7,274 results match your criteria Journal of the American College of Surgeons[Journal]


Surgical Repair of Occult Inguinal Hernia?

J Am Coll Surg 2019 Feb 12. Epub 2019 Feb 12.

Fort Bragg, NC.

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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.006DOI Listing
February 2019

Enhancing Parathyroid Gland Visualization Using a Near Infrared Fluorescence-Based Overlay Imaging System.

J Am Coll Surg 2019 Feb 12. Epub 2019 Feb 12.

Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN. Electronic address:

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). Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.017DOI Listing
February 2019

Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay?

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

Department of Surgery, Massachusetts General Hospital, Boston, MA.

Background: Current guidelines suggest that cholecystectomy during the third trimester of pregnancy is safe for both the women and the fetus. However, no population-based study has examined this issue. The aim of this analysis was to compare the results of cholecystectomy during the third trimester of pregnancy with outcomes in women operated on in the early postpartum period in a large population. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.024DOI Listing
January 2019

Frailty Cost: The Economic Impact of Frailty in the Elective Surgical Patient.

J Am Coll Surg 2019 Feb 8. Epub 2019 Feb 8.

Department of Surgery, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA; Division of Surgical Oncology, Maine Medical Center, Portland, ME. Electronic address:

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. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.015DOI Listing
February 2019
1 Read

Impact of Immunotherapy after Resection of Pancreatic Cancer.

J Am Coll Surg 2019 Feb 8. Epub 2019 Feb 8.

Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, and the Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL. Electronic address:

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). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193012
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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.016DOI Listing
February 2019
5 Reads

Multidisciplinary Approach and Clostridium difficile Infection in Adult Surgical Patients.

J Am Coll Surg 2019 Feb 7. Epub 2019 Feb 7.

Department of Surgery, Duke University Medical Center, Durham, NC.

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. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.045DOI Listing
February 2019
1 Read

Transferred Emergency General Surgery Patients Are at Increased Risk of Death: A NSQIP Propensity Score Matched Analysis.

J Am Coll Surg 2019 Jan 31. Epub 2019 Jan 31.

Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.

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. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.014DOI Listing
January 2019

A2 to B Kidney Transplantation in the Post-Kidney Allocation System Era: A 3-year Experience with Anti-A Titers, Outcomes, and Cost.

J Am Coll Surg 2019 Jan 30. Epub 2019 Jan 30.

Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.

Background: The new kidney allocation systems (KAS) instituted December 2014 permitted A2 to B deceased donor kidney transplantation (DDKTx) to improve access and reduce disparities in wait time for minorities. A recent United Network for Organ Sharing (UNOS) analysis, however, indicated only 4.5% of B candidates were registered for A2 kidneys. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.023DOI Listing
January 2019
2 Reads

A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy.

J Am Coll Surg 2019 Jan 30. Epub 2019 Jan 30.

Section of Minimally-Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA.

Background: Parathyroid glands are difficult to identify during total thyroidectomies and accidental resection can lead to problematic post-operative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) auto-fluorescence intra-operatively for parathyroid-gland identification; and to measure its impact on postoperative hypocalcemia incidence.

Study Design: Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.044DOI Listing
January 2019
1 Read

Evaluating the Impact of Technique and Mesh Type in Complicated Ventral Hernia Repair: A Prospective Randomized Multicenter Controlled Trial.

J Am Coll Surg 2019 Jan 29. Epub 2019 Jan 29.

Department of Surgery, Washington University School of Medicine, St Louis, MO.

Background: To our knowledge, there is an absence of PRMCTs evaluating both the impact of technique and mesh type on outcome in CVHR.

Study Design: A PRMCT of 120 patients at 3 sites was conducted in which patients were randomized to either overlay (anterior component separation) vs. underlay mesh placement (posterior component separation) and mesh type (human acellular HADM vs porcine acellular PADM dermis). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193008
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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.012DOI Listing
January 2019
5 Reads

Evolution of Firearm Violence over 20 Years: Integrating Law Enforcement and Clinical Data.

J Am Coll Surg 2019 Jan 28. Epub 2019 Jan 28.

