American Journal of Surgery

BACKGROUND: Gastrointestinal (GI) leaks after cytoreductive surgery and hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is a known life-threatening complication that may alter patients' outcomes. Our aim is to investigate risk factors associated with GI leaks and evaluate the impact of GI leaks on patient's oncological outcomes. METHODS: A retrospective analysis of perioperative and oncological outcomes of patients with and without GI leaks after CRS/HIPEC...

BACKGROUND: We aimed to clarify usefulness of the modified Frailty Index 11 (mFI-11) for assessing risk of postoperative complications (POCs) and effectiveness of perioperative management team (POMT) intervention for improving postoperative status of frail aged patients requiring colorectal cancer (CRC) surgery. METHODS: We compared, retrospectively, surgical outcomes among 151 consecutive CRC surgery patients aged ≥80 years. Patients were grouped by mFI-11 scores and by POMT intervention (vs...

BACKGROUND: Female medical students outnumber males with increasing representation in the workforce. However, women remain underrepresented in surgical leadership. Suggested reasons for this discrepancy are lack of female role models, mentorship, and gender discrimination. Thus, we set out to examine the change in leadership over time in our Department. METHODS: Leadership data was gathered from a Department of Surgery in 2016 and 2020. Demographics including gender, age, and leadership position were compared using chi-squared testing...

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BACKGROUND: The clinical impact of postoperative opioid use requires accurate prediction strategies to identify at-risk patients. We utilize preoperative claims data to predict postoperative opioid refill and new persistent use in opioid-naïve patients. METHODS: A retrospective study was conducted on 112,898 opioid-naïve adult postoperative patients from Optum's de-identified Clinformatics® Data Mart database. Potential predictors included sociodemographic data, comorbidities, and prescriptions within one year prior to surgery...

No abstract text is available yet for this article.

BACKGROUND: Surgical stabilization of rib fractures (SSRF) has been correlated with improved outcomes, including decreased length of stay (LOS). We hypothesized that an SSRF consultation service would increase the frequency of SSRF and improve outcomes. METHODS: A prospective observational study was performed to compare outcomes before and after implementing an SSRF service. Primary outcome was time from admission to surgery; secondary outcomes included LOS, mortality and morphine milligram equivalents (MME) prescribed at discharge...

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BACKGROUND: Incidental adrenal masses (IAMs) are common. Primary care providers (PCPs) are frequently responsible for incidentaloma evaluations. We evaluated whether PCPs view this paradigm effective, barriers faced, and strategies to optimize care delivery. METHODS: This is a sequential explanatory study, comprised of surveys followed by focus groups of PCPs. Because lung nodules are another type of common incidental finding, we compared PCP views on management of lung nodules to their views on IAMs...

During a pandemic, the responsibility of care is rightly shifted from the individual patient to safeguard the health of the large community. The coronavirus pandemic has reshaped the healthcare landscape, placing a strain on all healthcare workers, especially women in healthcare. During the ongoing COVID-19 Pandemic, the threatening pressure on the healthcare system has forced governments and healthcare systems to formulate complex policies to decide how to allocate limited resources. Women also make up one-third of the majority of frontline healthcare professionals around the world, making them vital to tackle this public health crisis...

BACKGROUND: Surgical decisions for ductal carcinoma in situ (DCIS) are based on lesion sizes. This study aims to determine the accuracy of pre-operative imaging in estimating the size of DCIS. METHODS: This was a retrospective review of clinicopathologic data of patients treated for DCIS with breast conserving surgery (BCS) between 2012 and 2018. Mammographic and sonographic lesion sizes were compared with final pathology sizes. RESULTS: For the 152 lesions visible on mammography, mean size on imaging was significantly smaller when compared to final pathology (2...

BACKGROUND: Contralateral prophylactic mastectomy (CPM) is not recommended for average-risk women with breast cancer due to lack of evidence for survival benefit, yet recent studies demonstrate increasing CPM rates. METHODS: We identified patients with breast cancer treated with unilateral mastectomy (UM) with or without CPM. Rates of malignancy in CPM specimens and factors in CPM rates were assessed. RESULTS: From 2013 to 2017, 1353 patients had UM and 355 had CPM...

BACKGROUND: The 8th edition AJCC Staging for small bowel neuroendocrine tumors created a novel N2 classification. This study investigates if it is independently prognostic. METHODS: Records of patients from 2008 to 2019 were reviewed. Survival rates were estimated by Kaplan-Meier method and compared by log-rank. The Cox Proportional Hazards model was used to determine factors associated with overall survival (OS) via multivariate analysis. RESULTS: Among 300 patients, 225 were N2 and 60 were N1...

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BACKGROUND: In the US, opioids are overprescribed after surgery contributing to the opioid epidemic. Patients' expectations regarding postoperative opioids remains unclear. METHODS: A representative survey using random-digit dial telephone sampling of English-speaking adults in US was conducted from August 28 to December 11, 2019. RESULTS: Of the 1533 eligible persons contacted, 1000 completed the interviews yielding a cooperation rate of 65%...

BACKGROUND: The accuracy of routine nasopharyngeal (NP) COVID19 testing in patients without respiratory symptoms is unknown. We describe a patient who presented with only gastrointestinal symptoms who tested negative twice, highlighting a variation of this disease that may be more difficult to defect by standard testing. CASE: A 17-year-old boy presented with 5 days of abdominal pain, headaches, vomiting and fevers. He was initially evaluate at another hospital where an NP swab was negative for COVID19...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Traumatic thoracic or chest wall hernias are relatively uncommon but highly challenging injuries that can be seen after a variety of injury mechanisms. Despite their description throughout history there remains scant literature on this topic that is primarily limited to case reports or series. Until recently, there also has been no effort to create a reliable grading system that can assess severity, predict outcomes, and guide the choice of surgical repair. The purpose of this article is to review the reported literature on this topic and to analyze the history, common injury mechanisms, likely presentations, and optimal management strategies to guide clinicians who are faced with these challenging cases...

BACKGROUND: Patterns of recurrence help to inform surveillance of patients with resected gastroenteropancreatic neuroendocrine tumors (GEP-NETs). METHODS: Patients with GEP-NETs in British Columbia, Canada (2004-2015) were reviewed. Associations between tumor characteristics, recurrence and survival were analyzed. RESULTS: Among 759 patients, 41%, 25%, and 17% had grade 1, 2, and 3 disease, respectively. 387 patients had R0/R1 resections, of which 30% recurred (median 25 months)...