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Characterization of Laryngotracheal Fractures and Repairs: A TQIP Study
Bourdillon, Alexandra T; Kafle, Samipya; Salehi, Parsa P; Steren, Benjamin; Pei, Kevin Y; Azizzadeh, Babak; Lee, Yan Ho
OBJECTIVES/OBJECTIVE:Laryngotracheal trauma is poorly studied and associated with serious morbidity and mortality. This study reports features associated with laryngotracheal fractures, and factors associated with laryngeal fracture repair. STUDY DESIGN/METHODS:edition encodings. Demographic, diagnostic and procedure characteristics were analyzed with univariate chi-squared analysis and multivariate logistic regression. RESULTS:We extracted 635 cases of laryngotracheal injury, with a median Injury Severity Score of 16 (IQR: 10 - 25). Most were caused unintentionally (65.7%), followed by assault (28.8%). Blunt trauma (79.5%) was more common than penetrating trauma (20.0%). These trends were upheld in the subgroup of repaired fractures, which made up 12.6% (80/635) of cases. The median length of hospital stay was 6 days (IQR: 3 - 13) in all fractures and 10 days (IQR: 6 - 14) in the subgroup of repaired fractures, while the median length of ICU stay was 4 days (IQR: 2 - 9) in all fractures and 4.5 (IQR: 6 - 14.3) in the subgroup of repaired fractures. Cut/pierce injuries (OR: 4.7, P < 0.001) and ISS (OR: 0.97, pP = 0.026) significantly affected rate of laryngeal fracture repair. CONCLUSION/CONCLUSIONS:Laryngotracheal fractures are uncommon but serious injuries. Our results show that penetrating causes of injuries have the shortest time to repair, and that a higher ISS score is negatively associated with repair.
PMID: 35817623
ISSN: 1873-4588
CID: 5772592
Practical Guide to Curricular Development Research [Comment]
Pei, Kevin Y; Schwartz, Todd A; Boermeester, Marja A
PMID: 38170534
ISSN: 2168-6262
CID: 5772662
Bullying in Orthopaedic Surgery: A Survey of US Orthopaedic Trainees and Attending Surgeons
DiFiori, Monica M; Gupta, Sanchita S; Cannada, Lisa K; Pei, Kevin Y; Stamm, Michaela A; Mulcahey, Mary K
INTRODUCTION:Bullying is a notable problem in surgery, creating a hostile environment for surgeons and trainees, and may negatively affect patient care. However, specific details regarding bullying in orthopaedic surgery are lacking. The primary aim of this study was to determine the prevalence and nature of bullying within orthopaedic surgery in the United States. METHODS:A deidentified survey was developed using the survey created by the Royal College of Australasian Surgeons and the validated Negative Acts Questionnaire-Revised survey tool. This survey was distributed to orthopaedic trainees and attending surgeons in April 2021. RESULTS:Of the 105 survey respondents, 60 (60.6%) were trainees and 39 (39.4%) were attending surgeons. Although 21 respondents (24.7%) stated they had been bullied, 16 victims (28.1%) did not seek to address this behavior. Perpetrators of bullying were most commonly male (49/71, 67.2%) and the victims' superior (36/82, 43.9%). Five bullying victims (8.8%) reported the behavior, despite 46 respondents (92.0%) stating that their institution has a specific policy against bullying. CONCLUSION:Bullying behavior occurs in orthopaedic surgery, with perpetrators being most commonly male and the victims' superiors. Despite the fact that an overwhelming majority of institutions have policies against bullying, the reporting of such behavior is lacking.
PMCID:10155897
PMID: 37141506
ISSN: 2474-7661
CID: 5772622
Utilizing Change Management Theory to Optimize Resources and Reduce Supply Chain Costs
Purnell, Shawn M; Pei, Kevin Y; Tilton, Julie; Bloom, Alexi; Dickinson, Karen; Zheng, Feibi
PMID: 33170032
ISSN: 1555-9823
CID: 5772092
Factors Potential Patients Deem Important for Decision-Making in High-Risk Surgical Scenarios
Dellen, Matthew; Flanagan, Mindy; Pfafman, Rachel; Drouin, Michelle; Pater, Jessica; Pei, Kevin Y
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.
PMID: 36519912
ISSN: 1879-1190
CID: 5772612
SURGERY IN PRACTICE AND SCIENCE
Rao, Varun; Deleon, Genaro; Becker, Timothy; Duggan, Benjamin; Pei, Kevin Y.
ISI:001063590200001
ISSN: 2666-2620
CID: 5772652
Impact of bowel preparation on elective colectomies for diverticulitis: analysis of the NSQIP database
Zhuo, Haoran; Liu, Zheng; Resio, Benjamin J; Liu, Jialiang; Wang, Xishan; Pei, Kevin Y; Zhang, Yawei
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.
PMCID:9469520
PMID: 36096764
ISSN: 1471-230x
CID: 5772602
Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship
Park, Keon Min; Rashidian, Nikdokht; Anderson, Chelsie; Brian, Riley; Calthorpe, Lucia M; Gee, Denise; Hernandez, Sophia; Lau, James; Nepomnayshy, Dmitry; Patel, Nell Maloney; Pei, Kevin; Reddy, Rishindra M; Roman, Sanziana A; Scott, Daniel J; Alseidi, Adnan
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.
PMID: 34171862
ISSN: 1528-1140
CID: 5772302
Perceptions and behaviors of learner engagement with virtual educational platforms
Dickinson, K J; Caldwell, K E; Graviss, E A; Nguyen, D T; Awad, M M; Olasky, J; Tan, S; Winer, J H; Pei, K Y; ,
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.
PMCID:8853863
PMID: 35184816
ISSN: 1879-1883
CID: 5772332
Diversity efforts in surgery: Are we there yet?
Oseni, Tawakalitu O; Kelly, Bridget N; Pei, Kevin; Nielsen, Matthew; Pitt, Susan C; Diego, Emilia; Mouawad, Nicolas J; Stein, Sharon L
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.
PMID: 35131086
ISSN: 1879-1883
CID: 5772312