Bio

Bio


I am a general and trauma surgeon, and surgical intensivist. I treat and care for injured patients and those with acute surgical emergencies, and mange critically ill surgical patients in the Intensive Care Unit.

My research is focused on evaluating the role surgical care plays in the delivery of health services in resource poor settings, in particular low and middle income countries. I am interested in barriers to access and provision of surgical care, the quality of surgical services, and outcomes research. My current projects focus on quality and cost effectiveness of care, and strategies for improving the safety and reliability of surgical delivery in resource poor settings. I have been involved in surgical program assessment projects in Cambodia, India, the UK, and the United States. From 2006-2009 I was part of the World Health Organization’s Safe Surgery Saves Lives program where we quantified the global volume of surgery and created, implemented, evaluated, and promoted the WHO Surgical Safety Checklist.

Clinical Focus


  • Trauma and Acute Care Surgery
  • Surgical Critical Care

Academic Appointments


Professional Education


  • Fellowship:Harborview Medical Center (2002) WA
  • Residency:Brigham and Women's Hospital Harvard Medical School (2002) MA
  • Residency:UC Davis Medical Center (2002) CA
  • Board Certification: General Surgery, American Board of Surgery (2012)
  • Board Certification: Surgical Critical Care, American Board of Surgery (2012)
  • Medical Education:University of New Mexico (2002) NM

Teaching

2014-15 Courses


Postdoctoral Advisees


Publications

Journal Articles


  • In-hospital Death following Inpatient Surgical Procedures in the United States, 1996-2006 WORLD JOURNAL OF SURGERY Weiser, T. G., Semel, M. E., Simon, A. E., Lipsitz, S. R., Haynes, A. B., Funk, L. M., Berry, W. R., Gawande, A. A. 2011; 35 (9): 1950-1956

    Abstract

    Over the past decade, improvements in perioperative care have been widely introduced throughout the United States, yet there is no clear indication that the death rate following surgery has improved. We sought to evaluate the number of deaths after surgery in the United States over a 10-year period and to evaluate trends in postoperative mortality.Using the National Hospital Discharge Survey, we identified patients who underwent a surgical procedure and subsequently died in the hospital within 30 days of admission.In 1996 there were 12,250,000 hospitalizations involving surgery, rising to 13,668,000 in 2006. Postoperative deaths, however, declined during this same period, from 201,000 to 156,000 (P < 0.01), giving a postoperative in-hospital death ratio (death per hospitalization) of 1.64 and 1.14% (P < 0.001), respectively, for the two time frames.The death rate following surgery is substantial but appears to have improved. Such mortality statistics provide an essential measure of the public health impact of surgical care. Incorporating mortality statistics following therapeutic intervention is an essential strategy for regional and national surveillance of care delivery.

    View details for DOI 10.1007/s00268-011-1169-5

    View details for Web of Science ID 000293705500002

    View details for PubMedID 21732207

  • Global operating theatre distribution and pulse oximetry supply: an estimation from reported data LANCET Funk, L. M., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Merry, A. F., Enright, A. C., Wilson, I. H., Dziekan, G., Gawande, A. A. 2010; 376 (9746): 1055-1061

    Abstract

    Surgery is an essential part of health care, but resources to ensure the availability of surgical services are often inadequate. We estimated the global distribution of operating theatres and quantified the availability of pulse oximetry, which is an essential monitoring device during surgery and a potential measure of operating theatre resources.We calculated ratios of the number of operating theatres to hospital beds in seven geographical regions worldwide on the basis of profiles from 769 hospitals in 92 countries that participated in WHO's safe surgery saves lives initiative. We used hospital bed figures from 190 WHO member states to estimate the number of operating theatres per 100,000 people in 21 subregions throughout the world. To estimate availability of pulse oximetry, we sent surveys to anaesthesia providers in 72 countries selected to ensure a geographically and demographically diverse sample. A predictive regression model was used to estimate the pulse oximetry need for countries that did not provide data.The estimated number of operating theatres ranged from 1·0 (95% CI 0·9-1·2) per 100,000 people in west sub-Saharan Africa to 25·1 (20·9-30·1) per 100,000 in eastern Europe. High-income subregions all averaged more than 14 per 100,000 people, whereas all low-income subregions, representing 2·2 billion people, had fewer than two theatres per 100,000. Pulse oximetry data from 54 countries suggested that around 77,700 (63,195-95,533) theatres worldwide (19·2% [15·2-23·9]) were not equipped with pulse oximeters.Improvements in public-health strategies and monitoring are needed to reduce disparities for more than 2 billion people without adequate access to surgical care.WHO.

