American Journal of Surgery

Awad Jarrar, Armin Edalatpour, Audry Sebikali-Potts, Dominic Vitello, Michael Valente, David Liska, Matthew Kalady, Conor P Delaney, Scott R Steele
INTRODUCTION: Our aim was to develop a nomogram taking into account factors such as tumor biology to predict overall and disease-free survival for patients with primary rectal adenocarcinoma undergoing curative intent surgical resection. METHODS: Patients undergoing resection for primary rectal adenocarcinoma (2007-2017) were included. Factors reflecting tumor biology and important clinical prognosticators were included in nomogram development. Prognostic factors were assessed with multivariable analysis using Cox regression...
October 30, 2019: American Journal of Surgery
Biqi Zhang, Maggie L Westfal, Cornelia L Griggs, Ya-Ching Hung, David C Chang, Cassandra M Kelleher
BACKGROUND: Practice pattern and work environment differences may impact career advancement opportunities and contribute to the gender gap within highly competitive surgical specialties. METHODS: Using a 2000-2015 New York statewide dataset, we compared board-certified pediatric surgeons by specialist case volume and Herfindahl-Hirschman Index (HHI), which quantifies surgeon focus within specialist case mix. RESULTS: 51 pediatric surgeons were analyzed for 461 surgeon-years...
October 30, 2019: American Journal of Surgery
Brittany L Johnson, Giovanni A Campagna, Jonathan M Hyak, Adam M Vogel, Sara C Fallon, Sohail R Shah, Mary L Brandt, Bindi J Naik-Mathuria
PURPOSE: Management of children with adhesive small bowel obstruction (ASBO) is often based on abdominal radiographs (AXR). Our purpose was to determine the significance of paucity of gas on initial AXR. METHODS: Retrospective, single center review of children with ASBO between 2011 and 2015. Analysis included chi-square, non-parametric tests and multivariate regression. RESULTS: Of 207 cases, 99 were operative. Initial AXR showed paucity of gas in 41% and gaseous loops in 59%...
October 29, 2019: American Journal of Surgery
Heather M Grant, Lindy L Davis, Jane Garb, Richard B Arenas, Mihaela S Stefan
BACKGROUND: Leukopenic patients have historically been considered poor surgical candidates due to a perceived increase in operative morbidity and mortality. METHODS: Retrospective cohort study using the NSQIP database to identify adult patients who received chemotherapy for malignancy within 30-days prior to elective or emergent abdominal surgery between 2008 and 2011. Leukopenia was defined as < 4000 WBC/mm3 within 2-days prior to surgery. Multiple logistic regression assessed if leukopenia was associated with morbidity and mortality...
October 28, 2019: American Journal of Surgery
Ryan J Ellis, Amy L Holmstrom, D Brock Hewitt, Kathryn E Engelhardt, Anthony D Yang, Ryan P Merkow, Karl Y Bilimoria, Yue-Yung Hu
BACKGROUND: General surgery residencies continue to experience high levels of attrition. METHODS: Survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination. Outcomes were consideration of leaving residency, potential alternative career paths, and reasons for staying in residency. RESULTS: Among 7,409 residents, 930 (12.6%) reported considering leaving residency over the last year. Residents were more likely to consider other general surgery programs (46...
October 25, 2019: American Journal of Surgery
Mariane Gouvêa Monteiro de Camargo, Xhileta Xhaja, Alexandra Aiello, David Liska, Emre Gorgun, David W Dietz, Matthew F Kalady, Conor P Delaney, Scott R Steele, Michael A Valente
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) has become the standard of care for locally advanced rectal cancer, decreasing locoregional recurrence, yet with an unclear survival advantage. We aimed to assess the benefit of nCRT on oncologic and perioperative outcomes of patients with clinical stage IIA rectal adenocarcinoma treated with abdominoperineal resection (APR). METHODS: Patients with clinical T3N0 rectal adenocarcinoma that underwent APR between 1995 and 2014 were included...
