Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States:An analysis of geographical distribution,academic,leadership,and demographic characteristics

BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.

Surgeon Perspectives on Anastomotic Leaks and FluidAI’s StreamTM Platform: Integrating Qualitative Insights for Technological Innovation

Purpose: This article investigates the critical importance of integrating surgeons’ direct input into the development of innovative technologies that address gaps in surgical care, including those aimed at reducing anastomotic leaks (AL), a major complication in gastrointestinal surgery. While traditional quantitative research methods are prevalent, they often overlook the invaluable insights of the surgeons who manage these complications firsthand. Subjects and Methods: This study employs a qualitative approach, utilizing semi-structured interviews with 40 surgeons from various specialties, including general, bariatric, colorectal, trauma, hepato-biliary, and thoracic surgery. The interviews were designed to probe the needs of surgeons, challenges currently faced, and gaps in clinical practice, research, and technology for detection and/or management of AL. The data were analyzed using thematic analysis, which revealed significant gaps in current technologies for early detection and prevention of leaks. Results: Surgeons expressed strong interest in FluidAI’s Stream™ Platform, a non-invasive medical device designed to monitor postoperative drainage fluid in real-time, providing continuous data on AL risk. The ability of this platform to offer early prediction through pH and electrical conductivity analysis was particularly appealing to participants, who emphasized the importance of timely interventions in improving patient outcomes. The study’s findings highlight not only the clinical challenges but also the emotional toll that AL takes on surgeons, underlining the need for innovations that are both data-driven and humanistic. Conclusion: By centering surgeons’ perspectives, this research advocates for a human-centered approach to technological advancement, ensuring that new tools are both clinically effective and aligned with the real-world needs of surgical practitioners.

Hans G.Beger:one of the most renowned general and gastrointestinal surgeons in Germany

Professor Beger is one of the most renowned general and gastrointestinal surgeons in Germany.His worldwide reputation is based on his expertise in surgery of the pancreas.He belongs to the group of the 100most cited surgeons worldwide.

Artificial intelligence awareness and perceptions among pediatric orthopedic surgeons:A cross-sectional observational study

BACKGROUND Artificial intelligence(AI)is a branch of computer science that allows machines to analyze large datasets,learn from patterns,and perform tasks that would otherwise require human intelligence and supervision.It is an emerging tool in pediatric orthopedic surgery,with various promising applications.An evaluation of the current awareness and perceptions among pediatric orthopedic surgeons is necessary to facilitate AI utilization and highlight possible areas of concern.AIM To assess the awareness and perceptions of AI among pediatric orthopedic surgeons.METHODS This cross-sectional observational study was conducted using a structured questionnaire designed using QuestionPro online survey software to collect quantitative and qualitative data.One hundred and twenty-eight pediatric orthopedic surgeons affiliated with two groups:Pediatric Orthopedic Chapter of Saudi Orthopedics Association and Middle East Pediatric Orthopedic Society in Gulf Cooperation Council Countries were surveyed.RESULTS The pediatric orthopedic surgeons surveyed had a low level of familiarity with AI,with more than 60%of respondents rating themselves as being slightly familiar or not at all familiar.The most positively rated aspect of AI applications for pediatric orthopedic surgery was their ability to save time and enhance productivity,with 61.97%agreeing or strongly agreeing,and only 4.23%disagreeing or strongly disagreeing.Our participants also placed a high priority on patient privacy and data security,with over 90%rating them as quite important or highly important.Additional bivariate analyses suggested that physicians with a higher awareness of AI also have a more positive perception.CONCLUSION Our study highlights a lack of familiarity among pediatric orthopedic surgeons towards AI,and suggests a need for enhanced education and regulatory frameworks to ensure the safe adoption of AI.

Entry-Level Forward Surgical Team Training Is Associated with Increased Confidence of Primary Combat Surgeons

Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.

Recording the direct surgeon’s view with an operating microscopic view improves microscopic ophthalmic surgery training

AIM:To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope,which lacks information on the movement and position of the surgeon’s hands,and to facilitate the reproduction of a skilled surgeon’s technique by a surgeon in training.METHODS:A small camera was attached to the operating microscope with a custom adapter.Microscopic surgeon’s view and direct surgeon’s view through this new camera were recorded in the surgical recording system.Both movies were synchronized and analyzed how do surgeons handle the instruments.RESULTS:A small camera attached to the operating microscope allowed the surgeon’s hands motion to be recorded without interfering with the surgeon’s movements.Different surgeons used different methods to manipulate the ultrasound handpiece and the irrigation/aspiration device.Even in the simple paracentesis procedure,different surgeons used different methods.Surgeons-in-training were able to identify and improve their weaknesses by watching synchronized movies of their hand motions and microscopic view.CONCLUSION:Simultaneous recording the surgical field out of the operating microscopic view by a small camera set on the microscope is comprehensive and improves surgeons-in-training understanding and learning surgeries.

