Journal of the American College of Surgeons

BACKGROUND: Trauma is the leading cause of death and disability for individuals under age 55. Many severely injured trauma patients experience complicated clinical courses despite appropriate initial therapy. We sought to identify novel circulating metabolomic signatures associated with clinical outcomes following trauma. STUDY DESIGN: Untargeted metabolomics and circulating plasma immune mediator analysis was performed on plasma collected during three post-injury time periods (<6h, 6h-24h, D2-D5) in critically ill trauma patients enrolled between April 2004 and May 2013 at UPMC Presbyterian Hospital in Pittsburgh, PA...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Previous studies have demonstrated disparities in transplantation for women, non-Caucasians, the uninsured or publicly insured, and rural populations. We sought to correlate transplant center characteristics with patient access to the waiting list and liver transplantation. HYPOTHESIS: Liver transplant centers vary greatly in providing equitable access to the waiting list and liver transplantation. STUDY DESIGN: Center-specific adult deceased donor liver transplant and waitlist data for the years 2013 to 2018 were obtained from the Scientific Registry of Transplant Recipients...

BACKGROUND: Imbalance of oxidants/antioxidants results in heart failure, contributing to mortality after burn injury. Cardiac mitochondria are a prime source of ROS, and a mitochondrial-specific antioxidant may improve burn-induced cardiomyopathy. We hypothesize that the mitochondrial-specific antioxidant, Mito-TEMPO, could protect cardiac function after burn. STUDY DESIGN: Male rats had a 60% TBSA scald burn injury and were treated with/without Mito-TEMPO (7 mg·kg-1, ip) and harvested at 24 hours post burn...

BACKGROUND: Papillary thyroid carcinoma (PTC) comprises the majority of thyroid malignancy, but it is associated with excellent long-term survival. Highly prevalent with increasing incidence, the optimal surgical management for patients with 1 to 4 cm PTC remains unclear. This study determines factors that affect clinical outcomes, including survival, in this patient population. STUDY DESIGN: Patients with 1 to 4 cm PTC who underwent thyroidectomy between 2004-2016 were identified in the National Cancer Database (NCDB)...

No abstract text is available yet for this article.

BACKGROUND: The performance and durability of various types of fundoplication is variable when stratified by disease severity. To date, magnetic sphincter augmentation (MSA) has not been evaluated in this context. We designed the current study to determine the efficacy of MSA in the treatment of severe GERD. METHODS: Guided by previous studies, a DeMeester score (DMS)≥50 was used as a cutoff point to define severe reflux disease. Subjects were divided into two groups using this cutoff and outcomes of severe cases were compared to those with less severe disease (DMS<50)...

INTRODUCTION: Self-efficacy (SE) is the personal judgement of how well one can successfully complete a task. The goal of this study is to assess SE of PGY5 residents for common general surgery operations. We hypothesize there are deficits in SE of PGY5 residents, and SE of a given operation correlates with 1) experience performing the operation without attending assistance (independently) and/or 2) teaching the operation start-to-finish. METHODS: A survey was linked to the 2020 ABSITE...

BACKGROUND: Incidental findings (IF) are reported in 20% or more of trauma CT scans. In addition to the importance of patient disclosure, there is significant legal pressure to avoid missed diagnoses. We reported previously 63.5% of IF were disclosed prior to discharge, with 20% non-disclosed. We initiated a multi-disciplinary systemic plan to effect pre-discharge disclosure by synoptic CT reports with American College of Radiology (ACR) recommended follow-up, EMR discharge prompts, and provider education...

INTRODUCTION: Preoperative discussion around postoperative discharge planning have been amplified by the COVID pandemic. We wish to determine if our preoperative frailty screen would predict postoperative LOI. METHODS: This single-institutional study included demographical, procedural, and outcome data from patients ≥65 years who underwent frailty screening prior to a surgical procedure. Frailty was assessed using the Edmonton Frailty Score (EFS). The Operative Severity Score was used to categorize procedures...

