Journal of the American College of Surgeons

Breast Magnetic Resonance Imaging (MRI) is a well-established, valuable adjunct to screening mammography in women that have documented high-risk for developing breast cancer; it is also used to evaluate implants for silicone rupture and as part of the baseline work-up for patients presenting with axillary metastatic disease but a mammographically/sonographically occult primary breast cancer. The role of breast MRI in the preoperative evaluation of other women with an established breast cancer diagnosis is controversial...

BACKGROUND: Significant analysis errors can be cause by non-validated data quality of electronic medical records (EHR) data. In order to determine surgical data fitness, a framework of foundational and study-specific data analyses was adapted and assessed using conformance, completeness, and plausibility analyses. STUDY DESIGN: EHR derived data from a cohort of 241,695 patients undergoing 412,182 procedures from October 1, 2014 to August 31, 2018 across three hospital sites was evaluated...

BACKGROUND: An impending surgeon shortage looms in the United States (US) due to increasing demand and stagnant number of surgeons entering practice. We sought to evaluate the state of our surgical workforce by exploring current practice patterns, job satisfaction, and reasons why surgeons consider leaving surgery. STUDY DESIGN: In 2018, a link to a detailed survey was distributed by email to Fellows of the American College of Surgeons (ACS) who actively practice in the US and have completed a general surgery residency or integrated cardiothoracic, vascular, or plastic surgery fellowship...

No abstract text is available yet for this article.

BACKGROUND: Online portals have been shown to be a valuable tool for patients to improve compliance with medical treatments in numerous studies across medical specialties. Our aim was to study the effects of the use of web- based applications that allow patients to track their appointments, labs, and provider visit notes on achievement of renal transplantation. STUDY DESIGN: This is a retrospective chart review of patients in two outpatient dialysis centers associated with a 719 bed tertiary care academic medical center...

BACKGROUND: Studies among populations at high risk of venous thromboembolism (VTE) have demonstrated that recommended doses for enoxaparin thromboprophylaxis are associated with high incidence of subprophylactic anti-Factor Xa (anti-Xa) levels. This study examines the efficacy and safety of dose adjusted enoxaparin guided by anti-Xa levels. STUDY DESIGN: Patients undergoing abdominal cancer surgery had dose adjustments based on peak anti-Xa levels to attain a target of >0...

BACKGROUND: Hypertonic saline (23.4%, HTS) bolus administration is common practice for refractory intracranial hypertension, but its effects on coagulation are unknown. We hypothesize that 23.4% HTS in whole blood results in progressive impairment of coagulation in vitro and in vivo in a murine model of traumatic brain injury (TBI). STUDY DESIGN: For the in vitro study, whole blood was collected from 10 healthy volunteers, and citrated native thrombelastography (TEG) was performed with normal saline (0...

BACKGROUND: Inefficient operating room (OR) utilization wastes resources. Studies have suggested "first case on-time starts" (FCOTS) reduce OR "idle time," yet no direct association between FCOTS and markers of OR efficiency like "last case on-time end" (LCOTE) or overtime costs have been reported. We performed this study to evaluate factors associated with FCOTS, LCOTE, and OR overtime costs. STUDY DESIGN: In April 2017, our medical center launched an FCOTS improvement initiative...

BACKGROUND: Venous thromboembolism (VTE) prophylaxis has become routine for patients undergoing most operations, but it remains controversial for breast operations due to perceived low risk of VTE. There is limited evidence to support routine or extended VTE prophylaxis in breast surgery. We investigated the benefits and risks of the Caprini risk stratification tool and corresponding prevention program, including extended prophylaxis for high-risk groups, in patients undergoing operations for benign and malignant breast lesions...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

INTRODUCTION: The average medical school debt in 2011 was $170,000 and by 2017 it increased to $190,000. High debt burden has been shown to affect career choices for residents in primary care specialties; however, it has not been well studied among surgical residents. The purpose of this multi-institutional study is to assess the amount of debt among general surgery residents and its effects on their career and lifestyle decisions. METHODS: Surveys were distributed to 607 categorical general surgery residents at 19 different residency programs...

BACKGROUND: Sacral chordomas are rare malignant bone tumors and are often very large for complete resection. Particle therapy for these tumors, which are adjacent to the gastrointestinal tract, is restricted because the tolerance dose of the intestine is low. This study aimed to demonstrate the technical aspects and treatment results of space-making particle therapy with surgical spacer placement for sacral chordoma. We aimed to investigate the dosimetric change in the particle therapy before and after spacer placement and the safety, efficacy, and long-term outcomes of space-making particle therapy...

BACKGROUND: Although physician health promotes retention to the profession and encourages higher quality patient care, residents may face challenges seeking routine medical care. Erratic working hours, time constraints, easy access to informal health consultation, and a culture of self-reliance may deter help-seeking behavior. Despite national focus on physician burnout and efforts to promote wellness, little is known about the self-care habits of residents. The goal of this study was to evaluate the routine healthcare practices of resident physicians...

BACKGROUND: Surgeons are prone to feelings of sadness, guilt, and anxiety when involved in major adverse events. We aimed to create and evaluate a second victim peer support program for surgeons and surgical trainees. STUDY DESIGN: The second victim peer-support program was an intervention performed in the Department of Surgery at a tertiary care academic medical center. Surgical attendings and trainees participated as peer supporters or affected peers. In this work, we describe the design of the program and its one-year impact...

BACKGROUND: Prehabilitation has been shown to improve postoperative outcomes in a variety of patient populations undergoing major surgery. The feasibility, generalizability, and value of broad implementation of prehabilitation outside the research environment is unknown. METHODS: Medicare claims data from 2014-2017 were used to conduct a multi-center (21 Michigan hospitals), pragmatic cohort study. Cases and controls were followed for the duration of their index surgical hospitalization and for 90 days postoperatively...

No abstract text is available yet for this article.

OBJECTIVE: Despite the presence of highly reliable data, studies on pRBC:FFP ratio suffer from limited sample size and the presence of survivor bias. We sought to study the association between FFP:pRBC and early mortality in the hemorrhaging trauma patient. DESIGN: Retrospective nationwide cohort. SETTING: All TQIP participating hospitals (2013-2016). PATIENTS: We included all trauma patients who were transfused ≥10 pRBCs and ≥1 FFP within 24 hours...

No abstract text is available yet for this article.

No abstract text is available yet for this article.