Background: Single-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited.
Methods: A multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. Read More
Background: Our study aims to identify the minimum number of lymph nodes (LN) associated with improved survival in patients who underwent NRT for stage II-III rectal cancer.
Methods: Adults with clinical stage II and III rectal adenocarcinoma in the National Cancer Data Base were stratified by NRT. Multivariable Cox regression modeling with restricted cubic splines was used to determine the minimum number of LNs associated with improved survival. Read More
Object: Acute pancreatitis (AP) keeps as severe medical diagnosis and treatment problem. Early evaluation for severity and risk stratification in patients with AP is very important. Some scoring system such as acute physiology and chronic health evaluation-II (APACHE-II), the computed tomography severity index (CTSI), Ranson's score and the bedside index of severity of AP (BISAP) have been used, nevertheless, there're a few shortcomings in these methods. Read More
Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
Purpose: The goal of this study was to evaluate the efficacy, morbidity and safety of local parastomal hernia repair using biological mesh.
Patients And Methods: A retrospective analysis of a prospectively maintained database was performed for parastomal hernia repairs. All patients who underwent local parastomal hernia repair with biological mesh between July 2006 and July 2015 were included in the study. Read More
Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Objective: Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. Read More
Background: We report our experience with metabolic syndrome screening for obese living kidney donor candidates to mitigate the long-term risk of CKD.
Methods: We retrospectively reviewed 814 obese (BMI≥30) and 993 nonobese living kidney donor evaluations over 12 years. Using logistic regression, we explored interactions between social/clinical variables and candidate acceptance before and after policy implementation. Read More
Background: Surgical site complications in the form of wound infections are a major burden to the healthcare system. Negative pressure wound therapy (NPWT) as delivered by a surgical incision management system (SIMS) is a novel approach to improve wound healing when applied to closed incisions. However, data is limited in its application to laparotomy incisions in the acute care surgery setting. Read More
Objective: Accurate early giant cell arteritis (GCA) diagnosis can be established through temporal artery biopsy (TAB). We herein investigate the relationship between specimen length and positive TAB result in a tertiary-care hospital in Germany during a 8-year period. Secondarily, we studied the relationships of specific epidemiological and laboratory parameters with positive TABs. Read More
Background: Perforation during colonoscopy is a rare but well recognized complication with significant morbidity and mortality. We aim to systematically review the currently available literature concerning care and outcomes of colonic perforation. An algorithm is created to guide the practitioner in management of this challenging clinical scenario. Read More
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Background: Adhesiolysis during abdominal surgery can cause iatrogenic organ injury, increased operative time and a more complicated convalescence. We assessed the impact of adhesiolysis and adhesiolysis-related complications on quality of life and functional status following elective abdominal surgery.
Methods: Prospective cohort study, comparing patients requiring and not requiring adhesiolysis during an elective laparotomy or laparoscopy using the SF-36 and DASI questionnaire scores. Read More
Baylor University Medical Center, Dallas, TX, United States. Electronic address:
Background: To assess the impact of participation of multiorgan procurement (MP) by general surgery (GS) residents on surgical knowledge and skills, a prospective cohort study of GS residents during transplant surgery rotation was performed.
Methods: Before and after participation in MPs, assessment of knowledge was performed by written pre and post tests and surgical skills by modified Objective Structured Assessment of Technical Skill (OSATS) score. Thirty-nine residents performed 84 MPs. Read More
Background: Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and conventional staged hepatectomy (CSH) are options for patients with unresectable liver tumors due to insufficient future liver remnant (FLR).
Methods: A retrospective comparison of clinical data, liver volumetry and surgical outcomes between 10 ALPPS and 29 CSH patients was performed.
Results: Patient demographics and disease characteristics were similar between both groups. Read More
Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA; Department of General Surgery, Michigan Medicine, Ann Arbor, MI, USA.
Introduction: The integrity of the medical literature about robotic surgery remains unclear despite wide-spread adoption. We sought to determine if payment from Intuitive Surgical Incorporated (ISI) affected quality of the research produced by surgeons.
Methods: Publicly available financial data from the CMS website regarding the top-20 earners from ISI for 2015 was gathered. Read More
Greys Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa; Edendale Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa. Electronic address:
Background: Traumatic shock cannot be diagnosed by a single physiological measurement and a number of vital sign based combined shock scores (CSS) have been proposed to identify and triage trauma patients with shock. This audit uses data from a prospectively entered electronic trauma registry to compare the ability of these CSS to predict in-hospital mortality, need for surgery, need for blood transfusion and ICU admission.
