American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New Crucial Literature: The Science You Need to Know

New Report Shows Value of Strict COVID-19 Infection Control Measures in Academic Hospital

Rhee C, Baker M, Vaidya V, et al. Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center. JAMA Netw Open. 2020;3(9):e2020498.

Data are available that document delays in necessary medical and surgical treatments that have resulted from patients’ belief that the risk of infection with COVID-19 is significant if they go to a hospital for a procedure or are admitted electively for inpatient care; patient harm in the form of preventable advances in disease stage and/or complications have been confirmed. This report presented data on the frequency of nosocomial infection with COVID-19 in a single academic center.

The data were gathered during an interval when a significant number of COVID-19-infected inpatients were being cared for in the institution. Infection control measures were in place and included dedicated COVID-19 units with airborne infection isolation rooms, PPE donning and doffing monitors, universal masking, restricted visitation and liberal testing of symptomatic and asymptomatic patients. The authors analyzed infection data in more than 9,000 patients (8,370 non-COVID-19 admissions). Among the non-COVID-19 admissions, 0.1 percent tested positive for the virus within 14 days of admission; after careful evaluation of these patients, only one instance of hospital-acquired infection was documented.

The authors concluded that implementation of recommended infection control measures provided a safe inpatient care environment for non-COVID-19 patients.

Research Letter Reports Data on Male Sexual Dysfunction after Pelvic Surgery for Colorectal Cancer

Ma J, Whittaker Y, Chandran P. Male Sexual Dysfunction after Pelvic Surgery for Colorectal Cancer. Br J Surg. 2020.

This research letter reported data from a questionnaire sent to 67 patients who underwent pelvic surgery for colorectal cancer. The survey assessed preoperative health and sexual activity and the frequency of male sexual dysfunction during a six-month interval following operation. The survey response rate was 42 percent and 17 patients were included in the final analysis. Reduced interest in sexual activity was reported in 88 percent of patients. Persistent moderate or severe sexual dysfunction was reported in more than 50 percent of patients.

Despite the small sample size, these data suggest that preoperative counseling and the provision of postoperative sexual dysfunction assessment and treatment have potential value for this patient group.

QoL and Occupational Outcomes Largely Improved after Laparoscopic Roux-En-Y Gastric Bypass Surgery, New Article Suggests

Gormsen J, Gögenur I, Helgstrand F. Quality of Life and Occupational Outcomes after Laparoscopic Roux-En-Y Gastric Bypass Surgery. Surgery. 2020;168(3):471-477.

Gormsen and coauthors reported data from a single center in Denmark on 749 patients who underwent Roux-en-Y gastric bypass for morbid obesity. A standard questionnaire was used to assess quality of life and occupational outcomes; data were collected over a median interval of 63 months. The analysis showed that quality of life improved postoperatively in more than 85 percent of patients. A small proportion of the study group showed diminished quality of life and occupational status at five years following surgery. Reduced quality of life and declines in occupational status were strongly associated with a diagnosis of chronic abdominal pain. The data suggest that occupational status decline may have occurred because of the necessity for opioid treatment of pain.

The authors concluded that patient counseling and planned protocols for management of postoperative abdominal pain could have value for patients undergoing surgical procedures for morbid obesity.

New Article Discusses a Platform for Video-Based Feedback to Provide Remote Review and Improve Surgical Technique

Schlick CJR, Bilimoria KY, Stulberg JJ. Video-Based Feedback for the Improvement of Surgical Technique: A Platform for Remote Review and Improvement of Surgical Technique. JAMA Surg. 2020.

Previous data reported by this group of investigators has shown a relationship between low scores on surgical technique assessment and elevated risk of postoperative complications. Provision of video-based feedback potentially could improve technique and reduce risk of morbidity.

The authors noted that barriers to implementing video-based technique assessment and interventions to improve technique include scheduling difficulties, market competition involving surgeons and potential coaches and challenges in establishing effective surgeon-coach pairing. They described a model for video-based technique assessment and improvement that attempts to overcome these barriers. The measures include intensive reviewer training to ensure high-quality feedback and accurate identification of actionable targets for improvement. Once videos have been reviewed and feedback from at least two reviewers is complete, the video and feedback are presented to participating surgeons anonymously; the videos can be reviewed remotely according to the participating surgeons’ schedules.

The authors noted that a detailed analysis is under way to determine the potential value of this system. Procedures that are eligible for review at the current stage of development include cholecystectomy, inguinal hernia repair, right hemicolectomy, sigmoid colectomy and hiatal hernia repair. Surgeons are encouraged to watch for additional data that evaluate the effectiveness of this and other approaches for assessing and improving technical skills.

Article and Commentary Explore the Need for Properly Defining and Responding to Resident Burnout

Hewitt DB, Ellis RJ, Hu YY, et al. Evaluating the Association of Multiple Burnout Definitions and Thresholds with Prevalence and Outcomes. JAMA Surg. 2020.

Danhauer SC, Files K, Freischlag JA. Broadening the Discussion on Physician Burnout. JAMA Surg. 2020.

Hewitt and coauthors reported data from nearly 7,000 residents from 301 surgical training programs; data were obtained following the 2019 American Board of Surgery ABSITE examination. The survey instrument was designed to determine the frequencies of symptoms of burnout such as depersonalization symptoms and emotional exhaustion.

The data analysis showed that emotional exhaustion, experienced at least weekly, was reported by 23 percent of participants and depersonalization symptoms were reported by 38.1 percent. At least one burnout symptom/week was reported by 43 percent of participants. The authors noted that application of various definitions of burnout would diagnose this condition over a wide range (3.2 percent–91.4 percent of residents). The authors concluded that burnout research contributions should employ a standard, well-described definition and that agreement on a single standard could have significant value.

In the accompanying editorial, Danhauer and coauthors agreed with the need to develop broadly acceptable, consistent definitions of burnout. They stressed the facts that recognition of this problem is a necessary task for all training programs and that dedicated efforts to develop support mechanisms, collegiality, leadership training, recognition of work well done, and communication transparency have the potential to increase recognition of burnout and reduce the harmful effects that result from this condition.

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JAMA Surg, Combating the Peacetime Effect in Military Medicine.