Dedicated instruction of fourth-year medical students with deliberate and distributed practice of microvascular techniques using a porcine end-to-side coronary artery anastomosis simulation model results in performance comparable to that of senior general surgery residents. These results suggest that focused tissue simulator training can compress the learning curve to acquire technical proficiency in comparison with real-time training.

Background Obesity has become a major epidemic in the US. Though research suggests obesity does not increase major morbidity or mortality after thoracic operations, it likely results in greater use of healthcare resources. Methods We examined all patients in the Society of Thoracic Surgeons General Thoracic Surgery database with primary lung cancer who underwent lobectomy from 2006 to 2010. We investigated the impact of body mass index (BMI) on total operating room time using a linear mixed-effects regression model, and multiple imputation to account for missing data. Secondary outcomes included postoperative length of stay and 30-day mortality. Covariates included age, gender, race, forced expiratory volume, smoking status, Zubrod score, prior chemotherapy or radiation, steroid use, number of comorbidities, surgical approach, hospital lobectomy volume, hospital percent obesity, and the addition of mediastinoscopy or wedge resection. Results A total of 19,337 patients were included. The mean BMI was 27.3 kg/m2, with 4,898 patients (25.3%) having a BMI ≥ 30 kg/m2. The mean total operating room time, length of stay, and 30-day mortality were 240 minutes, 6.7 days, and 1.8%, respectively. For every 10 unit increase in BMI, mean operating room time increased by 7.2 minutes (4.8 – 8.4 minutes, p<0.0001). Higher hospital lobectomy volume and hospital percentage of obese patients did not affect the association between BMI and operative time. BMI was not associated with 30-day mortality or increased length of stay. Conclusions Increased body mass index is associated with increased total operating room time, regardless of institutional experience with obese patients.

The GCS grading system is more strongly associated with outcomes than either the Hunt and Hess or World Federation of Neurological Societies scales, and it is an equivalent to a slightly better predictor of Glasgow Outcome Scale outcomes. Its simplicity, proven inter-rater reliability, and wide level of familiarity among health care personnel render the GCS grading system a superior grading scale for aneurysmal subarachnoid hemorrhage severity, warranting its consideration for universal use.