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American Journal of Surgery

Stephanie F Polites, Jennifer M Leonard, Amy E Glasgow, Martin D Zielinski, Donald H Jenkins, Elizabeth B Habermann
INTRODUCTION: Severely injured patients should receive definitive care at high acuity trauma centers. The purposes of this study were to determine the undertriage (UT) rate within a national sample of trauma centers and to identify characteristics of UT patients. METHODS: Severely injured adults ≥16 years were identified from the 2010-2012 NTDB. UT was defined as those who received definitive care or died at hospitals without state or ACS level I or II verification...
September 14, 2018: American Journal of Surgery
William C Cirocco
BACKGROUND: Incomplete and flawed national databases reveal strikingly inferior outcomes for rectal cancer patients resected at "low" versus "high " volume hospitals, therefore, a study of outcomes of a "high" volume surgeon in a "low" volume Midwest community hospital setting examined this perception in comparison to contemporary studies. METHODS: Review of 109 consecutive patients who underwent open resection of rectal cancer following neoadjuvant therapy, 1999-2010...
September 10, 2018: American Journal of Surgery
Vijaya T Daniel, Didem Ayturk, Catarina I Kiefe, Heena P Santry
BACKGROUND: Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals. METHODS: The American Hospital Association (AHA) Annual Survey of Hospitals database was queried to identify acute care general hospitals. A hybrid mail/electronic survey was sent to 2811 acute care hospitals that met the inclusion criteria of hospitals that care for adult patients (≥18 years old) with an emergency room (ER), ≥ 1 operating room (OR), and 24-h ER access...
September 8, 2018: American Journal of Surgery
Heather A Lillemoe, David P Stonko, Maura E Sullivan, Sunil K Geevarghese, Kyla P Terhune
BACKGROUND: We collected data regarding specific aspects of perioperative surgical education within our institution's Section of Surgical Sciences as a needs assessment. METHODS: Categorical general surgery residents and attending surgeons were queried regarding their perceptions of resident preoperative planning and perioperative communication. RESULTS: The overall response rate was 81%, with 35 resident and 54 faculty respondents. Residents reported selecting an operative learning objective a median of 50% (IQR 36-67) of the time, whereas attending surgeons perceived this to be the case a median of 26% (IQR 15-35) of the time (P < 0...
September 7, 2018: American Journal of Surgery
Aaron M Williams, Umar F Bhatti, Meredith Barrett, Vahagn C Nikolian, Britta Han, Niki Matusko, Randall S Sung, Rishindra M Reddy, Erika A Newman, Kenneth J Woodside, Gurjit Sandhu
BACKGROUND: The impact of fellowship training on general surgery residency has remained challenging to assess. Surgical resident perceptions of fellow-led and resident-led surgical services have not been well described. METHODS: Retrospective cross-sectional data were collected from residents' service evaluations from 7/2014 through 7/2017. Surgical services were categorized as resident-led or fellow-led. 31 variables were evaluated and collapsed into 7 factors including clinical experience, educational experiences, clinical staff, workload, feedback, treatment of residents, and overall rotation...
September 7, 2018: American Journal of Surgery
Alaina Geary, Donald T Hess, Luise I M Pernar
INTRODUCTION: The Liaison Committee on Medical Education (LCME) requires that residents are trained to fulfill their educational duties toward medical students. This study reviews the literature on resident-as-teacher programs (RATPs) aimed at surgical residents. METHODS: Literature search with MeSH terms internship, residency, general surgery, teaching, education, and curriculum was performed using PubMed, Embase, Web of Science, and ERIC. Curriculum components and how curricula's success was measured were extracted for each study...
September 7, 2018: American Journal of Surgery
Joaquim M Havens, Manuel Castillo-Angeles, Stephanie L Nitzschke, Ali Salim
BACKGROUND: While advances in diagnosis and treatment of peptic ulcer disease have led to a decrease in hospital admissions the socioeconomic distribution of these benefits is unknown. METHODS: We designed a retrospective cohort study using the National Inpatient Sample from 2012 to 2013 including all patients that were admitted for peptic ulcer disease. We compared the types of ulcer related complications, the rates of intervention and the outcomes based on race and insurance status...
September 7, 2018: American Journal of Surgery
Moriah Wright, Vijay Menon, Lindsay Taylor, Maniamparampil Shashidharan, Twilla Westercamp, Charles A Ternent
Genetic variants of unknown significance (VUS) are an increasingly common result of genetic testing. VUS present dilemmas for treatment and surveillance. Family history may play a role in VUS reclassification over time. METHODS: All genetic tests performed at a tertiary referral center 2006-2015 were evaluated for the presence of VUS. Patients with VUS were evaluated for demographics, clinical characteristics, family history, and gene characteristics. RESULTS: In total, 2291 individuals were tested from 1639 families; 150 VUS were identified...
September 7, 2018: American Journal of Surgery
Jordan M Cloyd, Laura Prakash, Jean-Nicolas Vauthey, Thomas A Aloia, Yun Shin Chun, Ching-Wei Tzeng, Michel P Kim, Jeffrey E Lee, Matthew H G Katz
BACKGROUND: Although increasingly administered to patients with pancreatic ductal adenocarcinoma, the role of preoperative therapy for patients with distal cholangiocarcinoma is undefined. METHODS: All patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics and overall survival (OS) were compared between patients who underwent surgery de novo and those who received preoperative therapy...