Urinary tract injury during hysterectomy:Does surgeon specialty and surgical volume matter?

BACKGROUND Ureteral injury is a known complication of hysterectomies.Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies.Some studies have reported that as surgeon volume increases,urinary tract injury rates decrease.To our knowledge,no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy.AIM To determine the incidence of urinary tract injury between urogynecologists,gynecologic oncologists,and general gynecologists.METHODS The study took place from January 1,2016 to December 1,2021 at a large comm-unity hospital in Detroit,Michigan.We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy.After we identified eligible patients,the surgeon subspecialty was identified and the surgeon’s volume per year was calculated.Patient demographics,medical history,physician-dictated operative reports,and all hospital visits postoperatively were reviewed.RESULTS Urologic injury occurred in four patients(2%)in the general gynecologist group,in one patient(1%)in the gynecologic oncologist group,and in one patient(1%)in the urogynecologist group.When comparing high and low-volume surgeons,there was no statistically significant difference in urinary tract injury(1%vs 2%)or bowel injury(1%vs 0%).There were more complications in the low-volume group vs the high-volume group excluding urinary tract,bowel,or major vessel injury.High-volume surgeons had four(1%)patients with a complication and low-volume surgeons had 12(4%)patients with a complication(P=0.04).CONCLUSION Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists,however our study was underpowered.

外科医生的职业风险感知及其与自我效能感的关系研究

目的调查苏州市某三甲医院外科医生的职业风险感知并探讨其与自我效能感的关系,为促进医生心理健康提供建议。方法设计测量外科医生职业风险感知量表,采用因子分析、相关分析及回归分析等方法对收集的194份有效问卷进行分析。结果外科医生职业风险感知包括6个纬度:身体功能风险、经济风险、职业暴露风险、组织风险、时间风险以及社会心理风险,年龄、学历、职称和工作时长均是职业风险感知的影响因素,外科医生的职业风险感知与自我效能感显著负相关。结论量表具有较高的信效度,外科医生的职业风险感知水平较高,可以通过提高自我效能感来降低职业风险感知对医生的负面影响。

提高神经外科专培医师手术基本功的教学探讨

神经外科专科医师规范化培训(简称"专培")是毕业后教育的重要组成部分,旨在培养可独立诊治神经外科疾病的专科医师.为提高专培医师的手术基本功,郑大一附院神经外科专培基地精心设置培训课程,注重显微神经解剖训练,加强手术全程带教,全方位提升专培医师的手术操作技能.专培医师在临床与手术实践中不断总结经验,由量变产生质变,手术基本功不断提升,最终成为一名合格的、优秀的神经外科专科医师.

Intraocular lens exchange or explantation post cataract surgery

AIM:To report incidence,indications,and visual outcomes of intraocular lens(IOL)exchange/explantation surgery.METHODS:Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1^(st) January 2017 and 31^(st) December 2022.The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed.RESULTS:Out of 39778 cataract surgeries(with no preexisting ocular co-morbidities)during a six-year period(2017-2022),60(0.15%)needed IOL exchange/explantation.Surgeons-under-training performed 36/60 cases(60%)while 24/60(40%)were by experienced surgeons.The commonest indication was subluxated IOL in 26(43.3%),followed by dislocated IOL in 20(33.3%),postoperative refractive surprise in 7(11.6%),IOL induced uveitis in five and broken haptic in two eyes.Twenty-four(40%)eyes had intraoperative complications during primary surgery.Posterior chamber IOL(PCIOL)was the commonest secondary IOL in 21(35%)eyes,scleral fixated in 20(31.6%),anterior chamber IOL(ACIOL)in 13(21.6%),iris fixated IOL in three(5%)and three eyes(5%)were left aphakic.The mean time between primary and secondary surgery was 168d(168±338.8).Best corrected visual acuity(BCVA)of>20/60 was obtained in 43 eyes(71.66%),20/80-20/200 in 14(23.33%),20/250 in two and hand movements in one.No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons(UCVA 0.45±0.29 vs 0.53±0.32,P=0.20,BCVA 0.34±0.25 vs 0.37±0.26,P=0.69).CONCLUSION:IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor.This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

Nerves of Steel,Heart of Gold

The unwavering commitment of a Chinese neurosurgeon on African soil.Wang Xingwen,a 49-year-old neurosurgeon at the Xuanwu Hospital affiliated to Capital Medical University,is completing the final operation of the Year of the Rabbit.He must ensure his patient is in a stable post-operative state before he can purchase his train ticket to join his family in Shandong Province for the Lunar New Year.Due to his demanding career over the last 24 years,Wang has become accustomed to solitude during important festivities.

