Background Patients diagnosed with a malignancy must decide whether to travel for care at an academic center or receive treatment at a nearby hospital. Here we examine differences in demographics, ...treatment, and outcomes of those traveling to academic centers for their care vs those not traveling, as well as compare travel for an aggressive vs indolent malignancy. Study Design All patients with papillary thyroid carcinoma (PTC) or pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection and in the National Cancer Database were examined. Travel for care was abstracted from “crowfly” distance between patients' ZIP codes and treatment facility, region, county size, urban/metro/rural status, and facility type. Results In total, 105,677 patients with PTC and 22,983 patients with PDAC were analyzed. There were no survival differences by travel in the PTC group. Survival was improved for patients with PDAC traveling from urban/rural settings (hazard ratio = 0.89; 95% CI 0.82 to 0.96; p = 0.002). Patients traveling with PDAC were more likely to have a complete resection and lymph node dissection. Those traveling were less likely to receive chemotherapy or radiotherapy (all p < 0.001). Those traveling with PTC were older, more likely to be male, have Medicare insurance, and had a higher stage of disease (all p < 0.001). Rates of radioactive iodine were lower, American Thyroid Association guidelines were more likely followed, and lymph node dissection was more common for those traveling for care of their PTC (all p < 0.001). Conclusions There are improvements in both quality and survival for those traveling to academic centers for their cancer care. In the case of PTC, this difference in quality did not affect overall survival. In PDAC, however, differences in quality translated to a survival advantage.
Background Recurrent laryngeal nerve injuries remain a complication that is a source of concern to both surgeons and patients. RLN monitoring has gained popularity in recent years despite a lack of ...evidence showing decreased rates of recurrent laryngeal nerve injury when nerve monitoring is used. We sought to explore malpractice litigation in thyroid surgery with respect to recurrent laryngeal nerve monitoring. With increased public awareness and surgeon use of recurrent laryngeal nerve monitoring, we hypothesize an increase in its use in malpractice litigation in the area of thyroid surgery. Methods Using the LexisNexis Academic legal database, a retrospective review of all relevant federal and state cases from 1989 to 2009 was performed using the search terms “thyroid,” “surgery,” and “medical malpractice.” From this search, data were compiled including year and state of the court's decision, the outcome of the trial, the type of complication, any mention of recurrent laryngeal nerve monitoring, and the specialty of the surgeon who performed the procedure. The cases that were settled out of court were not included in this analysis. Results A total of 143 medical malpractice cases involving thyroid surgery were retrieved from our search from 1989 to 2009. After reviewing all cases, 33 cases in which the alleged negligence occurred after thyroid surgery were used for analysis. Of these cases, 15 involved recurrent laryngeal nerve injury; interestingly, no mention of recurrent laryngeal nerve monitoring was noted in any of the cases. Conclusion Although recurrent laryngeal nerve monitoring has become more widely available and used, there is no evidence that its use or nonuse has played a role in malpractice litigation in the last 20 years. recurrent laryngeal nerve injury remains a cause of malpractice litigation.
Despite many advances in surgical techniques during the last several decades, the risk for recurrent laryngeal nerve (RLN) injury during thyroid and parathyroid surgery has only declined, not ...disappeared. RLN monitoring is an attempt to reduce the risk of nerve injury during thyroid and parathyroid surgery. In this article, the author discusses how to use RLN monitoring, its effectiveness, and the options available. He also highlights potential legal and ethical issues that surround the use of this method.
Background A significant increase in industry support of professional medical associations coupled with data suggesting that gifts from industry have significant clinical influence have prompted ...calls from the Institute of Medicine and physician leaders to identify and manage conflicts of interest that stem from financial support of professional medical associations by industry. Study Design A joint task force of members appointed by the Association for Academic Surgery and the Society of University Surgeons was convened in July 2009. Recommendations were developed regarding management of all potential conflicts of interest that can arise within the context of an academic surgical society, with specific focus on relationships with industry. Task force members reached consensus around each recommendation and the guidelines were subsequently adopted by the Executive Councils of both societies. Results The committee identified 4 primary areas of need for transparent and definitive management of conflict of interest: 1) individual society activities, including general budget support, society endorsements, and journal affiliation; 2) individual personnel conflicts such as society leadership and standards for disclosure of conflict; 3) meeting activities including budgetary support, program committee associations, and abstract review process; and 4) foundation support and research and travel awards. The resulting guidelines aim to protect the societies and their membership from undue bias that may undermine the credibility and mission of these associations. Conclusions Policy guidelines to mitigate conflict of interest are necessary to protect the integrity of the work of academic surgical societies and their fiduciary duty to members and patients. Guidelines created and adopted by the Association for Academic Surgery and Society of University Surgeons form an effective model for academic surgical societies and their members.
Background Family members are important in the perioperative care of surgical patients. During the perioperative period, communication about the patient occurs between surgeons and family members. To ...date, however, surgeon-family perioperative communication remains unexplored in the literature. Study Design Surgeons were recruited from the surgical faculty of an academic hospital to participate in an interview regarding their approach to speaking with family members during and immediately after an operative procedure. An iterative process of transcription and theme development among 3 researchers was used to compile a well-defined set of qualitative themes. Results Thirteen surgeons were interviewed and described what informs their communication, how they practice surgeon-family perioperative communication, and how the skills integral to perioperative communication are taught. Surgeons saw perioperative communication with family members as having a special role of providing support and anxiety alleviation that is distinct from the role of communication during clinic or postoperative visits. Wide variability exists in how interviewed surgeons practice perioperative communication, including who communicates with the family, and the frequency and content of the communication. Surgeons universally reported that residents' instruction in perioperative communication with families was lacking. Conclusions Surgeons recognize perioperative communication with family members to be a part of their role and responsibility to the patient. However, during the perioperative period, they also acknowledge an independent responsibility to alleviate family members' anxieties. This independent responsibility supports the existence of a distinct “surgeon-family relationship.”
