Journal of the American College of Surgeons

BACKGROUND: The impact of cirrhosis on outcomes of acute colonic diverticulitis (ACD) has been studied infrequently. We investigated the effect of cirrhosis on outcomes of surgical patients with ACD treated either by an open or laparoscopic approach. MATERIALS AND METHODS: A cross-sectional study was performed using the Nationwide Inpatient Sample (NIS) 2012-2014. Patients with ACD were stratified into Cirrhotics [compensated (CC) and decompensated (DC)] for comparisons of demographics, hospital length of stay (HLOS), complications, mortality, and cost...

Many women around the world and throughout history have made tremendous sacrifices to provide surgical care to patients and further advance the field of surgery. In the process, many have become recognized surgeons, leaders, and mentors and continue to make tremendous contributions to the advancement of surgery. Queen Shubad of Ur (circa 3500 BC) may be the first documented female surgeon in history, as she was found buried with bronze and flint surgical instruments. Through the majority of recorded history, women were barred outright from practicing medicine or surgery...

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BACKGROUND: Recurrence after hiatal hernia repair is common. The causes are uncertain. Our observation is the site of recurrence is primarily the non-sutured or non-reinforced anterior-left lateral portion of the hiatus. Our aim was to assess the distribution of hiatal hernia recurrence location as a basis for developing a theory of recurrence. METHODS: Consecutive patients who underwent repair of recurrent hiatal hernias from 3/2012 to 12/2019 were reviewed. Data gleaned included age, sex, date of operation, location of hiatal hernia recurrence, operative approach, method of hiatal hernia repair, fundoplication performed, need for gastrectomy, and additional procedures...

BACKGROUND: Enhanced recovery after surgery (ERAS) programs are being used increasingly in microvascular breast reconstruction. However, it is unclear as to what extent the benefits outweigh the costs. We hypothesized that an ERAS pathway for microvascular breast reconstruction would be cost-effective relative to the standard of care. STUDY DESIGN: A decision-analytic model was made incorporating clinically relevant health states after microvascular breast reconstruction with ERAS vs standard of care...

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BACKGROUND: Prior work has demonstrated the impact of gender on the relationship between confidence and competence, with women having less confidence and less self-perceived competence. Recent recruitment of examiners by the American Board of Surgery (ABS) allowed exploration of confidence and perceived competence. METHODS: 23,869 eligible board-certified surgeons (4,382 women) were solicited via email to serve as examiners for the ABS General Surgery Certifying Examination (GCE)...

BACKGROUND: The common use of laparoscopic interventions produces impressive amounts of video data that are difficult to review for surgeons wishing to evaluate and improve their skills. Therefore, a need exists for the development of computer-based analysis of laparoscopic videos to accelerate surgical training and assessment. We developed a surgical instrument detection system for video recordings of laparoscopic gastrectomy procedures. This system, whose use may increase the efficiency of the video reviewing process, is based on the open source neural network platform, YOLOv3...

BACKGROUND: The ACGME requires diversity in residency. The self-identified race/ethnicity of general surgery applicants, residents, and core teaching faculty were assessed to evaluate underrepresented minority (URM) representation in surgery residency programs and to determine the impact of URM faculty and resident on URM applicants' selection for interview or match. STUDY DESIGN: Data from the 2018 application cycle was collated for 10 general surgery programs...

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BACKGROUND: Circumferential resection margin (CRM) status is an important predictor of outcomes following rectal cancer surgery and influenced not only by operative technique, but also by incorporation of a multi-disciplinary treatment strategy. This study sought to develop a risk-adjusted quality metric, based on CRM status to assess hospital-level performance for rectal cancer surgery. STUDY DESIGN: Retrospective observational cohort study of 58,374 patients with resected stage I-III rectal within 1,303 hospitals were identified from the National Cancer Database (2010-2015)...