    View details for DOI 10.1016/S0140-6736(10)60392-3

    View details for Web of Science ID 000282411600032

    View details for PubMedID 20598365

  • Standardised metrics for global surgical surveillance LANCET Weiser, T. G., Makary, M. A., Haynes, A. B., Dziekan, G., Berry, W. R., Gawande, A. A. 2009; 374 (9695): 1113-1117

    Abstract

    Public health surveillance relies on standardised metrics to evaluate disease burden and health system performance. Such metrics have not been developed for surgical services despite increasing volume, substantial cost, and high rates of death and disability associated with surgery. The Safe Surgery Saves Lives initiative of WHO's Patient Safety Programme has developed standardised public health metrics for surgical care that are applicable worldwide. We assembled an international panel of experts to develop and define metrics for measuring the magnitude and effect of surgical care in a population, while taking into account economic feasibility and practicability. This panel recommended six measures for assessing surgical services at a national level: number of operating rooms, number of operations, number of accredited surgeons, number of accredited anaesthesia professionals, day-of-surgery death ratio, and postoperative in-hospital death ratio. We assessed the feasibility of gathering such statistics at eight diverse hospitals in eight countries and incorporated them into the WHO Guidelines for Safe Surgery, in which methods for data collection, analysis, and reporting are outlined.

    View details for Web of Science ID 000270370900034

    View details for PubMedID 19782877

  • A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. NEW ENGLAND JOURNAL OF MEDICINE Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. S., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C., Merry, A. F., Moorthy, K., Reznick, R. K., Taylor, B., Gawande, A. A. 2009; 360 (5): 491-499

    Abstract

    Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation.The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.

    View details for Web of Science ID 000262812400008

    View details for PubMedID 19144931

  • An estimation of the global volume of surgery: a modelling strategy based on available data LANCET Weiser, T. G., Regenbogen, S. E., Thompson, K. D., Haynes, A. B., Lipsitz, S. R., Berry, W. R., Gawande, A. A. 2008; 372 (9633): 139-144

    Abstract

    Little is known about the amount and availability of surgical care globally. We estimated the number of major operations undertaken worldwide, described their distribution, and assessed the importance of surgical care in global public-health policy.We gathered demographic, health, and economic data for 192 member states of WHO. Data for the rate of surgery were sought from several sources including governmental agencies, statistical and epidemiological organisations, published studies, and individuals involved in surgical policy initiatives. We also obtained per-head total expenditure on health from analyses done in 2004. Major surgery was defined as any intervention occurring in a hospital operating theatre involving the incision, excision, manipulation, or suturing of tissue, usually requiring regional or general anaesthesia or sedation. We created a model to estimate rates of major surgery for countries for which such data were unavailable, then used demographic information to calculate the total worldwide volume of surgery.We obtained surgical data for 56 (29%) of 192 WHO member states. We estimated that 234.2 (95% CI 187.2-281.2) million major surgical procedures are undertaken every year worldwide. Countries spending US$100 or less per head on health care have an estimated mean rate of major surgery of 295 (SE 53) procedures per 100 000 population per year, whereas those spending more than $1000 have a mean rate of 11 110 (SE 1300; p<0.0001). Middle-expenditure ($401-1000) and high-expenditure (>$1000) countries, accounting for 30.2% of the world's population, provided 73.6% (172.3 million) of operations worldwide in 2004, whereas poor-expenditure (

    View details for Web of Science ID 000257552400028

    View details for PubMedID 18582931

  • Beyond the hospital doors: Improving long-term outcomes for elderly trauma patients JOURNAL OF TRAUMA AND ACUTE CARE SURGERY Ayoung-Chee, P. R., Rivara, F. P., Weiser, T., Maier, R. V., Arbabi, S. 2015; 78 (4): 837-843

    Abstract

    Elderly trauma patients (TPs) are the fastest growing trauma population, increasing the need for postacute care rehabilitation. For TP, discharge to skilled nursing facilities (SNFs) has been associated with higher 1-year mortality compared with discharge to inpatient rehabilitation facilities (IRFs) or home. The availability of IRF beds has been decreasing, but the proportion occupied by non-TPs, specifically stroke patients (SPs), has increased. We wanted to better characterize trends in trauma discharges and compare them with a population that is equally dependent on postdischarge rehabilitation. We hypothesized that discharge to SNF is rapidly increasing, while discharge to IRF is declining for trauma, but not for SPs.This is retrospective cohort study of adult trauma and SPs discharged from 2003 to 2009. The National Trauma Data Bank and National Inpatient Sample were used to study TPs and SPs, respectively.Falls became the leading cause of injury, and the proportion of older TPs increased from 23% to 30%. Older TPs discharged to SNF increased from 30.7% in 2003 to 40.8% in 2009 (p < 0.001). TPs were 34% (adjusted relative risk [RR], 1.34; 95% confidence interval [CI], 1.15-1.57) more likely to be discharged to an SNF and 36% (adjusted RR, 0.64; 95% CI, 0.48-0.85) less likely to be discharged to an IRF. From 2003 to 2009, SPs were 78% more likely to be discharged to an IRF (adjusted RR, 1.78; 95% CI, 1.74-1.82). The largest absolute increase in SP discharges to IRFs occurred the year following implementation of the stroke center certification program.For TPs, there was a significant increase in SNF discharges and a decrease in IRF discharges. During the same period, after implementation of stroke center certification, SPs were more likely to be discharged to an IRF. Future research should focus on evaluating which postacute care setting is most effective in providing rehabilitation for TPs and adjusting our discharge efforts to improve long-term outcomes.Prognostic and epidemiologic study, level III.

