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American Journal of Surgery

Emanuel Eguia, Marshall S Baker, Bipan Chand, Patrick J Sweigert, Paul C Kuo
INTRODUCTION: This study aims to evaluate the effect of the ACA Medicaid expansion on the utilization of minimally invasive (MIS) approaches to common general surgical procedures. METHODS: We queried five Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates of utilization and costs of MIS and open approaches pre and post Medicaid expansion. RESULTS: 117,241 patients met the inclusion criteria. Following the enactment of the ACA, use of both laparoscopic gastric bypass (IRR 1...
July 9, 2019: American Journal of Surgery
Matthew R Smeds, Matthew R Janko, Steven Allen, Kwame Amankwah, Tracey Arnell, Parswa Ansari, Marcus Balters, Donald Hess, Elizabeth Ferguson, Patrick Jackson, Mary K Kimbrough, David Knight, Melissa Johnson, Michael Porter, Brian D Shames, Rebecca Schroll, Julia Shelton, Jeffrey Sussman, Peter Yoo
BACKGROUND: Burnout affects surgical residents' well-being. OBJECTIVE: We sought to identify factors associated with burnout among surgery residents. METHODS: An electronic/anonymous survey was sent to surgical residents at 18 programs, consisting of demographic/programmatic questions and validated scales for burnout, depression, perceived stress, self-efficacy, and social support. Residents were grouped into quartiles based off burnout, and predictors were assessed using univariate and multivariate analyses...
July 9, 2019: American Journal of Surgery
Christopher G Yheulon, Andrew T Schlussel, Justin J Ernat, Danielle E Cafasso, Terri L Carlson, Margaret E Gallagher, Dwight C Kellicut
OBJECTIVE: The purpose of this study is to define the publication patterns and the impact of self-citation among program directors of surgical fellowships. METHODS: Program directors were identified through the respective fellowship accrediting council and association websites for eleven surgical subspecialties. Using the Scopus database, the number of publications, citations, self-citations, and h-indices were calculated. RESULTS: 781 program directors were identified...
July 9, 2019: American Journal of Surgery
Aalap C Shah, Bala Nair, Courtney Lang, Kevin Ma, Moni B Neradilek, Frank H Zucker, John D Lang
BACKGROUND: The "weekend effect," whereby surgeries performed during weekend haven been associated with poorer postoperative outcomes. We explored whether Saturday elective procedures at our hospital were associated with poorer post-operative outcomes when compared with weekday surgeries. METHODS: A retrospective cohort study of patients undergoing elective surgery on the abdomen or perineum from 2008 to 2015 was performed. Procedures were classified by day (Group 1: Monday, Tuesday, Wednesday; Group 2: Saturday)...
July 2, 2019: American Journal of Surgery
Madison Argo, Juan Favela, Tri Phung, Sergio Huerta
BACKGROUND: There is variation in the anesthetic technique for open inguinal hernia repair (OIHR) worldwide. Factors determining the anesthetic technique remains equivocal. We hypothesize that outcomes and operative room times are superior with local anesthesia (LA) compared to AO [all others (general and spinal anesthesia)]. METHODS: Following PRISMA guidelines and set inclusion and exclusion criteria, various databases were reviewed and 18 RCT's were isolated...
July 2, 2019: American Journal of Surgery
Laura Harmon, Ronald Bilow, Kathirkama Shanmuganathan, Margret Lauerman, S Rob Todd, Justin Cardenas, Christine E Haugen, Roxie Albrecht, Stephen Pittman, Mitchell Cohen, Krista Kaups, Rachel Dirks, Clay Cothren Burlew, Charles J Fox, Jorge Con, Kenji Inaba, Paul B Harrison, Gina M Berg, Christine J Waller, Kara J Kallies, Rosemary Ann Kozar
BACKGROUND: Multi-detector computed tomography imaging is now the reference standard for identifying solid organ injuries, with a high sensitivity and specificity. However, delayed splenic hemorrhage (DSH), defined as no identified injury to the spleen on the index scan but delayed bleeding from a splenic injury, has been reported. We hypothesized that the occurrence of DSH would be minimized by utilization of modern imaging techniques. METHODS: Data was retrospectively collected from 2006 to 2016 in 12 adult Level I and II trauma centers...