October 23, 2019: American Journal of Surgery
Jan Franko, Benjamin Ferrel, Paul Pierson, Shankar Raman, Daniela Frankova, Lindsey M Rearigh, Aneesa Afroze, Maria A Guevara Hernandez, David Terrero-Salcedo, David Kermode, Marc Gorvet
BACKGROUND: Remote appendectomy was linked to increased incidence of Clostridioides difficile infection (CDI). We evaluated the effect of absence of vermiform appendix and/or gallbladder on recurrence rate and severity of CDI. METHODS: We assessed a systemwide patient cohort diagnosed with initial CDI in 2014 (n = 250). The primary outcome was recurrence. RESULTS: Appendix and gallbladder were absent among 47 and 64 patients, respectively...
October 23, 2019: American Journal of Surgery
Joaquin Gómez-Ramírez, Adela Gómez-Valdazo, Patricia Luengo, Belen Porrero, Irene Osorio, Sonia Rivas
BACKGROUND: Some patients with primary hyperparathyroidism (PHPT) have an elevated PTH that does not always correlate with high blood calcium levels. We aimed to compare the clinical presentation between normocalcaemic and hypercalcaemic forms using ionized calcium levels as an inclusion criterion. METHODS: We included all patients referred for surgery for PHPT between January 2015 and December 2017. Patients were divided into 2 groups (hypercalcaemic (hPHTP)/normocalcaemic (nPHPT))...
October 22, 2019: American Journal of Surgery
Daniel Grabo, James Bardes, Melinda Sharon, David Borgstrom
BACKGROUND: Operative trauma volume for general surgery residents (GSR) continues to decline. This pilot study examines the impact of utilizing perfused cadavers in trauma surgical skills training for GSR. METHODS: GSR (post graduate year (PGY) 1 through 4) participated in trauma surgical skills training utilizing perfused cadavers. GSR completed surveys assessing confidence in their ability to perform critical procedures before and after training. RESULTS: Sixteen GSR participated in trauma skills training...
October 21, 2019: American Journal of Surgery
Hong-En Chen, Cheyenne C Sonntag, Katelin A Mirkin, David F Pepley, David C Han, Jason Z Moore, Scarlett R Miller
BACKGROUND: The objective of this study was to validate the transfer of ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) placement skills from training on a Dynamic Haptic Robotic Trainer (DHRT), to placing US-IJCVCs in clinical environments. DHRT training greatly reduces preceptor time by providing automated feedback, standardizes learning experiences, and quantifies skill improvements. METHODS: Expert observers evaluated DHRT-trained (N = 21) and manikin-trained (N = 36) surgical residents on US-IJCVC placement in the operating suite using a US-IJCVC evaluation form...
October 21, 2019: American Journal of Surgery
Anthony H Bui, Jonathan A Ripp, Kyu Young Oh, Frank Basloe, Dahlia Hassan, Saadia Akhtar, I Michael Leitman
BACKGROUND: The prevalence of burnout and depression are high among surgical trainees. This study examined the impact of program-driven initiatives to improve surgical trainee wellness. METHODS: A survey was administered to residents and fellows at all surgical training programs across an urban academic health system. The survey measured burnout, depressive symptoms, and perceptions of program-driven wellness initiatives. RESULTS: The response rate was 44% among 369 residents...
October 20, 2019: American Journal of Surgery
Ajda Altinoz, Ahmed Maasher, Fatima Jouhar, Amira Babikir, Maha Ibrahim, Talat Al Shaban, Abdelrahman Nimeri
BACKGROUND: Internal hernia rate after Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is variable (0.5%-9%). METHODS: We retrospectively reviewed all patients who underwent diagnostic laparoscopy for possible internal hernia after RYGB from 2009 to 2016. All internal hernia defects were closed. RESULTS: We performed 574 RYGB cases between 2013 and 2016, 33 diagnostic laparoscopies were performed (6 after RYGB done at our institution & 27 after RYGB done at outside institutions)...
