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    23540 results match your criteria American journal of surgery[Journal]

    1 OF 471

    Early experience with a combined surgical and obstetrics/gynecology clerkship: We do get along.
    Am J Surg 2018 Feb 16. Epub 2018 Feb 16.
    The Ohio State University Wexner Medical Center, Department of Surgery, 410 W. 10th Ave., N749 Doan Hall, Columbus OH 43210, USA. Electronic address:
    Background: In 2012, the Ohio State University College of Medicine (OSUCOM) implemented a new undergraduate medical curriculum. We compare outcomes of a third year traditional clerkship format to a combined Surgery and Obstetrics/Gynecology 'ring'.

    Methods: Performance outcomes of 4 consecutive classes were compared between pre- (2014, 2015) and post-curricular revision (2016, 2017). Read More

    Use of integrative services is associated with maintenance of work schedule during and after cancer treatment.
    Am J Surg 2018 Feb 13. Epub 2018 Feb 13.
    Surgical Oncology, Legacy Medical Group, 1040 N.W. 22nd Ave., Suite 560, Building 2, Legacy Good Samaritan Medical Center, Portland, OR 97227, USA.
    Introduction: Cancer diagnosis affects employment status. Our health network offers supportive services to cancer patients. We hypothesized patients who used these services were more likely to continue to work during and after treatment. Read More

    Higher robotic colorectal surgery volume improves outcomes.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Providence St. Joseph's Health, USA.
    In this study we sought to assess the effect of surgeon volume on outcomes of robotic colorectal operations performed by surgeons with low or high volume across a large health system. We performed a retrospective review of colon or rectal resections performed between January 1, 2013 and January 1, 2017 within the Providence Health System Hospitals. Procedures were separated into those performed by surgeons with high volume (30 or more robotic cases per year) vs. Read More

    Hospital readmission following open, single-stage, elective abdominal wall reconstructions using acellular dermal matrix affects long-term hernia recurrence rate.
    Am J Surg 2018 Feb 5. Epub 2018 Feb 5.
    Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address:
    Background: We evaluated the incidence of and the risk factors for readmission in patients who underwent abdominal wall reconstruction (AWR) using acellular dermal matrix (ADM) and assess whether readmission affects AWR long-term outcomes.

    Methods: A retrospective, single-center study of patients underwent AWR with ADM was conducted. The primary outcome was the incidence of unplanned readmission within 30 days after the initial discharge post-AWR. Read More

    Postoperative opioid prescribing: Getting it RIGHTT.
    Am J Surg 2018 Feb 6. Epub 2018 Feb 6.
    Harvard Medical School, Division of Acute Care Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address:
    Background: Prescription opioid medications account for a large number of fatal and non-fatal overdoses. Many opioid prescription medications after surgery go unused, with the potential for diversion and misuse. As surgeons become increasingly aware of their role in opioid misuse, better tools are needed to guide behavior. Read More

    Preoperative pain measures ineffective in outpatient abdominal surgeries.
    Am J Surg 2018 Feb 6. Epub 2018 Feb 6.
    University of Denver, United States. Electronic address:
    Background: The multimodality addition of preoperative gabapentin, acetaminophen, and celecoxib (GAC) and postoperative TENS has been recommended to diminish narcotics. We predict that GAC-TENS implementation will reduce recovery room time, improve pain control, reduce narcotic refills, and demonstrate usefulness of TENS treatment.

    Methods: A prospective study compared a control group of patients not utilizing the GAC-TENS protocol during 2015 to patients using the GAC-TENS protocol during 2016. Read More

    The role of antibiotics in acute uncomplicated diverticulitis: A systematic review and meta-analysis.
    Am J Surg 2018 Feb 2. Epub 2018 Feb 2.
    Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, AB, Canada. Electronic address:
    Background: Antibiotics use in acute uncomplicated diverticulitis (AUD) remains debated despite recent studies suggesting no difference in outcomes for patients treated without antibiotics.