    View details for DOI 10.1097/TA.0000000000000567

    View details for Web of Science ID 000352074000025

    View details for PubMedID 25742250

  • The burden of selected congenital anomalies amenable to surgery in low and middle-income regions: cleft lip and palate, congenital heart anomalies and neural tube defects. Archives of disease in childhood Higashi, H., Barendregt, J. J., Kassebaum, N. J., Weiser, T. G., Bickler, S. W., Vos, T. 2015; 100 (3): 233-238

    Abstract

    To quantify the burden of selected congenital anomalies in low and middle-income countries (LMICs) that could be reduced should surgical programmes cover the entire population with access to quality care.Burden of disease and epidemiological modelling.LMICs from all global regions.All prevalent cases of selected congenital anomalies at birth in 2010.Disability-adjusted life years (DALYs).Surgical programmes for three congenital conditions were analysed: clefts (lip and palate); congenital heart anomalies; and neural tube defects. Data from the Global Burden of Disease 2010 Study were used to estimate the combination of fatal burden that could be addressed by surgical care and the additional long-term non-fatal burden associated with increased survival.Of the estimated 21.6 million DALYs caused by these three conditions in LMICs, 12.4 million DALYs (57%) are potentially addressable by surgical care among the population born with such conditions. Neural tube defects have the largest potential with 76% of burden amenable by surgery, followed by clefts (59%) and congenital heart anomalies (49%). Sub-Saharan Africa and South Asia have the greatest proportion of surgically addressable burden for clefts (68%), North Africa and Middle East for congenital heart anomalies (73%), and South Asia for neural tube defects (81%).There is an important and neglected role surgical programmes can play in reducing the burden of congenital anomalies in LMICs.

    View details for DOI 10.1136/archdischild-2014-306175

    View details for PubMedID 25260520

  • Surgically avertable burden of digestive diseases at first-level hospitals in low and middle-income regions. Surgery Higashi, H., Barendregt, J. J., Kassebaum, N. J., Weiser, T. G., Bickler, S. W., Vos, T. 2015; 157 (3): 411-419

    Abstract

    To quantify the burden of digestive diseases avertable by surgical care at first-level hospitals in low- and middle-income countries (LMICs).We examined 4 digestive diseases from the Global Burden of Disease (GBD) 2010 STUDY: Appendicitis, intestinal obstruction, inguinal and femoral hernia, and gallbladder and bile duct disease. Using demographic and epidemiologic data from the GBD 2010 STUDY, we calculated the potential decrease in burden of digestive diseases if quality surgical services were available universally and accessible at first-level hospitals. The lowest case fatality rates for each age and sex grouping from all GBD regions were assumed to reflect the best possible state of full surgical coverage and treatment. These best scenario rates were applied to the GBD 2010 results from all LMIC regions to estimate surgically avertable burden.Overall, 4.8 million disability-adjusted life-years (DALYs) or 65% of burden related to the 4 digestive diseases are avertable potentially with first-level surgical care in LMICs. Sub-Saharan Africa has the greatest avertable burden in absolute DALYs (1.7 million) and avertable proportion (83%). Intestinal obstruction accounted for the largest portion of avertable burden among the 4 digestive diseases (2.2 million DALYs; 64% avertable).Improving the capacity of surgical services at first-level hospitals is essential for averting the burden of digestive diseases in LMICs. Practicable strategies for scaling up surgical capacities in rural districts are available potentially, which must be given due attention.

    View details for DOI 10.1016/j.surg.2014.07.009

    View details for PubMedID 25444219

  • Adding Insult to Injury: Discontinuous Insurance Following Spine Trauma JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Kastenberg, Z. J., Hurley, M. P., Weiser, T. G., Cole, T. S., Staudenmayer, K. L., Spain, D. A., Ratliff, J. K. 2015; 97A (2): 141-146

    Abstract

    Spine trauma patients may represent a group for whom insurance fails to provide protection from catastrophic medical expenses, resulting in the transfer of financial burden onto individual families and public payers. This study compares the rate of insurance discontinuation for patients who underwent surgery for traumatic spine injury with and without spinal cord injury with the rate for matched control subjects.We used the MarketScan database to perform a retrospective cohort study of privately insured spine trauma patients who underwent surgery from 2006 to 2010. Kaplan-Meier survival analysis was used to assess the time to insurance discontinuation. Cox proportional-hazards regression was used to determine hazard ratios for insurance discontinuation among spine trauma patients compared with the matched control population.The median duration of existing insurance coverage was 20.2 months for those with traumatic spinal cord injury, 25.6 months for those with traumatic spine injury without spinal cord injury, and 48.0 months for the matched control cohort (log-rank p < 0.0001). After controlling for multiple covariates, the hazard ratios for discontinuation of insurance were 2.02 (95% CI [confidence interval], 1.83 to 2.23) and 2.78 (95% CI, 2.31 to 3.35) for the trauma patients without and with spinal cord injury, respectively, compared with matched controls.Rates of insurance discontinuation are significantly higher for trauma patients with severe spine injury compared with the uninjured population, indicating that patients with disabling injuries are at increased risk for loss of insurance coverage.

