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Life Expectancy in 2013

Life Expectancy in 2013

Life expectancy at birth represents the average number of years that a group of infants would live if the group was to experience throughout life the age-specific death rates present for their year of...
Postoperative AFib After Cardiac Surgery

Postoperative AFib After Cardiac Surgery

According to published research, new onset post-operative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery, with incidence rates ranging between 10% and 30% in this patient population. The risk of atrial fibrillation increases with age, and the elderly population is a group that is increasingly undergoing cardiac operations. “Studies have shown that POAF is an important determinant of postoperative length of stay, resource utilization, and readmission rates, but the magnitude of this impact has not been well characterized,” says Gorav Ailawadi, MD. He says a better understanding is needed regarding the impact of POAF on patient outcomes, hospital resources, and healthcare costs. Finding ways to reduce POAF incidence may improve outcomes and decrease associated costs. A Closer Look The Virginia Cardiac Surgery Quality Initiative (VCSQI) is a voluntary consortium of 17 cardiac surgery centers in Virginia that exchanges and compares data in an effort to improve patient outcomes, quality, and costs. The VCSQI—which links to the national Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database—aims to identify quality improvement opportunities and find ways to enhance surgical processes of care. Dr. Ailawadi and colleagues had a study published in Annals of Thoracic Surgery that used these data to examine the impact of POAF on mortality, hospital resources, and costs among multiple centers. For the study, investigators examined more than 49,000 patient records from the STS-certified database for cardiac operations from 2001 to 2012 and stratified patients by the presence of POAF versus non-POAF. New onset POAF occurred in one-out-of-five cardiac surgery patients and was associated with an increased risk of additional complications. “After risk...
Living for Yourself, Prioritizing Your Needs

Living for Yourself, Prioritizing Your Needs

Research indicates that physicians tend to put the needs of their patients before their own. “We’re never taught that we’re allowed to put any of our own needs first, or even that it’s sometimes healthy to do so,” says Robb Hicks, MD. “Unfortunately, this perception often continues when physicians are developing and maintaining a practice because it requires being as available to patients as possible.” Understanding Priorities Dr. Hicks says that physicians must ensure that their own needs are being met in order to be the best providers for their patients. “That means that physicians must prioritize their time and energy,” he says. “This requires us to put some of our own needs before those of our patients.” Providers who are unable to find a work–life balance are likely to burn out and make mistakes. “While we shouldn’t put all our needs first, we must make daily efforts to maintain our own physical, mental, spiritual, and emotional health,” Dr. Hicks says. “The key is to figure out what things are truly needs, and which are simply desires.” Once there is an understanding of priorities in their life, physicians must notice when their thoughts or behaviors are not consistent with their priorities. “It’s important for physicians to recognize when they sacrifice time with their spouse or their children, or when they give up their routine activities because of work obligations,” says Dr. Hicks. “This is when their priorities have become confused or are out of sync.” Making Positive Changes Recognizing that changes are needed and making these changes are two different things, according to Dr. Hicks. “The inability to create...
Handling Sin

Handling Sin

There’s an old adage in surgery that says: “It takes 2 years to teach a resident how to operate and another 3 to teach a resident when not to operate.” Surgery is an active profession. Above all, the surgeon is expected to take action, even when that involves the decision to NOT do surgery. Surgical sins are different from Medical sins. There are sins of commission—hubris, arrogance, pride, vanity—of which we are all guilty at one time or another during our careers. Some of them are also surgical strengths depending on the situation. There are also the sins of omission—carelessness, sloth, ignorance, and perhaps the most egregious, indecision. As a mentor once said, “A surgeon doesn’t have to be right, but he has to be certain.” It’s incumbent on us by the nature of what we do to people in surgery to be affirmative in making decisions. By that I mean, any decision should be made actively, through consideration of the action we are taking and its potential consequences. But wait, aren’t all decisions made that way? No, not always. Delay, procrastination ‘watchful waiting’ often lead to a decision of indecision where the patient’s condition changes in spite of our attention rather than because of it. If I, as a surgeon, chose not to operate on a patient, it should be because I have a valid reason for expecting that the situation will resolve without surgery, or perhaps because the patient’s condition is such that surgery presents an unacceptable risk. I recently decided not to operate on an elderly woman with free air in her abdomen. Free air means...
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