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  1. Article ; Online: Invited Commentary: A Tale of 2 Perspectives: The Evolving Culture of Surgery.

    Lebares, Carter C

    Journal of the American College of Surgeons

    2023  Volume 237, Issue 2, Page(s) 290–291

    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000773
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  2. Article ; Online: From challenge to change in Surgery.

    Lebares, Carter C

    American journal of surgery

    2021  Volume 223, Issue 4, Page(s) 624–625

    MeSH term(s) General Surgery ; Humans
    Language English
    Publishing date 2021-09-06
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2021.09.002
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  3. Article ; Online: Scoping mindfully.

    Jangi, Sushrut / Lebares, Carter

    Gastrointestinal endoscopy

    2021  Volume 94, Issue 4, Page(s) 877–878

    Language English
    Publishing date 2021-09-16
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 391583-9
    ISSN 1097-6779 ; 0016-5107
    ISSN (online) 1097-6779
    ISSN 0016-5107
    DOI 10.1016/j.gie.2021.05.043
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  4. Article ; Online: Robotic repair of moderate-sized midline ventral hernias reduced complications, readmissions, and length of hospitalization compared to open techniques.

    Carter, Jonathan / Ahamed, Fayyaz / Juprasert, Jackly / Anderson, Mark / Lin, Matthew / Lebares, Carter / Soriano, Ian

    Journal of robotic surgery

    2024  Volume 18, Issue 1, Page(s) 142

    Abstract: Purpose: To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias.: Methods: From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively ... ...

    Abstract Purpose: To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias.
    Methods: From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively collected. We studied hernias potentially suitable for robotic repair: elective, midline, 3-10 cm rectus separation, no prior mesh, and no need for concomitant procedure. Robotic or open repair was performed by surgeon or patient preference. The primary outcome was any complication using Clavien-Dindo scoring. Secondary outcomes were operative time, length-of-stay, and readmissions. Regression identified predictors of complications.
    Results: Of 648 hernias repaired, 70 robotic and 52 open repairs met inclusion criteria. The groups had similar patient demographics, co-morbidities, and hernia size, except that there were more immunosuppressed patients in the open group (11 versus 5 patients, p = 0.031). Complications occurred after 7 (13%) open repairs versus 2 (3%) robotic repairs, p = 0.036. Surgical site infection occurred after four open repairs but no robotic repair, p = 0.004. Length-of-stay averaged almost 3 days longer after open repair (4.3 ± 2.7 days versus 1.5 ± 1.4 days, p = 0.031). Readmission occurred after 6 (12%) oppen repairs but only 1 (1%) robotic repair. A long-term survey (61% response rate after mean follow-up of 2.8 years) showed that the HerQLes QOL score was better after robotic repair (46 ± 15 versus 40 ± 17,  = 0.049). In regression models, only open technique predicted complications.
    Conclusions: Robotic techniques were associated with fewer complications, shorter hospitalization, fewer infections, and fewer readmissions compared to open techniques. Open surgical technique was the only predictor of complications.
    MeSH term(s) Humans ; Patient Readmission ; Robotic Surgical Procedures/methods ; Quality of Life ; Hernia, Ventral/surgery ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Surgical Mesh ; Laparoscopy ; Retrospective Studies
    Language English
    Publishing date 2024-03-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-024-01909-7
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  5. Article ; Online: Flourishing as a guide to intervention: a national multicenter study of general surgery residents.

    Greenberg, Anya L / Boscardin, Christy / Lebares, Carter C

    Global surgical education : journal of the Association for Surgical Education

    2022  Volume 1, Issue 1, Page(s) 12

    Abstract: Purpose: Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have ... ...

    Abstract Purpose: Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have been limited. Here we provide early data on modifiable targets, potential interventions, and comparative impact.
    Methods: In this cross-sectional survey-based study of mixed-level residents at 16 academic General Surgery training programs, gender-identity, race, post-graduate year, and gap years were self-reported. Correlation between our primary outcome variable, flourishing, and measures of resilience (mindfulness, personal accomplishment [PA], workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, perceived stress, anxiety, workplace demand) were assessed.
    Results: Of 891 recipients, 300 responded (60% non-male, 41% non-white). Flourishing was significantly positively correlated with all measured resilience factors and negatively correlated with all measured risk factors. In multivariable modelling, mindfulness, PA, and workplace support were positively and significantly associated with flourishing, with PA having the strongest resilience effect. Depression and anxiety were negatively and significantly associated with flourishing, with depression having the strongest risk effect.
    Conclusions: Our results suggest that interventions that increase mindfulness, workplace support, and PA, as well as those that decrease depression and anxiety may particularly impact flourishing (i.e., global wellbeing) in surgical trainees. These findings provide preliminary guidance on allocation of resources toward wellbeing interventions. In particular, cognitive (i.e., mindfulness) training is a feasible intervention with modest but significant association with flourishing, and potential indirect effects through influence on PA, anxiety and depression.
    Supplementary information: The online version contains supplementary material available at 10.1007/s44186-022-00014-3.
    Language English
    Publishing date 2022-03-31
    Publishing country United States
    Document type Journal Article
    ISSN 2731-4588
    ISSN (online) 2731-4588
    DOI 10.1007/s44186-022-00014-3
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  6. Article: Non-operative management of pneumoperitoneum following cardiopulmonary resuscitation.

