Journal of the American College of Surgeons

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)...

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BACKGROUND: Conditional recurrence-free survival (RFS) probability, i.e., recurrence probability after a given interval without recurrence, has not been reported after resection of colorectal liver metastases (CLM). We aimed to estimate conditional RFS and identify factors affecting conditional RFS. STUDY DESIGN: Patients undergoing initial resection of CLM during 2000-2016 with mutation data were identified. 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: 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 two regional Level 1 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...

BACKGROUND: Lateral abdominal wall (LAW) myofascial defects are a challenging reconstructive problem, and no consensus exists on their surgical management. We hypothesized that mesh repairs anchored to the non-yielding LAW boundaries [pillar-anchored repairs (PARs)] would provide more durable reconstructions with lower hernia recurrence and bulge occurrence rates compared to mesh repairs anchored to the surrounding oblique muscle complexes [direct repairs (DRs)]. STUDY DESIGN: We retrospectively reviewed LAW reconstructions at a single center from 2004-2010...

BACKGROUND: Attention has been focused on the amplitude of esophageal body contraction to avoid persistent dysphagia after a Nissen fundoplication. The current recommended level is a contraction amplitude in the distal third of esophagus above the 5th percentile. We hypothesized that a more physiologic approach is to measure outflow resistance imposed by a fundoplication, which needs be overcome by the esophageal contraction amplitude. STUDY: Design: The esophageal outflow resistance, as reflected by the intra-bolus pressure (iBP) measured 5 cm above the LES, was measured in 53 normal subjects and 37 reflux patients with normal esophageal contraction amplitude before and after a standardized Nissen fundoplication...

BACKGROUND: Overall incidence of CC is decreasing, however with increasing early-onset colon cancer (EOCC <50 y.o.). Our recent study revealed unique over-expression of Cartilage Oligomeric Matrix Protein (COMP) in EOCC and its association with aggressiveness. The aim of this study was to assess CC biology, especially in the young, by evaluating the role of COMP in CC carcinogenesis and cancer progression, detecting COMP in serum and its association with disease stage. STUDY DESIGN: Cancer and matching non-involved tissue blocks from 12 sporadic EOCC and LOCC patients of four disease stages were obtained from pathology archives...

BACKGROUND: Glucagon-like peptide-1 (GLP-1) is a gut derived incretin hormone that stimulates insulin secretion, cellular glucose uptake and has immune-regulatory functions. GLP-1 is markedly altered following trauma and sepsis, but the implications remain unclear. STUDY DESIGN: We performed an analysis of a prospective, longitudinal cohort study of critically-ill surgical patients with sepsis. Patient characteristics, and clinical data were collected, as well as peripheral blood sampling for biomarker analysis, out to 28 days after sepsis onset...

BACKGROUND: Recent attention has been paid to the role trauma centers play in responding to mass shootings. Although high-profile public events are the primary focus of media and policy makers, firearm-injured patients (FIPs) present in clusters to urban trauma centers every day. We examined the burden of FIP clusters from an urban trauma system perspective. STUDY DESIGN: In this descriptive epidemiologic study, we used data from the Philadelphia Police Department registry of shootings from 2005-2015...

BACKGROUND: Acute and chronic sleep deprivation are significantly associated with depressive symptoms and felt to be contributors to the development of burnout. In-house call (IHC) inherently includes frequent periods of disrupted sleep and is common amongst acute care surgeons (ACS). The relationship between IHC and sleep deprivation (SD) amongst ACS has not been previously studied. The goal of this study was to determine prevalence and patterns of SD in ACS. STUDY: Design: A prospective study of ACS with IHC responsibilities from two Level I trauma centers was performed...

BACKGROUND: Previous studies have evaluated dose/weight ratios in order to define best practices for obtaining therapeutic anti-Xa assays for enoxaparin venous thromboembolism (VTE) prophylaxis. These studies have not examined relationships between dosing, patient characteristics, and therapeutic assays. This study examines factors associated with therapeutic assays and enoxaparin prophylaxis. STUDY DESIGN: This is a retrospective review of patients admitted to a Level 1 Trauma Center between March 2016 and June 2018...

INTRODUCTION: Patient engagement is an increasingly important component of surgical decision- making. Given the many factors associated with successful ventral hernia repair (VHR), we developed and validated the Outcomes Reporting App for CLinical and Patient Engagement (ORACLE) tool to help facilitate preoperative surgeon-patient discussions regarding VHR. METHODS: All patients undergoing elective, VHR with 30-day follow-up data available within the Americas Hernia Society Quality Collaborative (AHSQC) were eligible for study inclusion...

BACKGROUND: Elevated D-Dimers in injured patients with paradoxically low fibrinolysis activity measured by viscoelastic assays has been speculated to be "occult" fibrinolysis. However, an alternative explanation is these patients have previously activated their fibrinolytic system and have shut it down by the time of blood draw, and would gain no benefit in clot strength with tranexamic acid (TXA). We hypothesize that TXA will not increase clot strength in injured patients with low fibrinolytic activity measured by thrombelastography (TEG) despite biomarkers of fibrinolysis activation...

BACKGROUND: The majority of newly diagnosed breast cancers in the US are in women aged older than 65 years who can have additional comorbidities. Balancing the risks and benefits of treatment should take into account these competing risks of death. STUDY DESIGN: The Surveillance, Epidemiology, and End Results Program-Medicare database was used to identify women with stage I breast cancer undergoing operations from 2004-2012. Using neural network analysis, comorbidities associated with mortality were grouped into clinically relevant categories...

BACKGROUND: Patients with primary aldosteronism undergo imaging of the adrenal glands after confirmation of the disease. Adrenal venous sampling (AVS) is a useful adjunct to imaging, and advocates believe that AVS should be performed prior to surgical management. Others argue that patients with unilateral lesions on imaging do not require AVS. Although AVS accuracy has been established, few studies have evaluated how AVS alters management. Our study aimed to determine how AVS affected management of these patients...

BACKGROUND: Firearm-related injuries are the second leading cause of pediatric death in the U.S. We sought to evaluate the effectiveness of both state child access prevention (CAP) laws and gun regulations on pediatric firearm mortality. We hypothesized that states with more stringent firearm legislation had lower pediatric firearm mortality. STUDY DESIGN: We used 2014-2015 firearm mortality data from the Web-Based Injury Statistics Query and Reporting System, 2014 Brady scores (used to quantify stringency of state gun regulations) and CAP laws...

BACKGROUND: We compared the rates of stroke, death and/or myocardial infarction (MI) between men and women, stratified by symptomatic status and procedure type (carotid endarterectomy (CEA) or carotid artery stent (CAS)). STUDY DESIGN: Using the Nationwide Inpatient Sample (NIS), crude and propensity-matched rates of the composite outcome of stroke/death/MI were estimated. Multivariable logistic regression was utilized to calculate the odds of stroke/death/MI associated with gender...