July 2, 2019: American Journal of Surgery
Tina Hernandez-Boussard, Laura A Graham, Ian Carroll, Elise A Dasinger, Ashley L Titan, Melanie S Morris, Mary T Hawn
Understanding variation in perioperative opioid exposure and its effect on patients' outcomes is critical for pain management. This study characterized perioperative exposure to morphine and its association with postoperative pain and 30-day readmissions. We utilized nationwide Veterans Healthcare Administration (VHA) data on four high-volume surgical procedures, 2007-2014. We identified 235,239 Veterans undergoing orthopedic, general, or vascular surgery; 5.4% high trajectories (116.1 OME/Day), 53.2% medium trajectories (39...
June 28, 2019: American Journal of Surgery
Jason M Samuels, Shane Urban, Erik Peltz, Thomas Schroeppel, Holly Heise, Warren C Dorlac, Linda J Britton, Clay Cothren Burlew, Caitlin Robinson, Megan L Swope, Robert C McIntyre
BACKGROUND: Indications for angioembolization (AE) following liver injury are not clearly defined. This study evaluated the outcomes and complications of hepatic AE. We hypothesize hepatic angioembolization is a useful adjunct to non-operative management of liver injury but with significant morbidity. METHODS: Subjects were identified utilizing trauma registries from centers in a regional trauma network from 2010 to 2017 with an Abbreviated Injury Scale (AIS) coded hepatic injury and an ICD9/10 for hepatic angiography (HA)...
June 26, 2019: American Journal of Surgery
Jose Wilson B Mesquita-Neto, Peter Cmorej, Hassan Mouzaihem, Donald Weaver, Steve Kim, Francis I Macedo
INTRODUCTION: The Affordable Care Act (ACA) expanded Medicaid eligibility to persons with income up to 138% of the federal poverty line. We investigated how Medicaid expansion (ME) impacted the access to cancer-specific surgical care in the US. METHODS: We used a nationwide population-based database (SEER) to identify patients with the 8 most prevalent cancers between 2007 and 2015. Adjusted difference-in-differences (DiD) and multivariate regression were used for statistical analysis...
June 26, 2019: American Journal of Surgery
Nicolas Contreras, James W Jakub
OBJECTIVE: To describe the incidence of post-operative seroma and interventions attempted to reduce this complication in patients undergoing minimally invasive inguinal lymph node dissection (MILND). BACKGROUND: MILND has resulted in fewer wound complications, hospital readmissions, and shorter length of stay; unfortunately, seroma formation remains a major source of morbidity. METHODS: A retrospective study of MILNDs performed from 2010 to 2017 was conducted...
June 24, 2019: American Journal of Surgery
Bhavneet Singh, Gurkirat Singh, Nayef Alzahrani, David L Morris
OBJECTIVES: To assess the impact of short and long term outcomes of diaphragm resection and repair in cyto-reductive surgery (CRS) and intra-peritoneal chemotherapy (IPC). METHODS: 1230 consecutive CRS/IPC procedures were performed between 1996 and 2018 in Sydney, Australia. Among these, 652 underwent diaphragmatic intervention. The analysis was preformed according to histological subtype. First diaphragm interventions were compared to non-diaphragmatic CRS. Secondly, diaphragm resection was compared to diaphragm stripping...
June 23, 2019: American Journal of Surgery
Min Sun Jeon, Young Mi Jeong, Jeong Yee, Eunsook Lee, Kwang-Il Kim, Byung Koo Lee, Sandy Jeong Rhie, Jee Eun Chung, Hye Sun Gwak
BACKGROUND: This study aimed to determine whether pre-operative medication use is associated with unplanned 30-day readmission in elderly people undergoing cancer surgery. METHODS: Patients aged 65 years or older who were scheduled for cancer surgery and presented for comprehensive geriatric assessment were included. Comparisons of variables between patients with readmission and those without readmission were performed by univariate and multivariate analyses. RESULTS: A total of 473 patients were included...