University of Tennessee Health Science Center, Department of Surgery, Memphis, TN.

Background: Data linking ballistics to injury are lacking. To address this data chasm, a partnership with law enforcement was developed to describe clinical outcomes from specific firearms.

Study Design: A random sample of patients with gunshot wounds over a 20-year period ending in 2015, was identified. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193004
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.033DOI Listing
January 2019
1 Read

Surgeon Re-Excision Rates after Breast Conserving Surgery: A Measure of Low-Value Care.

J Am Coll Surg 2019 Jan 28. Epub 2019 Jan 28.

Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address:

Background: To better understand re-excision practice patterns following breast-conserving therapy (BCT), we evaluated variation in surgeon-specific re-excision rates and associated factors.

Study Design: We performed a retrospective analysis using Medicare claims from 2012-2018 to identify patients undergoing BCT and subsequent breast resection procedures within 12 months. We compared rates before and after the 2014 "no tumor on ink" consensus guideline. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.043DOI Listing
January 2019

Real World Outcomes of Talimogene Laherparepvec Therapy: A Multi-Institutional Experience.

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address:

Background: Talimogene laherparepvec (TVEC) is a FDA-approved oncolytic herpes virus used to treat unresectable stage IIIB-IV metastatic melanoma via intralesional injection. This study aims to characterize the efficacy TVEC in patients with unresectable stage IIIB-IV melanoma.

Methods: We performed a multi-institutional, IRB-approved review of all patients who received TVEC at three centers from 10/2015-10/2018. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.027DOI Listing
January 2019

Development of Diabetes after Pancreaticoduodenectomy: Results of a 10-Year Series Using Prospective Endocrine Evaluation.

J Am Coll Surg 2019 Jan 25. Epub 2019 Jan 25.

Department of Surgery, Atlanta, GA; Winship Cancer Institute, Atlanta, GA. Electronic address:

Background: Limited literature is available regarding the development of impaired glucose tolerance and diabetes mellitus after pancreaticoduodenectomy. The primary aim was to define the diabetic phenotype and correlate pre-operative glycemic laboratories to new-onset diabetes after pancreaticoduodenectomy.

Study Design: In this prospective study, perioperative fasting and postprandial (OGTT) plasma glucose, A1c, insulin, and c-peptide were measured in consecutive patients undergoing pancreaticoduodenectomy by the senior author from 2006-2017. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193007
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.042DOI Listing
January 2019
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Evaluating Surveillance Patterns after Chemoradiation-Only Compared with Conventional Management for Older Patients with Rectal Cancer.

J Am Coll Surg 2019 Jan 24. Epub 2019 Jan 24.

Background: Upfront chemoradiation with omission of surgery (CR-only) is increasingly being used to treat rectal cancer. When CR-only is used with curative intent, intense surveillance is recommended. We hypothesize that in practice few patients treated with CR-only receive intensive post-treatment surveillance. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.010DOI Listing
January 2019

February 2019 Featured Articles, Volume 228.

Authors:

J Am Coll Surg 2019 Feb;228(2):213-216

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.11.004DOI Listing
February 2019
1 Read

Operating Room Attire.

Authors:
Michael Cotton

J Am Coll Surg 2019 Feb;228(2):209-210

Montreux, Switzerland.

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.11.001DOI Listing
February 2019

Association of periOperative Registered Nurses Clarifies Position on Surgical Attire.

Authors:
Lisa Spruce

J Am Coll Surg 2019 Feb;228(2):207-208

Denver, CO.

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.11.007DOI Listing
February 2019
1 Read

Robotic Pancreaticoduodenectomy Is the Future: Here and Now.

J Am Coll Surg 2019 Jan 22. Epub 2019 Jan 22.

Department of Advanced Minimally Invasive and Robotic Surgery, Florida Hospital Tampa, Tampa, FL.

Introduction: This study was undertaken to examine our outcomes after robotic pancreaticoduodenectomy and to compare our outcomes to predicted outcomes utilizing the National Surgical Quality Improvement Program (NSQIP) Risk Calculator and to outcomes reported through NSQIP.