心血管外科专科医师规范化培训实施的探讨

作为专科医师规范化培训体系中一个重要组成部分,心血管外科专科医师规范化培训为我国心血管外科专业人才的培养做出了极其重要的贡献。文章通过总结科室及医院多年住培教学经验,针对心血管外科学科专业性强、实践动手能力要求高的特点,创新性地建立了科学健全、灵活规范、切实有效的心血管外科专科医师培训制度和培养模式。具体措施包括:导师负责制、心血管外科专科医师学分制管理、多种教学方式融合教学法、流程化培训、定期师生考核等方法及方式。通过对住院医师在心血管外科专业的理论和技能两方面的培训以提高住院医师的受训效果。新的培训制度和培养模式明显提高了心血管外科专科医师的培训质量,同时可以为即将到来的“5+3+X”模式的临床医学人才培养提供理论及实践基础。

Magnetic resonance imaging in rectal cancer:A surgeon's perspective

Magnetic resonance imaging(MRI)in rectal cancer was first investigated in 1999 and has become almost mandatory in planning rectal cancer treatment.MRI has a high accuracy in predicting circumferential resection margin involvement and is used to plan neoadjuvant therapy.The accuracy of MRI in assessing mesorectal lymph nodes remains moderate,as there are no reliable criteria to assess nodal involvement.MRI seems to be good in assessing peritoneal involvement in upper rectal cancer;this however has been assessed in only a few studies and needs further research.For low rectal cancers,mesorectum is thin at the level of levator ani especially in relation to prostate;so predicting circumferential resection margin involvement is not easy.However high spatial resolution coronal imaging shows levator muscles,sphincter complex and intersphincteric plane accurately.This is used to stage low rectal tumors and plan plane of surgery(standard surgery,intersphincteric resection,Extralevator abdominoperineal resection).While most centres perform MRI post chemoradiotherapy,its role in accurate staging post neoadjuvant therapy remains debatable.THe role of Diffusion weighted MRI post neoadjuvant therapy is being evaluated in research settings.

Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists

Objective： To compare the numbers of positive and total lymph nodes and prognosis in gastric cancer patients whose perigastric lymph node retrieval was performed by surgeons and pathologists. Methods： We conducted a retrospective analysis of clinical and follow-up data from 1,056 patients who underwent gastric cancer D2 radical lymph node resection between January 2008 and December 2010 in the Gastrointestinal Surgery Department of Yantai Yuhuangding Hospital. The follow-up ended in December 2015. Patients were divided into two groups according to the specialty of physicians who performed the postoperative perigastric lymph node retrieval： the surgeon group （475 cases） and the pathologist group （581 cases）. The numbers of positive and total perigastric lymph nodes and the 3- and 5-year survival were compared between gastric cancer patients in the two groups overall and stratified by TNM stage （AJCC 7th Edition）. Results： Overall, the numbers of positive and total lymph nodes were significantly higher in the surgeon group than in the pathologist group （6.53±4.07 vs. 4.09±3.70, P=0.021; 29.64±11.50 vs. 20.71±8.56, P〈0.001）. Further analysis showed that the total number of lymph nodes in stage Ⅰ patients （19.40±9.62 vs. 15.45±8.59, P=0.011） and the numbers of positive and total lymph nodes in stage Ⅱ（1.38±1.08 vs. 0.87±1.55, P=0.031; 25.35±10.80 vs. 16.75±8.56, P〈0.001） and stage Ⅲ patients （8.11±6.91 vs. 6.66±5.12, P=0.026; 32.34±12.55 vs. 25.45±8.31, P〈0.001） were significantly higher in the surgeon group than in the pathologist group. The survival analysis showed that the 3- and 5-year survival of stage Ⅱ and Ⅲ patients was significantly higher in the surgeon group than in the pathologist group （82.0% vs. 73.1%, 69.5% vs. 61.2%, P=0.038; 49.2% vs. 38.9%, 36.3% vs. 28.0%; P=0.045）. Conclusions： Compared with retrieval performed by pathologists, postoperative perigastrie lymph node retrieval performed by surgeons was associated with significant increase in the total lymph node number of stage Ⅰ patients, the numbers of positive and total lymph nodes of stageⅡ and Ⅲ patients, and the survival of stageⅡ and stage Ⅱ gastric cancer patients.

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.

Gastric cancer:Where is the place for the surgeon,the oncologist and the endoscopist today?