    View details for DOI 10.2106/JBJS.N.00148

    View details for Web of Science ID 000348217200012

  • Surgically avertable burden of obstetric conditions in low- and middle-income regions: a modelled analysis BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY Higashi, H., Barendregt, J. J., Kassebaum, N. J., Weiser, T. G., Bickler, S. W., Vos, T. 2015; 122 (2): 228-236

    Abstract

    To quantify the burden of maternal and neonatal conditions in low- and middle-income countries (LMICs) that could be averted by full access to quality first-level obstetric surgical procedures.Burden of disease and epidemiological modelling.LMICs from all global regions.The entire population in 2010.We included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion(1) ; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability-adjusted life years (DALYs) of these conditions into surgically 'avertable' and 'non-avertable' burdens. We applied the lowest age-specific fatality rates from all global regions to each LMIC region to estimate the avertable deaths, assuming that the differences of death rates between each region and the lowest rates reflect the gap in surgical care.Deaths and DALYs avertable.Of the estimated 56.6 million DALYs (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million DALYs (37%) are avertable by full coverage of quality obstetric surgery in LMICs. The avertable burden in absolute term is substantial given the size of burden of these conditions in LMICs. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million DALYs) among the five conditions, followed by abortion (2.1 million DALYs).Improving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs.

    View details for DOI 10.1111/1471-0528.13198

    View details for Web of Science ID 000346915800021

    View details for PubMedID 25546047

  • Burden of Injuries Avertable By a Basic Surgical Package in Low- and Middle-Income Regions: A Systematic Analysis From the Global Burden of Disease 2010 Study WORLD JOURNAL OF SURGERY Higashi, H., Barendregt, J. J., Kassebaum, N. J., Weiser, T. G., Bickler, S. W., Vos, T. 2015; 39 (1): 1-9

    Abstract

    Injuries accounted for 11 % of the global burden of disease in 2010. This study aimed to quantify the burden of injury in low- and middle-income countries (LMICs) that could be averted if basic surgical services were made available and accessible to the entire population.We examined all causes of injury from the Global Burden of Disease 2010 Study. We split the disability-adjusted life years (DALYs) for these conditions between surgically "avertable" and "nonavertable" burdens. For estimating the avertable fatal burden, we applied the lowest fatality rates among the 21 epidemiologic regions to each LMIC region, assuming that the differences in death rates between each region and the lowest rates reflect the gap in surgical care. We adjusted for fatal cases that occur prior to reaching hospitals as they are not surgically avertable. Similarly, we applied the lowest nonfatal burden per case to each LMIC region.Overall, 21 % of the injury burden in LMICs was potentially avertable by basic surgical care (52.3 million DALYs). The avertable proportion was greater for deaths than for nonfatal burden (23 vs. 20 %), suggesting that surgical services for injuries more effectively save lives than ameliorate disability. Sub-Saharan Africa had the largest proportion of potentially avertable burden (25 %). South Asia had the highest total avertable DALYs (17.4 million). Road injury comprised the largest total avertable burden in LMICs (16.1 million DALYs).Basic surgical care has the potential to play a major role in reducing the injury-related burden in LMICs.

    View details for DOI 10.1007/s00268-014-2685-x

    View details for Web of Science ID 000346789500001

    View details for PubMedID 25008243

  • Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis LANCET GLOBAL HEALTH Chao, T. E., Sharma, K., Mandigo, M., Hagander, L., Resch, S. C., Weiser, T. G., Meara, J. G. 2014; 2 (6): E334-E345
  • Evaluation of a large-scale donation of Lifebox pulse oximeters to non-physician anaesthetists in Uganda ANAESTHESIA Finch, L. C., Kim, R. Y., Ttendo, S., Kiwanuka, J. K., Walker, I. A., Wilson, I. H., Weiser, T. G., Berry, W. R., Gawande, A. A. 2014; 69 (5): 445-451

    Abstract

    Pulse oximetry is widely accepted as essential monitoring for safe anaesthesia, yet is frequently unavailable in resource-limited settings. The Lifebox pulse oximeter, and associated management training programme, was delivered to 79 non-physician anaesthetists attending the 2011 Uganda Society of Anaesthesia Annual Conference. Using a standardised assessment, recipients were tested for their knowledge of oximetry use and hypoxia management before, immediately following and 3-5 months after the training. Before the course, the median (IQR [range]) test score for the anaesthetists was 36 (34-39 [26-44]) out of a maximum of 50 points. Immediately following the course, the test score increased to 41 (38-43 [25-47]); p < 0.0001 and at the follow-up visit at 3-5 months it was 41 (39-44 [33-49]); p = 0.001 compared with immediate post-training test scores, and 75/79 (95%) oximeters were in routine clinical use. This method of introduction resulted in a high rate of uptake of oximeters into clinical practice and a demonstrable retention of knowledge in a resource-limited setting.

