The Aging Population and Its Impact on the Surgery Workforce

Etzioni, David A.; Liu, Jerome H.; Maggard, Melinda A.; Ko, Clifford Y.

doi:10.1097/01.sla.0000081085.98792.3d

Cited by 675 publications

(397 citation statements)

References 23 publications

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“…4 An increasing number of elderly patients will be undergoing surgery, leading to a projected 31% increase in general surgery workload. 5 In recent years, a standardized measure of a patient's physiologic reserve has been developed in an effort to predict postoperative morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Karamanos

Schmoekel

Blyden

et al. 2016

TPJ

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Background: Unplanned postoperative reintubation increases the risk of mortality, but associated factors are unclear.Objective: To elucidate factors associated with increased mortality risk in patients with unplanned postoperative reintubation.Design: Retrospective study. Patients older than 40 years who underwent unplanned reintubation from 2005 to 2010 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Multiple regression models were used to examine the impact on mortality of factors that included the modified frailty index (mFI) we developed, American Society of Anesthesiologists (ASA) score, age decile, and days to reintubation.Main Outcome Measure: Mortality.Results: A total of 17,051 postoperative reintubations in adults were analyzed. Overall mortality was 29.4% (n = 5009). On postoperative day 1, 4434 patients were reintubated and 878 (19.8%) died. On postoperative day 7 and beyond, 6329 patients were reintubated and 2215 (35.0%) died. Increasing mFI resulted in increasing incidence of mortality (mFl of 0 = 20.5% mortality vs mFl of 0.37-0.45 = 41.7% mortality). As ASA score increased from 1 to 5, reintubation was associated with a mortality of 12.1% to 41.6%, respectively. Similarly, increasing age decile was associated with increasing incidence of mortality (40-49 years, 17.9% vs 80-89 years, 42.1%). After adjustment for confounding factors, mFI, ASA score, age decile, and increasing number of days to reintubation were independently and significantly associated with increased mortality in the study population.Conclusion: Among patients who underwent unplanned reintubation, older and more frail patients had an increased risk of mortality.

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Section: Introductionmentioning

confidence: 99%

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Karamanos

Schmoekel

Blyden

et al. 2016

TPJ

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“…[1][2][3][4] Not surprisingly, cataract surgery by phacoemulsification and intraocular lens (IOL) implantation is the most commonly performed surgical procedure worldwide. 3,[5][6][7] Valid evaluation of cataract and its visual consequences is indispensable for the purpose of investigating possible risk factors for cataract formation and for documenting progression of cataract in epidemiologic and cohort studies. Also, reliable and valid assessment of cataract and its visual sequelae is equally important for clinical practice, if the ophthalmologist is to accurately evaluate the impact of age-related cataract on patient's visual performance and experience, and therefore identify those who are likely to benefit from surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract

Charalampidou

Nolan

Loughman

et al. 2011

Eye

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Purpose To investigate whether psychophysical, morphological, and/or optical characteristics of symptomatic non-advanced cataract are complementary to, or more appropriate than, visual acuity (VA) for the purposes of recording visual data that reflect subjective visual difficulty in patients with cataract that exhibit relative sparing of high contrast acuity (0.4 logarithm of minimal angle of resolution (logMAR) scale or better). Methods Eighty-two patients with symptomatic non-advanced cataract and no other ocular pathology were asked to complete a validated questionnaire, and to perform a series of visual function assessments including: corrected distance VA (CDVA); photopic and mesopic contrast sensitivity; photopic and mesopic glare disability (GD); reading acuity and reading speed; stereoacuity; and retinal sensitivity. Optical and morphological characteristics of the cataract were evaluated by lens optical density and by the Lens Opacities Classification System III, respectively. Correlations between questionnaire score and each of these measures were calculated. Results Statistically significant negative correlations were observed between the Rasch-scaled questionnaire score and mesopic GD (at 3 and 6 cycles per degree (cpd); r ¼ À0.396 (Po0.01) and À0.451 (Po0.05), respectively) and between the Rasch-scaled questionnaire score and photopic GD (at 3 and 6 cpd; r ¼ À0.328 (Po0.01) and À0.440 (Po0.01), respectively). Conclusion Symptomatic non-advanced cataract, in the presence of good CDVA, is associated with measurable subjective visual difficulty, best reflected in a decrease in mesopic and photopic GD (at medium spatial frequencies). CDVA does not reflect the patient's visual dissatisfaction in such cases.

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“…In 2008, a further study conducted on the Hip and Knee specialist workforce identified a chasm between the 23 % increase in the demand for services but only a 2 % increase in supply of specialists. The issues that beseech predicting future supply and demand models stem from the unpredictable shift in demographics and the evolving spectrum of chronic disease [10]. On the supply side restructuring of training schemes and large scale reform of working patterns result in difficulties in forecasting the functional capacity of the orthopedic community.…”

Section: Concepts Of Workforce Planningmentioning

confidence: 99%

Matching residency numbers to the workforce needs

Khan

Johnston

Faimali

et al. 2014

Curr Rev Musculoskelet Med

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Matching the number of surgeons to the demands for orthopedic services has been notoriously difficult. Not only does one need to evaluate current trends in the supply and provision of services but anticipate the impact of future reforms on these variables. The British Orthopaedic Association has aspired to provide consultant to population ratio of 1:15,000 by 2020. Currently, the orthopedic community is tasked with providing care for an aging population with soaring levels of obesity; with both of these factors set to grow and also with an overall decline in productivity. Orthopedic surgeons must brace themselves for an explosion in demand. At the same time, a paradigm shift has occurred in the delivery of services with the creation of specialist centers. We are amidst a generational shift in the demographics and psychology of the orthopedic workforce. The orthopedic community must be aware of the effects of these far-reaching changes when tailoring the supply of surgeons for the future needs.

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The Aging Population and Its Impact on the Surgery Workforce

Abstract: The aging of the US population will result in significant growth in the demand for surgical services. Surgeons need to develop strategies to manage an increased workload without sacrificing quality of care.

Cited by 675 publications

References 23 publications

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract

Matching residency numbers to the workforce needs

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