American Journal of Surgery

BACKGROUND: We evaluated the association between operating room time and developing a deep vein thrombosis (DVT) or pulmonary embolus (PE) after emergency general surgery (EGS). METHODS: We reviewed six common EGS procedures in the 2013-2015 NSQIP dataset. After tabulating their incidence of postoperative VTE events, we calculated predictors of developing a VTE using adjusted multivariate logistic regressions. RESULTS: Of 108,954 EGS patients, 1,366 patients (1...

BACKGROUND: Opioid misuse is currently plaguing the US. Efforts to reduce this include opioid prescribing education (OPE). Orthopaedic residents often prescribe opioids but, their education is unknown. METHODS: A survey was sent to orthoapedic residency program directors (PDs) regarding their program's controlled substance (CS) policies and knowledge of local CS regulations. RESULTS: There were 60 (36.8%) completed surveys. 54 (90.0%) programs allow resident outpatient opioid prescribing...

INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct used to temporize uncontrolled abdominopelvic hemorrhage. No published clinical data exist that describe average catheter lengths or balloon fill volumes necessary to occlude the aorta. METHODS: A prospective, single-institution registry was queried for patients who underwent placement of a Prytime ER-REBOA™ catheter. Demographic, catheter, hemodynamic, and morphometric data were measured...

BACKGROUND: Ambulatory surgery centers (ASCs) are frequently utilized; however some ambulatory procedures may be performed in hospital outpatient departments (HOPs). Our aim was to compare operating room efficiency between our ASC and HOP. METHODS: We reviewed outpatient general surgery procedures performed at our ASC and HOP. Total case time was divided into five components: ancillary time, procedure time, exit time, turnover time, and nonoperative time. RESULTS: Overall, 220 procedures were included (114 ASC, 106 HOP)...

OBJECTIVES: to investigate whether Neutrophil-to-lymphocyte ratio (NLR) can predict acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis. METHODS: A search of electronic information sources was conducted to identify all studies reporting NLR in patients with clinical suspicion or confirmed diagnosis of acute appendicitis. We considered two comparisons:1) appendicitis versus no appendicitis; 2) uncomplicated appendicitis versus complicated appendicitis...

BACKGROUND: Mesh suture used in high-tension wound closures produces large knots susceptible to increased palpability, infection, and foreign body response; yet has superior tensile strength and increased resistance to cutting through tissue compared to standard suture. This study investigates mesh suture fixation in abdominal tissue with a knotless novel, low-profile anchor-clip. METHODS: Single and double end fixation of mesh suture in swine rectus abdominus fascia with an anchor-clip, a knot, and predicate device fixation underwent cyclic testing followed by pull-to-failure testing...

BACKGROUND: The aim was to assess chronic pain after two Lichtenstein repairs for inguinal hernias (Lichtenstein-Lichtenstein) compared with Lichtenstein followed by a laparoscopic reoperation (Lichtenstein-Laparoscopy). METHODS: In this cohort study, adults having an inguinal hernia reoperation were identified in a nationwide database. Lichtenstein-Lichtenstein was matched 1:3 with Lichtenstein-Laparoscopy and sent validated pain questionnaires. The primary outcome was difference in proportion of patients with chronic pain-related functional impairment...

BACKGROUND: Elevated levels of preoperative tumor markers (TMs), including carcinoembryonic antigen and carbohydrate antigen 19-9 are risk factors for the survival of patients with pancreatic cancer (PC). However, TMs are not always applicable in various conditions. This study aimed to investigate the prognostic value of systemic inflammatory marker (SIM) in such patients. METHODS: Seventy-seven patients who underwent curative surgery for PC with negative TMs were included in this study...