    View details for DOI 10.1111/anae.12632

    View details for Web of Science ID 000334368300009

    View details for PubMedID 24738801

  • The epidemiology of trauma-related mortality in the United States from 2002 to 2010 JOURNAL OF TRAUMA AND ACUTE CARE SURGERY Sise, R. G., Calvo, R. Y., Spain, D. A., Weiser, T. G., Staudenmayer, K. L. 2014; 76 (4): 913-919

    Abstract

    Epidemiologic trends in trauma-related mortality in the United States require updating and characterization. We hypothesized that during the past decade, there have been changing trends in mortality that are associated with multiple public health and health care-related factors.Multiple sources were queried for the period of 2002 to 2010: the National Trauma Data Bank, the National Centers for Disease Control, the National Highway Traffic Safety Administration, the Nationwide Emergency Department Sample, and the US Census Bureau. The incidence of injury and mortality for motor vehicle traffic (MVT) collisions, firearms, and falls were determined using National Centers for Disease Control data. National Highway Traffic Safety Administration data were used to determine motor vehicle collision information. Injury severity data were derived from the Nationwide Emergency Department Sample and National Trauma Data Bank. Analysis of mortality trends by year was performed using the Cochran-Armitage test for trend. Time-trend multivariable Poisson regression was used to determine risk-adjusted mortality over time.From 2002 to 2010, the total trauma-related mortality decreased by 6% (p < 0.01). However, mortality trends differed by mechanism. There was a 27% decrease in the MVT death rate associated with a 20% decrease in motor vehicle collisions, 19% decrease in the number of occupant injuries per collision, lower injury severity, and improved outcomes at trauma centers. While firearm-related mortality remained relatively unchanged, mortality caused by firearm suicides increased, whereas homicide-associated mortality decreased (p < 0.001 for both). In contrast, fall-related mortality increased by 46% (5.95-8.70, p < 0.01).MVT mortality rates have decreased during the last decade, owing in part to decreases in the number and severity of injuries. Conversely, fall-related mortality is increasing and is projected to exceed both MVT and firearm mortality rates should current trends continue. Trauma systems and injury prevention programs will need to take into account these changing trends to best accommodate the needs of the injured population.Epidemiologic study, level III.

    View details for DOI 10.1097/TA.0000000000000169

    View details for Web of Science ID 000334161500003

  • The Role of Surgery in Global Health: Analysis of United States Inpatient Procedure Frequency by Condition Using the Global Burden of Disease 2010 Framework PLOS ONE Rose, J., Chang, D. C., Weiser, T. G., Kassebaum, N. J., Bickler, S. W. 2014; 9 (2)

    Abstract

    The role of surgical care in promoting global health is the subject of much debate. The Global Burden of Disease 2010 study (GBD 2010) offers a new opportunity to consider where surgery fits amongst global health priorities. The GBD 2010 reinforces the DALY as the preferred methodology for determining the relative contribution of disease categories to overall global burden of disease without reference to the likelihood of each category requiring surgery. As such, we hypothesize that the GBD framework underestimates the role of surgery in addressing the global burden of disease.We compiled International Classification of Diseases, Version 9, codes from the United States Nationwide Inpatient Sample from 2010. Using the primary diagnosis code for each hospital admission, we aggregated admissions into GBD 2010 disease sub-categories. We queried each hospitalization for a major operation to determine the frequency of admitted patients whose care required surgery. Major operation was defined according to the Agency for Healthcare Research and Quality (AHRQ). In 2010, 10 million major inpatient operations were performed in the United States, associated with 28.6% of all admissions. Major operations were performed in every GBD disease subcategory (range 0.2%-84.0%). The highest frequencies of operation were in the subcategories of Musculoskeletal (84.0%), Neoplasm (61.4%), and Transport Injuries (43.2%). There was no disease subcategory that always required an operation; nor was there any disease subcategory that never required an operation.Surgical care cuts across the entire spectrum of GBD disease categories, challenging dichotomous traditional classifications of 'surgical' versus 'nonsurgical' diseases. Current methods of measuring global burden of disease do not reflect the fundamental role operative intervention plays in the delivery of healthcare services. Novel methodologies should be aimed at understanding the integration of surgical services into health systems to address the global burden of disease.

