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> The complex surgery involved a team of more than 50 specialists including surgeons, nurses, anesthesiologists, and residents > Their observations will inform

by lhorie 6y ago

> The complex surgery involved a team of more than 50 specialists including surgeons, nurses, anesthesiologists, and residents > Their observations will inform the development of Mount Sinai’s Tracheal Transplant Program, enabling Dr. Genden to offer this therapeutic approach to patients nationwide and internationally This is without a doubt an impressive achievement. Can someone speak to the logistics of expanding this program though? I don't suppose a 18 hour, 50 person procedure is in any way easy to coordinate, and I imagine it must be extremely expensive, both in terms of financial cost and time investment. How feasible is it to propagate the expertise? Are there factors related to the novelty that make it attractive for other medical teams to invest time in training for this procedure? Is risk a deterrent in terms of insurance coverage?

annoyingnoob 6y ago
I suspect a some of those folks were on-shift or on-call and just doing their job. Since anything over 12 hours spans shifts I'm guessing nurses had a shift change during the case for example. My wife worked as an Operating Room Nurse at a medium sized hospital for over 10 years.
rscho 6y ago
It is very difficult to propagate expertise for rare procedures. Oftentimes the teaching center already has limited volume, so trainees may become "experts" with a rather limited number of procedures under their belt. The problem becomes apparent when those trainees migrate back to smaller centers where volume is almost nil. I'm the perfect example of this myself, although being a cardiothoracic anesthesiologist it's easier to maintain my expertise compared to surgeons because surgical expertise almost only relies on continued practice, while anesthesiology mostly relies on know-how. The end result is mostly catastrophic outcomes on complex surgery that is rarely done. So this is very expensive and risky surgery, but the economics surrounding this type of program are a bit obscure. Some people are obviously making tons of money with such cases, but I doubt anyone really has a comprehensive overview of all the economic pro/cons. In Europe at least, insurance companies don't seem that reluctant towards transplants and there are other lower hanging fruits if the system wants to spend less. As for logistics, it's probably not that different from transplanting another organ. In anything involving the trachea, the technical details of the procedure and the coordination between surgery and anesthesia is where the difficulty lies.

by lhorie 6y ago

annoyingnoob 6y ago

I suspect a some of those folks were on-shift or on-call and just doing their job. Since anything over 12 hours spans shifts I'm guessing nurses had a shift change during the case for example. My wife worked as an Operating Room Nurse at a medium sized hospital for over 10 years.

rscho 6y ago

It is very difficult to propagate expertise for rare procedures. Oftentimes the teaching center already has limited volume, so trainees may become "experts" with a rather limited number of procedures under their belt. The problem becomes apparent when those trainees migrate back to smaller centers where volume is almost nil. I'm the perfect example of this myself, although being a cardiothoracic anesthesiologist it's easier to maintain my expertise compared to surgeons because surgical expertise almost only relies on continued practice, while anesthesiology mostly relies on know-how. The end result is mostly catastrophic outcomes on complex surgery that is rarely done. So this is very expensive and risky surgery, but the economics surrounding this type of program are a bit obscure. Some people are obviously making tons of money with such cases, but I doubt anyone really has a comprehensive overview of all the economic pro/cons. In Europe at least, insurance companies don't seem that reluctant towards transplants and there are other lower hanging fruits if the system wants to spend less. As for logistics, it's probably not that different from transplanting another organ. In anything involving the trachea, the technical details of the procedure and the coordination between surgery and anesthesia is where the difficulty lies.