SURGICAL ANALYSIS

The following objects were exported in .RData format form the surgical_analysis.R file to be imported in this report:

the surgeries_stats dataframe
the procedures_stats dataframe

1. PROCEDURES

This is the report of the procedures performed between 2012 and 2026.

Table

surgeries_stats |> 
  select(year, procedures) |>
  mutate(cumulative = cumsum(procedures)) |>
  rename(
    "Year" = year,
    "Procedures" = procedures,
    "Running total" = cumulative
  ) |>
  kbl(align="c")|>
  kable_styling(
    bootstrap_options = "striped", 
    full_width = FALSE,      
    position = "center"
  ) |>
  column_spec(1:3, width = "150px")

Year	Procedures	Running total
2012	81	81
2013	288	369
2014	409	778
2015	273	1051
2016	248	1299
2017	387	1686
2018	847	2533
2019	663	3196
2020	280	3476
2021	467	3943
2022	308	4251
2023	187	4438
2024	188	4626
2025	238	4864
2026	20	4884

Plot

# 1. Create plot theme
  my_plot_theme <- theme_minimal() +
    theme(
      plot.title = element_text(face = "bold", size = 22, hjust = 0.5, margin = margin(t = 10, b = 20)),
      axis.title = element_text(face = "bold", size = 12),
      axis.text  = element_text(face = "bold", size = 12),
      axis.line  = element_line(color = "black", size = 0.5),
      axis.ticks = element_line(color = "black")
    )  
  
# 2. Plot 
  surgeries_plot <- ggplot(
      data = surgeries_stats,
      aes(x = year)
    ) +
    geom_bar(
      aes(y = procedures),
      stat = "identity",
      fill = "lightgrey",
      color = "black",
      alpha = 0.6
    ) +
    geom_text(
      aes(y = procedures, label = procedures),
      vjust = -0.5,
      fontface = "bold",
      size = 5
    ) +
    scale_x_continuous(
      name ="",
      breaks = seq(min(surgeries_stats$year), max(surgeries_stats$year), by = 1)
    ) +
    scale_y_continuous(
      name = "",
      expand = expansion(mult = c(0, 0.05))
    ) +
    labs(
      title = paste0("TOTAL PROCEDURES PER YEAR (", min(surgeries_stats$year), "-", max(surgeries_stats$year), ")")
    ) +
    my_plot_theme
  print(surgeries_plot)

2. PROCEDURES AS LEAD SURGEON

This is the report of the procedures performed as lead surgeon between 2012 and 2026.

The table shows, for each year:

the total amount of performed procedures
the % of procedures performed as lead surgeon relative to the total amount of performed procedures

Data show a clear consistently increasing % of procedures performes as lead surgeon, to indicate a constantly increasing surgical autonomy.

Table

surgeries_stats |> 
  select(year, lead, pct_lead) |>
  mutate(pct_lead = sprintf("%.2f%%", pct_lead)) |>
  mutate(cumulative = cumsum(lead)) |>
  rename(
    "Year" = year,
    "As lead surgeon" = lead,
    "%" = pct_lead,
    "Running total" = cumulative
  ) |>
  kbl(align="c")|>
  kable_styling(
    bootstrap_options = "striped", 
    full_width = FALSE,      
    position = "center"
  ) |>
  column_spec(1:4, width = "150px")

Year	As lead surgeon	%	Running total
2012	4	4.94%	4
2013	23	7.99%	27
2014	18	4.40%	45
2015	10	3.66%	55
2016	5	2.02%	60
2017	90	23.26%	150
2018	278	32.82%	428
2019	240	36.20%	668
2020	145	51.79%	813
2021	166	35.55%	979
2022	95	30.84%	1074
2023	85	45.45%	1159
2024	125	66.49%	1284
2025	175	73.53%	1459
2026	18	90.00%	1477