June 22, 2019: American Journal of Surgery
Lena M Napolitano
No abstract text is available yet for this article.
June 21, 2019: American Journal of Surgery
Ted A James, Gyulnara Kasumova, Amuyla Alapati, Anita Mamtani
BACKGROUND: Understanding the underlying factors associated with unplanned readmissions is an important first step toward interventions designed to improve quality of care. This study aimed to identify predictors of unplanned 30-day readmission using a national breast surgery cohort. STUDY DESIGN: Using the National Cancer Database, we performed a review of patients undergoing surgery for breast cancer from 2006 to 2014. A multivariatble logistic regression model was generated to assess predictors of 30-day unplanned readmission...
June 20, 2019: American Journal of Surgery
Ragavan Siddharthan, Elizabeth Dewey, Kevin Billingsley, Erin Gilbert, Vassiliki Liana Tsikitis
BACKGROUND: Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is reported to have a prolonged length of stay (LOS). We incorporated an enhanced recovery after surgery (ERAS) protocol to examine whether we could reduce our LOS. METHODS: Patients were identified who underwent CRS/HIPEC from 2015 to 2018 before and after initiation of ERAS protocol. The protocol included pre-operative, peri-operative and post-operative interventions...
June 20, 2019: American Journal of Surgery
Mustafa Şentürk, Murat Çakır, Ahmet Tekin, Tevfik Küçükkartallar, Mehmet Aykut Yıldırım, Selman Alkan, Sıddıka Fındık
BACKGROUND: Recurrent laryngeal nerve (RLN) injury is an important complication of thyroid surgery. In our study, we aimed to compare the effects of primary repair and polyglycolic acid (PGA) coated tube repair on nerve function and regeneration in RLN cuts in rats. METHODS: Twenty seven rats were used for the study. Group-1 with only nerve cuts, group-2 with primary repair, and group-3 with conduit repair. The study was planned over two-stage surgery. In the first step, nerve defect formation and nerve repair were performed in the same session...
June 20, 2019: American Journal of Surgery
Anna C Beck, Haimiao Yuan, Junlin Liao, Pamela Imperiale, Krysten Shipley, Lillian M Erdahl, Sonia L Sugg, Ronald J Weigel, Ingrid M Lizarraga
BACKGROUND: BRCA genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) in breast cancer patients who meet specific criteria. Limited data are available on the likelihood of detecting a mutation when these guidelines are followed. METHODS: A retrospective chart review examined patients with breast cancer who underwent BRCA testing based on NCCN guidelines. RESULTS: Twelve (6.0%) of the 199 patients had a deleterious BRCA mutation...
June 19, 2019: American Journal of Surgery
Aaron J Done, Marshall J Fairres, Joseph C Heiler, Cody J Smith, William Rappaport
BACKGROUND: Treatment of a subcutaneous abscess is a commonly encountered scenario across multiple specialties. Prior simulation models for abscess incision and drainage have been limited by their cost and reproducibility. METHODS: We developed a realistic abscess model with commonly available materials that can be utilized in fresh cadaver labs at a cost of less than $1 USD per use. The model was evaluated for content validity with pre- and post-measures by 25 pre-clinical medical students...
June 19, 2019: American Journal of Surgery
Natalie A Rosseau, Sowmya Mangipudi, Amy Tronnier, Daniel Vryhof, Glenn Geelhoed
No abstract text is available yet for this article.
June 19, 2019: American Journal of Surgery
Shushan Rana, Arpana Naik, Susha Pillai, John Vetto, Rodney Pommier, Charlotte Dai Kubicky
BACKGROUND: Intraoperative radiotherapy (IORT) was implemented at our institution for early stage breast cancer patients including those with geographic or medical co-morbidity limitations to whole breast radiation therapy (WBRT). METHODS: Retrospective review of patients (n = 127) who underwent IORT from 2009 to 2016 for breast cancer. Demographics, pathology, toxicity, and recurrences were ascertained. RESULTS: The median age was 67 years (interquartile range: 62-73)...
June 18, 2019: American Journal of Surgery
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