Background Burnout is a complex syndrome of emotional distress that can disproportionately affect individuals who work in healthcare professions. Study Design For a national survey of burnout in US general surgery residents, we asked all Accreditation Council for Graduate Medical Education-accredited general surgery program directors to email their general surgery residents an invitation to complete an anonymous, online survey. Burnout was assessed with the Maslach Burnout Inventory; total scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) subscales were calculated. Burnout was defined as having a score in the highest tertile for EE or DP or lowest tertile for PA. Chi-square tests and one-way analyses of variance were used to test associations between burnout tertiles for each subscale and various resident and training-program characteristics as appropriate. Results From April–December, 2014, 665 residents actively engaged in clinical training had data for analysis; 69% met the criterion for burnout on at least one subscale. Higher burnout on each subscale was reported by residents planning private practice compared with academic careers. A greater proportion of women than men reported burnout on EE and PA. Higher burnout on EE and DP was associated with greater work hours per week. Having a structured mentoring program was associated with lower burnout on each subscale. Conclusions The high rates of burnout among general surgery residents are concerning given the potential impact of burnout on the quality of patient care. Efforts to identify at-risk populations and to design targeted interventions to mitigate burnout in surgical trainees are warranted.

Background Flail chest (FC) results in paradoxical chest wall movement, altered respiratory mechanics, and frequently respiratory failure. Despite advances in ventilatory management, FC remains associated with significant morbidity and mortality. Operative fixation of the flail segment has been advocated as an adjunct to supportive care, but no definitive clinical trial exists to delineate the role of surgery. Objective To perform a systematic review and meta-analysis of studies comparing operative to nonoperative therapy in adult FC patients. Outcomes were duration of mechanical ventilation (DMV), intensive care unit length of stay (ICULOS), hospital length of stay (HLOS), mortality, incidence of pneumonia, and tracheostomy. Methods A comprehensive search of 5 electronic databases was performed to identify randomized controlled trials and observational studies (cohort or case-control). Pooled effect size (ES) or relative risk (RR) was calculated using a fixed or random effects model, as appropriate. Results Nine studies with a total of 538 patients met inclusion criteria. Compared to control treatment, operative management of FC was associated with shorter DMV (pooled ES −4.52; days, 95% confidence interval [CI] −5.54, −3.50), ICULOS (−3.40 days; 95% CI −6.01,−0.79), HLOS (−3.82 days; 95% CI −7.12,−0.54), and decreased mortality (pooled RR 0.44; 95% CI 0.28, 0.69), pneumonia (0.45; 95% CI 0.30, 0.69), and tracheostomy (0.25; 95% CI 0.13, 0.47). Conclusions As compared to nonoperative therapy, operative fixation of FC is associated with reductions in DMV, LOS, mortality, and complications associated with prolonged MV. These findings support the need for an adequately powered clinical study to further define the role of this intervention.

A significant percentage of women undergoing unilateral or bilateral mastectomy for breast cancer at our institution elect to undergo reconstruction. Prosthetic reconstruction was the most common method utilized. The impetus for referral to the reconstructive surgeon was nearly always initiated by the surgical oncologist.

The optimal treatment strategy for cT2N0 esophageal cancer depends on the accuracy of endoscopic ultrasound staging. High-risk features that confer increased probability of upstaging can inform clinical decision making to recommend induction chemoradiation for select cT2N0 patients.

Background The SSO/ASTRO consensus statement was the first professional guideline in breast oncology to declare “no ink on tumor” as a negative margin in patients with stages I/II breast cancer undergoing breast conservation therapy (BCT). We sought to analyze the financial impact of this guideline at our institution using a historic cohort. Study Design We identified women undergoing re-excision following breast-conserving surgery for invasive breast cancer from 2010–2013 using a prospectively-maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis. Results Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with DCIS. A subcohort of 83 patients (32.7%) who underwent BCT for Stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure per the SSO/ASTRO guideline. The majority had invasive ductal carcinoma (70, 84.3%) and had invasive disease (45, 54.2%) and/or DCIS (49, 59.0%) within 1 mm of the specimen margin. Seventy-nine patients underwent one re-excision, and 4 patients underwent two re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations. Conclusions Implementation of the SSO/ASTRO consensus guideline holds great potential to optimize resource utilization. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200,000. Further analysis of patient outcomes and margin assessment methods is needed to define the long-term impact on surgical practice.