    View details for DOI 10.1371/journal.pone.0089693

    View details for Web of Science ID 000332389000078

    View details for PubMedID 24586967

  • Thyroid surgery in a district hospital: a vertical program embedded in a rural hospital. World journal of surgery Weiser, T. G. 2013; 37 (7): 1574-1575

    View details for DOI 10.1007/s00268-013-2098-2

    View details for PubMedID 23649532

  • Safety in the operating theatre-a transition to systems-based care NATURE REVIEWS UROLOGY Weiser, T. G., Porter, M. P., Maier, R. V. 2013; 10 (3): 161-173

    Abstract

    All surgeons want the best, safest care for their patients, but providing this requires the complex coordination of multiple disciplines to ensure that all elements of care are timely, appropriate, and well organized. Quality-improvement initiatives are beginning to lead to improvements in the quality of care and coordination amongst teams in the operating room. As the population ages and patients present with more complex disease pathology, the demands for efficient systematization will increase. Although evidence suggests that postoperative mortality rates are declining, there is substantial room for improvement. Multiple quality metrics are used as surrogates for safe care, but surgical teams--including surgeons, anaesthetists, and nurses--must think beyond these simple interventions if they are to effectively communicate and coordinate in the face of increasing demands.

    View details for DOI 10.1038/nrurol.2013.13

    View details for Web of Science ID 000316712500007

    View details for PubMedID 23419492

  • Review article: Perioperative checklist methodologies CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE Weiser, T. G., Berry, W. R. 2013; 60 (2): 136-142

    Abstract

    Checklists are increasingly being used by surgical teams in the perioperative period to improve clinical care and increase patient safety. In this article, we review some of the mechanisms by which checklists work and evaluate evidence supporting their use.There is a growing body of evidence showing the importance of team-based checklists in clinical care. In multiple complex clinical environments, from the operating room to the intensive care unit, checklists can help ensure adherence to known standards of care and improve communication amongst team members. In addition, the efficacy of checklists is being shown in both developed and developing settings.Checklists can aid clinicians involved in complex processes and multidisciplinary team interactions to improve the quality and safety of care by prompting dialogue and exchange of information.

    View details for DOI 10.1007/s12630-012-9854-x

    View details for Web of Science ID 000315579500006

    View details for PubMedID 23233394

  • Mass casualty incident training in a resource-limited environment (Br J Surg 2012; 99: 356-361) BRITISH JOURNAL OF SURGERY Weiser, T. G. 2012; 99 (3): 361-361

    View details for DOI 10.1002/bjs.7774

    View details for Web of Science ID 000303148800010

    View details for PubMedID 22287072

  • Rates and patterns of death after surgery in the United States, 1996 and 2006 SURGERY Semel, M. E., Lipsitz, S. R., Funk, L. M., Bader, A. M., Weiser, T. G., Gawande, A. A. 2012; 151 (2): 171-182

    Abstract

    Nationwide rates and patterns of death after surgery are unknown.Using the Nationwide Inpatient Sample, we compared deaths within 30 days of admission for patients undergoing surgery in 1996 and 2006. International Classification of Diseases codes were used to identify 2,520 procedures for analysis. We examined the inpatient 30-day death rate for all procedures, procedures with the most deaths, high-risk cardiovascular and cancer procedures, and patients who suffered a recorded complication. We used logistic regression modeling to adjust 1996 mortality rates to the age and gender distributions for patients undergoing surgery in 2006.In 1996, there were 12,573,331 admissions with a surgical procedure (95% confidence interval [CI], 12,560,171-12,586,491) and 224,111 inpatient deaths within 30 days of admission (95% CI, 221,912-226,310). In 2006, there were 14,333,993 admissions with a surgical procedure (95% CI, 14,320,983-14,347,002) and 189,690 deaths (95% CI, 187,802-191,578). Inpatient 30-day mortality declined from 1.68% in 1996 to 1.32% in 2006 (P < .001). Of the 21 procedures with the most deaths in 1996, 15 had significant declines in adjusted mortality in 2006. Among these 15 procedures, 8 had significant declines in operative volume. The inpatient 30-day mortality rate for patients who suffered a complication decreased from 12.10% to 9.84% (P < .001).Nationwide reporting on surgical mortality suggests that the number of inpatient deaths within 30 days of surgery has declined. Additional research to determine the underlying causes for decreased mortality is warranted.

    View details for DOI 10.1016/j.surg.2011.07.021

    View details for Web of Science ID 000299607800005

    View details for PubMedID 21975292

  • Postgame Analysis: Using Video-Based Coaching for Continuous Professional Development JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Hu, Y., Peyre, S. E., Arriaga, A. F., Osteen, R. T., Corso, K. A., Weiser, T. G., Swanson, R. S., Ashley, S. W., Raut, C. P., Zinner, M. J., Gawande, A. A., Greenberg, C. C. 2012; 214 (1): 115-124

