National criteria for academic appointment in vascular surgery

ObjectiveAdvancement in academic medicine is multifactorial. Our objectives were to characterize academic appointments in vascular surgery and to investigate what factors, particularly publications, influenced academic appointment.MethodsAcademic vascular surgeons at Accreditation Council for Graduate Medical Education vascular training programs or at primary sites of U.S. allopathic medical schools were included. Those with qualified titles, such as “adjunct” or a “clinical” prefix, were excluded. Sex, education, region, board certification, and affiliation details were recorded. Web of Science was queried for publication details and h-index. The h-index is a “personal impact factor” defined as “x” number of publications cited at least “x” number of times. After surgeons' information was deidentified, univariate and multivariable analyses were completed for academic appointment and appointment as division chief.ResultsThere were 642 vascular surgeons who met criteria: 297 (46.3%) assistant professors, 150 (23.4%) associate professors, and 195 (30.4%) professors. There were 96 (15%) division chiefs and 10 (1.6%) chairs of surgery, and 83.2% were male. Surgeons worked in the Northeast (33.5%), Southern (32.6%), Central (20.1%), and Western (13.9%) United States. The mean (±standard deviation) number of publications was 13.7 ± 15.4 for assistant professors, 33.9 ± 28.8 for associate professors, and 86.8 ± 63.6 for professors (P < .001). Mean number of first or last author publications was 5.3 ± 6.4 for assistant professors, 12.2 ± 12.7 for associate professors, and 38.7 ± 35.3 for professors (P < .001). Mean h-index was 5.9 ± 5.4 for assistant professors, 12 ± 7.7 for associate professors, and 24.9 ± 12.6 for professors (P < .001). In multivariable analysis, vascular surgery board certification (adjusted odds ratio [OR], 6.08; 95% confidence interval [CI], 1.15-32.2; P = .03), academic appointment at a public medical school (OR, 1.99; 95% CI, 1.18-3.37; P = .01), years since medical school graduation (OR, 1.13; 95% CI, 1.09-1.18; P < .001, per year), and number of publications (OR, 1.05; 95% CI, 1.03-1.06; P < .001, per publication) were independently associated with associate professor. Factors independently associated with professor were years since medical school graduation (OR, 1.18; 95% CI, 1.12-1.24; P < .001, per year) and number of first or last author publications (OR, 1.05; 95% CI, 1.02-1.09; P = .003, per publication). Appointment as division chief was independently associated with h-index (OR, 1.04; 95% CI, 1.01-1.08; P = .016, per point).ConclusionsTotal number of publications was independently associated with associate professor, with number of first or last author publications particularly important for professor. The h-index was not independently associated with academic appointment, but it was for appointment as division chief. This study provides relevant data for promotional guidance in academic vascular surgery.     

Industry Payments to Adult Reconstruction-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019

BackgroundIn recent time, there has been an increased push toward transparency in industry funding toward physicians. The Physician Payments Sunshine Act called for the creation of the Open Payments Database managed by the Centers for Medicare & Medicaid Services. To our knowledge, there have been no studies evaluating the trends in payments among adult reconstruction fellowship-trained orthopedic surgeons. The purpose of this study is to investigate trends in all payments to adult reconstruction-trained orthopedic surgeons from 2014 to 2019. Secondary outcomes included evaluating trends in yearly subpayment categories, regional variations, as well as characterizing the top 5 industry companies.MethodsA review of the Centers for Medicare & Medicaid Services Open Payments Database was performed to identify all payments to adult reconstruction-trained orthopedic surgeons. A total of 94,265 payments were made to 4911 surgeons accounting for a total of $258,865,231.20 during the study period. Our primary outcome was to assess the trend in median payment per year to individual surgeons. Secondary outcomes included evaluating payment trends with respect to subtype, location as defined by United States Census regions, as well as specifics concerning the top 5 companies.ResultsOver the study period, there was a nonsignificant increasing trend in median payment per surgeon (r = 0.49, P = .096). However, there was also a significantly increasing trend in the number of payments per year (r = 0.83, P = .014), as well as the number of surgeons receiving payments (r = 0.88, P = .019). With respect to subcategory payments, there were significantly increasing trends in the median payment per surgeon for education (1054%, r = 0.942, P < .001) and entertainment/food and beverage expenses (20.2%, r = 0.49, P = .020), as well as a significantly decreasing trend for median honoraria payments per surgeon (20.2%, r = −0.04, P = .005). No significant regional trends were identified. Of the top 5 companies, one demonstrated a significantly decreasing trend in median payment per surgeon (21.6%, r = −0.109, P < .001), whereas the others remained unchanged.ConclusionIn this study, we found a nonsignificant increasing trend in payments to adult reconstruction-trained surgeons as well as an increasing number of surgeons receiving payments. There were increasing trends in median payment per surgeon for education and entertainment expenses, but a decreasing trend for honoraria payments. No significant regional trends were identified. The majority of the top 5 companies had nonsignificant trends in their payments. Further studies are needed to characterize the disclosure of payments and the impact of industry payments on clinical outcomes.Level of EvidenceIV.     

