Success in Academic Surgery: Health Services Research

XV, 292 p. 41 illus., 23 illus. in color.online r

Optimizing Cancer Care Delivery through Implementation Science

The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer

Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another?

BACKGROUND: Recent data establish a strong link between peer video ratings of surgical skill and clinical outcomes with laparoscopic gastric bypass. Whether skill for one bariatric procedure can predict outcomes for another related procedure is unknown. METHODS: Twenty surgeons voluntarily submitted videos of a standard laparoscopic gastric bypass procedure, which was blindly rated by 10 or more peers using a modified version of the Objective Structured Assessment of Technical Skills. Surgeons were divided into quartiles for skill in performing gastric bypass, and within 30 days of sleeve gastrectomy, their outcomes were compared. Multivariate logistic regression analysis was utilized to adjust for patient risk factors. RESULTS: Surgeons with skill ratings in the top (n = 5), middle (n = 10, middle 2 combined), and bottom (n = 5) quartiles for laparoscopic gastric bypass saw similar rates of surgical and medical complications after laparoscopic sleeve gastrectomy (top 5.7%, middle 6.4%, bottom 5.5%, P = .13). Furthermore, surgeons\u27 skill ratings did not correlate with rates of reoperation, readmission, and emergency department visits. Top-rated surgeons had significantly faster operating room times for sleeve gastrectomy (top 76 minutes, middle 90 minutes, bottom 88 minutes; P \u3c .001) and a higher annual volume of bariatric cases per year (top 240, middle 147, bottom 105; P = .001). CONCLUSION: Video ratings of surgical skill with laparoscopic gastric bypass do not predict outcomes of laparoscopic sleeve gastrectomy. Evaluation of surgical skill with one procedure may not apply to other related procedures and may require independent assessment of surgical technical proficiency