Browsing by Author "Monfared, Sara"
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Item Can a brief assessment of social support predict outcomes after bariatric surgery?(Wiley, 2021-02) Hilgendorf, William; Monfared, Sara; Hassan Beygi Monfared, Sina; Athanasiadis, Dimitrios I.; Selzer, Don; Choi, Jennifer N.; Banerjee, Ambar; Stefanidis, Dimitrios; Surgery, School of MedicineSocial support is important to optimize bariatric surgery outcomes, but limited tools exist for brief and effective assessment preoperatively. The aims of the study were to determine the extent to which two ratings of social support can predict bariatric surgery outcomes, and to examine any associations between these two methods.In this retrospective study, patients were included for whom the Cleveland clinic behavioral rating system (CCBRS) and Flanagan quality of life scale (FQoLS) scores were obtained as part of their preoperative psychosocial evaluation. They were followed up for 6 to 24 months after bariatric surgery. Linear and logistic regressions were performed with patients' CCBRS and FQoLS scores as independent variables, and percent excess weight loss (%EWL), length of stay (LOS), complications, readmissions and loss to follow-up as dependent variables. The prediction of CCBRS ratings from FQoLS social support items was also evaluated. A total of 415 patients were included in the analysis. There were significant associations between the CCBRS and three of the four relevant FQoLS self-ratings. As CCBRS and FQoLS scores increased, complications decreased significantly. The CCBRS alone additionally predicted decreased length of hospital stay and approached significance for predicting decreased readmission rates. There were no associations between %EWL and behavior ratings. The degree of patients' social support is associated with important bariatric surgery outcomes. It is possible to obtain this valuable information via the administration of brief assessments prior to bariatric surgery.Item A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents’ Operative Performance and Decreases Skill Variability: Cohort Study(Wolters Kluwer, 2022-12) Huffman, Elizabeth M.; Choi, Jennifer N.; Martin, John R.; Anton, Nicholas E.; Nickel, Brianne L.; Monfared, Sara; Timsina, Lava R.; Dunnington, Gary L.; Stefanidis, Dimitrios; Surgery, School of MedicineObjective: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill. Summary of Background Data: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition. We implemented a CBE LC curriculum to improve resident performance and decrease skill variability. Methods: PGY-2 residents completed the curriculum during monthly rotations starting in July 2017. Once simulator proficiency was reached, residents performed elective LCs with a select group of faculty at 3 hospitals. Performance at curriculum completion was assessed using LC simulation metrics and intraoperative operative performance rating system scores and compared to both baseline and historical controls, comprised of rising PGY-3s, using a 2-sample Wilcoxon rank-sum test. PGY-2 group’s performance variability was compared with PGY-3s using Levene robust test of equality of variances; P < 0.05 was considered significant. Results: Twenty-one residents each performed 17.52 ± 4.15 consecutive LCs during the monthly rotation. Resident simulated and operative performance increased significantly with dedicated training and reached that of more experienced rising PGY-3s (n = 7) but with significantly decreased variability in performance (P = 0.04). Conclusions: Completion of a CBE rotation led to significant improvements in PGY-2 residents’ LC performance that reached that of PGY-3s and decreased performance variability. These results support wider implementation of CBE in resident training.Item High Rates of Nicotine Use Relapse and Ulcer Development Following Roux-en-Y Gastric Bypass(Springer, 2021-02) Athanasiadis, Dimitrios I.; Christodoulides, Alexei; Monfared, Sara; Hilgendorf, William; Embry, Marisa; Stefanidis, Dimitrios; Surgery, School of MedicinePURPOSE: Given that smoking is known to contribute to gastrojejunal anastomotic (GJA) ulcers, cessation is recommended prior to laparoscopic Roux-en-Y gastric bypass (LRYGB). However, smoking relapse rates and the exact ulcer risk remain unknown. This study aimed to define smoking relapse, risk of GJA ulceration, and complications after LRYGB. MATERIALS AND METHODS: We performed a retrospective cohort study of patients who underwent primary LRYGB during 2011-2015. Initially, three patient categories were identified: lifetime non-smokers, patients who were smoking during the initial visit at the bariatric clinic or within the prior year (recent smokers), and patients who had ceased smoking more than a year prior to their initial clinic visit (former smokers). Smoking relapse, GJA ulcer occurrences, reinterventions, and reoperations were recorded and compared. RESULTS: A total of 766 patients were included in the analysis. After surgery, 53 (64.6%) recent smokers had resumed smoking. Out of these relapsed smokers, 51% developed GJA ulcers compared with 14.8% in non-relapsed recent smokers, 16.1% in former smokers, and 6% in lifetime nonsmokers (p < 0.001). Furthermore, relapsed smokers required more frequently endoscopic reinterventions (60.4%) compared with non-relapsed smokers (20.8%, p < 0.001), former smokers (20.7%, p < 0.001), and lifetime non-smokers (15.4%, p < 0.001). Additionally, relapsed smokers required a reoperation (18.9%) more often than non-relapsed recent smokers (5.7%, p < 0.001) and lifetime non-smokers (1.3%, p < 0.001). CONCLUSION: Smokers relapse frequently after LRYGB, and the majority experience GJA complications. They should be counseled about this risk preoperatively and directed towards less ulcerogenic procedures when possible. Alternatively, longer periods of preoperative smoking abstinence might be needed.Item Identifying Barriers and Facilitators of Exoskeleton Implementation in the Operating Room(Sage, 2019) Cha, Jackie S.; Monfared, Sara; Ecker, Kaylee; Lee, Derek; Stefanidis, Dimitrios; Nussbaum, Maury A.; Yu, Denny; Surgery, School of MedicineMembers of the surgical team experience musculoskeletal (MS) symptoms that impact occupational health. Although the prevalence of MS symptoms in this population is well-recognized, limited interventions with sustained success exist for the operating room (OR) environment. The purpose of this work was to determine the facilitators of and barriers to exoskeleton technology in the OR, as a potential intervention to reduce upper-body MS pain and discomfort for surgical team members.Item Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial(Lippincott, 2020-08) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of MedicineObjective: To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. Summary Background Data: There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. Methods: Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores. Results: All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82–0.97) but moderate for GEARS ratings (0.40–0.67). Conclusions: We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with controls on a transfer test. We therefore argue for its implementation across training programs before surgeons apply these skills clinically.Item Response to “Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial” Not only surgeon's manual skills...”(Wolters Kluwer, 2020-12) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of MedicineItem Supporting Surgical Teams: Identifying Needs and Barriers for Exoskeleton Implementation in the Operating Room(Sage, 2020) Cha, Jackie S.; Monfared, Sara; Stefanidis, Dimitrios; Nussbaum, Maury A.; Yu, Denny; Surgery, School of MedicineObjective: The objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR). Background: MS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions. Method: Surgical team members (n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes. Results: Four themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 (SD = 8.1), which was in the acceptable range of usability. Conclusion: Adoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed. Application: Findings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams.Item Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients(Springer, 2019-03) Monfared, Sara; Martin, Anna; Gupta, Kamna; Stefanidis, Dimitrios; Selzer, Don; Choi, Jennifer; Butler, Annabelle; Banerjee, Ambar; Surgery, School of MedicineBackground Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. Methods A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Results Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3 years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12 months between the groups. Conclusion When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost.Item What delays your case start? Exploring operating room inefficiencies(Springer, 2021-06) Athanasiadis, Dimitrios I.; Monfared, Sara; Whiteside, Jake; Banerjee, Ambar; Keller, Donna; Butler, Annabelle; Stefanidis, Dimitrios; Surgery, School of MedicineIntroduction Improving operating room (OR) inefficiencies benefits the OR team, hospital, and patients alike but the available literature is limited. Our goal was, using a novel surgical application, to identify any OR incidents that cause delays from the time the patient enters the OR till procedure start (preparatory phase). Materials and methods We conducted an IRB approved, prospective, observational study between July 2018 and January 2019. Using a novel surgical application (ExplORer Surgical) three observers recorded disrupting incidents and their duration during the preparatory phase of a variety of general surgery cases. Specifically, the number and duration of anesthesia delays, unnecessary/distracting conversations, missing items, and other delays were recorded from the moment they started until they stopped affecting the normal workflow. Results Ninety-six OR cases were assessed. 20 incidents occurred in 18 (19%) of those cases. The average preparatory duration for all the cases was 20.7 ± 8.6 min. Cases without incidents lasted 19.5 ± 7.4 min while cases with incidents lasted 25.9 ± 11.2 min, p = 0.03. The average incident lasted 3.7 min, approximately 18% of the preparatory phase duration. Conclusion The use of the ExplORer Surgical app allowed us to accurately record the incidents happening during the preparatory phase of various general surgery operations. Such incidents significantly prolonged the preparatory duration. The identification of those inefficiencies is the first step to targeted interventions that may eventually optimize the efficiency of preoperative preparation.