    Data Sources: Systematic review and meta-analysis were performed to determine the role of antibiotics in managing AUD. Literature search was conducted using Medline, EMBASE, Scopus, the Cochrane Library, and Web of Science databases from 1946 to June 2017. Read More

    PGY-specific benchmarks improve resident performance on Fundamentals of Laparoscopic Surgery tasks.
    Am J Surg 2018 Feb 8. Epub 2018 Feb 8.
    Department of Surgery, Oregon Health and Sciences University, Portland, OR, United States; VirtuOHSU Simulation and Surgical Training Center, Oregon Health and Sciences University, Portland, OR, United States.
    Background: Although expert proficiency times for Fundamentals of Laparoscopic Surgery (FLS) tasks exist, these times are not always attainable for junior residents. We hypothesize that post-graduate year (PGY)-specific benchmarks will improve resident performance of FLS tasks.

    Methods: In 2014, PGY-specific benchmarks were developed for FLS tasks for PGY1-PGY4 general surgery residents by averaging completion times for each task from 2007 to 2013. Read More

    Open abdomen in liver transplantation.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Division of General Surgery, Department of General Surgery, University of British Columbia (UBC), Vancouver, BC, Canada.
    Introduction: Damage control laparotomy with vacuum assisted closure (VAC) is used for selective cases in trauma. In liver transplantation, VAC has also been applied for management of intra-operative hemorrhage. The primary objective was to evaluate peri-operative blood loss and blood product utilization in VAC compared to primary abdominal closure (PAC) at the index transplant operation. Read More

    Redefining "bowel regimen": Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas.
    Am J Surg 2018 Feb 12. Epub 2018 Feb 12.
    Virginia Commonwealth University, Department of General Surgery, 1200 East Broad Street, West Hospital, 15th Floor North Wing, Richmond, VA 23219, USA. Electronic address:
    Enterocutaneous fistulae (ECF) and enteroatmospheric fistulae (EAF) are difficult complications that primarily arise after abdominal surgical procedures. Development of an ECF or EAF carries significant mortality and morbidity. Effective management of patients with these disease states requires a multidisciplinary approach, which includes surgical, pharmacotherapeutic, and nutritional interventions. Read More

    Right ventricular fractional area of change is predictive of ventilator support days in trauma and burn patients.
    Am J Surg 2018 Feb 5. Epub 2018 Feb 5.
    Department of Anesthesiology and Perioperative Medicine, University of Alabama in Birmingham, Birmingham, AL, 35294, USA.
    Echocardiography has contributed to the care of critically ill patients but there remains a need for more publications about its association with outcomes to confirm its role. We conducted a retrospective review of trauma and burn patients that were admitted to our intensive care unit between 2015 and 2017 that underwent hemodynamic transesophageal echocardiography. Data collected included demographics, clinical and laboratory data. Read More

    Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors.
    Am J Surg 2018 Feb 7. Epub 2018 Feb 7.
    Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA.
    Introduction: Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.

    Methods: A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period. Read More

    Importance of mesh overlap on hernia recurrence after open umbilical hernia repair with bilayer prosthesis.
    Am J Surg 2018 Feb 2. Epub 2018 Feb 2.
    Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain.
    Background: importance of mesh overlap on recurrence after open umbilical hernia repair has been poorly studied.

    Methods: a retrospective cohort study was performed with patients who underwent open umbilical hernia repair with bilayer prosthesis between 2004 and 2015.

    Results: 1538 patients were included. Read More

    Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis?
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Department of Radiology, McGill University Health Centre, Montreal, QC, Canada. Electronic address:
    Background: Percutaneous cholecystostomy (PC) is an alternative among high-risk surgical patients or those with multiple comorbidities, but its indications have not been clearly established in the literature. The aim of this paper is to provide the reader with an updated review of the literature summarizing what is known on this topic.

    Data Sources: We reviewed articles from 1979 to 2016 using the PubMed/Medline Database on PC and especially those evaluating this option as a bridge to surgery. Read More

    Statin medications are associated with decreased risk of sepsis and anastomotic leaks after rectal resections.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Colon and Rectal Surgery, St. Joseph Mercy Hospital Ann Arbor, Ann Arbor, MI, USA. Electronic address:
    Background: This study was designed to determine the effect of statins on colorectal postoperative complications related to sepsis. Previous studies have reported conflicting results.

