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American Journal of Surgery

Bhavani Pokala, Laura Flores, Priscila R Armijo, Vishal Kothari, Dmitry Oleynikov
BACKGROUND: This study sought to evaluate surgical outcomes, cost, and opiate utilization of patients who underwent laparoscopic (LC) or robotic cholecystectomy (RC). METHODS: The Vizient database was queried for patients admitted with mild to moderate severity of illness (SOI) scores who underwent LC or RC from January 2015 through December 2017. Rates of overall complications, postoperative infection, mortality, LOS, cost, and opiate utilization were compared between groups using IBM SPSS v...
September 4, 2019: American Journal of Surgery
Hunter B Moore, Rachel Culp-Hill, Julia A Reisz, Peter J Lawson, Angela Sauaia, Richard D Schulick, Marco Del Chiaro, Trevor L Nydam, Ernest E Moore, Kirk C Hansen, Angelo D'Alessandro
BACKGROUND: A reliable biomarker to detect pancreatic ductal adenocarcinoma (PDAC) continues to be elusive. With employing metabolomics we hypothesize that a broader analysis of systemic blood can differentiate different stages of PDAC. METHODS: Patients undergoing pancreatic resection had plasma samples grouped by diagnosis and assayed with mass spectrometry. 10 per group [neuroendocrine (PNET), intraductal papillary mucinous neoplasm (IPMN), localized PDAC, locally advanced PDAC, and metastatic] were analyzed to assess if metabolites could delineation different stages of adenocarcinoma...
August 27, 2019: American Journal of Surgery
Gregory J Harbison, John D Vossler, Nicholas H Yim, Kenric M Murayama
BACKGROUND: Utilization of robotic-assistance for esophagectomy is increasing. The differences in outcomes between robotic-assisted minimally-invasive esophagectomy (RAMIE) and non-robotic minimally-invasive esophagectomy (MIE) for esophageal cancer are unknown. The purpose of this study was to compare 30-day postoperative outcomes between RAMIE and MIE. METHODS: A retrospective analysis was conducted using the ACS-NSQIP 2016-2017 databases. Primary outcome was 30-day postoperative mortality and morbidity...
August 26, 2019: American Journal of Surgery
Daniel W Maxwell, Mohammad Raheel Jajja, Salila S Hashmi, Edward Lin, Jahnavi K Srinivasan, John F Sweeney, Juan M Sarmiento
BACKGROUND: Incisional ventral hernias(IVH) are a common complication following open abdominal surgery. The aim of this study was to uncover the hidden costs of IVH following right-sided hepatectomy. METHODS: Outcomes and hospital billing data for patients undergoing open(ORH) and laparoscopic right-sided hepatectomies(LRH) were reviewed from 2008 to 2018. RESULTS: Of 327 patients undergoing right-sided hepatectomies, 231 patients were included into two groups: ORH(n = 118) and LRH(n = 113)...
August 21, 2019: American Journal of Surgery
Jillian L Angelo, Amy H Kaji, Lara H Spence, David S Plurad, Marlo Asis, Annabel Barber, Thomas J Schroeppel, Emma C Callaghan, Brandon T Grover, Justin L Regner, Michael Truitt, Dennis Y Kim
BACKGROUND: The objective of this multi-center study was to examine the follow-up trends after emergency department (ED) discharge in a large and socioeconomically diverse patient population. METHODS: We performed a 3-year retrospective analysis of adult patients with acutely symptomatic hernias who were discharged from the EDs of five geographically diverse hospitals. RESULTS: Of 674 patients, 288 (43%) were evaluated in the clinic after discharge from the ED and 253 (37%) underwent repair...
August 20, 2019: American Journal of Surgery
Navpreet K Dhillon, Galinos Barmparas, Ting-Lung Lin, Rodrigo F Alban, Nicolas Melo, Audrey R Yang, Daniel R Margulies, Eric J Ley
BACKGROUND: This study determined the prevalence of complicated appendicitis in elderly patients diagnosed preoperatively with uncomplicated appendicitis. METHODS: Patients with a preoperative diagnosis of uncomplicated appendicitis at an academic hospital from 11/2013 to 05/2017 were reviewed. Patients ≥65 years were compared to those younger. Pathology reports were categorized as either uncomplicated or complicated (COMP). The primary outcome was the prevalence of COMP appendicitis...
