Sandra R DiBrito1, Mary Grace Bowring2, Courtenay M Holscher2, Christine E Haugen2, Sarah V Rasmussen2, Mark D Duncan2, David T Efron3, Kent Stevens4, Dorry L Segev5, Jacqueline Garonzik-Wang2, Elliott R Haut6. 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: dibrito@jhmi.edu. 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
BACKGROUND: Transplant recipients are living longer than ever before, and occasionally require acute care surgery for nontransplant-related issues. We hypothesized that while both acute care surgeons (ACS) and transplant surgeons would feel comfortable operating on this unique patient population, both would believe transplant centers provide superior care. METHODS: To characterize surgeon perspectives, we conducted a national survey of ACS and transplant surgeons. Surgeon- and center-specific demographics were collected; surgeon preferences were compared using χ2, Fisher's exact, and Kruskal-Wallis tests. RESULTS: We obtained 230 responses from ACS and 204 from transplant surgeons. ACS and transplant surgeons believed care is better at transplant centers (78% and 100%), and transplant recipients requiring acute care surgery should be transferred to a transplant center (80.2% and 87.2%). ACS felt comfortable operating (97.5%) and performing laparoscopy (94.0%) on transplant recipients. ACS cited transplant medication use as the most important underlying cause of increased surgical complications for transplant recipients. Transplant surgeons felt it was their responsibility to perform acute care surgery on transplant recipients (67.3%), but less so if patient underwent transplant at a different institution (26.5%). Transplant surgeons cited poor transplanted organ resiliency as the most important underlying cause of increased surgical complications for transplant recipients. CONCLUSIONS: ACS and transplant surgeons feel comfortable performing laparoscopic and open acute care surgery on transplant recipients, and recommend treating transplant recipients at transplant centers, despite the lack of supportive evidence. Elucidating common goals allows surgeons to provide optimal care for this unique patient population.
BACKGROUND: Transplant recipients are living longer than ever before, and occasionally require acute care surgery for nontransplant-related issues. We hypothesized that while both acute care surgeons (ACS) and transplant surgeons would feel comfortable operating on this unique patient population, both would believe transplant centers provide superior care. METHODS: To characterize surgeon perspectives, we conducted a national survey of ACS and transplant surgeons. Surgeon- and center-specific demographics were collected; surgeon preferences were compared using χ2, Fisher's exact, and Kruskal-Wallis tests. RESULTS: We obtained 230 responses from ACS and 204 from transplant surgeons. ACS and transplant surgeons believed care is better at transplant centers (78% and 100%), and transplant recipients requiring acute care surgery should be transferred to a transplant center (80.2% and 87.2%). ACS felt comfortable operating (97.5%) and performing laparoscopy (94.0%) on transplant recipients. ACS cited transplant medication use as the most important underlying cause of increased surgical complications for transplant recipients. Transplant surgeons felt it was their responsibility to perform acute care surgery on transplant recipients (67.3%), but less so if patient underwent transplant at a different institution (26.5%). Transplant surgeons cited poor transplanted organ resiliency as the most important underlying cause of increased surgical complications for transplant recipients. CONCLUSIONS: ACS and transplant surgeons feel comfortable performing laparoscopic and open acute care surgery on transplant recipients, and recommend treating transplant recipients at transplant centers, despite the lack of supportive evidence. Elucidating common goals allows surgeons to provide optimal care for this unique patient population.
Authors: Janet T Lee; Ty B Dunn; Anne-Marie Sirany; Genevieve B Melton; Robert D Madoff; Mary R Kwaan Journal: J Gastrointest Surg Date: 2014-05-17 Impact factor: 3.452
Authors: Sandra R DiBrito; Christine E Haugen; Courtenay M Holscher; Israel O Olorundare; Yewande Alimi; Dorry L Segev; Jacqueline Garonzik-Wang Journal: Am J Surg Date: 2018-07-19 Impact factor: 2.565
Authors: Sandra R DiBrito; Israel O Olorundare; Courtenay M Holscher; Claudia S Landazabal; Babak J Orandi; Nabil N Dagher; Dorry L Segev; Jacqueline Garonzik-Wang Journal: Clin Transplant Date: 2018-04-17 Impact factor: 2.863
Authors: Kenneth A Andreoni; Harry Lightfoot; David A Gerber; Mark W Johnson; Jeffery H Fair Journal: Am J Transplant Date: 2002-04 Impact factor: 8.086
Authors: Ceara Tess Cunningham; Hude Quan; Brenda Hemmelgarn; Tom Noseworthy; Cynthia A Beck; Elijah Dixon; Susan Samuel; William A Ghali; Lindsay L Sykes; Nathalie Jetté Journal: BMC Med Res Methodol Date: 2015-04-09 Impact factor: 4.615