A call to increase diversity among academic surgery faculty (ASF) was made in 2008, after recognizing the lack of surgeons considered underrepresented in medicine (URM). We aimed to quantify and ...assess trends among URM ASF in the interval since that call to action.
Publicly available data on ASF were reviewed. We calculated the percentage of ASF in 2018 by URM group, then stratified by academic rank of assistant professor, associate professor, and full professor. We compared 2005-2018 ASF of Hispanic or Latino (HL) and African American (AA) background; 2005 data were unavailable for other URM groups.
In 2018, URM surgeons accounted for 7.06% (n = 1013/14,340) of ASF (AA: n = 492, 3.43%; HL: n = 485, 3.38%; American Indian or Alaskan Native: n = 23, 0.16%; and Native Hawaiian/Pacific Islander: n = 13, 0.09%). When comparing 2005-2018, AA ASF remained stable across ranks (total: n = 298, 3.12% versus n = 492, 3.43%; P = 0.09), whereas HL ASF decreased across ranks (total: n = 415, 4.35% versus n = 485, 3.38%; P = 0.00007).
Surgeons from URM backgrounds account for 7% of ASF. No increase in AA and a decrease in HL ASF occurred from 2005 to 2018. There is a paucity of data for other URM groups. Active strategies to increase diversity and inclusion in academic surgery are necessary.
•Approximately 7% of all academic surgeons in the United States come from backgrounds considered underrepresented in medicine (African American, Hispanic/Latino, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander).•The percentage of African American academic surgery faculty has not significantly increased when comparing 2005-2018 URM ASF data.•The percentage of Hispanic/Latino academic surgery faculty decreased when comparing 2005-2018 URM ASF data.
The 2015 American Thyroid Association (ATA) guidelines called for consideration of thyroid lobectomy (TL) as an acceptable surgical treatment for small and less aggressive papillary thyroid cancers ...(PTC) with no clinical evidence of metastasis or extrathyroidal extension. Optimal extent of surgery, however, remains controversial.
A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. PUBMED, EMBASE, Scopus, and Cochrane Library databases were searched to identify studies comparing TL to total thyroidectomy (TT) for low-risk PTC. Studies were grouped according to the major outcomes in the literature: survival and the need for completion thyroidectomy (CT).
Overall survival for low-risk PTC patients who underwent TL was comparable to TT. Locoregional recurrence (LRR) rate following TL was less than 6% and salvaged with CT. The proportion of patients meeting the 2015 ATA guidelines selection criteria for TL who subsequently would need CT varied by study but averaged 34%. After excluding microscopic extrathyroidal extension and positive resection margin as indications for CT to facilitate radioactive iodine ablation, the estimated rate across the included studies was 11%.
We performed a systematic review of outcomes following TL or CT for low-risk PTC according to 2015 ATA guidelines. Initial operative approach did not have a negative impact on overall survival. There is a paucity of high-quality data on this topic across the literature. Long-term follow-up studies on oncologic and patient-centered outcomes are essential.
A myriad of examples of racial injustice have been identified in the surgical literature including disparities in disease outcome,1 academic progression,2 mentorship and integration into surgical ...culture, as well as higher attrition rates for trainees whose background is underrepresented in medicine (UIM).3–5 While the challenges of racism and social injustice are not new, there seems to be increased appetite for viable pathways and pragmatic solutions.6 In fact, much progress has occurred in other industries when compared to academic medicine. Whereas many businesses have instituted high-potential leadership development programs for UIMs, only a handful of academic medical institutions have demonstrated the ability to stand up strong, viable leadership programs for UIMs. ...independent analysis of membership 2007–2017 revealed underrepresentation of Latino and African American members in societal leadership, and inconsistent representation of women and Asians in leadership.9 Endocrine surgery, when compared to 8 other surgical specialties, has the most gender diversity, though the reason for this remains unknown.10 Recognizing that many societal membership applications are completed by administrative personnel, societies can directly and ask members to update their profiles.
Blogging is a new and innovative means of information exchange in the surgical community. We examined the Association of Women Surgeons (AWS) blog to understand its audience and most read content.
...Google Analytics was used to assess the AWS blog site data. A search was performed from February 2018 to February 2019. Demographic data, blog posts, and tags sorted by unique pageviews were recorded.
There were 31,221 unique pageviews during the search period. The AWS Blog readership was mostly women (75%), ages 25–44 years (70.3%). The three tags that elicited the most pageviews were “residency (16.95%),” “medical students (12.12%),” and “family life (10.38%).” The most read blog post was responsible for 9.7% of total pageviews.
Most of the AWS Blog readership are young, women, and interested in content related to graduate and postgraduate medical education or family life. Blogging may be a good vehicle for topics not covered in traditional scientific literature.
•AWS blog readers care about education, family, work-life integration, and respect.•Blogs address issues not captured in traditional scientific literature.•Blogs provide powerful platform for information-sharing in surgery.
•Surgeons who are Black, Hispanic, female, and international medical graduates are underrepresented in national and regional surgical society leadership.•Having attended an academic program with ...reputational prestige, for undergraduate and graduate medical education, appears to be important for surgical society leaders; upwards of 80% of non-White presidents attended reputational top 25 schools or programs.•There has been a significant decrease over the last decade in the frequency of presidents of surgical societies from racial/ethnic minority backgrounds. However, the 2020-21 executive council members are more diverse than the last decade of presidents, suggesting a pipeline of diverse leaders who may be ready to assume presidential positions.
