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1. Educational perspectives in cardiothoracic anesthesia in the United States using a survey of educators and learners

Author

Rushil Bose, Matthew Evers, Wai-Man Liu, Shannon Grap, and Theodore J Cios

Subjects
anesthesia, cardiac, anesthesia, cardiac procedures, fellowships and scholarships, graduate medical education, internship and residency, thoracic surgery, Anesthesiology, RD78.3-87.3, Medicine
Abstract

Background Cardiothoracic anesthesiology training presents learners with unique challenges, procedural skills, and the management of high-intensity critical scenarios. An effective relationship between educator and learner can serve as the backbone for effective learning, which is crucial for the development of budding anesthesiologists. Strengthening this educational alliance between teachers and trainees involves understanding the educational values educators and learners find most important to their learning experiences. This study aimed to identify the key educational values related to cardiothoracic anesthesia for both learners and educators. By identifying these values in separate cohorts (learners and educators), the importance of various educational values can be examined and compared between the trainees and teachers. Methods Two separate surveys (one for learners and one for teachers) were adapted from the Pratt and Collins Teaching Perspectives Inventory to establish the importance of various educational values related to cardiothoracic anesthesia. Surveys were sent to 165 Accreditation Council for Graduate Medical Education-accredited anesthesiology residency training programs in the United States to trainees (residents and cardiothoracic anesthesiology fellows) and educators (board-certified cardiothoracic anesthesiologists). Results Analysis of survey results from 19 educators and 57 learners revealed no statistical differences across the two groups, except Q15: “Let trainee perform critical technical steps” (P value = 0.02). Conclusions While learners and educators in cardiothoracic anesthesia hold similar values regarding cardiac anesthesia education, they differ in the degree to which critical technical steps should be performed by learners.

Published
2024
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2. Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction

Author

Allison M. Fernandez, Srijaya K. Reddy, Heather Gordish-Dressman, Bridget L. Muldowney, José Luis Martinez, Franklin Chiao, Paul A. Stricker, Christopher Abruzzese, Jesus Apuya, Amy Beethe, Hubert Benzon, Wendy Binstock, Alyssa Brzenski, Stefan Budac, Veronica Busso, Surendrasingh Chhabada, Franklyn Cladis, Danielle Claypool, Michael Collins, Rachel Dabek, Nicholas Dalesio, Ricardo Falcon, Patrick Fernandez, John Fiadjoe, Meera Gangadharan, Katherine Gentry, Chris Glover, Susan M. Goobie, Amanda Gosman, Shannon Grap, Heike Gries, Allison Griffin, Charles Haberkern, John Hajduk, Rebecca Hall, Jennifer Hansen, Mali Hetmaniuk, Vincent Hsieh, Henry Huang, Pablo Ingelmo, Iskra Ivanova, Ranu Jain, Michelle Kars, Courtney Kowalczyk-Derderian, Jane Kugler, Kristen Labovsky, Indrani Lakheeram, Andrew Lee, Brian Masel, Eduardo Medellin, Petra Meier, Heather Mitzel Levy, Wallis T. Muhly, Jonathon Nelson, Julie Nicholson, Kim-Phuong Nguyen, Thanh Nguyen, Olutoyin Olutuye, Margaret Owens-Stubblefield, Uma Ramesh Parekh, Timothy Petersen, Vanessa Pohl, Julian Post, Kim Poteet-Schwartz, Jansie Prozesky, Russell Reid, Karene Ricketts, Daniel Rubens, Laura Ryan, Rochelle Skitt, Codruta Soneru, Rachel Spitznagel, Davinder Singh, Neil R. Singhal, Emad Sorial, Susan Staudt, Bobbie Stubbeman, Wai Sung, Tariq Syed, Peter Szmuk, Brad M. Taicher, Douglas Thompson, Lisa Tretault, Galit Ungar-Kastner, Rheana Watts, John Wieser, Karen Wong, and Lillian Zamora

Subjects
Adult, Male, medicine.medical_specialty, Hospitals, Low-Volume, Time Factors, Blood transfusion, Adolescent, medicine.medical_treatment, Blood Loss, Surgical, Craniosynostosis, law.invention, Craniosynostoses, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, 030202 anesthesiology, law, Pediatric surgery, medicine, Humans, Blood Transfusion, Registries, Young adult, Child, Perioperative Period, business.industry, Incidence, Incidence (epidemiology), Age Factors, Perioperative, Length of Stay, Plastic Surgery Procedures, medicine.disease, Intensive care unit, Surgery, Intensive Care Units, Treatment Outcome, Anesthesiology and Pain Medicine, Female, Observational study, business, Hospitals, High-Volume, 030217 neurology & neurosurgery
Abstract

BACKGROUND Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODS The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTS The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P < .001). The low-volume group had higher perioperative transfusion volumes (P = .02 versus middle; P = .01 versus high). There was no significant relationship between surgical case volume and the incidence of major postoperative complications or hospital length of stay. CONCLUSIONS In this study, low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes. Hospital length of stay was homogeneous in the 3 groups, suggesting a limited overall clinical impact of the observed transfusion outcome differences.

