When Do Surgeons Hit Their Prime?

A surgeon's skill and performance peak at mid-career, according to new research published in the British Medical Journal.

The study's authors tracked the rates of 2 permanent and recurrent complications after more than 3,500 thyroidectomies performed by 28 surgeons at 5 French hospitals. Surgeons between the age of 35 and 50 had better post-op outcomes than their younger and older colleagues, say the study's authors.

During the early years of their careers, younger surgeons should undergo simulation training, proctoring, continuous monitoring of performance and targeted retraining if needed, suggest the researchers.

An experienced surgeon's performance could decline over time due to mental fatigue, notes the study. Set-in-their-ways surgeons might also resist new techniques that could reduce complication rates. "Talent and experience are not enough to guarantee safe surgery," say the researchers, who suggest that recertification of surgeons older than 50 years of age could focus on mental coaching and raising awareness of clinical performances.

Novice surgeons cannot improve their performances simply by working in a high-volume hospital, say the researchers. At the same time older physicians don't improve by passively accumulating experience. This, according to the study, "raises concerns about ongoing training and motivation throughout a career that extends several decades."

Daniel Cook

Incident Reporting Systems Capture Few Adverse Events

Hospital incident reporting systems capture less than 15% of adverse events, according to a study issued by the U.S. Department of Health and Human Services' Office of Inspector General.

In the study, researchers found that the 189 hospitals surveyed relied "heavily" on incident reporting systems to identify and monitor adverse events. But the systems only tracked an estimated 14% of incidents. The remaining incidents were not reported because staff did not perceive them as reportable, or did not report them for the incidents in question.

The OIG is recommending that the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services develop guidance and incentives to help hospitals use incident reporting systems more fully. One idea: Develop a list of potentially reportable events. The OIG is also urging CMS to include information about how surveyors should assess the adequacy of hospital event collection efforts, including incident reporting systems, in guidance it is currently developing for surveyors.

Mark McGraw

Ergonomics and Exercise Ensure Wellness at Work

"A hard-working staff often ignores their own aches and pains, but that neglect could shorten careers," writes Lisa Burry, RN, BSN, the head of quality improvement and safety at The Bone and Joint Surgery Center of Novi in Michigan.

Three simple steps, however, can help to prevent your clinical and business employees from becoming patients themselves due to musculoskeletal injuries, repetitive movement stress, eyestrain or other hazards of their daily duties.

Check out Ms. Burry's advice in the January issue of Outpatient Surgery Magazine.

David Bernard

InstaPoll: Do You Appreciate Your Instrument Reprocessors?

It's easy to take your central sterile staff for granted. Most often, you'll find them toiling away in the basement or some cramped alcove. Yet the work they do is absolutely critical to a well-run surgical facility. Tell us in this week's InstaPoll if your reprocessors feel appreciated or not.

Last week we asked if your anesthesia providers use safe injection practices. The results, based on 304 responses

  • 54%: all of the time.

  • 33%: most of the time.

  • 13%: some of the time.

    Dan O'Connor

  • News & Notes
  • Surgeon tells all In his new book, Confessions of a Surgeon, Paul A. Ruggieri, MD, promises to share the "good, bad and complicated" of life behind OR doors. "I do not react well to imperfection," he writes. "Defective devices - I can have them replaced. Unmotivated staff - I can have them removed. I haven't quite figured out yet what to do with myself." To learn more, check out excerpts from the book or read a review from the New York Times.

  • Safer hydrocodone formulation studied Hydrocodone bitartrate, a formulation of the opioid that does not include acetaminophen, could be "the first single-entity hydrocodone therapy" if approved by the FDA, allowing providers to treat chronic pain without the threat of liver damage associated with acetaminophen overdose. The drug, Zohydro, manufactured by Zogenix, has received high marks for pain relief in Phase III clinical trials. Researchers note, however, that as with any opioid drug, it still carries risks of misuse and abuse.

  • Headphones ease pain Men undergoing prostate biopsies can reduce pain and anxiety by putting on headphones for a bit of classical music, according to research from the Duke Cancer Institute. A study of 88 prostate biopsy patients found those listening to Bach concertos reported less pain.

  • Tip of the week When surveyors drop in to see how compliant you are with infection control standards, they often want to know where you keep your equipment manufacturers' reprocessing guidelines. Why not keep them all in one easily accessible place? In a recent issue of Outpatient Surgery Magazine, Kelly Parkes Wilson, RN, BS, describes how to assemble a guidelines notebook.