Training Patterns and Lifetime Career Achievements of US Academic Cardiothoracic Surgeons

Background

We aimed to investigate the impact of taking dedicated time for research (DTR) during training and/or getting a PhD on subsequent career achievements of US academic cardiothoracic surgeons.

Methods

Online resources (institutional Web sites, CTSNet, Scopus, NIH RePORTER) were queried to collect training information (timing of medical school/residency/fellowship graduation, DTR, PhD) and academic metrics (publications, citations, research funding) for 694 academic cardiothoracic surgeons practicing at 56 premiere US institutions.

Results

Excluding missing data, 464 (75 %) surgeons took DTR and 156 (25 %) did not; 629 (91 %) were MD only and 65 (9 %) also had a PhD. DTR was associated with higher number of ongoing publications (~5.6/year vs. ~3.8/year), with no difference for accrued number of total citations. History of DTR was more prevalent among surgeons with versus without NIH funding (87 vs. 71 %; p < 0.001), but no difference was seen across academic ranks and among those who were division/department chiefs. No overall increase in publications/citations, academic rank advancement, NIH funding, or leadership roles was found for those with a PhD.

Conclusions

Among cardiothoracic surgeons, devoting time during the training years exclusively to research might be associated with higher career-long academic productivity in terms of annual number new publications and ability to get NIH funding, but without significant impact in terms of academic rank or institutional role advancement. No significant difference was found between those with versus without a PhD in terms of career-long number of publications/citations, academic rank, NIH funding, or leadership role, even though sample size might have been insufficient to identify any such potential difference.

     

The Impact of Arthroplasty Fellowship Training on Total Joint Arthroplasty: Comparison of Peri-Operative Metrics between Fellowship-Trained Surgeons and Non-Fellowship-Trained Surgeons

BackgroundWe sought to identify differences between total joint arthroplasties (TJAs) performed by adult reconstruction fellowship-trained surgeons (FT) than non-fellowship-trained surgeons (NFT).MethodsA single-institution database was utilized to identify patients who underwent elective TJA between 2016 and 2019.ResultsIn total, 16,882 TJAs were identified: 9111 total hip arthroplasties (THAs) and 7771 total knee arthroplasties (TKAs). Patients undergoing THA by FT surgeons were older (63.11 vs 61.84 years, P < .001), more likely to be white, insured by Medicare, and less likely to be active smokers (P < .0001). Both surgical time (90.03 vs 113.1 minutes, P < .0001) and mean length of stay (LOS) (1.85 vs 2.72 days, P < .0001) were significantly shorter for THAs performed by FT surgeons than NFT surgeons. A significantly greater percentage of patients were discharged home after THA by FT surgeons than NFT surgeons (88.7% vs 85.2%, P = .002). FT patients were quicker to mobilize with therapy and required 25% less opioids. TKAs performed by FT surgeons were associated with shorter surgical times (87.4 vs 94.92 minutes, P < .0001), LOS (2.62 vs 2.84 days, P < .0001), and nearly 19% less opioid requirement in the peri-operative period. In addition to higher Activity Measure for Post-Acute Care scores associated with FT surgeons after TKA, a significantly greater percentage of patients were discharged home after TKA by FT surgeons than NFT surgeons (83.97% vs 80.16%, P < .001).ConclusionFor both THA and TKA, patients had significantly shorter surgical times, LOS, and required less opioids when their procedure was performed by FT surgeons compared to NTF surgeons. Patients who had their TJA performed by a FT surgeon achieved higher Activity Measure for Post-Acute Care scores and were discharged home more often than NFT surgeons. In an era of value-based care, more attention should be paid to the patient outcomes and financial implications associated with arthroplasty fellowship training.Level III EvidenceRetrospective Cohort Study.     

