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.

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.

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.

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.

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.

Census report on Chinese urological surgeons

Objective:To grasp the general situation of Chinese urological surgeons and the status quo of their scientific research,work and training,thus providing valuable recommendations for urological talent team construction in future.Methods:The survey respondentswere the urological surgeons,who held the Certificate ofMedical Practitioner in the People’s Republic of China,whose scope of practice was confined to urological surgery.The urological surgeons involved in the project completed an online questionnaire survey.All the data were collected through the internet.Results:There were a total of 18981 urological surgeons in China in 2015,of whom 15875 from 2602 hospitals participated in this project,with a mean age of 39.64 years old.In 2015,1949631 cases of surgery were performed,including 493723 cases of open surgery,1146444 cases of endoscopic/laparoscopic surgery(robot-assisted laparoscopic surgery were excluded),6259 robot-assisted surgery and other types of urological surgery.Besides,Chinese urological surgeons published 1358 monographs as well as 14558 academic papers,and also obtained 2064 scientific funds in 2015.A total of 92122 person-time participated in academic conferences.Urological surgeons with higher educational degrees as well as higher academic titles and from Eastern China or higher-level hospitals hadmore opportunities to participate in further education and training.

Occupational injuries and burn out among orthopedic oncology surgeons

BACKGROUND Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures.These types of surgeries increase the risk of physical and psychological stressors,which may in turn make these physicians prone to workrelated occupational injuries.AIM The aim of this study was to explore in orthopedic oncologists,the prevalence of work-related physical injuries and psychological disturbances.METHODS A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society,the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies.The survey was sent by email,and it explored musculoskeletal complaints,psychological disturbances,treatment required for these complaints and the requirement of time off work.RESULTS A total of 67 surgeon responses were collected.A high number of orthopedic oncologists(84%)reported an occupational injury.Low back pain(39%)was the most prevalent musculoskeletal condition,followed by lumbar disk herniation(16%),shoulder tendinitis(15%)and lateral epicondylitis(13%).Of the cohort,46%required surgery and 31%required time off work due to their injury.Thirty-three respondents reported a psychological disorder.Burnout(27%),anxiety(20%)and insomnia(20%)were the most commonly reported.Time required off work due to injury was associated with old age and years in practice.CONCLUSION Orthopedic oncology surgeons report a high prevalence of work-related disorders.Lower back related injury and burnout were the most reported disorders.Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.

Preoperative Laboratory Testing by Surgeons: Implication on Anaesthetic Management

Background: Request for preoperative laboratory investigations is usually done by surgeons. On some occasions, the patient may come with laboratory investigations that have been requested by the primary physician. This occurs in situations where the primary physician saw the patient first and referred to the surgeon. There is usually no indications based on history or physical examination before these laboratory request is done but rather on speculations that the “anaesthetist may require them”. This is done in order to avoid cancellation or delay of cases. The aim of this study was to find out how tests ordered in Komfo Anokye Teaching Hospital (K.A.T.H.) by the surgeons affected the decisions of the anaesthetists in the perioperative management of the patients. Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K.A.T.H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. A close and open-ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Abnormal test results did not influence the anaesthetic management in 70.5% of cases but led to either delay or cancelation of cases or requirement for transfusion of blood or blood products in 29.5% of cases. Conclusion: Preoperative laboratory tests ordered by Surgeons in KomfoAnokye Teaching Hospital do not significantly influence the anaesthetic managements of patients.

A Critical Deficit of OBGYN Surgeons in the U.S by 2030

Objective: To estimate the OB/GYN Surgical workforce needed in the U.S by 2030 to meet the needs of our population. Methods: Using a population based analysis, the net supply of OB/GYNs was calculated. Our assumptions included: a ratio of OB/GYN's to population of 27.10/100,000 women, practicing 25 years from Board Certification to retirement, 1200 graduates finishing from residency programs per year. Results: To maintain our current ratio per 100,000 population, we should have 50,135 OBGYN's practicing for a population of 364 million in 2030. We estimate the supply to be only 30,000 and hence a shortage of 20,135. To rectify the deficit 44,135 residents will require training in OBGYN with the cumulative cost exceeding $14 billion. Conclusions: 1) We estimate a 40% shortage of OB/GYN's as the best case scenario to meet the needs of the U.S population by 2030 if the current training paradigm stays constant. 2) The cumulative cost of training adequate numbers of OB/GYN’s is estimated at $14 billion and 3) In addition to revising the BBA of 1997 to permit more residents to be trained in the United States, additional strategies must be considered to provide an adequate workforce and ensure patient access to OBGYN's.

Frequency of Musculoskeletal Pain among Surgeons in Karachi

To determine the dynamic physical strain exerted on an individual during work, an evaluation of all physical performances is necessary. For surgeons, sustaining healthy ergonomics is essential, particularly for cases requiring long standing hours. Indeed, the absence of proper ergonomics may lead to multiple musculoskeletal issues. Failure to check these problems may lead to future degenerative changes and eventually career-ending damages. Pain among surgeons is expected since they spend many hours caring for patients that they ignore their health, standing for prolonged hours. Lack of attention to work ergonomics often leads to work-related muscle pain and increased risk of problems.