Methods: We prospectively followed 155 patients undergoing robotic pancreaticoduodenectomy. Outcomes were compared to predicted outcomes calculated using the NSQIP Surgical Risk Calculator and to outcomes documented in NSQIP for pancreaticoduodenectomy from 2012-17. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.040DOI Listing
January 2019
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Pancreatic Cancer Lymph Node Resection Revisited: A Novel Calculation of the Number of Lymph Nodes Required.

J Am Coll Surg 2019 Jan 21. Epub 2019 Jan 21.

Background: Pancreatic cancer is the third leading cause of cancer related deaths in the U.S. Though lymph node metastasis is a prognostic indicator, the extent of lymph node (LN) resection is still debated. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193004
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.031DOI Listing
January 2019
2 Reads

Trauma Resuscitation Considerations: Sex Matters.

J Am Coll Surg 2019 Jan 21. Epub 2019 Jan 21.

University of Colorado-Denver, Department of Surgery, Aurora, CO. Electronic address:

Background: Sex dimorphisms in coagulation have been recognized but whole blood assessment of these dimorphisms and their relationship to outcomes in trauma have not been investigated. This study characterizes the viscoelastic hemostatic profile of severely injured patients by sex and examines how sex-specific coagulation differences affect clinical outcomes, specifically massive transfusion (MT) and death. We hypothesize that severely injured females are more hypercoagulable and thus, have lower rates of MT and mortality. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2019.01.009DOI Listing
January 2019
5.122 Impact Factor

W Dean Warren, MD: Iron Hand and Principles of Steel.

J Am Coll Surg 2019 Jan 21. Epub 2019 Jan 21.

Department of Surgery, University of Miami School of Medicine, Miami, FL 33136.

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.039DOI Listing
January 2019

Bilateral Neck Exploration for Sporadic Primary Hyperparathyroidism: Utilization Patterns in 5,597 Patients Undergoing Parathyroidectomy in the Collaborative Endocrine Surgery Quality Improvement Program.

J Am Coll Surg 2019 Jan 21. Epub 2019 Jan 21.

Department of Surgery Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address:

Intro: For many surgeons, focused parathyroidectomy has become the preferred approach for the management of sporadic primary hyperparathyroidism (HPT). This study describes utilization patterns of bilateral neck exploration (BE) by endocrine surgeons participating in the Collaborate Endocrine Surgery Quality Improvement Program (CESQIP).

Methods: Using the CESQIP parathyroid dataset (2014-2017), utilization trends, demographic and clinical characteristics of patients undergoing BE vs. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.034DOI Listing
January 2019
2 Reads

Post-Pancreatoduodenectomy Outcomes and Epidural Analgesia: A 5-Year Single Institution Experience.

J Am Coll Surg 2019 Jan 21. Epub 2019 Jan 21.

Surgery Departments of Indiana University School of Medicine; Biochemistry/Molecular Biology; Walther Oncology Center, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. Electronic address:

Introduction: Optimal pain control post-pancreatoduodenectomy is a challenge. Epidural analgesia (EDA) is increasingly utilized despite inherent risks and unclear effects on outcomes.

Methods: All pancreatoduodenectomies (PD) performed from 1/2013-12/2017 were included. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.038DOI Listing
January 2019
3 Reads

Resident Sensitive Processes of Care: the Impact of Surgical Residents on Inpatient Testing.

J Am Coll Surg 2019 Jan 17. Epub 2019 Jan 17.

Stanford Department of Surgery. Stanford University. Stanford, CA; Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University. Stanford, CA.

Introduction: Healthcare value is a national priority, and there are substantial efforts to reduce overuse of low-value testing. Residency training programs and teaching hospitals have been implicated in excessive testing. We evaluated the impact of surgery residents on the frequency of inpatient testing and investigated potential inter-resident variation. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.037DOI Listing
January 2019
1 Read
5.122 Impact Factor

Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Operation: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway.

J Am Coll Surg 2019 Jan 17. Epub 2019 Jan 17.

Department of Surgery and the Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.

Background: This study was designed to determine whether a standardized recovery pathway could reduce post-pancreaticoduodenectomy hospital length of stay to 5 days without increasing complication or readmission rates.

