Journal of the American College of Surgeons

BACKGROUND: The 'Safety Culture' within hospital systems is increasingly recognized important to delivery of high-quality care. We examine the safety culture in a statewide hospital quality improvement collaborative and its associations with surgical outcomes. STUDY DESIGN: A modified Safety Attitudes Questionnaire (SAQ) was sent to administrators, quality improvement teams, nurses, anesthesiologists, and surgeons in 49 hospitals participating in the Illinois Surgical Quality Improvement Collaborative (ISQIC) in 2015...

BACKGROUND: The extent of lymph node dissection for patients with gastroesophageal carcinoma (GEC) remains controversial. We sought to examine the perioperative risk and survival outcomes in a large Western series of patients undergoing limited (D0/D1) vs extended (D1+/D2) lymphadenectomy (LAD) for GEC. STUDY DESIGN: Clinicopathologic and treatment factors for 520 patients with GEC undergoing potentially curative resection at a single institution from 1995 - 2017 were analyzed for their impact on perioperative morbidity and mortality, lymph node (LN) yield, and overall survival...

BACKGROUND: It is assumed axillary ultrasound (AxUS) is the best method for axillary nodal evaluation in newly diagnosed breast cancer patients. However, few have evaluated the efficacy of preoperative axillary MRI. Herein, we compare the statistical accuracy of AxUS and MRI in detecting nodal metastases among breast cancer patients who were selected for neoadjuvant chemotherapy. STUDY DESIGN: We retrospectively analyzed 219 breast cancer patients undergoing neoadjuvant chemotherapy from 2007-2015 all of whom had AxUS and breast MRI prior to-chemotherapy...

No abstract text is available yet for this article.

BACKGROUND: Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most effective therapies for obesity and may have beneficial effects on the immune system. Therefore, we compared RYGB versus SG outcomes in the patients with IBD. STUDY DESIGN: In this retrospective cohort study, we identified 54 patients with either Crohn's Disease (CD; n=31) or Ulcerative Colitis (UC; n=23) diagnosed before bariatric surgery between 2000-2017. 19 patients underwent RYGB and 35 patients underwent SG...

BACKGROUND: There is a substantial learning curve associated with minimally invasive pancreaticoduodenectomy (MIPD). We sought to determine if national MIPD pancreatic fistula rates are decreasing with time. METHODS: All patients undergoing elective MIPD and accrued into the pancreatectomy targeted NSQIP database between 2014-2017 were included in the study. Trends in MIPD outcomes by year were examined using Cochran-Armitage and Mann-Kendall tests for trend. Multivariable logistic regression was used to assess for an independent association between increasing year of operation and pancreatic fistula...

BACKGROUND: Opioids are the mainstay of pain management in critically ill trauma patients. However, the risks of opioid use mandate a different approach. Multimodal analgesia employs a combination of opioid and non-opioid agents utilizing different mechanisms that have synergistic effects in treating pain. This study examines the effects of multimodal analgesia on the opioid requirements of critically ill trauma patients. STUDY DESIGN: This was a pre-post cohort study of adult trauma intensive care unit patients before and after the implementation of a multimodal pain management order set...

BACKGROUND: Current standard-of-care technologies such as imaging and cyst fluid analysis are unable to consistently distinguish intraductal papillary mucinous neoplasms of the pancreas (IPMN) at high-risk of pancreatic cancer from low-risk IPMN. The objective was to create a single-platform assay to identify IPMN that are at high-risk for malignant progression. STUDY DESIGN: Building on the Verona International Consensus Conference BD-IPMN biomarker study, specific protein, cytokine, mucin, DNA, and miRNA cyst fluid targets were identified for creation of a q-PCR based assay as we have previously published...

No abstract text is available yet for this article.

BACKGROUND: Two operations are performed for management of secondary hyperparathyroidism, subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX- AT). There is no consensus among endocrine surgeons regarding which operation is the preferred treatment. This study compares the short and long term outcomes of SPTX and TPTX-AT for dialysis patients with secondary hyperparathyroidism. STUDY DESIGN: This is a retrospective review of 46 dialysis patients undergoing parathyroidectomy from 2006- 2017 at a 719 bed tertiary care hospital...

