Cost effectiveness after a pancreaticoduodenectomy: bolstering the volume argument

AbstractBackgroundThe cost implication of variability in pancreatic surgery is not well described. It was hypothesized that for a pancreaticoduodenectomy (PD), lower volume centres demonstrate worse peri-operative outcomes at higher costs.MethodsFrom 2009–2011, 9883 patients undergoing a PD were identified from the University HealthSystems Consortium (UHC) database and stratified into quintiles by annual hospital case volume. A decision analytic model was constructed to assess cost effectiveness. Total direct cost data were based on Medicare cost/charge ratios and included readmission costs when applicable.ResultsThe lowest volume centres demonstrated a higher peri-operative mortality rate (3.5% versus 1.3%, P < 0.001) compared with the highest volume centres. When both index and readmission costs were considered, the per-patient total direct cost at the lowest volume centres was $23 005, or 10.9$2263 per case) more than at the highest volume centres. One-way sensitivity analyses adjusting for peri-operative mortality (1.3% at all centres) did not materially change the cost effectiveness analysis. Differences in cost were largely recognized in the index admission; readmission costs were similar across quintiles.ConclusionsFor PD, low volume centres have higher peri-operative mortality rates and 10.9% higher cost per patient. Performance of PD at higher volume centres can lead to both better outcomes and substantial cost savings

Perception of Transplant Surgery and the Pursuit of a Career in Transplant Surgery Among US General Surgery Residents

Background: A recent report by the ASTS Pipeline Taskforce demonstrated that United States (US)-trained general surgery residents are less likely to pursue transplant surgery. We aimed to describe resident perceptions about their transplant surgery experience and factors influencing transplant surgery as a career. Methods: A cross-sectional analysis was conducted using an anonymous survey composed of multiple choice, closed yes/no, and Likert scale questions. The survey was sent to US general surgery program directors soliciting internal distribution to residents from June to July 2021. Results: A total of 192 surveys were returned from 255 programs. 38% of residents indicated interest in a transplant surgery career or fellowship. Greater than half (59%) answered they were satisfied with operative experience during their transplant rotation, and most (69%) believed transplant surgery attendings had job satisfaction. Rotation factors associated with greater interest in a transplant surgery career included perceived attending and fellow career satisfaction, experience (operative, rounding, teaching) satisfaction, perception of team role importance, identification of an attending mentor, and possible fellowship at home institution (Table 1, Figure 1). Residents with a higher number of surgeries scrubbed and proportion of cases scrubbed as a junior surgeon were more likely to report greater operative satisfaction. Conclusion: In our study, US-trained general surgery residents demonstrated low interest in transplant surgery as a career. Improving the resident transplant rotation experience and the perception of transplant surgery attending satisfaction may improve the transplant pipeline

Does Intentional Support of Degree Programs in General Surgery Residency Affect Research Productivity or Pursuit of Academic Surgery? A Multi-Institutional Study

To determine whether pursuit of an advanced degree during dedicated research time (DRT) in a general surgery residency training program impacts a resident's research productivity. A retrospective, multi-institutional cohort study. General surgery residency programs that were approved to graduate more than 5 categorical residents per year and that offered at least 1 year of DRT were contacted for participation in the study. A total of 10 general surgery residency programs agreed to participate in the study. Residents who started their residency between 2000 and 2012 and spent at least one full year in DRT (n = 511) were included. Those who completed an advanced degree were compared on the following parameters to those who did not complete one: total number of papers, first-author papers, the Journal Citation Reports impact factors of publication (2018, or most recent), and first position after residency or fellowship training. During DRT, 87 (17%) residents obtained an advanced degree. The most common degree obtained was a Master of Public Health (MPH, n = 42 (48.8%)). Residents who did not obtain an advanced degree during DRT published fewer papers (median 8, [interquartile range 4-12]) than those who obtained a degree (9, [6-17]) (p = 0.002). They also published fewer first author papers (3, [2-6]) vs (5, [2-9]) (p = 0.002) than those who obtained a degree. Resident impact factor (RIF) was calculated using Journal Citation Reports impact factor and author position. Those who did not earn an advanced degree had a lower RIF (adjusted RIF, 84 ± 4 vs 134 ± 5, p < 0.001) compared to those who did. There was no association between obtaining a degree and pursuit of academic surgery (p = 0.13) Pursuit of an advanced degree during DRT is associated with increased research productivity but is not associated with pursuit of an academic career