August 20, 2019: American Journal of Surgery
Elizabeth A Alore, Jeremy L Ward, S Rob Todd, Chad T Wilson, Stephanie D Gordy, Marcus K Hoffman, James W Suliburk
BACKGROUND: Current guidelines fail to specify optimal timing of early cholecystectomy for acute cholecystitis. We hypothesized delaying operation past hospital day (HD) 2 would result in increased 30-day morbidity and mortality. METHODS: The ACS-NSQIP database was queried from 2012 to 2015 for all cholecystectomies for acute cholecystitis from HD 1-7. RESULTS: Delay in cholecystectomy to HD 3-7 was observed in 30% of patients with acute cholecystitis...
August 19, 2019: American Journal of Surgery
Katherine Bingmer, Asya Ofshteyn, David W Dietz, Sharon L Stein, Emily Steinhagen
BACKGROUND: Immunosuppressed patients have an increased risk of developing anal cancer, but little data exists regarding outcomes of this population. METHODS: A retrospective review of anal cancer patients at a single academic institution from 2006 to 2017 was performed. RESULTS: 19 (14%) of 136 anal cancer patients were immunosuppressed. Immunosuppressed patients were more likely to be hypoalbuminemic (21% vs. 6%, p = 0.025), less likely to complete chemotherapy (58% vs...
August 19, 2019: American Journal of Surgery
S E Roberts, J A Shea, M Sellers, P Butler, R R Kelz
BACKGROUND: There are few African American students in medical school, and even fewer are choosing academic surgical careers. The objective of this study is to provide insight into what barriers URM students perceive when considering a career in academic surgery. METHODS: This qualitative, descriptive study was conducted at the University of Pennsylvania. Sixteen African American students with an interest in surgery were recruited to participate in the study. The outcomes reported are themes of how participants perceive the challenges of pursuing an academic surgical career...
August 17, 2019: American Journal of Surgery
Asya Ofshteyn, Morgan Terry, Katherine Bingmer, Sharon L Stein, Emily Steinhagen
BACKGROUND: Previous studies have suggested that general surgery residents graduate with suboptimal anorectal experience. However, competence in anorectal procedures is an important part of general surgery training. METHODS: ACGME general surgery resident case logs from 1999 to 2017 were reviewed. Mean number of anorectal procedures were evaluated, comparing Period 1 (1999-2008) and Period 2 (2009-2017). RESULTS: Between 1999 and 2017, the mean number of all anorectal procedures performed by each general surgery resident has increased from 25...
August 17, 2019: American Journal of Surgery
Thomas K Maatman, Jamaica A Westfall-Snyder, Megan E Nicolas, Elliott J Yee, Eugene P Ceppa, Michael G House, Attila Nakeeb, C Max Schmidt, Nicholas J Zyromski
INTRODUCTION: Necrotizing pancreatitis (NP) patients commonly require antibiotic treatment during the several month-long disease course. We hypothesized that Clostridium difficile infection (CDI) is common in NP and significantly impacts outcomes. MATERIALS AND METHODS: Retrospective review of 704 NP patients treated at a single-institution (2005-2018). RESULTS: 10% (67/704) of patients developed CDI a mean 78 days after NP onset. Patients developing CDI experienced increased total hospital days (CDI, 104; No CDI, 42; P < 0...
August 13, 2019: American Journal of Surgery
Esteban Calderon, Christopher Webb, Heidi E Kosiorek, M D Richard J Gray, Patricia Cronin, Karen Anderson, Donald Northfelt, Ann McCullough, Idris Tolgay Ocal, Barbara Pockaj
BACKGROUND: The Choosing Wisely Organization and the American College of Surgeons have issued recommendations for patients >70 with breast cancer involving screening and use of radiation therapy (RT) and sentinel lymph node biopsies (SNLB) in early stage tumors. This study evaluated compliance and implementation of these recommendations. METHODS: A database of patients undergoing breast cancer surgery was retrospectively queried from 2002 to 2017. Patients were divided into cohorts before and after the year of each guideline publication...
August 10, 2019: American Journal of Surgery
Natalie C McClintock, Kelsey E Gray, Angela L Neville, Amy H Kaji, Mary M Wolfe, Kristine E Calhoun, Farin F Amersi, Timothy R Donahue, Tracey D Arnell, Benjamin T Jarman, Kenji Inaba, Marc L Melcher, Jon B Morris, Brian R Smith, Mark E Reeves, Jeffrey M Gauvin, Edgardo S Salcedo, Richard A Sidwell, Daniel L Dent, Kenric M Murayama, Richard B Damewood, Venkateswara P Poola, Christian M de Virgilio
BACKGROUND: Although most surgery residents pursue fellowships, data regarding those decisions are limited. This study describes associations with interest in fellowship and specific subspecialties. METHODS: Anonymous surveys were distributed to 607 surgery residents at 19 US programs. Subspecialties were stratified by levels of burnout and quality of life using data from recent studies. RESULTS: 407 (67%) residents responded. 372 (91.4%) planned to pursue fellowship...