    Johnson, Christopher L / Gomes, Camilla / Cheng, Justin / Lebares, Carter C

    Journal of surgical case reports

    2022  Volume 2022, Issue 5, Page(s) rjac219

    Abstract: Spontaneous pneumoperitoneum in a patient with a tracheostomy tube following cardiopulmonary resuscitation is exceedingly rare, with little experimental nor observational data to guide evidence-based management. We present the case of a 75-year-old woman ...

    Abstract Spontaneous pneumoperitoneum in a patient with a tracheostomy tube following cardiopulmonary resuscitation is exceedingly rare, with little experimental nor observational data to guide evidence-based management. We present the case of a 75-year-old woman with a tracheostomy tube who developed pneumoperitoneum following CPR. The patient experienced pulseless electrical activity arrest requiring nine rounds of chest compressions to return to spontaneous circulation. Computerized tomography demonstrated pneumothoraces, subcutaneous emphysema and extensive intraperitoneal, extraperitoneal and retroperitoneal free air without evidence of visceral perforation. The patient's abdomen was distended without tenderness, guarding or rebound. She had a white blood cell count mildly elevated from her baseline levels. The management plan of serial abdominal exams without operative intervention was chosen given the absence of clinical and laboratory signs of peritonitis. This case highlights the importance of developing a standardized management algorithm for patients with pneumoperitoneum in the setting of tracheostomy tubes without evidence of perforation.
    Language English
    Publishing date 2022-05-18
    Publishing country England
    Document type Case Reports
    ZDB-ID 2580919-2
    ISSN 2042-8812
    ISSN 2042-8812
    DOI 10.1093/jscr/rjac219
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  7. Article ; Online: Looking Across the Drape: A Novel Quality Improvement Approach to Understanding Surgeon and Anesthesiologist Burnout.

    Sinskey, Jina L / Schwartz, Rachel / Boscardin, Christy K / Chang, Joyce M / Kumar, Sandhya B / Lebares, Carter C

    Annals of surgery

    2024  

    Abstract: Objective: To identify well-being threats for surgeons and anesthesiologists and develop interventions using the Quality of Life Improvement (QOLI) approach.: Background: Developing feasible perioperative well-being interventions requires identifying ...

    Abstract Objective: To identify well-being threats for surgeons and anesthesiologists and develop interventions using the Quality of Life Improvement (QOLI) approach.
    Background: Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs.
    Methods: Anesthesia and surgery faculty in eight perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live-voting to identify well-being priorities.
    Results: 104 perioperative faculty completed the survey. Across specialties, higher MHC-SF scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded five areas for intervention: (1) Work culture, (2) Work environment/resources, (3) Sources of fulfillment, (4) Work/life harmony, (5) Financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were OR inefficiencies/delays and excessive workload, while anesthesiologists cited understaffing and unpredictable work hours.
    Conclusions: Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions.
    Language English
    Publishing date 2024-02-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000006241
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  8. Article ; Online: Operationalizing the Culture of Burnout and Well-Being: Multicenter Study of Value Congruence and Flourishing in General Surgery Residency.

    Cevallos, Jenny R / Gonzales, Paul Adam / Berler, Michael H / Greenberg, Anya L / Lebares, Carter C

    Journal of the American College of Surgeons

    2023  Volume 237, Issue 3, Page(s) 397–407

    Abstract: Background: Value congruence (VC) is the degree of alignment between worker and workplace values and is strongly associated with reduced job strain and retention. Within general surgery residency, the impact of VC and how to operationalize it to improve ...

