities, IPV during pregnancy, migration to the USA, socioeconomic instability, and a previous history of IPV. There are a variety of risk assessment tools used in healthcare settings, each developed within specific contexts of providers, participants, and settings. Finally, policies restricting firearm access to previous perpetrators of IPV has been associated with decreased rates in IPH. Summary: While there are discrete risk factors and vulnerabilities for IPH, further work is needed to better understand risk within historically marginalized communities. The variation in risk assessment tools suggests that the administrator should select the one that best meets the patient"™s specific situation. Finally, the association between firearm control and IPH rates is an encouraging example for future directions of impacting IPH. While there are still challenges to identifying and intervening on IPH, there are promising opportunities to innovate new methods of providing safety and empowerment.

The American Association for the Surgery of Trauma Diversity, Equity, and Inclusion (DEI) Ad Hoc Committee organized a luncheon symposium with a distinguished panel of experts to discuss how to ensure a diverse surgical workforce. The panelists discussed the current state of DEI efforts within surgical departments and societal demographic changes that inform and necessitate surgical workforce adaptations. Concrete recommendations included the following: obtain internal data, establish DEI committee, include bias training, review hiring and compensation practices, support the department members doing the DEI work, commit adequate funding, be intentional with DEI efforts, and develop and support alternate pathways for promotion and tenure.

BACKGROUND:The American College of Surgeon (ACS), American Surgical Association (ASA), Association of Women Surgeons (AWS), and Society of Black Academic Surgeons (SBAS) partnered to gain insight into whether inequities found in surgical society presidents may be present earlier. METHODS:ACS, ASA, AWS, and SBAS presidents' CVs were assessed for demographics and scholastic achievements at the time of first faculty appointment. Regression analyses controlling for age were performed to determine relative differences across societies. RESULTS:66 of the 68 presidents' CVs were received and assessed (97% response rate). 50% of AWS future presidents were hired as Instructors rather than Assistant professors, compared to 29.4% of SBAS, 25% of ASA and 29.4% of ACS. The future ACS, ASA, and SBAS presidents had more total publications than the AWS presidents, but similar numbers of 1st and Sr. author publications. CONCLUSION/CONCLUSIONS:Gender inequities in academic surgeon hiring practices and perceived scholastic success may be present at first hire.

INTRODUCTION/BACKGROUND:Health-care disparities based on race and socioeconomic status among trauma patients are well-documented. However, the influence of these factors on the management of rib fractures following thoracic trauma is unknown. The aim of this study is to describe the association of race and insurance status on management and outcomes in patients who sustain rib fractures. METHODS:The Trauma Quality Improvement Program database was used to identify adult patients who presented with rib fractures between 2015 and 2016. Patient demographics, injury severity, procedures performed, and outcomes were evaluated. Multivariate logistic regression analysis was used to determine the effect of race and insurance status on mortality and the likelihood of rib fixation surgery and epidural analgesia for pain management. RESULTS:A total of 95,227 patients were identified. Of these, 2923 (3.1%) underwent rib fixation. Compared to White patients, Asians (AOR: 0.57, P = 0.001), Blacks or African-Americans (AA) (AOR: 0.70, P < 0.001), and Hispanics/Latinos (HL) (AOR: 0.78, P < 0.001) were less likely to undergo rib fixation surgery. AA patients (AOR: 0.67, P = 0.004), other non-Whites (ONW) (AOR: 0.61, P = 0.001), and HL (AOR 0.65, P = 0.006) were less likely to receive epidural analgesia. Compared to privately insured patients, mortality was higher in uninsured patients (AOR: 1.72, P < 0.001), Medicare patients (AOR: 1.80, P < 0.001), and patients with other non-private insurance (AOR: 1.23, P < 0.001). CONCLUSIONS:Non-White race is associated with a decreased likelihood of rib fixation and/or epidural placement, while underinsurance is associated with higher mortality in patients with thoracic trauma. Prospective efforts to examine the socioeconomic disparities within this population are warranted.

As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.

OBJECTIVE:To determine the role of race and gender in the career experience of Black/AA academic surgeons and to quantify the prevalence of experience with racial and gender bias stratified by gender. SUMMARY OF BACKGROUND DATA/BACKGROUND:Compared to their male counterparts, Black/African American (AA) women remain significantly underrepresented among senior surgical faculty and department leadership. The impact of racial and gender bias on the academic and professional trajectory of Black/AA women surgeons has not been well-studied. METHODS:A cross-sectional survey regarding demographics, employment, and perceived barriers to career advancement was distributed via email to faculty surgeon members of the Society of Black American Surgeons (SBAS) in September 2019. RESULTS:Of 181 faculty members, 53 responded (29%), including 31 women (58%) and 22 men (42%). Academic positions as a first job were common (men 95% vs women 77%, p = 0.06). Men were more likely to attain the rank of full professor (men 45% vs women 7%, p = 0.01). Reports of racial bias in the workplace were similar (women 84% vs men 86%, NS); however, reports of gender bias (women 97% vs men 27%, p < 0.001) and perception of salary inequities (women 89% vs 63%, p = 0.02) were more common among women. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Despite efforts to increase diversity, high rates of racial bias persist in the workplace. Black/AA women also report experiencing a high rate of gender bias and challenges in academic promotion.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) use in patients following traumatic injury continues to increase. Some consider traumatic brain injury (TBI) as an absolute contraindication for VV-ECMO because of the concern for systemic anticoagulation (A/C) worsening intracranial injury. We evaluated outcomes and complications in patients with TBI treated with VV-ECMO.

OBJECTIVE:To describe and evaluate trends of general surgery residency applicants, matriculants, and graduates over the last 13 years. SUMMARY OF BACKGROUND DATA/BACKGROUND:The application and matriculation rates of URMs to medical school has remained unchanged over the last three decades with Blacks and Hispanics representing 7.1% and 6.3% of matriculants, respectively. With each succession along the surgical career pathway, from medical school to residency to a faculty position, the percentage of URMs decreases. METHODS:The Electronic Residency Application Service to General Surgery Residency and the Graduate Medical Education Survey of residents completing general surgery residency were retrospectively analyzed (2005-2018). Data were stratified by race, descriptive statistics were performed, and time series were charted. RESULTS:From 2005 to 2018, there were 71,687 Electronic Residency Application Service applicants to general surgery residencies, 26,237 first year matriculants, and 24,893 general surgery residency graduates. Whites followed by Asians represented the highest percentage of applicants (n = 31,197, 43.5% and n = 16,602, 23%), matriculants (n = 16,395, 62.5% and n = 4768, 18.2%), and graduates (n = 15,239, 61% and n = 4804, 19%). For URMs, the applicants (n = 8603, 12%, P < 0.00001), matriculants (n = 2420, 9.2%, P = 0.0158), and graduates (n = 2508, 10%, P = 0.906) remained significantly low and unchanged, respectively, whereas the attrition was significantly higher (3.6%, P = 0.049) when compared to Whites (2.6%) and Asians (2.9%). CONCLUSION/CONCLUSIONS:Significant disparities in the application, matriculation, graduation, and attrition rates for general surgery residency exists for URMs. A call to action is needed to re-examine and improve existing recommendations/paradigms to increase the number of URMs in the surgery training pipeline.