Study Design: Pancreaticoduodenectomy patients (high-risk patients excluded) were enrolled in an IRB-approved, prospective, randomized controlled trial (NCT02517268) comparing a 5-day Whipple accelerated recovery pathway (WARP) with our traditional 7-day pathway (control). Whipple accelerated recovery pathway interventions included early discharge planning, shortened ICU stay, modified postoperative dietary and drain management algorithm, rigorous physical therapy with in-hospital gym visit, standardized rectal suppository administration, and close telehealth follow-up post discharge. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.032DOI Listing
January 2019

Should Sentinel Lymph Node Biopsy Be Performed for All T1b Melanomas in the New 8 Edition American Joint Committee on Cancer Staging System?

J Am Coll Surg 2019 Jan 17. Epub 2019 Jan 17.

Hiram C Polk Jr, MD, Department of Surgery, University of Louisville, Louisville, KY.

Background: In the 8 edition of the American Joint Committee on Cancer melanoma staging system, the T1b category has been redefined based solely on thickness and ulceration. National Comprehensive Cancer Network guidelines recommend consideration of sentinel lymph node biopsy (SLNB) for all patients with T1b melanomas (0.8 to 1. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193004
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.030DOI Listing
January 2019
3 Reads

Simulation in Surgical Education: Influences of and Opportunities for The Southern Surgical Association.

Authors:
John B Hanks

J Am Coll Surg 2019 Jan 16. Epub 2019 Jan 16.

Departure of Surgery, University of Virginia Health System , Charlottesville, VA.

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.029DOI Listing
January 2019
1 Read

Effect of Donor Race-Matching on Overall Survival for African-American Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma.

J Am Coll Surg 2019 Jan 10. Epub 2019 Jan 10.

Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI. Electronic address:

Background: Liver transplantation (LT) is the preferred treatment for early hepatocellular carcinoma (HCC) in select patients. Differences in outcomes after LT have been previously described between recipient races, but the role of donor race is not well defined. This study sought to examine the effect of donor-recipient race-matching on overall survival after liver transplantation for HCC in African-American patients (AA). Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.11.016DOI Listing
January 2019
1 Read

First, Do No Harm: Rethinking Routine Diversion in Sphincter-Preserving Rectal Cancer Resection.

J Am Coll Surg 2019 Jan 9. Epub 2019 Jan 9.

Department of Surgery, Division of General Surgery, Washington University School of Medicine, St Louis, MO.

Background: Although diverting stomas have reduced anastomotic leak rates after sphincter-preserving proctectomy in some series, the effectiveness of routine diversion among a broad population of rectal cancer patients remains controversial. We hypothesized that routine temporary diversion is not associated with decreased rates of leak or reintervention in cancer patients at large undergoing sphincter-sparing procedures.

Study Design: The Florida State Inpatient Database (AHRQ, Healthcare Cost and Utilization Project) was queried for patients undergoing sphincter-preserving proctectomy for cancer (2005 to 2014). Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.012DOI Listing
January 2019

Valproic Acid and Neural Apoptosis, Inflammation, and Degeneration 30 Days after Traumatic Brain Injury, Hemorrhagic Shock, and Polytrauma in a Swine Model.

J Am Coll Surg 2019 Jan 9. Epub 2019 Jan 9.

Department of Surgery, University of Michigan Health System, Ann Arbor, MI. Electronic address:

Background: A single-dose (150 mg/kg) of valproic acid (VPA) has been shown to decrease brain lesion size and improve neurologic recovery in preclinical models of traumatic brain injury (TBI). However, the longer-term (30 days) impact of single-dose VPA treatment after TBI has not been well evaluated.

Study Design: Yorkshire swine were subjected to TBI (cortical impact), hemorrhagic shock, and polytrauma. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.026DOI Listing
January 2019
2 Reads

Impact of New Vascular Fellowship Programs on Vascular Surgery Operative Volume of Residents in Associated General Surgery Programs.

J Am Coll Surg 2019 Jan 9. Epub 2019 Jan 9.