    Abstract

    The surgical learning curve persists for years after training, yet existing continuing medical education activities targeting this are limited. We describe a pilot study of a scalable video-based intervention, providing individualized feedback on intraoperative performance.Four complex operations performed by surgeons of varying experience--a chief resident accompanied by the operating senior surgeon, a surgeon with less than 10 years in practice, another with 20 to 30 years in practice, and a surgeon with more than 30 years of experience--were video recorded. Video playback formed the basis of 1-hour coaching sessions with a peer-judged surgical expert. These sessions were audio recorded, transcribed, and thematically coded.The sessions focused on operative technique--both technical aspects and decision-making. With increasing seniority, more discussion was devoted to the optimization of teaching and facilitation of the resident's technical performance. Coaching sessions with senior surgeons were peer-to-peer interactions, with each discussing his preferred approach. The coach alternated between directing the session (asking probing questions) and responding to specific questions brought by the surgeons, depending on learning style. At all experience levels, video review proved valuable in identifying episodes of failure to progress and troubleshooting alternative approaches. All agreed this tool is a powerful one. Inclusion of trainees seems most appropriate when coaching senior surgeons; it may restrict the dialogue of more junior attendings.Video-based coaching is an educational modality that targets intraoperative judgment, technique, and teaching. Surgeons of all levels found it highly instructive. This may provide a practical, much needed approach for continuous professional development.

    View details for DOI 10.1016/j.jamcollsurg.2011.10.009

    View details for Web of Science ID 000299054400017

    View details for PubMedID 22192924

  • Surgical outcome measurement for a global patient population: Validation of the Surgical Apgar Score in 8 countries SURGERY Haynes, A. B., Regenbogen, S. E., Weiser, T. G., Lipsitz, S. R., Dziekan, G., Berry, W. R., Gawande, A. A. 2011; 149 (4): 519-524

    Abstract

    Surgical care is a vital component of health care worldwide, yet there is no clinically meaningful measure of operative outcomes that could be applied globally. The Surgical Apgar Score, a simple metric derived from 3 intraoperative parameters, has been shown in U.S. academic medical centers to predict 30-day patient outcomes after operation, but has not been validated more broadly.We collected the components of the Surgical Apgar Score at the time of operation for 5,909 adult patients undergoing noncardiac operative procedures under general anesthesia at 8 hospitals in diverse international settings and evaluated the relationship between patients' scores and the incidence of inpatient postoperative morbidity and mortality, using generalized estimating equations to adjust for clustering within sites.During the first 30 days of postoperative hospitalization, 544 patients (9.2%) experienced ? 1 complications. Compared with patients with the median score of 7--whose complication rate was 9.1%-those with a Surgical Apgar Score <5 (n = 302) had an adjusted complication rate of 32.9% (relative risk [RR],3.6; 95% CI, 2.9-4.5), whereas those with a score of 10 (n = 238) had a 3.0% adjusted complication rate (RR, 0.3; 95% CI, 0.1-1.1). The score's c-statistic for prediction of any complication is 0.70; for death it is 0.77.The Surgical Apgar Score is easily calculated, predictive, and moderately discriminative for major complications among adults undergoing inpatient noncardiac operative procedures. Such a score could provide objective indication of relative postoperative risk for inpatients and provide a potential target for quality improvement efforts, particularly in resource-limited settings.

    View details for DOI 10.1016/j.surg.2010.10.019

    View details for Web of Science ID 000289017500007

    View details for PubMedID 21216419

  • Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention BMJ QUALITY & SAFETY Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. S., Dellinger, E. P., Dziekan, G., Herbosa, T., Kibatala, P. L., Lapitan, M. C., Merry, A. F., Reznick, R. K., Taylor, B., Vats, A., Gawande, A. A. 2011; 20 (1): 102-107

    Abstract

    To assess the relationship between changes in clinician attitude and changes in postoperative outcomes following a checklist-based surgical safety intervention.Pre- and post intervention survey.Eight hospitals participating in a trial of a WHO surgical safety checklist.Clinicians actively working in the designated study operating rooms at the eight hospitals. SURVEY INSTRUMENT: Modified operating-room version Safety Attitudes Questionnaire (SAQ).Change in mean safety attitude score and correlation between change in safety attitude score and change in postoperative outcomes, plus clinician opinion of checklist efficacy and usability.Clinicians in the preintervention phase (n=281) had a mean SAQ score of 3.91 (on a scale of 1 to 5, with 5 representing better safety attitude), while the postintervention group (n=257) had a mean of 4.01 (p=0.0127). The degree of improvement in mean SAQ score at each site correlated with a reduction in postoperative complication rate (r=0.7143, p=0.0381). The checklist was considered easy to use by 80.2% of respondents, while 19.8% felt that it took a long time to complete, and 78.6% felt that the programme prevented errors. Overall, 93.4% would want the checklist used if they were undergoing operation.Improvements in postoperative outcomes were associated with improved perception of teamwork and safety climate among respondents, suggesting that changes in these may be partially responsible for the effect of the checklist. Clinicians held the checklist in high regard and the overwhelming majority would want it used if they were undergoing surgery themselves.