Scholarly Productivity Among Academic Foot and Ankle Surgeons Affiliated With US Podiatric Medicine and Surgery Residency and Fellowship Training Programs

Foot and ankle surgeons practicing within academic medicine balance clinical or surgical training, course instruction, administrative duties, and research. Along with clinical skills and patient volume, promotion within academia often relies on scholarly productivity. Previous research across specialties described this productivity using variables including publications, citations, and the h-index, a scale that quantifies the productivity and citation impact of published works, among academic ranks. As no studies examine the scholarly impact of foot and ankle surgeons with academic appointments, this study aimed to analyze the productivity and gender differences present in this specialty. A systematic review of academic-affiliated foot and ankle surgery residencies and fellowships was performed; and faculty members were screened for sex, academic rank, publication history, citations, h-index, and years in practice. Among 234 programs reviewed, 44 programs allowed for the analysis of 106 practitioners with an academic rank eligible for analysis. Overall, 78.3% of practitioners were male with the most common rank being assistant professor. Men published more documents and maintained higher citations as well as longer years in practice, and this was significant (p < .05). A significant difference was exhibited among all academic ranks (p ≤ .001). Multivariate regression revealed the publication history and years in practice are strongly correlated with the h-index of providers (p ≤ .001). Foot and ankle surgeons practicing in an academic setting may use the results of this study to gauge their productivity and identify benchmarks that similar providers have met at varying academic ranks.     

Impact of advanced clinical fellowship training on future research productivity and career advancement in adult cardiac surgery

BackgroundAdvanced clinical fellowships are important for training surgeons with a niche expertise. Whether this additional training impacts future academic achievement, however, remains unknown. Here, we investigated the impact of advanced fellowship training on research productivity and career advancement among active, academic cardiac surgeons. We hypothesized that advanced fellowships do not significantly boost future academic achievement.MethodsUsing online sources (eg, department webpages, CTSNet, Scopus, Grantome), we studied adult cardiac surgeons who are current faculty at accredited United States cardiothoracic surgery training programs, and who have practiced only at United States academic centers since 1986 (n = 227). Publicly available data regarding career advancement, research productivity, and grant funding were collected. Data are expressed as counts or medians.ResultsIn our study, 78 (34.4%) surgeons completed an advanced clinical fellowship, and 149 (65.6%) did not. Surgeons who pursued an advanced fellowship spent more time focused on surgical training (P < .0001), and those who did not were more likely to have completed a dedicated research fellowship (P = .0482). Both groups exhibited similar cumulative total publications (P = .6862), H-index (P = .6232), frequency of National Institutes of Health grant funding (P = .8708), and time to achieve full professor rank (P = .7099). After stratification by current academic rank, or by whether surgeons pursued a dedicated research fellowship, completion of an advanced clinical fellowship was not associated with increased research productivity or accelerated career advancement.ConclusionAcademic adult cardiac surgeons who pursue advanced clinical fellowships exhibit similar research productivity and similar career advancement as those who do not pursue additional clinical training.     

Academic Surgical Oncologists’ Productivity Correlates with Gender,Grant Funding,and Institutional NCI Comprehensive Cancer Center Affiliation

Background

A scholar’s h-index is defined as the number of h papers published, each of which has been cited at least h times. We hypothesized that the h-index strongly correlates with the academic rank of surgical oncologists.