October 19, 2019: American Journal of Surgery
Radwan Kassir, Nikos Tsiminikakis, Aleksandar Celebic, Carole Felsenheld, Nada Helmy, Rani Kassir, Elie Chouillard
PURPOSE: The optimal time to perform elective surgery remains to be determined. We analyzed the impact of time interval to surgery on short-terme outcome parameters in patients undergoing elective laparoscopic left colonic resection for diverticulitis. MATERIALS AND METHODS: Retrospective analysis of two series of case-matched patients according to the timing of operation after the last episode of diverticulitis: group A (within 90 days) and group B (beyond 90 days)...
October 19, 2019: American Journal of Surgery
Christopher R McHenry
No abstract text is available yet for this article.
October 17, 2019: American Journal of Surgery
Carter C Lebares, Ekaterina V Guvva, Aditi Desai, Amy Herschberger, Nancy L Ascher, Hobart W Harris, Patricia O'Sullivan
BACKGROUND: Burnout and distress are widespread issues in surgical training. While effective interventions are slowly coming to light, little has been published regarding the sustainable implementation of such interventions, including the critical need to identify barriers and enablers. METHODS: Enhanced Stress Resilience Training (ESRT), a mindfulness-based cognitive intervention for surgical trainees, was delivered and studied on three separate occasions. For each, focus groups, field notes, surveys and interviews were collected involving leadership, administrators and participants...
October 17, 2019: American Journal of Surgery
Awad Jarrar, Reena Sheth, James Tiernan, Audry Sebikali-Potts, David Liska, Dominic Vitello, Matthew Kalady, Conor P Delaney, Scott R Steele
BACKGROUND: Locoregional colon cancer recurrence occurs in around 10% of patients following initial curative intent primary resection. We hypothesized oncological results can vary based on the recurrence site. Our aim was to determine outcomes for patients undergoing resection with curative intent for locally recurrent colon cancer. METHODS: Patients with locoregional recurrence after curative intent resection for colon cancer were identified (1999-2017). Demographics, operative details and outcome data were recorded...
October 16, 2019: American Journal of Surgery
Aldo Fafaj, Luciano Tastaldi, Hemasat Alkhatib, Samuel Zolin, Diya Alaedeen, Clayton Petro, Ajita S Prabhu, Steven Rosenblatt, Michael J Rosen, David M Krpata
BACKGROUND: Chronic postoperative inguinodynia is a challenging long-term complication after inguinal hernia repair. Surgery may be an option for patients who are refractory to non-operative measures. We aim to evaluate the short-term outcomes of surgical treatment for chronic inguinodynia at our institution. METHODS: Consecutive patients undergoing surgical treatment for chronic groin pain were identified in a prospectively maintained database. Outcomes included operative details, intra- and postoperative complications, pain scores, and patient satisfaction...
October 15, 2019: American Journal of Surgery
Nicholas E Anton, Aimee K Gardner, Dimitrios Stefanidis
INTRODUCTION: Progressing the field of surgical simulation research cohesively requires organization. The purpose of this study was to establish contemporary research priorities utilizing Delphi methodology. METHODS: Surgical researchers with expertise in simulation-based research were invited to submit important questions for the field according to an organized framework. Thematic analysis was used to collapse questions into unique questions. In a second round, experts rated the importance of questions...
October 12, 2019: American Journal of Surgery
Jeffrey B Matthews
No abstract text is available yet for this article.
October 12, 2019: American Journal of Surgery
Gregory T Kennedy, Christine M Hill, Ye Huang, Alycia So, Joshua Fosnot, Liza Wu, John T Farrar, Julia Tchou
INTRODUCTION: Enhanced Recovery after Surgery (ERAS) protocols have contributed to shortened hospital stays and reduced narcotic use after common surgical procedures. Though ERAS protocols exist for breast surgery, they have not been studied for implant-based reconstruction after mastectomy. METHODS: Twenty-three consecutive patients undergoing mastectomy with implant-based reconstruction were treated with perioperative gabapentin, acetaminophen, and NSAIDs. Data regarding clinical course and medication requirement were compared to a historical control cohort (n = 23) receiving usual care after mastectomy...
October 12, 2019: American Journal of Surgery
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