    Methods: This is a retrospective propensity score analysis of postoperative outcomes from a large regional database of patients who underwent elective colorectal resection from June 2012-July 2015. Read More

    Individual learning plans foster self-directed learning skills and contribute to improved educational outcomes in the surgery clerkship.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Department of Surgery, Medical College of Wisconsin, USA; Clement J. Zablocki VA Medical Center, USA; Division of Education in the Department of Surgery, Medical College of Wisconsin, USA.
    Background: The Individual Learning Plan (ILP) is a newly implemented curricular element designed to foster self-directed learning (SDL) skills among medical students during our surgery clerkship. Our aim was to determine the impact of ILPs on educational outcomes and acquisition of SDL skills.

    Methods: Students were surveyed regarding the educational value of ILPs, their acquisition of SDL skills, and the impact of the surgery clerkship on fostering these skills. Read More

    The presence of papillary features in thyroid nodules diagnosed as atypia of undetermined significance or follicular lesion of undetermined significance increases cancer risk and should influence treatment.
    Am J Surg 2018 Jan 5. Epub 2018 Jan 5.
    Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada. Electronic address:
    Background: The objective of this study was to evaluate the influence of papillary features on risk of malignancy (ROM) within the Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS-FLUS) Bethesda System for Reporting Thyroid Cytopathology (BSRTC) diagnostic category.

    Methods: A Retrospective review of cases with an AUS-FLUS diagnosis that underwent a thyroidectomy was carried out, and cases were subcategorized based upon the presence of papillary features.

    Results: For the entire study population there were 93 (22%) of 427 FNAB specimens that had an AUS-FLUS diagnosis, and a 32% associated ROM. Read More

    Base deficit is superior to lactate in trauma.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    UCSF Fresno Department of Surgery, Department of Surgery 1st Floor, 2823 Fresno St., Fresno, CA 93721, USA. Electronic address:
    Background: Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to determine the association of BD and lactate and to determine if one is superior.

    Methods: A retrospective review from 3/2014-12/2016 was performed. Read More

    Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias.
    Am J Surg 2018 Feb 2. Epub 2018 Feb 2.
    The Pennsylvania State University, College of Medicine, Department of Surgery, Hershey, PA 17033-0850, USA. Electronic address:
    Background: After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care.

    Methods: Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR.

    Results: In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41. Read More

    Outcomes in complex ventral hernia repair with anterior component separation in class III obesity patients.
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Rush University Medical Center, Department of Surgery, 1653 W Congress Parkway, Suite 792, Chicago, IL 60612, USA.
    Background: Consensus guidelines recommend against elective ventral hernia repair (VHR) in patients with BMI >30 kg/mwithout preoperative weight loss intervention. We aim to compare hernia recurrence and perioperative complications in VHR utilizing anterior component separation (CS) in patients with class III obesity (BMI >40 kg/m).

    Methods: A retrospective review of patients undergoing VHR with CS was performed. Read More

    Tele-mentored damage-control and emergency trauma surgery: A feasibility study using live-tissue models.
    Am J Surg 2018 Feb 2. Epub 2018 Feb 2.
    Vancouver General Hospital, 855 W 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
    Background: Damage-control and emergency surgical procedures in trauma have the potential to save lives. They may occasionally not be performed due to clinician inexperience or lack of comfort and knowledge.

    Methods: Canadian Armed Forces (CAF) non-surgeon Medical Officers (MOs) participated in a live tissue training exercise. Read More

    The evolving role of pre-pectoral ADM-assisted implant-based immediate breast reconstruction following skin-sparing mastectomy.
    Am J Surg 2018 Feb 2. Epub 2018 Feb 2.
    The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK. Electronic address:
    Introduction: The increasing use of acellular dermal matrix (ADM) and fat transfer in the context of breast reconstruction, following skin sparing mastectomy (SSM) for therapeutic and risk reducing purposes, combined with the need to eliminate animation deformities, reduce post-operative dysfunctional pain and the risk of capsular contracture, has prompted surgeons to investigate the possibility of placing the mammary implant over the pectoralis major muscle with complete coverage with ADM thus reviving the pre-pectoral approach which was previously abandoned due to high complications rates and poor aesthetics in the pre-ADM era.