Methods

We utilized the National Cancer Institute (NCI) website to identify NCI-designated Comprehensive Cancer Centers (CCC) and Doximity to identify the 50 highest-ranked general surgery residency programs with surgical oncology divisions. Demographic data of respective academic surgical oncologists were collected from departmental websites and Grantome. Bibliometric data were obtained from Web of Science.

Results

We identified 544 surgical oncologists from 64 programs. Increased h-index was associated with academic rank (p?<?0.001), male gender (p?<?0.001), number of National Institutes of Health (NIH) grants (p?<?0.001), and affiliation with an NCI CCC (p?=?0.018) but not number of additional degrees (p?=?0.661) or Doximity ranking (p?=?0.102). H-index was a stronger predictor of academic rank (r?=?0.648) than total publications (r?=?0.585) or citations (r?=?0.450).

Conclusions

This is the first report to assess the h-index within academic surgical oncology. H-index is a bibliometric predictor of academic rank that correlates with NIH grant funding and NCI CCC affiliation. We also highlight a previously unexpected and unappreciated gender disparity in the academic productivity of US surgical oncologists. When academic rank was accounted for, female surgical oncologists had lower h-indices compared with their male colleagues. Evaluation of the etiologies of this gender disparity is needed to address barriers to academic productivity faced by female surgical oncologists as they progress through their careers.

     

Formal research training during surgical residency: scaffolding for academic success

BackgroundThe purpose of this study was to determine the impact of a formal surgical research program (leading to a postgraduate degree) during residency, on future research productivity.MethodsWe surveyed all North American graduates of the McGill University general surgery residency program between 1987 and 2005. The survey included questions on research involvement before, during, and after general surgery residency. This was combined with a literature search revealing all research publications of the participants. Outcomes were the yearly average of publications and awarded funding as faculty members.ResultsSeventy-five of 119 graduates (63%) responded. Staff physicians who had participated in formal research programs during residency (n = 35), compared with those who had not (n = 40), produced more publications per year (2.8 ± 2.3 vs 1.1 ± 1.2, P < .01) and had greater funding success (81% vs 55%, P = .03).ConclusionsResidents who had participated in formal research programs during residency were more likely to have greater academic success.     

Observational study of complex abdominal wall reconstruction using porcine dermal matrix: How have outcomes changed over 14 years?

BackgroundOur center has adopted many evidence-based practices to improve outcomes for complex abdominal wall reconstruction with porcine dermal matrix. This study analyzed outcomes over time using porcine dermal matrix in complex abdominal wall reconstruction.MethodsProspective, tertiary hernia center data was examined for patients undergoing complex abdominal wall reconstruction with porcine dermal matrix. Early (2008–2014) and Recent (2015–2021) cohorts were defined by dividing the study interval in half. Multivariable analyses of wound complications and recurrence were performed.ResultsComparing 117 Early vs 245 Recent patients, both groups had high rates of previously repaired hernias (76.1% vs 67.4%; P = .110), Centers for Disease Control and Prevention class 3 or 4 wounds (76.0% vs 66.6%; P = .002), and very large hernia defects (320 ± 317 vs 282 ± 164 cm²; P = .640). Recent patients had higher rates of preoperative botulinum injection (0% vs 21.2%; P < .001), posterior component separation (15.4% vs 35.5%; P < .001), and delayed primary closure (23.1% vs 38.8%; P < .001), but lower rates of concurrent panniculectomy (32.3% vs 27.8%; P = .027) and similar anterior component separation (29.1% vs 18.2%; P = .060). Most mesh was placed preperitoneal (74.4% vs 93.3%; P < .001). Recent patients had less inlay (9.4% vs 2.1%; P < .01) and other mesh locations as fascial closure rate increased (88.0% vs 95.5%; P < .001). Over time, there was a decrease in wound complications (42.1% vs 14.3%; P < .001), length of stay (median [interquartile range]:8 [6–13] vs 7 [6–9]; P = .003), and 30-day readmissions (32.7% vs 10.3%; P < .001). Hernia recurrence decreased (10.3% vs 3.7%; P = .016) with mean follow-up of 2.8 ± 3.2 and 1.7 ± 1.7 years, respectively.Respective multivariable models(odds ratio, 95% confidence interval) demonstrated an increased risk of wound complications with diabetes (2.65, 1.16–5.98; P = .020), panniculectomy (2.63, 1.21–5.73; P = .014), and anterior component separation (5.1, 1.98–12.9; P < .001), with recurrence risk increased by wound complication (3.8, 1.4-2-7.62; P = .032).ConclusionPorcine dermal matrix in complex abdominal wall reconstruction performs well with low recurrence rates. Internal assessment and implementation of evidence-based practices improved outcomes such as length of stay, wound complications, and recurrence rate.     