BACKGROUND: Hernia mesh removal is growing in demand. Meanwhile, there is no standard in handling the mesh specimen, nor is there any consensus on the clinical value of the surgical pathology findings. STUDY DESIGN: All hernia mesh specimens gathered from 2013-2018 were analyzed. Patients were categorized based on indication for mesh removal. "Mesh reaction" group included those with clinical reaction deemed to be related to the mesh material. "Mesh non-reaction" group included patients who had mesh removed for a clinical indication unrelated to the mesh material...

BACKGROUND: The rising incidence of ductal carcinoma in situ (DCIS) since the widespread enactment of mammography screening has been well documented. Patterns in DCIS incidence among women of various ages and across different racial/ethnic groups have not been well described. STUDY DESIGN: The Surveillance, Epidemiology, and End Results public-use dataset was queried for all women aged >40 years and diagnosed with DCIS between 1990 and 2014. Annual age-adjusted incidence rates were compared among white, black, Hispanic, and Asian-Pacific Islander (API) women...

BACKGROUND: Venous thromboembolism (VTE) events are tracked in trauma registries and by administrative datasets. Both databases are used to assess outcomes despite having varying processes for data capture. STUDY DESIGN: This study was performed at an urban, university-based, level-one trauma center from 2004-2014. Retrospective review of the trauma registry and the hospital's administrative database was performed querying for all VTEs. Each VTE was then validated through manual chart review...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Misidentifying parathyroid glands (PGs) during thyroidectomies or parathyroidectomies, could significantly increase post-operative morbidity. Imaging systems based on near-infrared autofluorescence (NIRAF) detection can localize PGs with high accuracy. These devices however depict NIRAF images on remote display monitors, where images lack spatial context and comparability with actual surgical field-of-view (FOV). In this study, we designed an Overlay Tissue Imaging System (OTIS) that detects tissue NIRAF and back-projects the collected signal as a visible image directly onto the surgical FOV instead of a display monitor, and tested its ability for enhancing parathyroid visualization...

BACKGROUND: Frailty in the surgical patient has been associated with increased morbidity, mortality, and failure-to-rescue. However, there is little understanding of the economic impact of frailty. STUDY DESIGN: A prospective database of elective surgery patients at an academic medical center was utilized to create a modified version of the Risk Analysis Index, a validated frailty index. This included 10,257 patients undergoing elective surgery from 2016-2017. Patients were classified as not frail (RAI = 0), somewhat frail (RAI = 1-10), or significantly frail (RAI > 10)...

BACKGROUND: Adjuvant immunotherapy has improved outcomes in patients with advanced melanoma; however, the potential benefit for patients with pancreatic ductal adenocarcinoma (PDAC) remains unknown. The aim of this study is to determine the impact of adjuvant chemotherapy and immunotherapy (CTx-IT) compared to CTx alone on patient survival following resection of PDAC. STUDY DESIGN: Patients who underwent resection of PDAC from 2004 to 2015 were identified from the National Cancer Database (NCDB)...

BACKGROUND: In 2017, our hospital was identified as a "High Outlier" for postoperative Clostridium difficile infections (CDI) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated an CDI Task Force with representation from Surgery, Infectious Disease, Pharmacy, and Performance Services to analyze available data, identify opportunities for improvement, and implement strategies to reduce CDI. STUDY DESIGN: Strategies to reduce CDI were reviewed from the literature and multi-disciplinary strategies were initiated...

BACKGROUND: Emergency General Surgery (EGS) encompasses high risk patients undergoing high risk procedures. Admission source, particularly interhospital transfer, is rarely accounted for in clinical performance benchmarking. Our goal was to assess the impact of transfer status on outcomes following EGS. STUDY DESIGN: This was a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database (2005-2014)...