August 8, 2019: American Journal of Surgery
Arika Hoffman, Rachel Ghoubrial, Melanie McCormick, Praise Matemavi, Robert Cusick
BACKGROUND: Letters of recommendation (LoR) are considered one of the most important predictors of matching into a pediatric surgery fellowship. We determined if gendered differences exist in LoR written for resident candidates. METHODS: A retrospective review of blinded LoR to a fellowship program between 2015 and 2017 was performed. RESULTS: Of the 364 LoR reviewed for 49 female and 48 male applicants, male surgeons wrote 82.5% of letters...
August 8, 2019: American Journal of Surgery
Karla Bernardi, Alexander C Martin, Julie L Holihan, Oscar A Olavarria, Juan R Flores-Gonzalez, Deepa V Cherla, Nicole B Lyons, Puja Shah, Lillian S Kao, Tien C Ko, Mike K Liang
BACKGROUND: We hypothesized that long-term quality of life (QoL) is improved among patients with ventral hernias (VHs) and comorbid conditions managed operatively than with non-operative management. METHODS: This was the 3-year follow-up to a prospective observational study of patients with comorbid conditions and VHs. Primary outcome was change in QoL measured utilizing the modified Activities Assessment Scale (AAS), a validated, hernia-specific survey. Outcomes were compared using: (1)paired t-test on matched subset and (2)multivariable linear regression on the overall cohort...
August 7, 2019: American Journal of Surgery
Ryan Bailer, Robert C G Martin
BACKGROUND: Assimilating diagnostic radiology education into undergraduate medical education remains a challenge. This challenge places a greater emphasis in surgical residency to ensure this education occurs. The objective of this study is to determine whether a 3D-reconstruction may improve surgical residents' assessment of resectability of pancreatic lesions. METHODS: Four cases were identified of patients with a pancreatic lesion; high-quality, triphasic abdominal CT scans were obtained and evaluated to ensure sufficient resolution and slice thickness...
August 6, 2019: American Journal of Surgery
Aaron R Jensen, Francesca Bullaro, Richard A Falcone, Margot Daugherty, L Caulette Young, Cory McLaughlin, Caron Park, Christianne Lane, Jose M Prince, Daniel J Scherzer, Tensing Maa, Julie Dunn, Laura Wining, Joseph Hess, Mary C Santos, James O'Neill, Eric Katz, Karen O'Bosky, Timothy Young, Emily Christison-Lagay, Omar Ahmed, Randall S Burd, Marc Auerbach
BACKGROUND: Best practices for benchmarking the efficacy of simulation-based training programs are not well defined. This study sought to assess feasibility of standardized data collection with multicenter implementation of simulation-based training, and to characterize variability in pediatric trauma resuscitation task completion associated with program characteristics. METHODS: A prospective multicenter observational cohort of resuscitation teams (N = 30) was used to measure task completion and teamwork during simulated resuscitation of a child with traumatic brain injury...
August 5, 2019: American Journal of Surgery
Jiqiao Zhu, Xianliang Li, Han Li, Zixi Liu, Jun Ma, Jiantao Kou, Qiang He
BACKGROUND: We aimed to compare the enhanced recovery after surgery pathway with the standard perioperative care protocol concerning complications, postoperative length of stay and 1-year survival rate. METHODS: Using a before-after cohort study design, data from patients with pancreatic head cancer, who consecutively underwent pancreaticoduodenectomy, were retrospectively collected. RESULTS: Compared to the control group, patients with soft pancreas in the enhanced recovery after surgery group had a lower incidence of delayed gastric emptying (36...
August 5, 2019: American Journal of Surgery
J Madison Hyer, Diamantis I Tsilimigras, Faiz Gani, Kota Sahara, Aslam Ejaz, Susan White, Timothy M Pawlik
BACKGROUND: Considered the top 5% of healthcare utilizers, "super-utilizers" are estimated to consume as much as 40-55% of all healthcare costs. The aim of this study was to identify factors associated with switching between low- and super-utilization. METHODS: Low and super-utilizers who underwent abdominal aortic aneurysm (AAA) repair, coronary artery bypass graft (CABG), colectomy, total hip arthroplasty (THA), total knee arthroplasty (TKA), or lung resection between 2013 and 2015 were identified from 100% Medicare Inpatient Standard Analytic Files...
August 5, 2019: American Journal of Surgery
Mohammad Hossein Khosravi
No abstract text is available yet for this article.
August 5, 2019: American Journal of Surgery
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