American Journal of Surgery

BACKGROUND: There are concerns about overuse of abdominopelvic-computed tomography (CTAP) in pediatric blunt abdominal trauma (BAT) given malignancy risks. This study evaluates how an evidence-based algorithm affected CTAP and hospital resource use for hemodynamically stable children with BAT. MATERIALS AND METHODS: This is a retrospective cohort study of hemodynamically stable pediatric BAT patients one year before and after algorithm implementation. We included children less than or equal to 14 years of age treated in a Level I pediatric trauma center...

INTRODUCTION: Injuries are a leading cause of preventable morbidity and mortality among children. Trauma registries are fundamental to assess priorities for the prevention, control, minimization, and/or elimination of injury in children. METHODS: We used a pediatric trauma register to identify temporal trends in pediatric trauma admissions between 2010 and 2017. Factors associated with independent temporal trends were identified using ordinal logistic regression modeling...

Nipple-sparing mastectomy is used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer. This technique allows to remove the entire glandular tissue preserving the skin envelope and the nipple-areola complex. Common indications to nipple-sparing mastectomy include extensive or multicentric disease, inability to obtain clear surgical margins with breast conserving-surgery, large tumor size with respect to the breast size, as well as cases with contraindications for radiotherapy as well as patient preference...

BACKGROUND: There has been an increasing interest in the complete pathological response (pCR) in rectal cancers following neoadjuvant therapy. The aim of this study was to identify predictive factors of pCR in locally advanced rectal cancer following neoadjuvant therapy. METHODS: The studies identified were appraised with standard selection criteria. The selection criteria included studies on patients with stage II or III rectal cancer who underwent neoadjuvant therapy...

BACKGROUND: Oncoplastic Breast Conserving Surgery (OBCS) allows adequate resection margins of tumours unsuitable for standard breast conserving surgery (SBCS) whilst allowing for better cosmesis and reduced morbidity when compared to mastectomy. However, there is limited evidence on its oncological safety. METHODS: This study aims to compare oncological safety of OBCS with SBCS and mastectomy by examining the relative risk of cancer recurrence and re-operation rates through meta-analysis...

BACKGROUND: Given the long tradition of oral examinations in surgical training, surgical clerkships continue to use oral examinations to evaluate medical students even though the value of oral examination at the post-graduate level has been questioned. The key issue in the context of undergraduate surgical training then is to understand value of the oral examination in assessment. The goal of this study is to clarify what oral examinations do, or appear to, test and how this complements other methods of assessment...

BACKGROUND/AIM: To investigate whether teaching procedures and surgical experience are associated with surgical site infection (SSI) rates. METHODS: This prospective cohort study of patients undergoing general, orthopedic trauma and vascular surgery procedures was done between 2012 and 2015 at two tertiary care hospitals in Switzerland/Europe. RESULTS: Out of a total of 4560 patients/surgeries, 1403 (30.8%) were classified as teaching operations...

BACKGROUND: The preoperative and intraoperative factors that could predict a higher risk of anastomotic/staple line leak for gastric cancer patients has not been accurately defined. METHODS: Patients who underwent surgery with curative intent for gastric malignancies between 2002 and 2018 were evaluated from a single prospective database. RESULTS: A total of 195 patients were evaluated with an overall complication rate of 40%. Anastomotic/staple line leak occurred in 13%, with 4% undergoing reoperation during the same hospitalization...

INTRODUCTION: Bilateral internal iliac artery embolization (BIIAE) with temporary embolic materials epitomizes damage-control principles in the treatment of exsanguinating hemorrhage from pelvic trauma. However, instances of ischemic complications have been reported. The aim of our study was to assess safety and effectiveness of BIIAE. METHODS: All patients who received BIIAE for pelvic trauma at a Level I Trauma Center between 1998 and 2018 were reviewed. Effectiveness was assessed by radiographic bleeding control and clinical bleeding control, i...

