Joseph Hart
Joseph P. Hart, MD trained in general and vascular surgery at Medical College of Wisconsin and is an active vascular and endovascular surgeon. After post-fellowship training in carotid and peripheral intervention at AZ Sint Blasius, Dendermonde, Belgium, his career has taken him to the University of Rochester (2006), the Medical University of South Carolina (2008), the University of Cincinnati (2011) and Eastern Maine Medical Center (2013). He was Chief of Endovascular Surgery at the MUSC from 2008-2011 where he also held a joint appointment as an interventional radiologist. At MUSC, he was an active carotid interventionalist and helped begin a program of EVAR for ruptured and symptomatic abdominal aortic aneurysms. At the University of Cincinnati, he was Associate Program Director for the Vascular Integrated Residency and Fellowship. He is a member of the Society for Vascular Surgery, Association of Program Directors in Vascular Surgery, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Southern Association for Vascular Surgery, Midwest Vascular Surgery Society, Eastern Vascular Society, International Society for Vascular Surgery, International Society for Endovascular Specialists, Association for Surgical Education, American Heart Association, Surgical Outcomes Club, and Society for Vascular Ultrasound. He is a Fellow of the American College of Surgeons and a Corresponding Member of the European Society for Vascular Surgery. He was selected to Top Doctors 2013 and 2014 (Vascular Surgery) by Cincinnati Magazine. He attended Northwestern University Medical School after graduation from Grinnell College. At Grinnell, he obtained a BA in Biology with departmental honors and was co-recipient of the Smith Family Prize for Outstanding Senior in Biology and Chemistry (1991). He was born in Brooklyn, NY, is a graduate of Regis High School, NYC, and a life member of the National Eagle Scout Association.
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vena cava (IVC) filters. The authors note that the radial
force exerted by the filters studied correlates with published rates of caval perforation or penetration elsewhere
in the literature. The study is noteworthy for its simplicity;
it used a straightforward protocol to measure what is
apparent to those who deploy these devices and
reviewed evident complications subsequently
The development of the ability to estimate patient mortality preoperatively in surgical trainees has not been well studied.
DESIGN:
Prospective comparative study in which the expected perioperative mortality risk and the maximum tolerable mortality at which operation would still be offered were estimated by the operating surgeons immediately before planned vascular procedures.
SETTING:
University vascular surgery teaching service.
PARTICIPANTS:
Predicted and maximum allowable mortality risks were compared between trainees and attending surgeons, with the mortality calculated using the Veterans Administration Surgical Quality Improvement Program (VASQIP) as a reference.
RESULTS:
Surveys were performed before 379 procedures over a 10-month period. The median expected mortality risk predicted by trainees (2%; interquartile range [IQR]: 1%-5%) was higher than the risk predicted by attending surgeons (1%; IQR: 0.8%-3%) (p < 0.01). The median expected mortality risk calculated by VASQIP (0.8%; IQR: 0.4%-1.7%) was less than that estimated by trainees by a median of 0.3% (IQR: 0.2%-3.2%) or and that by attending surgeons by 0.3% (IQR: 0.2-1.3%) (p < 0.01). The median maximum tolerable mortality risk predicted by trainees (10%; IQR: 5%-27.5%) was equal to the risk predicted by attending surgeons (10%; IQR: 5%-17.5%). The perioperative mortality calculated by VASQIP exceeded the maximum tolerable mortality offered by trainees or attending surgeons in 1% of cases each. Discrepancies between expected mortality and maximum tolerable mortality for trainees and attending surgeons were greater for younger (postgraduate year 1 or 2) trainees (0.8%; IQR: 0-3.0%) than for more senior (postgraduate year 4 or 5) trainees (0.4%; IQR: 0.1%-2.0%).
CONCLUSION:
Surgeons in training overestimated the perioperative mortality risk of operations and were willing to tolerate a greater mortality risk compared with attending surgeons. Both trainee and attending surgeons tended to overestimate the perioperative mortality risk compared with that calculated by VASQIP.
vena cava (IVC) filters. The authors note that the radial
force exerted by the filters studied correlates with published rates of caval perforation or penetration elsewhere
in the literature. The study is noteworthy for its simplicity;
it used a straightforward protocol to measure what is
apparent to those who deploy these devices and
reviewed evident complications subsequently
The development of the ability to estimate patient mortality preoperatively in surgical trainees has not been well studied.
DESIGN:
Prospective comparative study in which the expected perioperative mortality risk and the maximum tolerable mortality at which operation would still be offered were estimated by the operating surgeons immediately before planned vascular procedures.
SETTING:
University vascular surgery teaching service.
PARTICIPANTS:
Predicted and maximum allowable mortality risks were compared between trainees and attending surgeons, with the mortality calculated using the Veterans Administration Surgical Quality Improvement Program (VASQIP) as a reference.
RESULTS:
Surveys were performed before 379 procedures over a 10-month period. The median expected mortality risk predicted by trainees (2%; interquartile range [IQR]: 1%-5%) was higher than the risk predicted by attending surgeons (1%; IQR: 0.8%-3%) (p < 0.01). The median expected mortality risk calculated by VASQIP (0.8%; IQR: 0.4%-1.7%) was less than that estimated by trainees by a median of 0.3% (IQR: 0.2%-3.2%) or and that by attending surgeons by 0.3% (IQR: 0.2-1.3%) (p < 0.01). The median maximum tolerable mortality risk predicted by trainees (10%; IQR: 5%-27.5%) was equal to the risk predicted by attending surgeons (10%; IQR: 5%-17.5%). The perioperative mortality calculated by VASQIP exceeded the maximum tolerable mortality offered by trainees or attending surgeons in 1% of cases each. Discrepancies between expected mortality and maximum tolerable mortality for trainees and attending surgeons were greater for younger (postgraduate year 1 or 2) trainees (0.8%; IQR: 0-3.0%) than for more senior (postgraduate year 4 or 5) trainees (0.4%; IQR: 0.1%-2.0%).
CONCLUSION:
Surgeons in training overestimated the perioperative mortality risk of operations and were willing to tolerate a greater mortality risk compared with attending surgeons. Both trainee and attending surgeons tended to overestimate the perioperative mortality risk compared with that calculated by VASQIP.