Published
2019
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3. The Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference Methodology

Author

Courtney K. Derderian, Christopher A. Derderian, Allison Fernandez, Chris D. Glover, Susan Goobie, Jennifer K. Hansen, Michael King, Jane Kugler, Shih‐Shan Lang, Petra Meier‐Haran, Olivia Nelson, Srijaya K. Reddy, Russell Reid, Karene Ricketts, Stephen A. Rottgers, Davinder Singh, Peter Szmuk, Brad M. Taicher, Jesse Taylor, Paul A. Stricker, Christopher Abruzzese, Angelina Bhandari, Amy Beethe, Hubert Benzon, Wendy Binstock, Victoria Bradford, James Bradley, Alyssa Brzenski, Stefan Budac, Veronica Busso, Surendrasingh Chhabada, Franklin Chiao, Franklyn Cladis, Danielle Claypool, Michael Collins, Lynnie Correll, Andrew Costandi, Rachel Dabek, Nicholas Dalesio, Piedad Echeverry, Thejovathi Edala, Ricardo Falcon, Patrick Fernandez, John Fiadjoe, Meera Gangadharan, Chris Glover, Susan M. Goobie, Amanda Gosman, Anastasia Grivoyannis, Shannon Grap, Heike Gries, Allison Griffin, John Hajduk, Thorsten Haas, Rebecca Hall, Jennifer Hansen, Mali Hetmaniuk, Hercilia M. Homi, Vincent Hsieh, Henry Huang, Pablo Ingelmo, Iskra Ivanova, Ranu Jain, Siri Kanmanthreddy, Michelle Kars, Mike King, John Koller, Courtney Kowalczyk‐Derderian, Kristen Labovsky, Indrani Lakheeram, Alina Lazar, Andrew Lee, Jennifer Lee, Jose Luis Martinez, Aaron Mason, Eduardo Medellin, Vivek Mehta, Petra Meier, Heather Mitzel Levy, Wallis T. Muhly, Bridget Muldowney, Jonathon Nelson, Julie Nicholson, Kim‐Phuong Nguyen, Thanh Nguyen, Margaret Owens‐Stubblefield, Matt Pankratz, Uma Ramesh Parekh, Jasmine Patel, Roshan Patel, Vikram Patel, Carolina Perez‐Pradilla, Timothy Petersen, Julian Post, Kim Poteet‐Schwartz, Pavithra Ranganathan, Srijaya Reddy, Megan Rodgers McCormick, Laura Ryan, Kaitlyn Sbrollini, Peggy Seidman, Neil R. Singhal, Rochelle Skitt, Codruta Soneru, Emad Sorial, Rachel Spitznagel, Paul Stricker, Bobbie Stubbeman, Rani Sunder, Wai Sung, Tariq Syed, Jenna Taylor, Kimberly Taylor, Douglas Thompson, Galit Ungar‐Kastner, Karen Wong, Hannah Yates, and Lillian Zamora

Subjects
medicine.medical_specialty, Critical Care, business.industry, Skull, Consensus conference, Infant, Anemia, medicine.disease, Craniosynostosis, Collaborative group, Craniosynostoses, Anesthesiology and Pain Medicine, Anesthesiology, Pediatrics, Perinatology and Child Health, Cranial vault, medicine, Humans, Medical physics, Blood Transfusion, Craniofacial, Pediatric anesthesia, business, Child, Craniofacial surgery
Abstract

Objective This article describes the methodology used for the Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference. Design This is a novel Consensus Conference of national experts in Pediatric Craniofacial Surgery and Anesthesia, who will follow standards set by the Institute of Medicine and using the Research and Development/University of California, Los Angeles appropriateness method, modeled after the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Topics related to pediatric craniofacial anesthesia for open cranial vault surgery were divided into twelve subgroups with a systematic review of the literature. Setting A group of 20 content experts met virtually between 2019 and 2020 and will collaborate in their selected topics related to perioperative management for pediatric open cranial vault surgery for craniosynostosis. These groups will also identify where future research is needed. Conclusions Experts in pediatric craniofacial surgery and anesthesiology are developing recommendations on behalf of the Pediatric Craniofacial Collaborative Group for perioperative management of patients undergoing open cranial vault surgery for craniosynostosis and identifying future research priorities.

