1.Assessment of the gender gap in urology industry payments: An Open Payments Program data analysis
Yuzhi WANG ; Matthew James DAVIS ; Alexandra ROGERS ; Jonathan REXROTH ; Taylor Jane MALCHOW ; Alex STEPHENS ; Mohit BUTANEY ; Samantha WILDER ; Samantha RAFFEE ; Firas ABDOLLAH
Investigative and Clinical Urology 2024;65(4):411-419
Purpose:
The Open Payments Program (OPP), established in 2013 under the Sunshine Act, mandated medical device and pharmaceutical manufacturers to submit records of financial incentives given to physicians for public availability. The study aims to characterize the gap in real general and real research payments between man and woman urologists.
Materials and Methods:
The study sample included all urologists in the United States who received at least one general or research payment in the OPP database from 2015 to 2021. Recipients were identified using the National Provider Identifier and National Downloadable File datasets. Payments were analyzed by geography, year, payment type, and years since graduation.Multivariable analysis on odds of being in above the median in terms of money received was done with gender as a covariate. This analysis was also completed for all academic urologists.
Results:
There was a total of 15,980 urologists; 13.6% were woman, and 86.4% were man. Compared to man urologists, woman urologists were less likely to be in the top half of total payments received (odds ratio [OR] 0.62) when adjusted for other variables.When looking at academic urologists, 18.1% were woman and 81.9% were man. However, woman academic urologists were even less likely to be in the top 50% of payments received (OR 0.55).
Conclusions
This study is the first to characterize the difference in industry payments between man and woman urologists. The results should be utilized to educate physicians and industry, in order to achieve equitable engagement and funding for woman urologists.
2.The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay
James Wei Tatt TOH ; Jack CECIRE ; Kerry HITOS ; Karen SHEDDEN ; Fiona GAVEGAN ; Nimalan PATHMANATHAN ; Toufic EL KHOURY ; Angelina DI RE ; Annelise COCCO ; Alex LIMMER ; Tom LIANG ; Kar Yin FOK ; James ROGERS ; Edgardo SOLIS ; Grahame CTERCTEKO
Annals of Coloproctology 2022;38(1):36-46
Purpose:
Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).
Methods:
This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed.
Results:
ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.
Conclusion
Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.