    View details for DOI 10.1136/bmjqs.2009.040022

    View details for Web of Science ID 000289726400014

    View details for PubMedID 21228082

  • HEALTH POLICY All-or-none compliance is the best determinant of quality of care NATURE REVIEWS UROLOGY Weiser, T. G. 2010; 7 (10): 541-542

    View details for DOI 10.1038/nrurol.2010.155

    View details for Web of Science ID 000282679500005

    View details for PubMedID 20930866

  • Perspectives in quality: designing the WHO Surgical Safety Checklist INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE Weiser, T. G., Haynes, A. B., Lashoher, A., Dziekan, G., Boorman, D. J., Berry, W. R., Gawande, A. A. 2010; 22 (5): 365-370

    Abstract

    The World Health Organization's Patient Safety Programme created an initiative to improve the safety of surgery around the world. In order to accomplish this goal the programme team developed a checklist with items that could and, if at all possible, should be practised in all settings where surgery takes place. There is little guidance in the literature regarding methods for creating a medical checklist. The airline industry, however, has more than 70 years of experience in developing and using checklists. The authors of the WHO Surgical Safety Checklist drew lessons from the aviation experience to create a safety tool that supports essential clinical practice. In order to inform the methodology for development of future checklists in health care, we review how we applied lessons learned from the aviation experience in checklist development to the development of the Surgical Safety Checklist and also discuss the differences that exist between aviation and medicine that impact the use of checklists in health care.

    View details for DOI 10.1093/intqhc/mzq039

    View details for Web of Science ID 000281958200020

    View details for PubMedID 20702569

  • Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals HEALTH AFFAIRS Semel, M. E., Resch, S., Haynes, A. B., Funk, L. M., Bader, A., Berry, W. R., Weiser, T. G., Gawande, A. A. 2010; 29 (9): 1593-1599

    Abstract

    Use of the World Health Organization's Surgical Safety Checklist has been associated with a significant reduction in major postoperative complications after inpatient surgery. We hypothesized that implementing the checklist in the United States would generate cost savings for hospitals. We performed a decision analysis comparing implementation of the checklist to existing practice in U.S. hospitals. In a hospital with a baseline major complication rate after surgery of at least 3 percent, the checklist generates cost savings once it prevents at least five major complications. Using the checklist would both save money and improve the quality of care in hospitals throughout the United States.

    View details for DOI 10.1377/hlthaff.2009.0709

    View details for Web of Science ID 000281601300006

    View details for PubMedID 20820013

  • Effect of A 19-Item Surgical Safety Checklist During Urgent Operations in A Global Patient Population ANNALS OF SURGERY Weiser, T. G., Haynes, A. B., Dziekan, G., Berry, W. R., Lipsitz, S. R., Gawande, A. A. 2010; 251 (5): 976-980

    Abstract

    To assess whether implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent surgical cases would improve compliance with basic standards of care and reduce rates of deaths and complications.Use of the WHO Surgical Safety Checklist has been shown to be associated with significant reductions in complications and deaths. Before evaluation of this safety tool, concern was raised about whether its use would be practical or beneficial during urgent surgical procedures.We prospectively collected clinical process and outcome data for 1750 consecutively enrolled patients 16 years of age or older undergoing urgent noncardiac surgery before and after introduction of the WHO Surgical Safety Checklist in 8 diverse hospitals around the world; 842 underwent urgent surgery-defined as an operation required within 24 hours of assessment to be beneficial-before introduction of the checklist and 908 after introduction of the checklist. The primary end point was the rate of complications, including death, during hospitalization up to 30 days following surgery.The complication rate was 18.4% (n=151) at baseline and 11.7% (n=102) after the checklist was introduced (P=0.0001). Death rates dropped from 3.7% to 1.4% following checklist introduction (P=0.0067). Adherence to 6 measured safety steps improved from 18.6% to 50.7% (P<0.0001).Implementation of the checklist was associated with a greater than one-third reduction in complications among adult patients undergoing urgent noncardiac surgery in a diverse group of hospitals. Use of the WHO Surgical Safety Checklist in urgent operations is feasible and should be considered.

    View details for DOI 10.1097/SLA.0b013e3181d970e3

    View details for Web of Science ID 000277101200028

    View details for PubMedID 20395848

  • Population Health Metrics for Surgery: Effective Coverage of Surgical Services in Low-Income and Middle-Income Countries WORLD JOURNAL OF SURGERY Ozgediz, D., Hsia, R., Weiser, T., Gosselin, R., Spiegel, D., Bickler, S., Dunbar, P., McQueen, K. 2009; 33 (1): 1-5

    Abstract

    Access to surgical services is emerging as a crucial issue in global public health. "Effective coverage" is a health metric used to evaluate essential health services in low- and middle-income countries. It measures the fraction of potential health gained that is actually realized for a given intervention by integrating the concepts of need, use, and quality.This study applies the concept of effective coverage to surgical services by considering injuries and obstetric complications as high-priority surgical conditions in low- and middle-income countries.Effective coverage for both is poor, but it is less well defined for traumatic conditions compared to obstetric conditions owing to a lack of data.More primary and secondary data are critical to measure effective coverage and to estimate the resources required to improve access to surgical services in low- and middle-income countries.

    View details for DOI 10.1007/s00268-008-9799-y

    View details for Web of Science ID 000261657300001

    View details for PubMedID 18958518

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