Publications by authors named "Alexandra B Columbus"
Importance: Only 7% of US surgical department chairs are occupied by women. While the proportion of women in the surgical workforce continues to increase, women remain significantly underrepresented across leadership roles within surgery.
Objective: To identify commonality among female surgical chairs with attention toward moderators that appear to have contributed to their professional success.
Background: Physician burnout is a highly prevalent issue in the surgical community. Burnout is associated with poor career satisfaction; female gender, and younger age place surgeons at higher risk for burnout. Here, we examined drivers behind burnout and career dissatisfaction in female and junior surgical faculty, with specific attention paid to gender-based differences.
View Article and Find Full Text PDFBackground: Emergency general surgery (EGS) is characterized by high rates of morbidity and mortality. Though checklists and associated communication-based huddle strategies have improved outcomes, these tools have never been specifically examined in EGS. We hypothesized that use of an evidence-based communication tool aimed to trigger intraoperative discussion could improve communication in the EGS operating room (OR).
View Article and Find Full Text PDFThe use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication.
View Article and Find Full Text PDFObjectives: Ineffective cross-cultural communication contributes to adverse outcomes for minority patients. To address this, the authors developed a novel curriculum for surgical residents built on the principle of cultural dexterity, emphasizing adaptability to clinical and sociocultural circumstances to tailor care to the needs of the individual patient. This study's objective was to evaluate the feasibility, acceptability, and perception of this program upon conclusion of its first year.
View Article and Find Full Text PDFObjective: The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement.
Background: Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed.
Importance: Although there is evidence that changes in clinicians during the continuum of care (care discontinuity) are associated with higher mortality and complications among surgical patients, little is known regarding the drivers of care discontinuity among emergency general surgery (EGS) patients.
Objective: To identify hospital factors associated with care discontinuity among EGS patients.
Design, Setting, And Participants: We performed a retrospective analysis of the 100% Medicare inpatient claims file, from January 1, 2008, to November 30, 2011, and matched patient details to hospital information in the 2011 American Hospital Association Annual Survey database.
Article Synopsis
- Emergency general surgery (EGS) patients face a higher risk of complications and death, particularly influenced by malnutrition, which may worsen outcomes after ICU admission.
- * An observational study of 1361 EGS patients revealed that 60% had nonspecific malnutrition and that this condition significantly raises the odds of 90-day mortality, with a 1.5-fold increase for nonspecific malnutrition and a 3.1-fold increase for protein-energy malnutrition.
- * The findings suggest that malnutrition upon ICU admission is a key predictor of poor outcomes, including higher readmission rates and increased mortality in critically ill patients undergoing EGS.
Importance: Emergency general surgery (EGS) patients have a disproportionate burden of death and complications. Chronic liver disease (CLD) increases the risk of complications following elective surgery. For EGS patients with CLD, long-term outcomes are unknown and risk stratification models do not reflect severity of CLD.
View Article and Find Full Text PDFBackground: Intraoperative blood product transfusions carry risk but are often necessary in emergency general surgery (EGS).
Methods: We queried the American College of Surgery-National Surgical Quality Improvement Program database for EGS patients (2008 to 2012) at 2 tertiary academic hospitals. Outcomes included rates of high packed red blood cell (pRBC) use (estimated blood loss:pRBC < 350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.