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Primary Surgeon (primary + surgeon)
Selected AbstractsMeticillin-resistant Staphylococcus aureus in a veterinary orthopaedic referral hospital: staff nasal colonisation and incidence of clinical casesJOURNAL OF SMALL ANIMAL PRACTICE, Issue 4 2008C. L. McLean Objectives: To evaluate staff nasal colonisation with meticillin-resistant Staphylococcus aureus in a veterinary orthopaedic referral hospital, and its effect on the occurrence of meticillin-resistant Staphylococcus aureus -associated postoperative wound complications in orthopaedic and spinal surgical patients. Methods: Nasal bacterial swabs were collected from veterinary staff and environmental surfaces swabbed at six monthly intervals for meticillin-resistant Staphylococcus aureus monitoring over an 18 month period. The incidence of meticillin-resistant Staphylococcus aureus -associated postoperative wound complications of two veterinary orthopaedic surgeons was reviewed for a period when one was positive for nasal meticillin-resistant Staphylococcus aureus. Results: Meticillin-resistant Staphylococcus aureus was isolated from a maximum of two out of 10 staff on each occasion. The persistently infected clinician was primary surgeon in 180 cases, of which four developed meticillin-resistant Staphylococcus aureus -associated wound complications. None of 141 operations led by the other surgeon developed meticillin-resistant Staphylococcus aureus -associated complications. This difference is not statistically significant (P=0·0974). The 95 per cent confidence interval for this odds ratio was 0·83 to 44·0. Meticillin-resistant Staphylococcus aureus resistance patterns of the human nasal isolates and three of four wound-associated isolates were similar. Clinical Significance: Veterinary workers are at increased risk for meticillin-resistant Staphylococcus aureus colonisation, so it is likely that many veterinary patients are treated by meticillin-resistant Staphylococcus aureus -positive staff. Nasal colonisation of veterinary surgeons with meticillin-resistant Staphylococcus aureus appears to present only a small risk to their patients when appropriate infection control procedures are followed. [source] Program Directors' Opinions about Surgical Competency in Otolaryngology ResidentsTHE LARYNGOSCOPE, Issue 7 2005FRCSC, M M. Carr DDS Abstract Objectives: The purpose of this study was to determine whether certain surgical procedures could be used as benchmark skills to monitor resident progress in developing surgical competency. Study Design: Survey. Methods: A two-stage survey was sent to otolaryngology residency program directors in the United States. Respondents were given a list of otolaryngology surgical procedures monitored by the American Board of Otolaryngology (ABO) and were asked to indicate whether they felt residents should be able to do each as a primary surgeon. The appropriate level of training for competency in each procedure and estimated number of procedures to competency was indicated by respondents. Results: Respondents selected 16 common procedures they felt residents at different levels of training should be able to perform independently. There were discrepancies between estimated number of procedures needed for competence and the numbers reported by ABO graduates. Conclusions: Surgical skill is one aspect of clinical competency, and this indicates agreement among program directors with regard to a set of benchmark skills we can use for concentrated evaluation efforts. [source] Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study,ANAESTHESIA, Issue 8 2009M. J. Fredrickson Summary Little data exists regarding the frequency of neurological complications following ultrasound guided peripheral nerve blockade. Therefore, we studied single injection and continuous ultrasound guided interscalene, supraclavicular, infraclavicular, femoral and sciatic nerve blocks in patients undergoing orthopaedic extremity surgery. All patients were contacted during postoperative weeks 2,4 and questioned for numbness or altered sensation anywhere in the involved extremity, and pain or weakness unrelated to surgery. The presumed aetiology of symptoms was based on the collective agreement of principal investigator, primary surgeon and a neurologist. Multivariate analysis was performed for characteristics potentially important in the causation of neurological complications. Of 1010 consecutive blocks, successful follow up between weeks 2 and 4 occurred in 98.6%. New, all-cause, neurological symptoms were present in 56/690 blocks (8.2%) at day 10, 37/1010 (3.7%) at 1 month and 6/1010 (0.6%) at 6 months. Most symptoms were due to causes unrelated to the block. Of 452 patients directly questioned at the time of the block, new neurological symptoms were more common