Non-White and female surgeons are underrepresented in academic surgery faculty. We hypothesized that the leadership of major U.S. regional and national general surgery societies reflects these same racial and gender disparities. We suspected that attending a medical school or residency program with academic prestige would be more common for surgeons from underrepresented backgrounds.
Race/ethnicity and gender of the 2020-21 executive council members and 2012-21 society presidents of 25 major general surgery societies (7 regional, 18 national) was assessed. Academic prestige was determined by reputational top 25 programs, identified using U.S. News and World Report and Doximity rankings for medical school and residency, respectively.
Surgical society executive council members (n = 204) were predominantly White (75.5%) and male (67.2%). The 50 non-White council members were Asian (n = 37), Black (n = 7), and Latinx (n = 6). 14 (6.9%) were international medical graduates (IMGs). 56.4% attended a school or program ranked in the Top 25 (n = 115).
Surgical society presidents 2012-21 (n = 242) have been mostly White (87.6%) and male (83.4%). Non-White, male surgical society presidents were Asian (n = 13), Black (n = 9), and Latino (n = 6). Of the 41 female surgery society presidents, 92.7% were White, 7.3% (n = 3) Asian, and none Black or Latina. 13 were IMGs (5.3%). 55.0% of society presidents attended Top 25 (n = 133) schools or programs. The three non-White, female presidents all attended Top 25 schools/programs (100%). Of the 15 unique individuals who were male, non-White presidents, 12 attended top 25 schools or programs (80%).
Women, non-White surgeons, and IMGs are underrepresented in U.S. surgical society leadership. Increasing racial diversity in U.S. surgical society leadership may require intentionality in mentorship and sponsorship, particularly for surgeons who did not attend prestigious schools or programs.
In addition to biochemical cure, clinical benefits after surgery for primary aldosteronism depend on the magnitude of decrease in blood pressure (BP) and use of antihypertensive medications with a ...subsequent decreased risk of cardiovascular and/or cerebrovascular morbidity and drug-induced adverse effects.
To evaluate the change in BP and use of antihypertensive medications within an international cohort of patients who recently underwent surgery for primary aldosteronism.
A cohort study was conducted across 16 referral medical centers in Europe, the United States, Canada, and Australia. Patients who underwent unilateral adrenalectomy for primary aldosteronism between January 2010 and December 2016 were included. Data analysis was performed from August 2017 to June 2018. Unilateral disease was confirmed using computed tomography, magnetic resonance imaging, and/or adrenal venous sampling. Patients with missing or incomplete preoperative or follow-up data regarding BP or corresponding number of antihypertensive medications were excluded.
Clinical success was defined based on postoperative BP and number of antihypertensive medications. Cure was defined as normotension without antihypertensive medications, and clear improvement as normotension with lower or equal use of antihypertensive medications. In patients with preoperative normotensivity, improvement was defined as postoperative normotension with lower antihypertensive use. All other patients were stratified as no clear success because the benefits of surgery were less obvious, mainly owing to postoperative, persistent hypertension. Clinical outcomes were assessed at follow-up closest to 6 months after surgery.
On the basis of inclusion and exclusion criteria, a total of 435 patients (84.6%) from a cohort of 514 patients who underwent unilateral adrenalectomy were eligible. Of these patients, 186 (42.3%) were women; mean (SD) age at the time of surgery was 50.7 (11.4) years. Cure was achieved in 118 patients (27.1%), clear improvement in 135 (31.0%), and no clear success in 182 (41.8%). In the subgroup classified as no clear success, 166 patients (91.2%) had postoperative hypertension. However, within this subgroup, the mean (SD) systolic and diastolic BP decreased significantly by 9 (22) mm Hg (P < .001) and 3 (15) mm Hg (P = .04), respectively. Also, the number of antihypertensive medications used decreased from 3 (range, 0-7) to 2 (range, 0-6) (P < .001). Moreover, in 75 of 182 patients (41.2%) within this subgroup, the decrease in systolic BP was 10 mm Hg or greater.
In this study, for most patients, adrenalectomy was associated with a postoperative normotensive state and reduction of antihypertensive medications. Furthermore, a significant proportion of patients with postoperative, persistent hypertension may benefit from adrenalectomy given the observed clinically relevant and significant reduction of BP and antihypertensive medications.
The tall cell, columnar, and diffuse sclerosing subtypes are aggressive histologic subtypes of papillary thyroid cancer (PTC) with increasing incidence, yet there is a wide variation in reporting. We ...aimed to identify and compare factors associated with the reporting of these aggressive subtypes (aPTC) to classic PTC (cPTC) and secondarily identify differences in outcomes.
The National Cancer Database was utilized to identify cPTC and aPTC from 2004 to 2017. Patient and facility demographics and clinicopathologic variables were analyzed. Independent predictors of aPTC reporting were identified and a survival analysis was performed.
The majority of aPTC (67%) were reported by academic facilities. Compared to academic facilities, all other facility types were 1.4-2.0 times less likely to report aPTC (P < 0.05). Regional variation in reporting was noted, with more cases reported in the Middle Atlantic, despite there being more total facilities in the South Atlantic and East North Central regions. Compared to the Middle Atlantic, all other regions were 1.4-5 times less likely to report aPTC (P < 0.001). Patient characteristics including race and income were not associated with aPTC reporting. Compared to cPTC, aPTC had higher rates of aggressive features and worse 5-y overall survival (90.5% versus 94.5%, log rank P < 0.001).
Aggressive subtypes of PTC are associated with worse outcomes. Academic and other facilities in the Middle Atlantic were more likely to report aPTC. This suggests the need for further evaluation of environmental or geographic factors versus a need for increased awareness and more accurate diagnosis of these subtypes.
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