Published
2020

4. Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group

Author

Franklyn P. Cladis, Daniel Rubens, Galit Ungar-Kastner, Alyssa Brzenski, Surendrasingh Chhabada, Douglas Thompson, Vanessa Pohl, Brad M. Taicher, Jesus Apuya, Meera Gangadharan, Indrani Lakheeram, Jose Luis Martinez, Rochelle Skitt, Vincent Hsieh, Brian Masel, M. Hetmaniuk, Rheana Watts, Wai Sung, B.M. Taicher, Jane Kugler, Laura Ryan, John Hajduk, Shannon Grap, Veronica O. Busso, Chris D. Glover, Karen Wong, Wallis T. Muhly, Kim Poteet-Schwartz, Amanda Gosman, Michelle Kars, Andrew Lee, Jansie Prozesky, Jennifer K Hansen, Olutoyin Olutuye, P.G. Fernandez, Kim-Phuong Nguyen, Petra M. Meier, Bridget L. Muldowney, Hubert A. Benzon, Bobbie Stubbeman, Neil R. Singhal, Thanh Nguyen, S.M. Goobie, Jonathon Nelson, K.V. Isaac, Rachel Dabek, Allison Griffin, Courtney Kowalczyk-Derderian, Davinder J. Singh, John Wieser, Julian Post, Michael Collins, Lillian Zamora, Kristen Labovsky, Eduardo Medellin, Timothy Petersen, Codruta Soneru, Tariq Syed, Srijaya K Reddy, Stefan Budac, Rachel Spitznagel, Ricardo Falconl, Uma Ramesh Parekh, Susan M. Goobie, C.K. Derderian, Paul A. Stricker, Mali Hetmaniuk, Susan R. Staudt, Julie Nicholson, Christopher Abruzzese, John E. Fiadjoe, David Zurakowski, Patrick G. Fernandez, Margaret Owens-Stubblefield, Emad Sorial, Katherine R. Gentry, Peter Szmuk, Charles M. Haberkern, Danielle Claypool, Allison M Fernandez, Karene Ricketts, Heike Gries, Rebecca Hall, Henry Huang, P.A. Stricker, Russell R. Reid, Ranu Jain, Franklin Chiao, Nicholas M. Dalesio, Iskra Ivanova, Lisa Tretault, Heather Mitzel Levy, Amy Beethe, Wendy Binstock, and Pablo Ingelmo

Subjects
Male, medicine.medical_specialty, Adolescent, Risk Assessment, Craniosynostosis, Craniosynostoses, Postoperative Complications, Predictive Value of Tests, Medicine, Humans, Craniofacial, Child, Intraoperative Complications, Craniofacial surgery, Retrospective Studies, business.industry, Incidence (epidemiology), Incidence, Reproducibility of Results, Perioperative, Length of Stay, Plastic Surgery Procedures, medicine.disease, Anesthesiology and Pain Medicine, Child, Preschool, Emergency medicine, Observational study, Female, business, Risk assessment, Complication, Algorithms
Abstract

Background The current incidence of major complications in paediatric craniofacial surgery in North America has not been accurately defined. In this report, the Pediatric Craniofacial Collaborative Group evaluates the incidence and determines the independent predictors of major perioperative complications using a multicentre database. Methods The Pediatric Craniofacial Surgery Perioperative Registry was queried for subjects undergoing complex cranial vault reconstruction surgery over a 5-year period. Major perioperative complications were identified through a structured a priori consensus process. Logistic regression was applied to identify predictors of a major perioperative complication with bootstrapping to evaluate discrimination accuracy and provide internal validity of the multivariable model. Results A total of 1814 patients from 33 institutions in the US and Canada were analysed; 15% were reported to have a major perioperative complication. Multivariable predictors included ASA physical status 3 or 4 (P=0.005), craniofacial syndrome (P=0.008), antifibrinolytic administered (P=0.003), blood product transfusion >50 ml kg–1 (P Conclusions The predictive algorithm can be used as a prognostic tool to risk stratify patients and thereby potentially reduce morbidity and mortality. Craniofacial teams can utilise these predictors of complications to identify high-risk patients. Based on this information, further prospective quality improvement initiatives may decrease complications, and reduce morbidity and mortality.

Published
2018

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