Journal of the American College of Surgeons

BACKGROUND: Beta-blockade administration after lung contusion, hemorrhagic shock, and chronic stress has been shown to improve bone marrow function, decrease hypercatecholaminemia, and reduce inflammation. MicroRNAs (miR) are critical biologic regulators that can downregulate gene expression by causing messenger RNA degradation or inhibition of translation. This study sought to expand our understanding of the molecular mechanisms underlying the reduced inflammatory response after the administration of beta-blockade (BB) in our rodent trauma model...

BACKGROUND: Thyroid lobectomy (TL) has been proposed as definitive surgical treatment for papillary thyroid cancers (PTC) up to 4 cm. This study evaluates the use and appropriateness of TL for T1b and T2 PTC. STUDY DESIGN: The National Cancer Database was interrogated for adult patients having TL for T1b-T2 PTC between 2004-2014. Patients who should have undergone total thyroidectomy (TT) instead of lobectomy based on high-risk tumor features were identified. The two groups were compared for clinical and demographic characteristics, and overall survival...

BACKGROUND: Comprehensive and multidisciplinary care are critical in rectal cancer treatment. We sought to determine if completeness of preoperative care was associated with pathologic specimen quality and postoperative morbidity. STUDY DESIGN: Clinical stage I-III rectal adenocarcinoma patients who underwent elective low anterior resection or abdominoperineal resection were identified from the 2016-2017 American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database...

BACKGROUND: Supermicrosurgical lymphaticovenous anastomosis (LVA) alleviates lymphedema by draining stagnant lymph from the lymphatic vessels into the venous system. Nevertheless, LVA is believed to be unsuitable for treating moderate-to-severe lymphedema presenting diffuse-pattern dermal backflow (DB). DB is considered to be the sign of superficial lymphatic functional failure that renders LVA ineffective. Based on a current algorithm, a more invasive vascularized lymph node flap transfer is recommended instead of LVA...

OBJECTIVE: Transcarotid artery revascularization (TCAR) with flow reversal was recently introduced as a novel technique for carotid artery stenting (CAS). We examined the learning curve of surgeons adopting TCAR based on data from the Vascular Quality Initiative (VQI-TCAR Surveillance Project; TSP). METHODS: We identified all patients in the TSP who underwent TCAR from September 2016 to December 2018. Cases were numbered in chronological order for each unique surgeon...

INTRODUCTION: It is unknown if replacing clinic follow-up visits with telephone follow-up for low-risk core emergency general surgery (cEGS) procedures is safe. We measured the efficacy of telephone follow-up to determine if it could safely reduce the need for routine postoperative clinic visits in this population. METHODS: Low-risk non-elective laparoscopic appendectomy, laparoscopic cholecystectomy, umbilical hernia, and inguinal hernia repair patients received telephone follow-up for symptoms concerning for surgical complication within ten days of discharge...

BACKGROUND: Direct-to-consumer BRCA testing will increase BRCA diagnoses and subsequent abdominal imaging. It is unclear whether BRCA-carriers are at higher risk of developing pancreatic cysts (PCs) or cyst-associated pancreatic adenocarcinoma (PDAC). We investigate the prevalence of PCs in BRCA-tested patients, and whether BRCA-carriers have higher rates of PDAC when PCs are found. STUDY DESIGN: This is a retrospective cross-sectional study of patients with BRCA testing and abdominal imaging between 1996-2018...

BACKGROUND: With inpatient length of stay decreasing, discharge destination following surgery can serve as an important metric for quality of care. Additionally, patients desire information on possible discharge destination. Adequate planning requires a multidisciplinary approach, can reduce health care costs and ensure patient needs are met. The Surgical Risk Preoperative Assessment System (SURPAS) is a parsimonious risk assessment tool using eight predictor variables developed from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset...

