The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy

Background: Duration of surgery is a main cost factor of surgical training. The purpose of this analysis of operative times for laparoscopic cholecystectomies (LC) was to quantify the extra time and related costs in regards to the surgeons' experience in the operating room (OR). Methods: All LC performed between January 01, 2005 and December 31, 2008 in 46 hospitals reporting to the database of the Swiss Association for Quality Management in Surgery (AQC) were analyzed (n=10,010). Four levels of seniority were specified: resident (R), junior consultant (JC), senior consultant (SC), and attending surgeon (AS). The differences in operative time according to seniority were investigated in a multivariable log-linear and median regression analysis controlling for possible confounders. The OR costs were calculated by using a full cost rate in a teaching hospital. Results: A total of 9,208 LC were available for analysis; 802 had to be excluded due to missing data (n=212) or secondary major operations (n=590). Twenty-eight percent of the LC were performed by R as teaching operations (n=2,591). Compared with R, the multivariable analysis of operative time showed a median difference of −2.5min (−9.0; 4.8) for JC and −18min (−25; −11) for SC and −28min (−35; −10) for AS, respectively. The OR minute costs were €17.57, resulting in incremental costs of €492 (159; 615) per operation in case of tutorial assistance. Conclusions: The proportion of LC performed as tutorial assistance for R remains low. Surgical training in the OR causes relevant case-related extra time and therefore cost

Predicting complicated appendicitis based on clinical findings: the role of Alvarado and appendicitis inflammatory response scores

PURPOSE: The pre-interventional differentiation between complicated and uncomplicated appendicitis is decisive for treatment. In the context of conservative therapy, the definitive diagnosis of uncomplicated appendicitis is mandatory. This study investigates the ability of clinical scoring systems and imaging to differentiate between the two entities. METHODS: This is a retrospective analysis of two cohorts from two tertiary referral centers in Switzerland and Germany. All consecutive patients underwent appendectomy between January 2008 and April 2013 (in the first cohort) or between January 2017 and June 2019 (the second cohort). Exclusion criteria did not apply as all patients found by the database search and received an appendectomy were included. Diagnostic testing and calculation of a receiver operating curve were performed to identify a cutoff for clinical scores that resulted in a minimum sensitivity of 90% to detect complicated appendicitis. The cutoff was combined with additional diagnostic imaging criteria to see if diagnostic properties could be improved. RESULTS: Nine hundred fifty-six patients were included in the analysis. Two hundred twenty patients (23%) had complicated appendicitis, and 736 patients (77%) had uncomplicated appendicitis or no inflammation. The complicated appendicitis cohort had a mean Alvarado score of 7.03 and a mean AIR of 5.21. This compared to a mean Alvarado of 6.53 and a mean AIR of 4.07 for the uncomplicated appendicitis cohort. The highest Alvarado score with a sensitivity of > 90% to detect complicated appendicitis was >== 5 (sensitivity = 95%, specificity 8.99%). The highest AIR score with a sensitivity of > 90% to detect complicated appendicitis was >== 3 (sensitivity 91.82%, specificity 18.53). The analysis showed that additional CT information did not improve the sensitivity of the proposed cut-offs. CONCLUSION: AIR and Alvarado scores showed limited capability to distinguish between complicated and uncomplicated appendicitis even with additional imaging in this retrospective cohort. As conservative management of appendicitis needs to exclude patients with complicated disease reliably, appendectomy seems until now to remain the safest option to prevent undertreatment of this mostly benign disease

[Christian pamphlets. Vol. 12]

1 v. ; 24 cm.De scholiis Homericis ad historiam fabularem pertinentibus / Eduardus Schwartz -- Zur Stichometrie / Martin Schanz -- Die Iuli Frontini Strategematon libro qui fertur quarto / Gottholdus Gundermann -- Die Traditionen über die Stiftung der olympischen Spiele / P. Knapp -- Die älteste lateinische Inschrfit / P.K. -- Zu den Biographika des Suidas / Adam Daub -- Beiträge zur Erklärung von Wandbildern / Paul Knapp -- Ueber die Schriften des Cornelius Celsus / M. Schanz -- Zu Theognis / Eduard Hiller -- Index lectionum quae in universitate litter. Friederica Guilelma per sem. hib. 1880/1 habebuntur ; Index scholarum in universitate litter. Vratislaviensi per hiemem anni 1880/1 habendarum / Ludwig Martens -- Friedrich Wieseler, Scenische und kritische Bemerkungen zu Euripides' Kyklops / N. Wecklein.Antonius Jannarakis, Annotationes criticae in Longini qui fertur [peri hypsous] libellum / Ludwig Martens -- De Aristophane Byzantio et Suetonio Tranquillo Eustathi auctoribus / Leopold Cohn // Analecta Aristarchea / Adolfus Schimberg -- De M. Tullii Ciceronis Oratione in toga candida habita / Paulus Koetschau -- De figuris quaestiones criticae Part I. / Iohannes Mueller -- Ausonianarum quaestionum specimen primum / Guilelmus Brandes -- Westfälische Volkslieder in Wort und Weise .. / Reinhold Köhler -- August Reinbrecht, Die Legende von den sieben Schläfern und der anglo-normannische Dichter Chardri / H. Varnhagen -- De tropis et figuris apud Tibullum / Marx Hansen -- Bistânî's Encyclopédie arabe / Fleischer -- Tibetan and English dictionary by H.A. Jäschke / G. Th. Reichelt -- Geschichte des Artachšîr i Pâpakan, aus dem Pehlewi übersetzt ... von T. Nöldeke / Alfred von Gutschmid.Schī-kīng. Das kanonische Liederbuch der Chiesen. Aus dem Chinesischen übersetzt und erklärt von Victor von Strauss / V. von Strauss und Torney -- Bemerkungen zu Tabar's Sasanidengeschichte, übersetzt von Th. Nöldeke / Alfred von Gutschmid -- Fabius Pictor und Livius / Eduard Heydenreich -- De Euripideorum prologorum / Iosephus Klinkenberg -- Über den Codex Laurentianus 53, 35, nebst Nachträgen zu den neuesten Forschungen über Ciceros Briefe / Franz Rühl -- Friedrich Christoph Schlosser / Franz Rühl -- Miscellen -- Kritische Bemerkungen / A. Nauck