Increased Patient-Level Payment After Removal of Total Knee Arthroplasty From the Inpatient-Only List

BackgroundIn January 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the Inpatient Only (IPO) list. This study aimed to compare patient-level payments in TKA cases with a length of stay (LOS) <2 midnights before and after removal of TKA from IPO list.MethodsIn this retrospective cohort study, all Medicare patients who received a primary elective TKA from 2016-2019 with a LOS <2 midnights at an academic tertiary center were identified. Total and itemized charges and patient-level payments were compared between eligible TKA cases performed in 2016-2017 and those in 2018-2019. There were 351 eligible TKA cases identified: 151 in 2016-2017 and 200 in 2018-2019.ResultsThe percentage of patients making any out-of-pocket payment increased in 2018-2019 from 2016-2017 (51.0% versus 10.6%), as did median patient-level payment ($7.30 [range, $0.00-$3,389] versus $0.00 [range, $0.00-$1,248], P < .001 for both). A greater proportion of patients in 2018-2019 paid $1-$50 than in 2016-2017 (37.5% versus 1.3%, P < .001) with no change in the proportion of patients who made payments >$50. Total charges were less in 2018-2019 than in 2016-2017 (P = .001). Charges for drugs, laboratory tests, admissions/floor, and therapies decreased in 2018-2019, whereas charges for the operating room and radiology increased (P < .001 for all).ConclusionPatients receiving outpatient TKA in 2018-2019 were more likely to have out-of-pocket payments than patients with comparable hospital stay who were designated as inpatients, although most of these payments were less than $50.     

Pathologic Versus Native Hip Fractures: Comparing 30-day Mortality and Short-term Complication Profiles

BackgroundA large body of research on native hip fractures has resulted in several evidence-based guidelines aimed at improving postsurgical care for these patients. In contrast, there is a paucity of data on pathologic hip fractures, and whether native hip fracture protocols are generalizable to this population is unknown. The purpose of this study was to compare mortality rates and complication profiles between patients with pathologic and native hip fractures.MethodsUsing the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database, we identified patients who underwent surgical treatment for pathologic and native hip fractures from 2007 to 2017 and 2601 matched pairs were identified using propensity scoring. Baseline covariates were controlled for, and rates of 30-day postoperative complications and mortality were compared using McNemar’s test.ResultsPathologic hip fracture patients experienced significantly higher rates of death (6.3% vs 4.3%, P < .001), serious adverse events (17.3% vs 13.5%, P < .001), minor complications (34.3% vs 29.1%, P < .001), extended postoperative lengths of stay (30.2% vs 25.9%, P < .001), readmissions (11.9% vs 8.4%, P < .001), thromboembolic complications (3.0% vs 1.6%, P < .001), and perioperative transfusions (31.5% vs 26.4%, P < .001) compared to native hip fracture patients.ConclusionPathologic hip fractures result in significantly higher complication rates than native hip fractures after surgical treatment, suggesting that guidelines for native hip fractures may not be generalizable for pathologic hip fractures. Orthopedic surgeons should closely monitor these patients for deep vein thrombosis, utilize blood sparing techniques, and employ a multidisciplinary approach to help manage and prevent a more heterogenous profile of postsurgical complications.     

Factors associated with grip strength among adolescents: An observational study

Study DesignCross-sectional.IntroductionThe muscle strength has been studied in different populations in relation with individual and other factors.Purpose of the StudyThe purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance.MethodsA total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer.ResultsBoys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men.ConclusionsSex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.     