BACKGROUND: Although enhanced recovery pathways (ERPs) have demonstrated promising results in published literature, their effectiveness has been inconsistent. The objective of this study was to identify the most important data use practices associated with successful implementation of ERPs. STUDY DESIGN: As part of a national ERP implementation initiative, data regarding hospital's prior ERP implementation experience were collected. Specifically, four data use practices (data collection, report generation, feedback to leadership, and feedback to frontline providers) and two data types (process measures and outcome measures) were correlated with ERP implementation outcomes (hospital-reported success and patient outcomes from ACS NSQIP data)...

BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) fails to diagnose up to 25% of patients with pancreatic ductal adenocarcinoma (PDAC). Proteomics may help to overcome this clinical dilemma. We hypothesized that soluble protein signatures can differentiate PDAC from benign tissues. STUDY DESIGN: Tissues were obtained from resected surgical specimens, lysed, and homogenates collected for analysis with a 41-protein multiplex assay. Analyte concentrations were normalized to total protein...

BACKGROUND: The ACS NSQIP Surgical Risk Calculator (SRC) plays an important role in risk prediction and decision-making. We sought to 1) enhance the existing ACS NSQIP SRC with functionality to predict geriatric-specific outcomes and 2) assess the predictive value of geriatric-specific risk factors by comparing performance in outcome prediction using the traditional ACS NSQIP SRC versus models that also included geriatric risk factors. STUDY DESIGN: Data were collected from 21 ACS NSQIP Geriatric Surgery Pilot Project (GSPP) hospitals between 2014-2017...

BACKGROUND: Propensity score (PS) analysis is a statistical method commonly used in observational trials to account for confounding. Improper use of PS analysis can bias the effect estimate. The aim of this study is to review the use and reporting of PS methods in high-impact surgical journals with a focus on propensity score matching (PSM). STUDY DESIGN: The 10 surgical journals with the highest impact factor were searched to identify studies utilizing PS analysis from January 1st, 2016 to December 14th, 2018...

No abstract text is available yet for this article.

BACKGROUND: FD occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. While prophylactic mesh may prevent FD, its use in emergency surgery remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among high-risk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy...

INTRODUCTION: An optimal method to quantify surgical complexity using patient comorbidities derived from administrative billing data is lacking. We sought to develop a novel, easy-to-use surgical complexity score to accurately predict adverse outcomes among patients undergoing elective surgery. METHODS: A novel surgical Complexity Score was developed using 100% Medicare Inpatient and Outpatient Standard Analytic Files (SAFs) from years 2012-2016 (n=1,049,160). Comorbid conditions were entered into a machine learning algorithm to assign weights to maximize the correlation with multiple postoperative outcomes including morbidity, readmission, mortality, and postoperative super-utilization...

No abstract text is available yet for this article.

BACKGROUND: The complexity of retroperitoneal soft tissue sarcoma (RPS) surgery has prompted international recommendations to regionalize it to high-volume hospitals (HVH's). A minimum procedural volume threshold for RPS is not yet defined, hampering effective referral and regionalization in the US. This multi-hospital study sought to establish a HVH threshold informed by national data and international expert opinion. STUDY DESIGN: The 2004-2015 National Cancer Database identified 8,721 surgically treated RPS patients...

(275/275 words) BACKGROUND: Vertical integration is increasingly common among surgical specialties in the U.S., however, the effect of vertical integration on access to care for low-income populations remains poorly understood. We explore the characteristics of surgical practices associated with vertical integration and the effect of integration on surgical access for Medicaid populations. STUDY DESIGN: Using a survey of U.S. office-based physician practices, we examined characteristics of 15 surgical subspecialties from 2007 to 2017, including provider gender and specialty, practice payer mix, surgical volume and county socioeconomic status...

BACKGROUND: Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients. STUDY DESIGN: We performed a retrospective review of trauma patients from 2014 through 2018, excluding patients <16 years of age, ISS <16, and with incomplete height and/or weight documentation. MetS was defined as the presence of diabetes, hypertension, and a BMI ≥30 kg/m2 ...

BACKGROUND: Defining factors associated with remission and relapse of type 2 diabetes (T2D) after gastric bypass (RYGB) may allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. STUDY DESIGN: Retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medications discontinuation and/or HbA1c<6.5%; relapse was defined as recurrent medication use and/or HbA1c≥6...