Journal of the American College of Surgeons

INTRODUCTION: Decision making on optimal treatment strategy in patients with initially unresectable colorectal cancer liver metastases (CRLM) remains complex because uniform criteria for (un)resectability are lacking. This study reports on the feasibility and short-term outcomes of The Dutch Colorectal Cancer Group Liver Expert Panel. METHODS: The Expert Panel consists of thirteen hepatobiliary surgeons and four radiologists. Resectability assessment is performed independently by three randomly assigned surgeons...

BACKGROUND: Lateral pelvic lymph node dissection for rectal cancer is a difficult technique due to the complex pelvic anatomy involved. And three-dimensional (3D) organ models have been introduced as education tool to study anatomy in some fields. In this study, we educated the participants about pelvic anatomy using a 3D model and evaluated learning efficiency, comparing the outcomes with those using a traditional textbook. STUDY DESIGN: This study was a randomized, controlled, single-center trial conducted between July 2018 and July 2019...

BACKGROUND: In an era of competency-based education and concern about graduating resident readiness for practice, early resident autonomy and the ability to safely teach junior residents is becoming increasingly important. In this study we aimed to understand the effect of "Teaching Resident" (two residents operating under the supervision of an attending) appendectomy cases on outcomes. STUDY DESIGN: A single-center retrospective review of 928 patients from October 2014 to December 2017 who underwent appendectomy with the University of Wisconsin Hospital system...

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BACKGROUND: Non-alcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) is on the rise worldwide but data regarding long-term outcomes after curative surgery were limited. The primary aim of this study was to characterize the perioperative and long-term outcomes after liver resection. The secondary aim was to investigate the influence of the histological severity of non-alcoholic steatohepatitis (NASH) and its impact on perioperative outcomes and long-term survival...

BACKGROUND: Surgical site infections (SSI) represent a significant preventable source of morbidity, mortality and cost. Prophylactic antibiotics have been shown to decrease SSI rates, and β-lactam antibiotics are recommended by national guidelines. It is currently unclear whether recommended β-lactam and recommended non-β-lactam antibiotic regimens are equivalent with respect to SSI risk reduction in colectomy patients. STUDY DESIGN: Retrospective cohort study of SSI rates between prophylactic intravenously administered recommended β-lactam and non-β-lactam in colectomy patients (25 CPT codes) collected by the Michigan Surgical Quality Collaborative (MSQC) from January 2013 to February 2018...

BACKGROUND: Given the propensity for lung metastases (LM), NCCN guidelines recommend lung surveillance (LS) with either CXR or CT in high-grade soft tissue sarcoma (HG-STS). Considering survival, diagnostic sensitivity and cost, the optimal modality is unknown. METHODS: The US Sarcoma Collaborative database (2000-2016) was reviewed for patients who underwent resection of a primary HG-STS. Primary outcome was overall survival (OS). Cost analysis was performed. RESULTS: Among 909pts, 83% had truncal/extremity, 17% had retroperitoneal (RP) tumors...

BACKGROUND: Thrombin-based formulations have been used for topical hemostasis in surgery for decades. However, the number of randomized clinical trials comparing bovine vs. human thrombin is limited. STUDY DESIGN: A randomized, double-blind, non-inferiority phase-II study evaluated the hemostatic efficacy and safety of plasma-derived Topical Thrombin (Human) Grifols (TTH-Grifols) vs. Bovine Thrombin JMI® (BT-JMI) (2:1 ratio) in vascular, hepatic, soft tissue, and spinal surgeries...

The value of the critical view of safety (CVS) in preventing bile duct injuries during laparoscopic cholecystectomies partially resides in its extensive dissection requirements. Despite careful dissection, short cystic structures and high entering cystic arteries can at times impede to fully appreciate CVS. In such situations, the operator conclusively identifies the cystic artery by following it from its origin up into the gallbladder and by pulsation and then divides it to better expose the hepatocystic triangle...

BACKGROUND: Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs may improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients. METHODS: In Stage I, CPT and ICD codes were queried for patients undergoing thoracic, upper abdominal, or aortic open procedures at three institutions (n=210) from December 2014 to April 2016...

BACKGROUND: Risk prediction is important during combat operations because resources are limited and triage decisions must be rapid and accurate. We evaluated 2 point-of-care urinary biomarker tests for risk prediction in combat casualties. STUDY DESIGN: This was an observational cohort study of critically injured military personnel admitted to Craig Joint Theater Hospital in Afghanistan from October 2012 to December 2013. We collected urine within 3 hours of admission and measured urinary biomarkers with NephroCheck and a neutrophil gelatinase-associated lipocalin dipstick (NGALds) to evaluate their ability to predict a combined end point of need for renal replacement therapy or death...

BACKGROUND: Expansion of insurance coverage for gender confirmation surgery (GCS) has led to a large demand for GCS in the United States. This paper sought to determine the financial impact of providing comprehensive GCS services at an academic medical center. METHODS: Cross-sectional study of patients older than 18 who presented for GCS between January 1, 2015 and July 31, 2018 at a single academic medical center. The utilization of GCS services and associated work relative value units (wRVUs) is reported...

BACKGROUND: Accurate estimation of operative case-time duration is critical for optimizing operating room utilization. Current estimates are inaccurate and prior models include data not available at the time of scheduling. Our objective was to develop statistical models in a large retrospective dataset to improve estimation of case-time duration relative to current standards. STUDY DESIGN: We developed models to predict case-time duration using linear regression and supervised machine learning (ML)...

BACKGROUND: There has been increasing attention to gender inequity in speakers at professional meetings. The aim of this study was to evaluate temporal trends in representation of women at the Academic Surgical Congress (ASC) and American College of Surgeons Clinical Congress (CC), two prominent general interest, national surgical meetings. STUDY DESIGN: We reviewed ASC (2014-2019) and CC (2013-2018) meeting programs to determine counts and proportions of invited panelists and moderators by gender, including the frequency of men-only panels...

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