Journal of the American College of Surgeons

BACKGROUND: The majority of liver transplants (LT) in North America are performed by transplant surgery fellows with attending surgeon supervision. While a strict case volume requirement is mandatory for graduating fellows, no guidelines exist on providing constructive feedback to trainees during fellowship. STUDY DESIGN: A retrospective review of all adult LTs performed by abdominal transplant surgery fellows at a single ASTS-accredited academic institution from 2005-2019 was conducted...

BACKGROUND: Surgical complications have tremendous consequences and costs. Complication detection is important for quality improvement, but traditional manual chart review is burdensome. Automated mechanisms are needed to make this more efficient. To understand the generalizability of a machine learning algorithm between sites, automated surgical site infection (SSI) detection algorithms developed at one center were tested at another distinct center. METHODS: National Surgical Quality Improvement Program (NSQIP) patients had electronic health record (EHR) data extracted at one center (University of Minnesota Medical Center, Site A) over a 4-year period for model development and internal validation and a second center (University of California San Francisco, Site B) over a subsequent 2-year period for external validation...

BACKGROUND: We investigated whether preoperative clinical parameters predict diabetes remission and relapse after conventional gastrectomy for cancer and whether postoperative weight changes influence diabetes remission and relapse. STUDY DESIGN: This study included 5,150 patients with diabetes who underwent gastrectomy for cancer during 2004‒2014. Diabetes remission was defined in three ways according to postoperative antidiabetic medication and fasting plasma glucose (FPG) levels...

BACKGROUND: Surgeon experience, hospital volume and teaching hospital status may play a role in success of digit replantation. This study aims to analyse factors that influence digit replantation success rates. METHODS: We examined patients with traumatic digit amputations between 2000 and 2015 from the National Health Insurance Research Database (NHIRD) of Taiwan that comprises data of over 99% of its population. We measured the number of traumatic digit amputations and success rate of replantation...

INTRODUCTION: Arterial injuries occur in the setting of blunt and penetrating trauma. Despite increasing use, there remains paucity of data comparing long term outcomes of endovascular vs open repair management of these injuries. The aim of our study is to compare outcomes and readmission rates of open vs endovascular repair of traumatic arterial injuries. METHODS: The National Readmission Database (2011-2014) was queried for all adult (age ≥18y) patients presenting with peripheral arterial (axillary, brachial, femoral, and popliteal) injuries...

Over 20 million inguinal hernia repairs are performed worldwide annually.1 Robot-assisted repair has seen significant growth in the U.S. due to perceived benefits of its magnified three-dimensional visualization and superior range of motion in carrying out fine dissection,2 however clinical and cost benefits have yet to be established. In this study, we perform a systematic review of robot-assisted inguinal hernia repair compared with the laparoscopic and open approaches to evaluate intraoperative and short-term outcomes, including pain and hernia recurrence, as well as cost...

No abstract text is available yet for this article.

INTRODUCTION: The hernia sac to abdominal cavity volume ratio (VR) on abdominal computed tomography (CT) was previously described as a way to predict which hernias would be less likely to achieve fascial closure. The aim of this study was to test the reliability of the previously described cutoff ratio in predicting fascial closure in a cohort of patients with large ventral hernias. METHODS: Patients who underwent elective, open incisional hernia repair of 18 cm or larger width at a single center were identified...

INTRODUCTION: R0 resection for pancreatic cancer is considered standard of care, but not always achieved. This study looks at R1/R2 resection outcomes compared to chemotherapy alone. Our hypothesis is that patients with margin positive disease have better outcomes than chemotherapy alone. METHODS: Stage II pancreatic cancers that underwent R1/R2 surgery with/without neoadjuvant chemotherapy from NCDB 2010-2017 were identified and compared to similar staged patients who received chemotherapy alone...

BACKGROUND: The US News & World Report (USNWR) annual ranking of the best hospitals for gastroenterology and gastrointestinal surgery offers direction to patients and healthcare providers, especially for recommendations on complex medical and surgical gastrointestinal (GI) conditions. The objective of this study was to examine the outcomes of complex GI cancer resections performed at USNWR top-ranked, compared to non-ranked, hospitals. STUDY DESIGN: Using the Vizient database, data for patients who underwent esophagectomy, gastrectomy, and pancreatectomy for malignancy between January and December 2018 were reviewed...

BACKGROUND: The use of mesh in hernia repair has faced intense scrutiny, leading patients to become fearful of its use despite its benefits in reducing hernia recurrence. We report a single institutional experience in performing hernia repair with mesh in terms of hernia-specific outcomes, mesh-related complications and patient-reported quality of life. STUDY DESIGN: Patients who underwent abdominal wall hernia repair with mesh at a single institution were identified from a prospectively maintained quality database...

No abstract text is available yet for this article.

BACKGROUND: A growing body of evidence supports the efficacy of surgical treatments for lymphedema. This study reports the outcomes of vascularized lymph node transplantation (VLNT) for the treatment of patients with lymphedema compared with maximal conservative treatment alone. STUDY DESIGN: Consecutive patients undergoing VLNT to treat primary and secondary lymphedema affecting the upper or lower extremities were included. All patients were optimized preoperatively with conservative therapy...

BACKGROUND: Malignant adnexal cutaneous tumors (MACT) are rare and their natural history is poorly understood. Available literature indicates aggressive behavior with a significant risk of metastasis. STUDY DESIGN: Retrospective review of our institutional surgical oncology databases was performed for patients diagnosed with MACT (2001-2020). We hypothesized most patients have a low risk of lymph node involvement, recurrence, and death. Kaplan-Meier statistical analysis was used to assess risk of recurrence and 5-year survival...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The COVID-19 pandemic has introduced a global public health threat unparalleled in our history. The most severe cases are marked by the acute respiratory distress syndrome attributed to microvascular thrombosis. Hypercoagulability, resulting in a profoundly prothrombotic state, is a distinct feature of COVID-19 and is accentuated by a high incidence of fibrinolysis shutdown. The aims of this review are to describe the manifestations of fibrinolysis shutdown in COVID-19 and its associated outcomes, review the molecular mechanisms of dysregulated fibrinolysis associated with COVID-19, and discuss potential implications and therapeutic targets for patients with severe COVID-19...

BACKGROUND: As the incidence of adrenalectomy steadily increases, so do the utilization of minimally invasive approaches like the Posterior Retroperitoneoscopic Adrenalectomy (PRA). To date, the largest studies of PRA have been from abroad, and we sought to provide a contemporary American update on the outcomes following PRA. METHODS: A retrospective chart review was conducted on all PRAs performed at a single tertiary care institution between 2013 and 2020. Patient demographics, indication for surgery, operative details, and postoperative course were abstracted...