Materials And Methods: The data used in the study was obtained from the Hybrid Electronic Medical Record (HEMR) in Pietermaritzburg from January 2012-September 2015. Read More
Background: Patients' prognoses have been predicted by the preoperative inflammation-based score, but predicting a patient's risk for operative load remains challenging. This study investigates the usefulness of the postoperative C-reactive protein/albumin (CRP/Alb) ratio in patients with pancreatic ductal adenocarcinoma (PDAC).
Methods: This study retrospectively assessed 142 patients who underwent pancreatic resection for PDAC between 2004 and 2014. Read More
Background: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Read More
To test the efficacy of a community-based intervention, Empowering Communities for Life (EC4L), designed to increase colorectal cancer (CRC) screening through fecal occult blood test (FOBT) in rural underserved communities in a randomized controlled trial. Participants were randomized into 3 groups (2 interventions and 1 control). Interventions were delivered by community lay health workers or by academic health professionals. Read More
Importance: Neutrophils have classically been considered to mount a defensive response against tumor cells, yet recent evidence suggests tumors modulate neutrophil function to support tumor growth and progression.
Observations: Tumor-associated neutrophils (TANs) are phenotypically distinct from circulating neutrophils in terms of their surface protein composition and cyto/chemokine activity and response. Although TANs have been shown to both promote and inhibit tumor advancement, the preponderant activity augments tumor progression. Read More
Background: Equipoise still exists regarding routine mesh cruroplasty during laparoscopic paraesophageal hernia (PEH). We aimed to determine whether selective mesh cruroplasty is associated with differences in recurrence and patient-reported outcomes.
Methods: We compared symptom outcomes (n = 688) and radiographic recurrences (n = 101; at least 10% [or 2 cm] of stomach above hiatus) for 795 non-emergent PEH repair with fundoplication (n = 106 with mesh). Read More
Background: The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. Read More
Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS, 67214, USA; Department of Trauma Services, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 3082, Wichita, KS, 67214, USA. Electronic address:
Background: The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls.
Methods: A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Read More
Background: The overall utility of the Rothman Index (RI), a global measure of inpatient acuity, for surgical patients is unclear. We evaluate whether RI variability can predict rapid response team (RRT) activation in surgical patients.
Methods: Surgical patients who underwent RRT activation from 2013 to 2015 were matched to four control cases. Read More
Background: In anticipation of bundled-payment models for thyroid and parathyroid disease, a better understanding of resource utilization following surgery is required. We sought to characterize the use of hospital services following such operations using an analysis of readmissions.
Methods: Patients age 18+years who underwent a thyroid or parathyroid operation in CA or NY (2008-2011) were classified by procedure type. Read More
Am J Surg 2017 Sep 9;214(3):385-389. Epub 2016 Jul 9.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Heath, Boston, MA, USA; Trauma, Burn and Surgical Critical Care Division, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:
Background: The "obesity paradox" has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs).
Methods: The 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Read More
The component separation technique (CST) has gained popularity among general surgeons in the management of giant abdominal hernia. A systematic review of the MedLine and EMBASE databases was performed. 36 observational cohort studies were included for data-analysis and divided in 4 main groups: Open Anterior Approach (OAA), Transversus Abdominis Release (TAR), Laparoscopic Anterior Approach (LAA) and Perforator Preserving Approach (PPA). Read More
Department of Surgery, Northwestern Medicine, 251 E. Huron, Chicago, IL, 60611, USA; Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA. Electronic address:
Background: The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons.
Methods: Case logs collected from 1991-2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME "Major Case Categories" and there frequencies were determined. Read More
Introduction: The aim of this study was to investigate reoperation for recurrence in men and women with respect to method of repair, hernia anatomy and year of operation.
Method: Since 1992, groin hernia repairs performed in Sweden are prospectively registered in the Swedish Hernia Register, (SHR). Reoperations are noted, regardless of where the reoperation is performed. Read More
Introduction: In-operating room specimen radiography (ORSR) has not been studied among women undergoing radioactive seed localization (RSL) for breast cancer surgery and had the potential to decrease operative time and perhaps improve intraoperative margin management.
Methods: One hundred consecutive RSL segmental mastectomies among 98 patients using ORSR were compared to 100 consecutive segmental mastectomies among 98 patients utilizing conventional radiography (CSR) prior to the initiation of ORSR from December 2013 to January 2015 after radioactive seed localization. Final pathologic margins were considered to be 10 mm for all cases of no residual disease after biopsy or neoadjuvant therapy, but such patients were excluded from analyses involving tumor size. Read More
Background: Historically, evaluating operative-volumes has proven difficult due to mass-variability in operative-complexities and participation. This study aimed to introduce a national scoring interface for residents' operative-logs while forming meaningful observations on specialities, training-institutes and technical competency.
