IMPORTANCE Labor unions are purported to improve working conditions; however, little evidence exists regarding the effect of resident physician unions.OBJECTIVE To evaluate the association of resident unions with well-being, educational environment, salary, and benefits among surgical residents in the US. DESIGN, SETTING, AND PARTICIPANTSThis national cross-sectional survey study was based on a survey administered in January 2019 after the American Board of Surgery In-Training Examination (ABSITE). Clinically active residents at all nonmilitary US general surgery residency programs accredited by the American Council of Graduate Medical Education who completed the 2019 ABSITE were eligible for participation. Data were analyzed from December 5, 2020, to March 16, 2021. EXPOSURES Presence of a general surgery resident labor union. Rates of labor union coverage among non-health care employees within a region were used as an instrumental variable (IV) for the presence of a labor union at a residency program. MAIN OUTCOMES AND MEASURESThe primary outcome was burnout, which was assessed using a modified version of the abbreviated Maslach Burnout Inventory and was defined as experiencing any symptom of depersonalization or emotional exhaustion at least weekly. Secondary outcomes included suicidality, measures of job satisfaction, duty hour violations, mistreatment, educational environment, salary, and benefits. RESULTS A total of 5701 residents at 285 programs completed the pertinent survey questions (response rate, 85.6%), of whom 3219 (56.5%) were male, 3779 (66.3%) were White individuals, 449 (7.9%) were of Hispanic ethnicity, 4239 (74.4%) were married or in a relationship, and 1304 (22.9%) had or were expecting children. Among respondents, 690 residents were from 30 unionized programs (10.5% of programs). There was no difference in burnout for residents at unionized vs nonunionized programs (297 [43.0%] vs 2175 [43.4%]; odds ratio [OR], 0.92 [95% CI, 0.75-1.13]; IV difference in probability, 0.15 [95% CI, −0.11 to 0.42]). There were no significant differences in suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, salary, or benefits except that unionized programs more frequently offered 4 weeks instead of 2 to 3 weeks of vacation (27 [93.1%] vs 52 [30.6%]; OR, 19.18 [95% CI, 3.92-93.81]; IV difference in probability, 0.77 [95% CI, 0.09-1.45]) and more frequently offered housing stipends (10 [38.5%] vs 9 [16.1%]; OR, 2.15 [95% CI, 0.58-7.95]; IV difference in probability, 0.62 [95% CI 0.04-1.20]). CONCLUSIONS AND RELEVANCEIn this evaluation of surgical residency programs in the US, unionized programs offered improved vacation and housing stipend benefits, but resident unions (continued) Key Points Question Is the presence of a resident labor union associated with improved well-being at US surgical training programs? Findings In this cross-sectional survey study of 5701 residents, unionized programs were more likely to offer housing stipends and 4 weeks (instead of 2-3 weeks) of ...

Background: Artery-only replantation may be necessary in circumstances when venous repair cannot be performed due to their size or vessel injury. Venous congestion of the replanted part is inevitable. A systematic review was performed to identify techniques for mitigating congestion and analyze the outcomes of those techniques. Methods: A comprehensive literature search was performed to identify relevant articles related to artery-only replantation. An initial query identified 1286 unique articles. A total of 55 articles were included in the final review. Included studies were categorized by decongestive technique. Data from each article included the number of patients treated, level of amputation, graft use, anticoagulation or antiplatelet therapy, replant viability, and follow-up duration. Weighted averages were determined from studies that reported five or more digits. Results: A total of 1498 individual digital replantations were described. Very rarely did studies report artery-only replantation proximal to the distal interphalangeal joint. An overall survival rate of 78.5 percent was found irrespective of technique but was variable based on each particular study. Studies utilizing medicinal leech therapy were more likely to report use of intravenous anticoagulation, whereas surface bleeding techniques were more likely to report use of topical or local anticoagulant. Conclusions: Lack of a vein for anastomosis should not be regarded as a contraindication to replantation. These digits instead require a method to establish reliable drainage sufficient to allow for low resistance inflow and maintain a physiologic pressure gradient across capillary beds. The surgeon should select a decongestive technique that best suits the patient and their specific injury.

Summary: The purpose of this study was to evaluate whether neurosensory recovery of the inferior alveolar nerve (IAN) is influenced by its location following sagittal split osteotomy (SSO) in patients undergoing large mandibular movements. This was a prospective, split-mouth study of skeletally mature patients undergoing bilateral SSO. Patients were included as study subjects if they underwent bilateral SSO for mandibular advancement greater than 10 mm and, following the splits, the IAN was freely entering the distal segment on one side and within the proximal segment on the other. Descriptive, bivariate, and Kaplan-Meier statistics were computed. The study sample included 13 subjects (eight female subjects; mean age, 18.7 ± 1.8 years) undergoing 26 SSOs. Eleven subjects underwent bimaxillary surgery; 10 had simultaneous genioplasty. The mean mandibular movement was 12.2 ± 1.4 mm and was not significantly different between sides (P = 0.43). All subjects achieved functional sensory recovery (FSR) bilaterally within 1 year of surgery. There was no difference in the median times to FSR based on the location of the IAN (distal segment, 105 days, versus proximal segment, 126 days; P = 0.57). In SSO for mandibular advancement with movements greater than 10 mm, leaving the IAN within the proximal segment may not impact time to FSR. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.