Clinics in Colon and Rectal Surgery

Despite increasing female representation in U.S. medical schools, women remain underrepresented in academic surgery departments across the country. Even as the gap narrows in academic surgery, female surgeons' professional advancement does not parallel that of their male counterparts. This article explores how to continue to advance women in academic surgery, first by considering the barriers women surgeons face, then offering actionable steps-on the individual, interpersonal, and systems levels-to overcome these barriers and work toward gender equity...

The concept of equity ensures that each individual is given the environment, treatment, and resources needed to reach an equal outcome to those around them. Equity is central to initiatives for advancing diversity and inclusion among physicians. This article will identify key barriers to equity that women surgeons face within the professional setting. More specifically, inadequate female representation, discrimination in the form of unconscious gender bias and microaggressions, and sexual harassment will be explored regarding their continued threats to gender equity, as well as constructive ways to mitigate these effects...

The paucity of gender diversity in the biotech and medical/surgical technology fields remains a persistent challenge. Over the course of history, advancements have been made; however, women remain underrepresented in these sectors from the entry level to the leadership and corporate positions. Similarly, there is a notable lack of women-led startup teams obtaining funding from venture capitalists and fewer women-led teams submitting and securing patents. We will discuss current data surrounding the lack of gender diversity in these fields, explore parallels specifically between the lack of women in surgical specialties and science, technology, engineering, and mathematics (STEM) pathways, and how this translates to the lack of women in the surgical and medical technology industry...

The use of social media platforms in a professional capacity has grown and presents unique opportunities for women surgeons. Women surgeons face unique obstacles and challenges compared with their male counterparts. Social media has helped women surgeons create an online community and has provided opportunities for mentorship and professional advancement. In addition, it has helped break down traditional constructs of what it means to be a surgeon and allowed the medical community and public to view images of a modern surgeon...

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Quality improvement efforts take considerable commitment, including mentorship, training, and resources. Leveraging an established framework, such as that outlined by the American College of Surgeons, to design, implement, and analyze quality improvement projects offers the best chance for success. Herein, we illustrate the application of this framework to a gap in advance care planning for surgical patients. This article helps outline how to go from identifying and outlining a problem, to articulating a clearly defined project goal that is specific, measurable, attainable, relevant, and timebound, and later implementing and analyzing a gap in quality identified at the unit (e...

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With the rise in the availability of large health care datasets, database research has become an important tool for colorectal surgeon to assess health care quality and implement practice changes. In this chapter, we will discuss the benefits and drawbacks of database research for quality improvement, review common markers of quality for colorectal surgery, provide an overview of frequently used datasets (including Veterans Affairs Surgical Quality Improvement Program, National Surgical Quality Improvement Project, National Cancer Database, National Inpatient Sample, Medicare Data, and Surveillance, Epidemiology, and End Results), and look ahead to the future of database research for the improvement of quality...

Delivering high-quality surgical care requires knowing how best to define and measure quality in surgery. Patient-reported outcomes (PROs) enable surgeons, health care systems, and payers to understand meaningful health outcomes from the patient's perspective and can be measured using patient-reported outcome measures (PROMs). As a result, there is much interest in using PROMs in routine surgical care, to guide quality improvement and to inform reimbursement pay structures. This chapter defines PROs and PROMs, differentiates PROMs from other quality measures such as patient-reported experience measures, describes PROMs in the context of routine clinical care, and provides an overview of interpreting PROM data...

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No abstract text is available yet for this article.

Traditionally employed in medical anthropologic and sociologic literature, qualitative methods are emerging as an essential component of clinical research as surgeons and researchers strive to optimize care informed by patient perspectives. Qualitative methods in health care-related research may be used to understand subjective experiences, beliefs, and concepts that are not captured using quantitative analyses and to gain in-depth knowledge of a specific context or culture. A qualitative approach may also be employed to explore under-researched problems and generate new ideas...

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Given the increased life expectancy and improvements in the treatment of colorectal patients, the success of a treatment course can no longer be determined only by objective outcomes. Health care providers ought to take into consideration the impact an intervention will have on the quality of life of patients. Endpoints that take into account the patient's perspective are defined as patient-reported outcomes (PROs). PROs are assessed through patient-reported outcome measures (PROMs), usually in the form of questionnaires...

Accreditation has played a major role in the evolution of health care quality as well as the structure and organization of American medicine. In its earliest iterations, accreditation aimed to set a minimum standard of care, and now more prominently sets standards for high quality, optimal patient care. There are several institutions that provide accreditations that are relevant to colorectal surgery including the American College of Surgeons (ACS) Commission on Cancer, National Cancer Institute Cancer Center Designation, National Accreditation Program for Rectal Cancer, and the ACS Geriatrics Verification Program...

Patients expect high-quality surgical care and increasingly are looking for ways to assess the quality of the surgeon they are seeing, but quality measurement is often more complicated than one might expect. Measurement of individual surgeon quality in a manner that allows for comparison among surgeons is particularly difficult. While the concept of measuring individual surgeon quality has a long history, technology now allows for new and innovative ways to measure and achieve surgical excellence. However, some recent efforts to make surgeon-level quality data publicly available have highlighted the challenges of this work...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Malnutrition is common in surgical patients and is associated with substantially increased morbidity and mortality. Dedicated assessment of nutritional status is advised by major nutrition and surgical societies. Assessment may utilize comprehensive and validated nutritional assessment tools or targeted history, physical examination with accompanying serologic markers to identify nutritional risk preoperatively. Emergent surgery in malnourished patients should proceed as the clinical situation dictates with consideration of ostomy or primary anastomosis with proximal fecal diversion to mitigate postoperative infectious complications...

More than 50 million surgical procedures are carried out every year in the United States with the estimated risk of major adverse cardiac events perioperatively between 1.4 and 3.9%. Given that the majority of surgeries are elective, this allows ample opportunity to identify patients at higher risk of perioperative adverse events and optimize them for surgery. Preexisting cardiopulmonary disease is a major risk factor for adverse events perioperatively and can lead to significant morbidity and mortality. It can predispose patients to perioperative myocardial ischemia and infarction, perioperative pulmonary complications, and perioperative stroke among other complications...