Plot

# 1. Create plot theme
  my_plot_theme <- theme_minimal() +
    theme(
      plot.title = element_text(face = "bold", size = 22, hjust = 0.5, margin = margin(t = 10, b = 20)),
      axis.title = element_text(face = "bold", size = 12),
      axis.text  = element_text(face = "bold", size = 12),
      axis.line  = element_line(color = "black", size = 0.5),
      axis.ticks = element_line(color = "black")
    )  
  
# 2. Plot   
  lead_plot <- ggplot(
    data = surgeries_stats,
    aes(x = year)
  ) +
    geom_bar(
      aes(y = pct_lead),
      stat = "identity",
      fill = "lightgrey",
      color = "black",
      alpha = 0.6
    ) +
    geom_text(
      aes(y = pct_lead, label = paste0(round(pct_lead, 0), "%")),
      vjust = -0.5,
      fontface = "bold",
      size = 5
    ) +
    scale_x_continuous(
      name ="",
      breaks = seq(min(surgeries_stats$year), max(surgeries_stats$year), by = 1)
    ) +
    scale_y_continuous(
      name = "",
      expand = expansion(mult = c(0, 0.05))
    ) +
    labs(
      title = paste0("% AS LEAD SURGEON PER YEAR (", min(surgeries_stats$year), "-", max(surgeries_stats$year), ")")
    ) +
    my_plot_theme
  print(lead_plot)

3. TOP 15 PROCEDURES

This is the report of the top 15 procedures, performed between 2012 and 2026.

Short and long description of ICD-9 procedures were taken from the CMS.gov website.

Table

procedures_stats |>
  select(procedure, procedures, short_descr)|>
  rename(
    "ICD-9 Code" = procedure,
    "Procedures" = procedures,
    "ICD-9 short description" = short_descr
  ) |>
  kbl(align="ccl")|>
  kable_styling(
    bootstrap_options = "striped", 
    full_width = FALSE,      
    position = "center"
  ) |>
  column_spec(1, width = "150px") |>
  column_spec(2, width = "150px") |>
  column_spec(3, width = "300px")

ICD-9 Code	Procedures	ICD-9 short description
8385	659	Musc/tend lng change NEC
9353	519	Other cast application
9929	445	Inject/infuse NEC
7865	336	Remove imp device-femur
8118	334	Subtalr jt arthroereisis
7825	311	Limb short proc-femur
7867	190	Remov imp dev-tib/fibula
7728	168	Metatar/tar wedg osteot
7827	168	Limb shorten-tib/fibula
8375	161	Tendon trnsfr/transplant
7738	150	Metatar/tar division NEC
7725	105	Femoral wedge osteotomy
8832	97	Contrast arthrogram
7868	79	Remove imp dev-metat/tar
8192	60	Injection into joint

Plot

# 1. Create plot theme
  my_plot_theme <- theme_minimal() +
    theme(
      plot.title = element_text(face = "bold", size = 22, hjust = 0.5, margin = margin(t = 10, b = 20)),
      axis.title = element_text(face = "bold", size = 12),
      axis.text  = element_text(face = "bold", size = 12),
      axis.line  = element_line(color = "black", size = 0.5),
      axis.ticks = element_line(color = "black")
    )  
  
# 2. Plot  
  procedures_plot <- ggplot(
    data = procedures_stats,
    aes(x = reorder(short_descr, procedures), y = procedures)
  ) +
    geom_col(
      fill = "lightgrey",
      color = "black"
    ) +
    geom_text(
      aes(label = procedure),
      y = 0,
      hjust = -0.1,
      fontface = "bold",
      size = 4
    ) +
    geom_text(
      aes(label = procedures),
      hjust = -0.5, 
      fontface = "bold",
      size = 5
      ) +
    scale_x_discrete(
      name = ""
    ) +
    scale_y_continuous(
      name="",
      expand = expansion(mult = c(0, 0.05))
    ) +
    labs(
      title = paste("TOP",length(procedures_stats$procedure),"ICD-9 PROCEDURES"),
    ) +
    coord_flip() +
    my_plot_theme
  print(procedures_plot)