Complications Following Total Hip Arthroplasty: A Nationwide Database Study Comparing Elective vs Hip Fracture Cases

BackgroundThe changing evaluation of provider metrics and payments in total hip arthroplasty (THA) necessitates current information for leaders in advocacy and policy. This study aims to use a contemporary nationwide cohort to compare and quantify the differences between the preoperative profile and clinical outcomes of THA performed for elective indications and for femoral neck fractures.MethodsPatient records from 2007 to 2017 were queried from an administrative claims database of privately insured patients comparing THA performed for femoral neck fractures vs elective indications. Ninety-day readmission rates as well as in-hospital and 90-day postdischarge rates of local and systemic complications were collected and compared with multivariate logistic regression.ResultsOf 83,319 primary THAs, 6895 (8.3%) were fracture cases and 76,424 (91.7%) were elective. A greater proportion of fracture patients were older, female, not obese, and had a higher burden of comorbidities (all P < .001). Fracture patients had significantly higher average lengths of stay and complication rates for all perioperative and postoperative joint and systemic complications measured (all P < .001) as well as 90-day cost (32,228 vs 22,917 USD, P < .001).ConclusionFracture patients are inherently more difficult cases to manage as surgeons. The results of these data may have significance in improving care coordination and provide evidence for further risk adjustment in payment models. Leaders in advocacy and policy should consider patient-level risk adjustments within alternative payment models to account for the increased association of complications, length of stay, readmission rate, and comorbidities in fracture patients receiving THA compared to elective patients.     

Oncology Patients Are High Cost Outliers in Total Joint Replacement Bundled Payment Systems

BackgroundIn 2016, the Centers for Medicare and Medicaid Services began its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, which covers a 90-day episode of care. This study determined whether oncology patients enrolled in the CJR bundle incur higher hospital costs than patients with osteoarthritis (OA).MethodsA retrospective review of all patients enrolled in the CJR bundled payments system from April 1, 2016 to June 31, 2018 at a single academic medical center was conducted. To determine whether tumor patients had higher total episode costs, this group was compared to patients diagnosed with OA using a 2-tailed t-test. To adjust for moderators of total hospital costs, we used generalized linear regression with a log-link, including multiple variables abstracted from chart review.ResultsThree hundred fourteen patients met inclusion criteria (12 primary or metastatic tumors, 302 OA). Fifty-eight percent of tumor patients were over the target price vs 16% of OA patients. The mean tumor patient had $40,862 for total internal hospital costs compared to $16,356 in the OA group (P < .001). Length of stay was greater in the tumor group (6.75 vs 2.0 days, P < .001). A greater percentage of tumor patients were discharged to a skilled nursing facility (67% vs 27%, P = .006) with significantly higher skilled nursing facility episode costs ($18,852 vs $7731, P = .04). With adjustment for fracture status, tumor patients were 5.36 times more likely to exceed the CJR target price than OA patients (risk ratio 5.36, confidence interval 3.44-8.35, P < .001) and 50 times more likely to be outliers over the regional threshold than OA patients (risk ratio 50.33, confidence interval 16.33-155.19, P < .001).ConclusionOncology patients enrolled in the CJR bundled payment model incur significantly higher costs and have higher cost variability than patients with OA. We recommend that oncology patients be excluded from the CJR bundle.     

Surgical mentors' and mentees' productivity from 1993 to 2006

Background

Mentorship in academic surgery is reflected in part by senior surgeon support of younger individuals with their scholarly contributions to the literature. Scholarship is also reflected in the procurement of extramural funding. This study sought to quantify this process in recent years.

Study design

All active American Surgical Association and Society of University Surgeons members in the following 2 eras were defined as being mentors (N = 559): 1993 to 1999 (I) and 2000 to 2006 (II). Mentees (N = 7,037) were defined as a primary author associated with the mentor. MEDLINE-cited papers of mentors and mentees were abstracted. Randomly selected mentees from era I and II were examined for academic productivity. The National Institutes of Health (NIH) Computer Retrieval of Information on Scientific Projects database was queried for federal research funding for the mentors and mentees. Continuous categoric and logistical regression was used as appropriate.

