Journal of the American College of Surgeons

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...

BACKGROUND: Postoperative pulmonary complications (PPCs; unplanned reintubation, postoperative pneumonia, and failure to liberate from mechanical ventilation within 48 hours), contribute significantly to increased rates of morbidity and mortality. Procedure type is an important factor that contributes risk in generalized PPC prediction models. The objective of this study was to develop and validate procedure-specific risk scores for the six procedures with highest rates of PPCs. STUDY DESIGN: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File data (2005-2015) for patients undergoing pancreatectomy, hepatectomy, esophagectomy, abdominal aortic aneurysm repair, open aortoiliac repair, and lung resection were used for analysis...

BACKGROUND: Social determinants of health impact the delivery of care and outcomes in patients with pancreatic cancer. We explored the relationship between social determinants of health and presentation, treatment, and outcomes of patients with pancreatic adenocarcinoma at an urban, safety-net medical center. DESIGN: A single institution retrospective chart review of patients with pancreatic adenocarcinoma was conducted. Demographic, tumor, and treatment characteristics were obtained...

BACKGROUND: Surgeons have traditionally relied on opiates after hip replacement despite a growing abuse epidemic. This study assessed the efficacy of multimodal analgesia and impact of conservative opiate prescribing after discharge from hip surgery. STUDY DESIGN: In this cluster-randomized trial, 235 patients undergoing hip replacement (five surgeons) received one of three discharge pain regimens: scheduled-dose multimodal analgesia with a minimal opiate supply (Group-A), scheduled-dose multimodal analgesia with a traditional opiate supply(Group-B), or a traditional PRN opiate regimen alone(Group-C)...

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly utilized as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there may be a selected group of patients that could have benefited from prehospital placement of the REBOA. STUDY DESIGN: This was a retrospective cohort study including patients who presented to a Level 1 trauma center with cardiac arrest between January 2014 and March 2018...

BACKGROUND: Despite increased national attention on misuse of prescription and nonprescription opioids for adolescents and children, little is known about opioid use in a pediatric population during hospitalization for injury. The purpose of this investigation is to describe opioid administration and magnitude of opioid exposure in the first 48 hours of hospitalization in a pediatric trauma population. STUDY DESIGN: This is a secondary analysis of data collected for a randomized, prospective intervention study at four Midwestern children's trauma centers...

BACKGROUND: Endoscopic mucosal resection (EMR) has emerged as an esophageal-preserving treatment for T1 esophageal adenocarcinoma (EAC); however, only patients with negligible risk of lymph node metastasis (LNM) are eligible. Reliable clinical diagnostic tools for LNM are lacking - as such, several risk assessment scores have been developed. The purpose of this study was to externally validate two previously published risk scores (Lee and Weksler) for clinical prediction of LNM in T1 EAC patients...

BACKGROUND: The American College of Surgeons (ACS) NSQIP Virginia Surgical Quality Collaborative (VSQC) exists to improve surgical outcomes through multi-institutional collaboration. Enhanced recovery (ER) protocols improve morbidity and reduce length of stay (LOS) after elective surgery. We hypothesized implementation of ER through VSQC would reduce postoperative complications and LOS in patients undergoing elective colectomy. Our objective was to evaluate whether standardization of care based on evidenced-based practices in healthcare settings across multiple institutions improved outcomes...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: The feasibility of day case surgery (DCS) appendectomy for uncomplicated acute appendicitis (UCAA) was evaluated by the prospective AppendAmbu study (NCT01839435). The aim of this study was to evaluate the real-life feasibility of DCS for UCAA. STUDY DESIGN: This single-center, retrospective, non-interventional study was conducted after the AppendAmbu study and only included UCAA. The primary endpoint was the DCS success rate (LOS less than 12 hours) in the intention-to-treat (ITT) population (all patients with UCAA) and in the per protocol (PP) population (population with UCAA and no preoperative and intraoperative exclusion criteria)...

No abstract text is available yet for this article.

BACKGROUND: Conditional recurrence-free survival (RFS) probability, that is, the probability of remaining recurrence-free after a given interval without recurrence, has not been reported after resection of colorectal liver metastases (CLMs). We aimed to estimate conditional RFS and identify factors affecting conditional RFS. STUDY DESIGN: Patients undergoing initial resection of CLMs during 2000-2016 with mutation data were identified. The RFS and risk factors for recurrence were evaluated at the time of resection for all patients and at 1 year and 2 years after resection for patients who remained recurrence-free...

BACKGROUND: Opioids are overprescribed after surgery, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgery. STUDY DESIGN: Patients undergoing six procedures were offered the opportunity to participate in an opioid-sparing pain management pathway. Patients were advised to use acetaminophen and ibuprofen, and were provided with a small "rescue" opioid prescription for breakthrough pain...

BACKGROUND: Renal graft lifespan in simultaneous liver kidney transplant (SLK) is generally thought to be shorter than in kidney transplant (KT) alone, raising questions about the utility of SLK. This study aims to estimate what would be the outcome for a kidney allocated to SLK were it instead allocated to KT. METHOD: Using United Network for Organ Sharing data, recipients of SLK from 2003-2012 were paired with the recipient who received the partner kidney from the same donor in a kidney or kidney-pancreas transplant for analysis...

BACKGROUND: Insulin-like growth factor (IGF) dysregulation and gene copy number variations (CNV) are hallmarks of adrenocortical carcinoma (ACC). The contribution of IGF CNVs in adrenal carcinogenesis has not been previously studied. Moreover, studies demonstrating an association between SLC12A7 gene amplifications and enhanced metastatic behavior in ACC, as well as reported IGF-SLC12A7 signaling interactions in other cancers, suggests a potential IGF-SLC12A7 signaling circuitry in ACC...

BACKGROUND: Stored plasma products are widely regarded as being functionally acellular, obviating the need for leukoreduction. We tested the hypothesis that donor plasma is contaminated by leukocytes and platelets, which, after frozen storage, would release cellular debris in quantities sufficient to elicit significant pro-inflammatory responses. STUDY DESIGN: Samples of never-frozen liquid plasma from 2 regional Level I trauma centers were analyzed for leukocyte and platelet contamination...

BACKGROUND: The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Understanding the wounding pattern and incidence of potentially preventable death (PPD) following CPMS is key to updating prehospital response strategy. METHODS: A retrospective study of autopsy reports following CPMS events identified via the FBI CPMS database from December 1999 to December 31, 2017 was performed. Sites of injury, fatal injury, and incidence of PPD were determined independently by a multidisciplinary panel comprised by trauma surgery, emergency medicine, critical care paramedicine, and forensic pathology...

No abstract text is available yet for this article.

No abstract text is available yet for this article.