BACKGROUND: Surgery residents complete their research training early in residency. Non-surgical trainees typically have research incorporated toward the last two years of their fellowship, conferring an advantage to apply for grants with recent research experience and preliminary data. METHODS: The NIH RePORTER database was queried for K08 awardees trained in medicine, pediatrics, and surgery from 2013 to 2017. 406 K08 recipients were identified and time from completion of clinical training to achieving a K08 award was measured...

BACKGROUND: Our objective was to assess the impact of incorporating videos in a behaviorally anchored performance rating scale on the inter-rater reliability (IRR) of expert, intermediate and novice raters. METHODS: The Intra-corporeal Suturing Assessment Tool (ISAT) was modified to include short video clips demonstrating poor, average, and expert performances. Blinded raters used this tool to assess videos of trainees performing suturing on a porcine model. Three attending surgeons, 4 residents, and 4 novice raters participated; no rater training was provided...

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History is by nature a retrospective subject, there usually being an interval between any event, a review or impact of the subject being considered. This NPSA Historian's paper, takes a long and quick historical view of influences that fostered changes resulting in the current state of affairs in the field of medicine and medical care. The fields of medicine and surgery, are undergoing rapid changes as a result of technological and other advances that are making tomorrow's medical history seemingly happening yesterday...

BACKGROUND: A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery. METHODS: An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship...

BACKGROUND: A lateral pancreaticojejunostomy, or a Puestow procedure, is used in chronic pancreatitis with ductal dilation and pain. The current literature on the Puestow is sparse. This study examines outcomes of Puestow procedures nationwide. METHODS: Using ACS-NSQIP database, patients who underwent a Puestow procedure from 2010 to 2016 were identified. Univariate analysis and multivariable regression models were used to identify predictors of mortality and morbidities...

BACKGROUND: We aimed to identify differences in disparities among patients with a cancer in which screening is widely recommended (colorectal cancer [CRC]) and one in which it is not (esophageal cancer). METHODS: A retrospective analysis was performed using 2004-2015 data from the National Cancer Database. Multivariable generalized logistic regression was used to identify potential differences in the effect of disparities in stage at diagnosis. RESULTS: A total of 96,524 esophageal cancer patients and 361,187 CRC patients were included...

BACKGROUND: Metabolic syndrome (MetS) is defined by numerous comorbidities. We sought to assess MetS's effect on the 7 main emergency general surgery (EGS) procedures that constitute 80% of EGS procedures, mortalities, complications, and costs. METHODS: Data were acquired from the ACS-NSQIP database from 2005 to 2017. Current procedural terminology (CPT) codes were utilized to identify cases. Patients with obesity, diabetes, and hypertension were defined as having MetS...

BACKGROUND: Safety-net hospitals frequently underperform on surgical quality measures. To achieve equitable surgical care, creative strategies are needed to improve care for this vulnerable population. METHODS: We designed a trainee-led quality improvement (QI) program to promote evidence-based analgesia prescribing. The program included a collaborative resident leadership model and used educational interventions and performance feedback. RESULTS: Before the QI program, 48% of patients were discharged on acetaminophen post-operatively, and 0% were discharged on ibuprofen...

BACKGROUND: Surgical education is changing, with residents having less time to learn more procedures. We aim to explore how residents prepare for the operating room and what factors impact their preparation. METHODS: A qualitative study was conducted using conventional content analysis. General surgery residents at one institution were invited to participate in semi-structured interviews. Each interview was recorded, transcribed verbatim, and then inductively examined to generate themes...

BACKGROUND: Most blunt splenic injuries (BSI) are treated with nonoperative management (NOM) or embolization (EMBO). Little is known about the hematologic changes associated with these treatments. We aim to assess the temporal changes of hematologic markers in trauma patients who undergo splenectomy (SPL), packing and splenorrhaphy (P/S), EMBO, or NOM. We hypothesize that differences in trends of hematologic markers exist in patients undergoing EMBO or SPL, compared to NOM. METHODS: An 8-year review of adult patients with BSI and underwent SPL, EMBO, P/S, or NOM...