Methods: A weighted-scoring algorithm was applied prospectively to residents' operative volumes since July 8th(,) 2013 with daily web-based quantitative feedback. Read More
Background: We present single-center experience of surgery for primary epiphrenic diverticulum (PED) over a 12-year period.
Methods: Prospectively maintained database was queried to identify patients who underwent PED surgery. Preoperative and postoperative symptoms, operative data, perioperative complications, and follow-up were reviewed. Read More
Background: Surgery is a vital component of a comprehensive health system, but there are often personnel limitations in resource constrained areas. Zambia provides post graduate surgical training through two systems to help address this shortage. However, no studies have analyzed surgical trainees' perceptions of these programs. Read More
Introduction: Regionalization of care raises potential for differences in cost of care and outcome. This study was undertaken to determine if costs and outcome after pancreaticoduodenectomy vary by region in Florida, and whether costs and outcome are related.
Methods: Inpatient data for pancreaticoduodenectomy in Florida during 2010-2012 were obtained from the Florida Agency for Health Care Administration. Read More
Department of Gastrointestinal Surgery, Diakonhjemmet Hospital, Oslo, Norway; Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address:
Background: The effects of surgeons' leadership on team performance are not well understood. The purpose of this study was to examine the simultaneous effects of transformational, passive, abusive supervision and over-controlling leadership behaviors by surgeons on surgical team performance.
Methods: Trained observers attended 150 randomly selected operations at a tertiary care teaching hospital. Read More
Background: Parastomal hernia repair (PHR) remains a challenge with no optimal repair technique. During retromuscular hernia repair, traversing the stomal conduit through the abdominal wall can result in angulation and compression. Widening of traditional cruciate incisions in mesh and/or fascia likely contributes to recurrences. Read More
Background: We have previously reported favorable response and survival rates using drug-eluting beads loaded with doxorubicin (DEBDOX) for unresectable hepatic metastases. This study investigates the quality of life (QoL) impact of DEBDOX for the treatment of unresectable hepatic metastases from melanoma.
Methods: A multi-center, prospective, non-controlled clinical trial was reviewed. Read More
Background: In literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia.
Methods: Patients were prospectively randomized between March 2013 and March 2015. Read More
Background: Funding for graduate medical education (GME) is becoming scarce and is likely to worsen. There is a higher degree of accountability and return on investment demanded from public funds dedicated to GME. Academic centers (AC) partnered with clinical enterprises (CE) are finding it increasingly difficult to retain sustainable funding streams for GME activities. Read More
Background: A thorough understanding of attitudes toward and program policies for parenthood in graduate medical education (GME) is essential for establishing fair and achievable parental leave policies and fostering a culture of support for trainees during GME.
Methods: A systematic review of the literature was completed. Non-cohort studies, studies completed or published outside of the United States, and studies not published in English were excluded. Read More
Background: ACS-NSQIP classifies hospitals as "high outliers" if their performance is significantly worse than expected. We determined how often hospitals return to as-expected performance after being newly identified as outliers.
Methods: Outlier status was identified in ACS-NSQIP semi-annual reports (SARs) 2008-2011 for 13 postoperative adverse events. Read More
Background: Quantifying surgical skills assists novice surgeons when learning operative techniques. We measured the interaction force at a ligation point and clarified the features of the force pattern among surgeons with different skill levels during laparoscopic knot tying.
Methods: Forty-four surgeons were divided into three groups based on experience: 13 novice (0-5 years), 16 intermediate (6-15 years), and 15 expert (16-30 years). Read More
Backgroud: To better identify patients with high mortality risk, we developed a systematic inflammation index (IPI) based on neutrophil to lymphocyte ratio (NLR) and albumin.
Methods: The performance of pretreatment IPI was evaluated in patients with surgically resected non-metastatic colorectal cancer. IPI was predefined and compared with Glasgow Prognostic Score (GPS)/modified GPS in terms of discrimination and calibration abilities. Read More
Background: The hypothesis of this study is that non-modifiable factors are more important in ventral hernia repair (VHR) surgical site infection (SSI) than care process factors.
Methods: All VHR's which were reviewed retrospectively for both NSQIP-recorded data, and also: preoperative hospitalization, existing mesh, enterocutaneous fistula, open wound, case month, case day, case length, prophylactic antibiotics, skin preparation, other procedure performed, re-do operation, estimate blood loss, hernia size, repair approach, repair type, mesh used, skin closure, suture type, use of drains, and dressing.