    Methods: We reviewed the literature regarding this evolving technique of muscle sparing ADM-assisted implant-based immediate breast reconstruction.

    Results And Conclusions: Several authors have recently reported positive early results confirming the potential benefits of eliminating breast animation and reducing postoperative pain, however, most of these reports contain insufficient numbers of patients (<100) and were retrospective in nature with a very short-term follow-up and lack of data regarding objective aesthetic assessment. Read More

    Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials.
    Am J Surg 2018 Feb 2. Epub 2018 Feb 2.
    Colorectal Surgeon, Department of Surgery, Division of General Surgery, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada. Electronic address:
    Background: Alpha-1 adrenergic blockers used to treat postoperative urinary retention (POUR) may also have a preventative role. Here we assess the evidence behind their prophylactic use on POUR prevention.

    Study Design: PRISMA guidelines were followed. Read More

    Modified Appleby procedure for locally advanced pancreatic cancer.
    Am J Surg 2018 Jan 10. Epub 2018 Jan 10.
    Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA. Electronic address:
    Locally advanced pancreas cancer (LAPC) involving the celiac axis is typically considered unresectable and carries a poor prognosis. We present a case of a patient with LAPC who underwent a modified Appleby procedure for tumor clearance following neoadjuvant therapy. Technical aspects include diagnostic laparoscopy to exclude occult metastatic disease followed by complete mobilization of the pancreas and spleen, preservation of the left gastric artery, and resection and reconstruction of the common hepatic artery. Read More

    Risk factors associated with missing post-esophagectomy hospital milestones.
    Am J Surg 2018 Feb 1. Epub 2018 Feb 1.
    Oregon Health & Science University, Department of Surgery, Division of General Surgery, 3181 SW Sam Jackson Park RD Mail Code: L223A, Portland, OR 97239, USA. Electronic address:
    Background: Our institution utilizes an esophagectomy pathway to guide postoperative management. Our aim was to identify risk factors associated with missing pathway goals.

    Methods: Retrospective review of esophagectomies from 2010 to 2015. Read More

    Routine shave margins are not necessary in early stage breast cancer treated with Breast Conserving Surgery.
    Am J Surg 2018 Jan 16. Epub 2018 Jan 16.
    University of British Columbia, Faculty of Medicine, Division of General Surgery, 950 West 10th. Avenue, Vancouver, BC V5Z 1M9, Canada; Mount Saint Joseph Hospital, 3080 Prince Edward St, Vancouver, BC V5T 3N4, Canada. Electronic address:
    Introduction: Breast Conserving Surgery (BCS) is considered standard of care for women with early stage breast cancer. Between 20 and 50% of women treated with BCS will require re-operation for positive or close margins and it has been suggested that routine cavity shave margins may reduce the frequency of positive margins.

    Methods: Retrospective chart review of a prospectively maintained surgical database of patients undergoing BCS for early stage breast cancer, at a single institution, between January 2012 and December 2015. Read More

    Patients with sentinel lymph node positive melanoma: Who needs completion lymph node dissection?
    Am J Surg 2018 Feb 1. Epub 2018 Feb 1.
    Oregon Health & Science University, Department of Surgery, Portland, OR, USA; Oregon Health & Science University, Division of Surgical Oncology, Portland, OR, USA. Electronic address:
    Introduction: Completion lymph node dissection (CLND) for melanoma after positive sentinel lymph node biopsy (SLNB) was recently shown to improve regional but not overall survival, likely due to the majority of patients harboring no further nodal disease. We sought to determine predictors of non-sentinel node (NSN) positivity.

    Methods: Retrospective review of prospectively collected data on melanoma patients undergoing SLNB. Read More

    Ten-year trends in traumatic injury mechanisms and outcomes: A trauma registry analysis.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Department of Surgery, The University of Oklahoma, College of Medicine, Tulsa, OK, USA. Electronic address:
    Background: The Oklahoma Trauma Registry (OTR) collects data from all state-licensed acute care hospitals. This study investigates trends and outcomes of trauma in Oklahoma using OTR.