BACKGROUND: Exercise and weight loss are recommended for patients with obesity undergoing elective complex ventral hernia repair (cVHR). METHODS: Weight and BMI trajectory data on 230 obese patients undergoing cVHR from 2012 to 2017 were retrospectively analyzed from 12 months prior to first visit with the hernia surgeon to 12 months after surgery. RESULTS: One year prior to initial visit, 76 (33%) patients had lost > 1kg/m2 , 98 (43%) had gained> 1kg/m2 , and 56 (24%) had no change in body mass index (BMI)...

BACKGROUND: Our institution amended its trauma activation criteria to require a Level II activation for patients ≥65 years old on antithrombotic medication presenting with suspected head trauma. METHODS: Our institutional trauma registry was queried for geriatric patients on antithrombotic medication in the year before and after this criteria change. Demographics, presentation metrics, level of activation, and outcomes were compared between groups. RESULTS: After policy change, a greater proportion of patients received a trauma activation (19...

BACKGROUND: To identify trends in total and subtotal gastrectomy for middle and distal third gastric adenocarcinoma in the U.S. METHODS: NCDB was queried for patients with stage 0-III middle or distal gastric adenocarcinoma treated with total or subtotal gastrectomy. Statistical analysis including cox proportional hazards model was performed to examine overall survival by stage. RESULTS: 1,628 (85%) underwent subtotal gastrectomy and 283 (15%) underwent total...

No abstract text is available yet for this article.

BACKGROUND: Patient reported outcomes (PROs) are an important addition to oncologic breast surgical care. The majority of BREAST-Q PRO literature has been focused on mastectomy with reconstruction (MR), with a paucity of information on more common surgical approaches in practice namely, breast conserving therapy (BCT) and mastectomy (M). This information will help inform patients around decision-making regarding surgical options. METHODS: 837 women underwent surgery between 2010 and 2012, and were later invited to complete the postoperative BREAST-Q module specific to their most recent surgery...

Total pancreatectomy with islet autotransplantation is a promising treatment for refractory chronic pancreatitis. We analyzed postoperative complications in 83 TPIAT patients and their impact on islet graft function. We examined patient demographics, preoperative risk factors, intraoperative variables, and 30- and 90-day postoperative morbidity and mortality. Daily insulin requirement, HbA1c, C-peptide levels, and narcotic requirements were analyzed before and after surgery. Adverse events were recorded, with postoperative complications graded according to the Clavien-Dindo classification...

BACKGROUND: The consequences of opioids-including post-surgical prescriptions-remain a critical public health issue. We sought to determine how procedure type and subspecialty group influence new opioid use after procedures. METHODS: We analyzed 2011-2015 IBM MarketScan Research Databases to identify opioid-naïve adults prescribed opioids for single surgical procedures. We defined new opioid continuation (primary outcome) a priori as receipt of prescription opioids between 90 and 180 days after the procedure...

No abstract text is available yet for this article.

INTRODUCTION: Patient satisfaction remains a key component in successful delivery of high-quality healthcare. In this study, we attempted to better understand how patient demographics might influence perception of clinic wait times and determine factors that may positively influence perception of a clinic experience. METHODS: A prospective study was conducted assessing patient satisfaction during outpatient surgical clinics in minimally invasive, breast, plastic/reconstructive, and orthopaedic surgery between May and September 2017...

BACKGROUND: This study assessed our experience transplanting kidneys from young donors with severe acute kidney injury. METHODS: We performed a single center retrospective analysis of 315 kidney transplants between 1/1/2014-12/31/2016. Donor kidneys were classified according to the Acute Kidney Injury Network (AKIN) criteria. A case-matched cohort was created using recipient age, history of diabetes, donor specific antibody, donor age and donor after cardiac death...

No abstract text is available yet for this article.

BACKGROUND: Percutaneous Cholecystostomy Tubes (PCT) have become an accepted and common modality of treating acute cholecystitis in patients that are not appropriate surgical candidates. As percutaneous gallbladder drainage has rapidly increased newer research suggests that the technique may be overused, and patients may be burdened with them for extended periods. We examined our experience with PCT placement to identify independent predictors of interval cholecystectomy versus destination PCT...