Results

Combining both eras, mentors published a total of 23,558 articles, of which 3,854 were primary and 9,881 were senior authored. Mentor primary-authored papers were more common in era I than era II (mean = 8 vs 6 articles, P < .01), whereas the number of senior-authored papers was similar in both eras (mean = 18 vs 17 papers, P = .09). Fewer mentors had federal funding in era I compared with era II (42% vs 51%, P = .04). More mentees per mentor existed in era I compared with era II (15 ± 5 vs 9 ± 4, P < .001). Era I mentees examined in era II (n = 187) were primary and senior author of a mean of 2.5 and 5 articles, respectively. Of this group, 14 (7.5%) had federal funding. The number of primary- and senior-authored articles from the mentee but not their prior mentor correlated with federal funding (P < .05).

Conclusions

The number of mentees per mentor has decreased in recent years as has primary-authored authors, whereas federal funding has increased for mentors. Overall NIH funding for mentees was low but is related to their productivity with the mentor.     

Procedure Duration,Time Under Anesthesia,and Readmissions in Direct Anterior and Posterior Approach Total Hip Arthroplasty

BackgroundOperative time is related to complications in primary total hip arthroplasty (THA). This study compared operative time in direct anterior (DA) and posterior approach THA and whether differences were related to increased hospital readmissions within 90 days of discharge.MethodsProspectively documented data on 3,152 consecutively performed THAs by 16 surgeons at a large Midwestern United States academic healthcare system were retrospectively reviewed. All surgeons were beyond their learning curve. Cases characterized by factors extending operative time were excluded. A total of 1,235 analysis cases were performed with the DA approach and 1,608 with the posterior approach. DA patients had lower mean body mass index (P < .001), were more likely to be classified as American Society of Anesthesiologists Physical Status 1 or 2 (P < .001), and more likely to have surgery in an ambulatory setting (P < .001).ResultsTime under anesthesia was significantly longer for DA procedures by 19 to 27 minutes in hospital and ambulatory settings, respectively (P < .001). Increasing body mass index had a greater impact on anesthesia time for DA patients (P = .020). There were no differences in nontraumatic readmissions within 90 days of surgery based on surgical approach (P ≥ .480); however, significantly more DA patients classified as ASA-PS 3 or 4 were readmitted compared to those classified as ASA-PS 1 or 2 (P < .001), a difference not observed for posterior approach patients.ConclusionAnesthesia time is a modifiable risk factor for patient safety and an important factor in healthcare resource utilization. Consideration of ways to reduce DA operative times is encouraged.     

Outcomes of Mitral Valve Repair Among High- and Low-Volume Surgeons Within a High-Volume Institution

BackgroundVolume-outcome relationships have been described for mitral valve repair at the institution and surgeon level. We aimed to assess whether this relationship is mitigated at high-volume (HV) mitral repair centers between HV and low-volume (LV) surgeons.MethodsAll mitral repair cases at an HV mitral center (mean, 192 annual repairs) from 1992 to 2018 were considered. Cases with concomitant procedures other than tricuspid and atrial fibrillation procedures were excluded. Surgeons who performed ≥25 repairs per year were considered HV. The primary outcome was operative mortality; secondary outcomes were operative complications, long-term mortality, and reoperation.ResultsIn total, 2653 mitral repairs from 19 surgeons were included. The mean age of the patients in the HV and LV groups was 59.6 years and 61.8 years, respectively (P = .005), with no difference in other baseline characteristics. HV surgeons had significantly shorter median aortic cross-clamp times (80 vs 87 minutes; P < .001) compared with LV surgeons; however, there was no significant difference in operative mortality (0.9% vs 1.6%; P = .19), reoperation, perioperative complications, or length of stay. LV surgeons had higher repair conversion to replacement than HV surgeons did (9.0% vs 3.4%; P < .001). In the risk-adjusted analyses, surgeon volume group did not have an impact on longitudinal survival or reoperation.ConclusionsAt an HV mitral repair institution, LV surgeons appear to have short- and long-term outcomes similar to those of HV surgeons despite increased conversion rates. These findings suggest that institutional volume may mitigate the surgeon volume outcome. However, complex repairs may benefit from referral to HV surgeons, given the lower conversion rate.