Gastric cancer remains a major health issue and a leading cause of death worldwide.While the incidence is decreasing in western countries,there has been a shift to more proximal cancers of the diffuse type,which are usually more aggressive and associated with a worse prognosis.Radical surgery still offers the only chance of long term survival,but surgery has reached a plateau of effectiveness and more aggressive approaches like"ultraradical" lymphadenectomy have not improved prognosis.There are three options to improve the situation:Earlier detection,neoadjuvant chemotherapy and adjuvant therapy.Whilst systematic gastroscopic screening makes sense in countries with a high incidence of gastric cancer,in other regions targeted investigation of risk groups including first-degree relatives of cancer patients,patients with a chronic corpusdominant gastritis or with defined genetic abnormalities may help to detect cancer at an earlier stage.Neoadjuvant chemotherapy has meanwhile proved to significantly improve the prognosis not only in patients with a locally advanced cancer who cannot be resected for cure but but also in those who are potentially amenable to curative resection.In the largest randomised study so far reported,perioperative chemotherapy raised overall survival after 5 years from 23%to 36%.The role of adjuvant chemotherapy has been discussed for over 30 years.Meta-analyses demonstrate a small but significant effect which,however,seems to be restricted to Asian patients.In a large USstudy,adjuvant radiochemotherapy appeared to significantly improve outcomes.However,less than 50%of the study patients underwent a systematic lymphadenectomy and so the results of the therapy group were not better to those of"only resected"patients in two large European studies.Thus,the indication of adjuvant(radio-)chemotherapy in gastric cancer currently remains uncertain.Endoscopists have found a therapeutic role through endoscopic resection of early cancers,introduced mainly by Japanese authors.With the development of high resolution endoscopy,endosonography and adequate equipment,the endoscopic curative resection of T1a-tumors(restricted to the mucosal layer) has been established.

Evaluation of utility in shoulder pathology:Correlating the American Shoulder and Elbow Surgeons and Constant scores to the EuroQoL

AIM: To study whether health utility scores can be derived from shoulder-specific scores.METHODS: Authors investigated two questions:(1) do the American Shoulder and Elbow Surgeons(ASES) score and the Constant score correlate with the EuroQo L(EQ-5D), a measure of health utility?(2) can the ASES and Constant scores be obtained from a complete study sample without bias? Thirty subjects with various shoulder diagnoses completed ASES, Constant, and EQ-5D instruments. Pearson correlations were calculated to assess the associations between EQ-5D score and ASES and Constant scores.RESULTS: The correlation between EQ-5D score and ASES score was 0.60(P < 0.001); it was 0.54 for EQ-5D and Constant scores(P < 0.003). A multiple regression model containing ASES score, Constant score, age, and gender failed to adequately predict EQ-5D. Moreover, 25% of patients meeting the inclusion criteria did not complete the ASES questionnaire because they did not feel that specific questions, such as "do usual sport-list" and "throw ball overhand," applied to them.CONCLUSION: Authors' results do not support the use of the ASES and Constant scores in predicting EuroQ ol health utility values. However, the Constant score was more suitable for this patient population because all patients were able to complete it.

Prevalence and factors of work-related musculoskeletal disorders among hand surgeons

BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers,thus subjecting these surgeons to the risk of musculoskeletal(MSK)injuries during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among hand surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail.The collected data were analyzed using descriptive statistics,one-way analysis of variance,and Fisher’s exact test.P values of<0.05 were considered statistically significant.RESULTS Of the 578 respondents,60.4%reported that they had sustained a work-related MSK injury,of which the most common diagnoses were lateral elbow epicondylitis(18.7%),low back pain(17.1%)and carpal tunnel syndrome(15.6%).Among those that reported an injury,73.1%required treatment and 29.2%needed time off work as a direct result of their injury.The number of work-related injuries incurred by a surgeon increased significantly with increasing age(P<0.003),increasing years in practice(P<0.001)and higher case load(P<0.05).CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence.These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries,thus minimizing the financial and psychological burden on these surgeons and the healthcare system.

Hanging up the surgical cap:Assessing the competence of aging surgeons

BACKGROUND As the average age of surgeons continues to rise,determining when a surgeon should retire is an important public safety concern.AIM To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.METHODS We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety.The mandatory age and certification process,including cognitive and physical requirements,were reported for each profession.Methods for determining surgical competency currently in use,and those existing in the literature,were also identified.RESULTS Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified:Airline pilots,air traffic controllers,firefighters,and United States State Judges.Nine late career practitioner policies designed to evaluate the ageing physician,including surgeons,were described.Six of these policies included subjective performance testing,4 using peer assessment and 2 using dexterity testing.Six objective testing methods for evaluation of surgeon technical skill were identified in the literature.All were validated for surgical trainees.Only Objective Structured Assessment of Technical Skills(OSATS)was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.CONCLUSION A surgeon should not be forced to hang up his/her surgical cap at a predetermined age,but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency.The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons’surgical competency,showing who may require remediation or retirement.