Accreditation Council for Graduate Medical Education, Chicago, IL.

Background: General surgery (GS) resident vascular surgery (VS) operations have declined significantly in the last 15 years. We hypothesized that initiation of VS fellowship programs (VSFPs) contributes to that decline. This study examined the effect of establishing new VSFPs on VS case volumes of residents in associated GS programs. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.010DOI Listing
January 2019

Using Machine Learning to Identify Change in Surgical Decision Making in Current Use of Damage Control Laparotomy.

J Am Coll Surg 2019 Jan 9. Epub 2019 Jan 9.

Department of Surgery, University of Texas McGovern Medical School, Houston, TX; Center for Clinical Research and Evidence Based Medicine, University of Texas McGovern Medical School, Houston, TX.

Background: In an earlier study, we reported the successful reduction in the use of damage control laparotomy (DCL); however, no change in the relative frequencies of specific indications was observed. In this study, we aimed to use machine learning to help identify the changes in surgical decision making that occurred.

Study Design: Adult patients undergoing emergent trauma laparotomy were included: pre-quality improvement (QI): January 1, 2011 to October 31, 2013 and post-QI: November 1, 2013 to June 30, 2016. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193002
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.025DOI Listing
January 2019
4 Reads

Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands: A Propensity Score Matched Comparison with Conventional Laparoscopic Total Mesorectal Excision.

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands.

Background: TaTME is a relatively new, demanding technique for rectal cancer treatment. Results from national datasets are absent and comparative data with lapTME scarce. Therefore, this study aimed to evaluate the initial Transanal Total Mesorectal Excision (TaTME) experience in the Netherlands, by comparing outcomes with conventional laparoscopic TME (lapTME). Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.016DOI Listing
January 2019

Preemptive Treatment of Phantom and Residual Limb Pain with Targeted Muscle Reinnervation at the Time of Major Limb Amputation.

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

Division of Plastic Surgery and Department of Orthopedics, Uniformed Services University--Walter Reed National Military, Bethesda, MD.

Background: A majority of the nearly two million Americans living with limb loss suffer from chronic pain in the form of neuroma-related residual limb and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) surgically transfers amputated nerves to nearby motor nerves for prevention of neuroma. The objective of this study was to determine whether TMR at the time of major limb amputation decreases the incidence and severity of PLP and residual limb pain. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.015DOI Listing
January 2019
1 Read

Length of Stay and Opioid Dose Requirement with Transversus Abdominis Plane Block vs Epidural Analgesia for Ventral Hernia Repair.

J Am Coll Surg 2019 Jan 7. Epub 2019 Jan 7.

University of South Carolina School of Medicine Greenville, Department of Surgery, Greenville, SC.

Background: Major abdominal surgery often requires postoperative opioid analgesia. However, there is growing recognition of the potential for abuse. We previously reported a significant reduction in opioid consumption after implementation of an enhanced recovery after surgery (ERAS) protocol following ventral hernia repair (VHR) focusing on opioid reduction. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.017DOI Listing
January 2019
1 Read

Perioperative Bundle to Reduce Surgical Site Infection after Pancreaticoduodenectomy: A Prospective Cohort Study.

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering, New York, NY. Electronic address:

Background: Pancreaticoduodenectomy is historically associated with incisional surgical site infection (iSSI) rates between 15% and 20%. Prospective studies have been mixed with respect to the benefit of individual interventions directed at decreasing iSSI. We hypothesized that the application of a perioperative bundle during pancreaticoduodenectomy would decrease the rate of iSSIs significantly. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.018DOI Listing
January 2019
5 Reads

Blunt Thoracic Aortic Injury: Endovascular Repair Is Now the Standard.

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD. Electronic address:

Background: Incidence and treatment of blunt thoracic aortic injury (BTAI) has evolved, likely from improved imaging and emergence of endovascular techniques; however, multicenter data demonstrating this are lacking. We examined trends in incidence, management, and outcomes in BTAI.

Study Design: The American College of Surgeons National Trauma Databank (2003 to 2013) was used to identify adults with BTAI. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193001
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.022DOI Listing
January 2019
1 Read

How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis?