    Methods: 107,549 patients (2005-2014) with major severity and one of the following criteria were included: length of hospital stay ≥48 h, dead on arrival or death in the hospital, hospital transfer, ICU admission, or surgery on the head, chest, abdomen, or vascular system. Read More

    Medical student perceptions of a mistreatment program during the surgery clerkship.
    Am J Surg 2018 Jan 4. Epub 2018 Jan 4.
    Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA; Goodman Surgical Education Center, Department of Surgery, Stanford, CA, USA.
    Background: Medical student mistreatment remains a concern, particularly in the surgery clerkship. This is a single academic institution's report of medical student perceptions of a mistreatment program embedded in the surgery clerkship.

    Methods: Students who completed the surgery clerkship and the mistreatment program volunteered to be interviewed individually or in focus groups. Read More

    Changing practices: The addition of a novel surgical approach to gynecomastia.
    Am J Surg 2018 Jan 29. Epub 2018 Jan 29.
    Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Surgical Services, John L. McClellan Memorial Veterans Hospital, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. Electronic address:
    Introduction: Gynecomastia can be a significant impediment to quality of life for men who suffer from this affliction. Numerous surgical techniques have been described in the literature ranging from minimally invasive options such as liposuction to incision based reductions. The standard for the general surgeons at our institution has been subcutaneous mastectomy through a circumareolar incision, which often proved inadequate for patients with grade II or III gynecomastia. Read More

    The effect of hospital familiarity with complex procedures on overall healthcare burden.
    Am J Surg 2018 Jan 26. Epub 2018 Jan 26.
    Division of Colorectal Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Center for Innovation and Outcomes Research, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA. Electronic address:
    Background: This study aimed to evaluate variations in prolonged outcome after proctectomy based on hospital volume.

    Study Design: From the Premier Perspective database (2012-2014), hospital volumes for proctectomy of benign and malignant conditions were classified as low, intermediate and high. Hospitals were grouped into tertiles. Read More

    Urinary retention in early urinary catheter removal after colorectal surgery.
    Am J Surg 2018 Jan 29. Epub 2018 Jan 29.
    Department of Surgery, Division of General Surgery, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada. Electronic address:
    Background: High urinary infection (UTI) rate (12%) for our rectal surgery prompted practice change to early catheter removal (postoperative day 2) and prophylactic tamsulosin. Here we report urinary retention (UR) and UTI after this change.

    Methods: Retrospective cohort study in male patients 50+ years undergoing elective colorectal surgery from July 2015 to July 2017. Read More

    Association of shared decision-making on patient-reported health outcomes and healthcare utilization.
    Am J Surg 2018 Jan 31. Epub 2018 Jan 31.
    Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA. Electronic address:
    Background: Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their care. By evaluating all available healthcare options and weighing patients' personal values and preferences against available unbiased evidence, patients and healthcare professionals can make health-related decisions together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported outcomes, healthcare quality, and healthcare utilization. Read More

    Is there a role for Ytrrium-90 in the treatment of unresectable and metastatic intrahepatic cholangiocarcinoma?
    Am J Surg 2018 Jan 30. Epub 2018 Jan 30.
    Spectrum Health, General Surgery Residency Program, Grand Rapids, MI, USA; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA. Electronic address:
    Background: Selective internal radiation therapy (SIRT) with Ytrrium-90 (Y-90) has been used to treat hepatic malignancies with success. This study focuses on the efficacy and safety of Y-90 in the treatment of unresectable and metastatic intrahepatic cholangiocarcinoma (ICC).

    Methods: A single-institution retrospective case review was performed for patients with unresectable and metastatic ICC treated with Y-90 between 2006 and 2016. Read More

    Indocyanine green and fluorescence lymphangiography for sentinel node identification in patients with melanoma.
    Am J Surg 2018 Jan 23. Epub 2018 Jan 23.
    Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
    Background: Infrared fluorescence imaging with indocyanine green (ICG) is a novel method for sentinel node localization. Our objective was to assess ICG and fluorescence imaging for preoperative and intraoperative utility.

    Methods: 87 eligible patients participated in this prospective study. Read More

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