INTRODUCTION: Surgical Council on Resident Education (SCORE) curriculum is aligned with the American Board of Surgery (ABS) objectives. Our program adopted the SCORE curriculum in 2015 following poor ABS In-Training Examination (ABSITE) performance and lowest quartile ABS Certifying Exam (CE) and Qualifying Exam (QE) first-time pass rates. We examined the association of SCORE utilization with ABSITE performance and ABS board exam first-time pass rate. METHODS: At a single institution, a retrospective review of surgery residents' SCORE metrics and ABSITE percentile was conducted for academic year 2015 to 2019...

BACKGROUND: Surgical quality improvement efforts are challenging due to the multi-disciplinary nature of care, difficulties obtaining reliable data, and variability in quality metrics. The objective of this analysis was to assess whether participation in a regional collaborative quality initiative was associated with decreased in-hospital surgical complications in South Carolina (SC). STUDY DESIGN: In-hospital surgical complication rates were determined utilizing a statewide all payer claims data set...

BACKGROUND: Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) is a validated tool for capturing a patient's perception of their physical capacity. The goal of this study was to determine whether preoperative PF correlates with a risk of postoperative complications. STUDY DESIGN: Patients from a single-institution ACS-NSQIP database undergoing elective colorectal abdominal operations from 1/2018 to 6/2019 with a preoperative PROMIS-PF T-score were eligible for this retrospective study...

BACKGROUND: Prognostic impact of colorectal liver metastasis (CRLM) morphologic characteristics relative to KRAS mutational status following hepatic resection remains ill-defined. METHODS: Patients undergoing hepatectomy for CRLM between 2001-2018 were identified using an international multi-institutional database. Tumor burden score (TBS) was defined as distance from origin on a Cartesian plane that incorporated maximum tumor size (x-axis) and number of lesions (y-axis)...

BACKGROUND: Less than 50% of children with congenital lung lesions are treated thoracoscopically. There is variable data regarding the benefits and limited information on factors contributing to successful thoracoscopic lobectomies in pediatric patients. We sought to identify predictive factors leading to safe and efficient thoracoscopic lung resections. STUDY DESIGN: A single-center, retrospective chart review of patients (<18 yrs) who underwent lung resection between June 2009 to July 2020 was performed...

No abstract text is available yet for this article.

OBJECTIVE: Early close ratio transfusion with balanced component therapy (BCT) has been associated with improved outcomes in patients with severe hemorrhage; however, this modality is not comparable with WB constituents. We compared use of BCT vs. WB to determine if one yielded superior outcome in patients with severe hemorrhage. We hypothesized that WB would lead to reduced in-hospital mortality and blood product volume given in the first 24 hours of admission. STUDY DESIGN: This was a 1-year single institution prospective, observational study comparing BCT to WB in adult (18+) trauma patients with active hemorrhage who required blood transfusion upon arrival to the emergency department...

INTRODUCTION: This study analyzed data from the 2017 American College of Surgeons National Trauma Data Bank to examine the effects of pre-hospital Field Triage Decision Scheme Step 1 vital sign criteria (S1C) and vital sign decline on subsequent Emergency Department (ED) and hospital death in Emergency Medical Services (EMS) transported trauma victims. METHODS: Patient and injury characteristics, transport time, and ED and hospital disposition were collected. S1C (RR<10, RR>29, SBP<90, GCS<14) were recorded at the injury scene and hospital arrival...

BACKGROUND: The vast majority of women with breast cancer in sub-Saharan Africa present with advanced stage disease, due primarily to the lack of opportunities for early detection and treatment. As part of a larger effort to increase access to diagnostic and therapeutic services for women's cancers in the Democratic Republic of the Congo (DRC), we implemented a curriculum to train the local workforce and a program to build the supportive infrastructure for the diagnosis and treatment of breast cancer at a private sector health facility (Biamba Marie Mutombo Hospital) in Kinshasa...