    Abstract Background: Value congruence (VC) is the degree of alignment between worker and workplace values and is strongly associated with reduced job strain and retention. Within general surgery residency, the impact of VC and how to operationalize it to improve workplace well-being remain unclear.
    Study design: This 2-part mixed-methods study comprised 2 surveys of US general surgery residents and qualitative interviews with program directors. In Part 1, January 2021, mixed-level surgical residents from 16 ACGME-accredited general surgery residency programs participated in survey #1. This survey was used to identify shared or conflicting perspectives on VC concerning well-being initiatives and resources. In April 2021, interviews from 8 institutions were conducted with 9 program directors or their proxies. In Part 2, May to June 2022, a similar cohort of surgical residents participated in survey #2. Unadjusted logistic and linear regression models were used in this survey to assess the association between VC and individual-level global well-being (ie flourishing), respectively.
    Results: In survey #1 (N = 300, 34% response rate), lack of VC was an emergent theme with subthemes of inaccessibility, inconsiderateness, inauthenticity, and insufficiency regarding well-being resources. Program directors expressed variable awareness of and alignment with these perceptions. In survey #2 (N = 251, 31% response rate), higher VC was significantly associated with flourishing (odds ratio 1.91, 95% CI 1.44 to 2.52, p < 0.001).
    Conclusions: Exploring the perceived lack of VC within general surgery residency reveals an important cultural variable for optimizing well-being and suggests open dialogue as a first step toward positive change. Future work to identify where and how institutional actions diminish perceived VC is warranted.
    MeSH term(s) Humans ; United States ; Internship and Residency ; Surveys and Questionnaires ; Burnout, Professional/prevention & control ; General Surgery/education
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Multicenter Study ; Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000775
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  9. Article ; Online: Mindfulness Based Interventions for Surgeons: A Scoping Review.

    Coopersmith, Ari S / Shroff, Yash V / Wen, George A / Berler, Michael H / Gonzales, Paul A / Ojute, Feyisayo M / Lebares, Carter C

    Annals of surgery

    2024  

    Abstract: Objective: To review the evidence on mindfulness-based interventions (MBIs) for surgeons.: Background: Healthcare professionals have alarmingly high rates of burnout, yet little is known about psychological factors that support resilience. MBIs, ... ...

    Abstract Objective: To review the evidence on mindfulness-based interventions (MBIs) for surgeons.
    Background: Healthcare professionals have alarmingly high rates of burnout, yet little is known about psychological factors that support resilience. MBIs, which involve codified training in specific skills such as self-awareness, emotional regulation, and perspective-taking, have shown benefit to professionals in high stress environments, but have had limited implementation in the healthcare workplace and in surgery. To our knowledge, there has not been a scoping review of MBIs in surgery to date.
    Methods: We conducted a scoping review of the evidence for the feasibility and effectiveness of MBIs for surgeons, including evidence on interventions that explicitly train mindfulness, which spans multiple cohorts and settings, utilizing different methodologies and outcome measures.
    Results: This scoping review yielded 24 studies, including two mixed method/qualitative studies, nine randomized control trials, three non-randomized interventional studies, and eight single-arm interventional studies.
    Conclusions: We find that MBIs in surgery 1) are feasible in surgical contexts, with implementation science providing insights on sustainability; 2) increase mindfulness, 3) improve well-being in terms of burnout and both psychological and neurophysiological measures of stress, and 4) enhance performance as measured in executive function, surgical skills, and communication skills. These conclusions are supported by psychometric measures, observations of technical skills, and neurophysiological evidence. Future directions include studying MBIs in larger and more diverse populations, and iteratively tailoring mindfulness-based interventions to other healthcare contexts.
    Language English
    Publishing date 2024-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000006213
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  10. Article ; Online: Investigating influential factors and mechanisms of surgical resident well-being using social network analysis.

    Coopersmith, Ari S / Berler, Michael H / Johnston, Brianna / Knutilla, Lillian / Edwards, Anya L / Lebares, Carter C

    American journal of surgery

    2023  Volume 228, Page(s) 45–51

    Abstract: Background: Burnout and depression in General Surgery residents affect patient care and drive attrition. Few impactful interventions exist, in part because little is known about influential drivers and mechanistic relationships.: Methods: Residents ... ...

    Abstract Background: Burnout and depression in General Surgery residents affect patient care and drive attrition. Few impactful interventions exist, in part because little is known about influential drivers and mechanistic relationships.
    Methods: Residents from 16 general surgery programs completed published well-being scales in January 2021. Social network analysis demonstrated influential relationships between factors, and path analysis revealed drivers of burnout and depression.
    Results: 300 residents completed the survey (34% response rate). Workplace demand and mindfulness influenced depressive symptoms and emotional exhaustion, mediated by perceived stress. Mindfulness increased personal accomplishment, mediated by psychological well-being (p ​< ​0.05 for all results). All mediated effects were greater than direct effects.
    Conclusions: This study yielded a quantitative conceptual model of mechanistic relationships affecting well-being in surgical residency, identifying stress and psychological well-being (measuring sense of purpose) as central mediators, and triangulating workplace demand and mindfulness as potentially high-yield interventional targets for reducing burnout and depression in surgical residency.
    MeSH term(s) Humans ; Internship and Residency ; Social Network Analysis ; Burnout, Professional/prevention & control ; Burnout, Professional/psychology ; Surveys and Questionnaires ; Workplace
    Language English
    Publishing date 2023-09-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.09.004
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