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.

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.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary

AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Work-related musculoskeletal injuries among upper extremity surgeons:A web-based survey

BACKGROUND Work-related injuries have gained recent attention,especially in the orthopaedic literature.As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers,these surgeons can be at increased risk of acquiring workrelated musculoskeletal(MSK)disorders during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society 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 142 respondents,90.8% were males and the majority were younger than 55 years old(65.5%).A work-related MSK injury was reported by 89.4% of respondents,of which the most common diagnoses were low back pain(26.1%)and lateral elbow epicondylitis(18.3%).Among those that reported an injury,82.7%required treatment and 26% required time off work as a direct result of their injury.The need to undergo treatment due to the injury was associated with increased number of injuries(P<0.01).Moreover,surgeons were more likely to require time off work when they had been in practice for>21 years(P<0.05).CONCLUSION A high proportion of surgeons in our survey reported MSK injuries,with more than one quarter of surgeons reported requiring time off work due to an MSK injury.The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care.Awareness of operative ergonomics,irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.

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.

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019(COVID-19)for surgeons is not quantified which may be affected by their risk of exposure and individual factors.The objective of this review is to quantify the risk of COVID-19 among surgeons,and explore whether facemask can minimise the risk of COVID-19 among surgeons.A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers(HCWs)especially those work in surgical specialities including surgical nurses and intensivists.Additionally,systematic reviews that assessed the effectiveness of facemask against viral respiratory infections,including COVID-19,among HCWs were identified.Data from identified articles were abstracted,synthesised and summarised.Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask(and other personal protective equipment)were summarised.Although the risk of COVID-19 could not be quantified precisely among surgeons,about 14%of HCWs including surgeons had COVID-19,there could be variations depending on settings.Facemask was found to be somewhat protective against COVID-19,but the HCWs’compliance was highly variable ranging from zero to 100%.Echoing surgical societies’guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.

Knowledge and Practices of Dentists, Oral and Maxillofacial Surgeons of Cone Beam Computed Tomography (CBCT) and the Dentascanner in a Low Income Country: Case of Togo

Background: In dental-maxillofacial imaging, 3D sectional imaging progressively replaces conventional 2D imaging in developed countries. They are based specially on Computed tomography (CT-Scan), with the Dentascan application and cone beam computed tomography (CBCT). In developing countries those technics are newly introduced. Aim: This study aimed at studying the knowledge and practices of dentist and oral and maxillofacial surgeons on sectional imaging such as Dentascan and Cone Beam Computed Tomography (CBCT). Materials and Methods: We conducted an anonymous survey among dentists and oral maxillofacial surgeons in Togo over one month. Results: The response rate was 78.79% (27/33). They were mainly male sex (sex ratio of 2.25 men for one woman). They were aged between 27 and 71 years old with an average of 49.69 years old. The majority (61.54%) had a professional experience over 20 years. The majority of respondents (65.38%) believed their level of knowledge about dental x-Ray was poor. Half of them (50%) confirmed that they had never asked for a Dentascan, and 15.38% asked from time to time for it and only two (7.69%) asked often for this test. 96.15% confirm they have no knowledge of the Dentascan. Regarding the CBCT, 84.62% didn’t ask for it because this technique did not exist in Togo before. 69.20% of respondents confessed to be interested in continuing training on sectional imaging. Conclusion: This study shows that sectional imaging is very little used by oral and dental practitioners in Togo because of the ignorance of the new techniques and the absence of the CBCT. It is therefore necessary to promote the teaching of the new technique of sectional imaging in the training syllabus of oral and dental specialists and to initiate continuing medical training.

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.

Spinal surgeons＇ learning curve for lumbar microendoscopic discectomy： a prospective study of our first 50 and latest 10 cases

Background Microendoscopic discectomy （MED） is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons＇ learning curve. Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each： A-E. The control group F was ten MED patients treated later by the same medical team （September-October 2006）. All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure. Results Operation times by group were： A, （107±14） minutes; B, （85±13） minutes; C, （55±19） minutes; D, （52±12） minutes; E, （51±13） minutes; and F, （49±15） minutes. Blood loss were： A, （131±73） ml; B, （75±20） ml; C, （48±16） ml; D, （44±17） ml; E, （45±18） ml; and F, （45±16） ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment （JOA） score of each group in improvement rate immediately and one year after operation were as follows （in percentage）： A, （79.8±8.8）/（89.8±7.7）; B, （78.6±8.5）/（88.5±7.8）; C, （80.8±11.3）/（90.8±6.7）; D, （77.7±11.4）/（88.9±9.3）; E, （84.0±8.7）/（89.6±9.0）; and F, （77.8±11.6）/ （86.9±8.4）. Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups. Conclusions Spinal surgeons performing MED become proficient after 10-20 operations, when their skill becomes fairly sophisticated. Patients＇ improvement rate is the same regardless of surgeons＇ phase of learning curve.

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.