J Am Coll Surg 2019 Jan 7. Epub 2019 Jan 7.

Department of Surgery, Analysis Center, Clinical and Translational Science Institute, University of Minnesota Medical School, Minneapolis, MN; Department of Pediatrics, Analysis Center, Clinical and Translational Science Institute, University of Minnesota Medical School, Minneapolis, MN. Electronic address:

Background: A total pancreatectomy and intraportal islet cell autotransplant (TPIAT) is increasingly being offered to patients with chronic pancreatitis (CP). The benefits include removal of the root cause of pain and amelioration of diabetes. However, the long-term durability of this operation remains unclear. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193001
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.019DOI Listing
January 2019
11 Reads

Influence of Gender on Surgical Residency Applicants' Recommendation Letters.

J Am Coll Surg 2019 Jan 7. Epub 2019 Jan 7.

Department of Surgery. Electronic address:

Background: Implicit bias has been documented in candidate selection within academic medicine. Gender bias is exposed when writers systematically use different language to describe attributes of male and female applicants. This study examines the presence of gender bias in recommendation letters for surgical residency candidates. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.020DOI Listing
January 2019
1 Read

Dual Kidney Transplantation from Donors at the Extremes of Age.

J Am Coll Surg 2019 Jan 8. Epub 2019 Jan 8.

Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address:

Background: The study purpose was to analyze outcomes in recipients of pediatric dual en bloc (PEB) kidneys from small pediatric donors (SPDs, age ≤ 3 years) and dual kidney transplants (KTs) from adult marginal deceased donors (DDs) in the context of the Kidney Donor Profile Index (KDPI).

Study Design: This was a single center retrospective review. Recipient selection included primary transplant, low BMI, low immunologic risk, and informed consent. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.021DOI Listing
January 2019

Operative Mortality Prediction for Primary Rectal Cancer: Age Matters.

J Am Coll Surg 2019 Jan 7. Epub 2019 Jan 7.

Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD. Electronic address:

Background: The risk of colorectal cancer increases with age and the number of older adults requiring surgery has increased. The purpose of this study was to determine if a current risk calculator can accurately predict operative mortality for rectal cancer and if the predictive accuracy varied with age.

Methods: ACS-NSQIP database using ICD9/10 codes for rectal cancer and CPT codes for proctectomy was accessed (2012-2015). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193001
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.014DOI Listing
January 2019
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"Show Me the Data": A Recipe for Quality Improvement Success in an Academic Surgical Department.

J Am Coll Surg 2019 Jan 6. Epub 2019 Jan 6.

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.

Background: Surgeons in academic medical centers have traditionally taken a siloed approach to reducing postoperative complications. We initiated a project focusing on transparency and sharing of data to engage surgeons in collaborative quality improvement. Its key features were the development of a comprehensive department quality dashboard and the creation of the Clinical Operations Council that oversaw quality. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10727515193001
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.013DOI Listing
January 2019
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Reducing Implicit Bias: Association of Women Surgeons #HeForShe Taskforce Best Practice Recommendations.

J Am Coll Surg 2019 Jan 3. Epub 2019 Jan 3.

Department of Surgery, Johns Hopkins School of Medicine, Baltimore MD.

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.011DOI Listing
January 2019

Liver Transplant Survival Index for Patients with Model for End-Stage Liver Disease Score ≥ 35: Modeling Risk and Adjusting Expectations in the Share 35 Era.

J Am Coll Surg 2018 Dec 27. Epub 2018 Dec 27.

Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Trauma and Critical Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

Background: The Share 35 policy for liver allocation prioritizes patients with Model for End-Stage Liver Disease (MELD) scores ≥ 35 for regional sharing of liver allografts. To better assess donor-recipient interactions and inform expectations, this study identified factors affecting graft survival independent of MELD score and derived a risk index for transplantation in the MELD ≥ 35 population.

Study Design: The United Network for Organ Sharing (UNOS) STAR database was evaluated for deceased donor liver transplants with recipients' MELD ≥ 35, between January 2006 and June 2016. Read More

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http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.009DOI Listing
December 2018