in patients who experienced procedure-induced paraesthesia (odds ratio = 1.7, p = 0.029). The postoperative neurological symptom rate in this series is very similar to those previously reported following traditional techniques. [source] Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider CaseloadTHE LARYNGOSCOPE, Issue 8 2003Fred G. Barker II Abstract Objectives/Hypothesis For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume,outcome relationship for surgical excision of acoustic neuromas. Study Design Retrospective cohort study. Methods The Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status. Results At 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four-level scale at hospital discharge: death (0.5%) and discharge to long-term care (1.2%), to short-term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher-volume hospitals (OR 0.47 for fivefold-larger caseload, P <.001) or by higher-volume surgeons (OR 0.46, P <.001). Of patients who had surgery at lowest-volume-quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest-volume-quartile hospitals. There was a trend toward lower mortality for higher-volume hospitals (P = .1) and surgeons (P = .06). Of patients who had surgery at lowest-caseload-quartile hospitals, 1.1% died, compared with 0.6% at highest-volume-quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high-volume hospitals and surgeons. Length of stay was significantly shorter with high-volume hospitals (P = .01) and surgeons (P = .009). Hospital charges were lower for high-volume hospitals (by 6% [P = .006]) and surgeons (by 6% [P = .09]). Conclusion For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges. [source] Randomised controlled trial of glove perforation in single and double-gloving methods in gynaecologic surgeryAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2002Ekachai Kovavisarach ABSTRACT Objective To assess the value of double-gloving in gynaecological surgery. Design A prospective randomised controlled trial of glove perforation in single- and double-gloving methods. Setting Rajavithi Hospital between 1 September 1999 to 31 August 2000. Sample Eighty-eight (88) and 82 primary surgeons were selected at random to make up single- and doublegloving groups, respectively, while performing total abdominal hysterectomy (TAH) with or without bilateral salpingo-oophorectomy (BSO). Methods The gloves were tested by immersion in water. Results The glove perforation rate was 6.09% and 22.73% in double-inner and single gloves, respectively, with this difference being statistically different (p < 0.05). There was no significant difference between the glove perforation rates in single gloves (22.73%) and in double-outer gloves (19.51%). There was matched perforation of the same finger of both outer and inner gloves in 1.22% of total double-inner gloves. Conclusions The double-gloving methods significantly reduced the risk of surgeons' hands contacting blood, when compared with the single-gloving method, in TAH with/or without BSO. [source] Glove perforations during open surgery for gynaecological malignanciesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2008AP Manjunath Objective, To audit glove perforations at laparotomies for gynaecological cancers. Setting, Gynaecological oncology unit, cancer centre, London. Design, Prospective audit. Sample, Twenty-nine laparotomies for gynaecological cancers over 3 months. Methods, Gloves used during laparotomies for gynaecological cancer were tested for perforations by the air inflation and water immersion technique. Parameters recorded were: type of procedure, localisation of perforation, type of gloves, seniority of surgeon, operation time and awareness of perforations. Main outcome measure, Glove perforation rate. Results, Perforations were found in gloves from 27/29 (93%) laparotomies. The perforation rate was 61/462 (13%) per glove. The perforation rate was three times higher when the duration of surgery was more than 5 hours. The perforation rate was 63% for primary surgeons, 54.5% for first assistant, 4.7% for second assistant and 40.5% for scrub nurses. Clinical fellows were at highest risk of injury (94%). Two-thirds of perforations were on the index finger or thumb. The glove on the nondominant hand had perforations in 54% of cases. In 50% of cases, the participants were not aware of the perforations. There were less inner glove perforations in double gloves compared with single gloves (5/139 versus 26/154; P = 0.0004, OR = 5.4, 95% CI 1.9,16.7). The indicator glove system failed to identify holes in 44% of cases. Conclusions, Glove perforations were found in most (93%) laparotomies for gynaecological malignancies. They are most common among clinical fellows, are often unnoticed and often not detected by the indicator glove system. [source] | ||||||||||