September 6, 2018: American Journal of Surgery
Carter C Lebares, Hillary J Braun, Ekaterina V Guvva, Elissa S Epel, Frederick M Hecht
BACKGROUND: Physicians experience burnout and mental illness at significantly higher rates than the general population, with sequelae that negatively affect providers, patients, and the healthcare system at large. Gender is rarely considered in characterizing the problem or vetting interventions. METHODS: Using data from a recent national survey and a longitudinal pilot study of general surgery residents, we examined gender variation in burnout and distress. RESULTS: In the national survey, male residents had higher depersonalization and female residents had higher alcohol misuse, with a significant association between alcohol misuse, high depersonalization and low anxiety not seen in males...
September 3, 2018: American Journal of Surgery
Surya Vikram, Prashant Kumar, Muhsin, Ravi Bhushan Singh, Chandan Kumar Jha
No abstract text is available yet for this article.
September 1, 2018: American Journal of Surgery
D Dante Yeh, Joseph V Sakran, Rishi Rattan, Ambar Mehta, Gabriel Ruiz, Howard Lieberman, Michelle Mulder, Nicholas Namias, Tanya Zakrison, Gerd Daniel Pust
BACKGROUND: We surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. METHODS: A web-based survey was sent to the EAST membership. The primary composite endpoint was defined as 1-year incidence of perioperative complications, antibiotic failure, infections, ED visits, and readmissions. RESULTS: A total of 563 of 1645 surveys were completed (34% response). Mean age was 47 ± 10 years and 98% were from the United States...
September 1, 2018: American Journal of Surgery
Hiba Abdel-Aziz, C Michael Dunham
BACKGROUND: Computed tomography (CT) diagnostic accuracy for blunt bowel and mesenteric injuries (BBMI) is controversial. DATA SOURCES: A literature review to compute aggregate CT performance and individual CT sign sensitivity, specificity, and positive predictive value (PPV) for operative BBMI. CONCLUSIONS: Sensitivity, specificity, and PPV were: overall CT performance 85.3%, 96.1%, 51.4%; abnormal wall enhancement 30.1%, 95.7%, 64.0%; bowel wall discontinuity 22...
August 30, 2018: American Journal of Surgery
Elizabeth Palmer Kelly, Nicolette Payne, Timothy M Pawlik
Conversations around surgical goals of care should focus on relational (e.g., empathy, trust, understanding) instead of transactional processes (e.g., communication). Rather than reducing the patient-surgeon relationship to isolated variables such as "communication," a "relational lens" that considers all the aspects of the patient-surgeon relationship and its dynamic processes is needed.
August 30, 2018: American Journal of Surgery
Colleen M Trevino, Tracy VandeWater, Travis P Webb
BACKGROUND: Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems. METHODS: A prospective cohort of SBO patients was compared to a historical cohort of SBO patients after implementation of a SBO protocol using evidence-based guidelines and Omnipaque, a low-osmolar water soluble contrast. Patients without a history of abdominal surgery were excluded and data was collected through chart review...
August 29, 2018: American Journal of Surgery
Douaiher Jeffrey, Hussain Tanvir, Langenfeld Sean J
BACKGROUND: Consensus guidelines recommend a yield of 12 lymph nodes in resections for colon cancer. Factors affecting this yield are not well defined. METHODS: Retrospective study using the colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program for years 2014-2016. Primary outcome was resection of at least 12 nodes. Univariate and multivariate analyses determined factors associated with ≥12 LN yield. RESULTS: 17,612 colectomies for colon cancer were extracted from the NSQIP database...
August 29, 2018: American Journal of Surgery
Scha'chia Murphy, David E Clark, Damien W Carter
BACKGROUND: Age, total burn surface area (TBSA), and inhalation injury are proven predictors of mortality and morbidity following burn injury. Most previous studies have also found that African Americans and females with burns also fare worse. We sought to determine whether these disparities were reduced when burn victims were analyzed separately by categories of insurance coverage. METHODS: We evaluated records in the National Burn Registry (NBR) from 2002 to 2011...
August 29, 2018: American Journal of Surgery
S Mattoo, A Agarwal, M Sabaretnam, A Chekavar
No abstract text is available yet for this article.
August 29, 2018: American Journal of Surgery
Mohammad Raheel Jajja, Marvi Tariq, Daniel W Maxwell, Salila Shoaib Hashmi, Edward Lin, Juan M Sarmiento
BACKGROUND: Minimally invasive approaches for major hepatectomy have been marred by significant rates of conversion and associated morbidity. This study aimed to determine risk factors for conversion as well as postoperative morbidity in patients undergoing minimally invasive right-sided hepatectomy (MIRH). METHODS: Data for patients undergoing MIRH between 2008 and 2017 at Emory University were reviewed. Risk factors for conversion were determined using multivariate regression analysis...
August 29, 2018: American Journal of Surgery
Joshua Lyons, Lauren McCaulley, Nicole Maronian, Jeffrey M Hardacre
BACKGROUND: The timing of inpatient discharges can impact hospital throughput with later discharges leading to decreased patient satisfaction, increased length of stay (LOS), and longer boarding times. METHODS: A 12-month targeted intervention that included both pre-operative and inpatient components was implemented across all surgical inpatient services to increase the proportion of patients discharged by noon. RESULTS: Discharge by noon rates increased from 14...
August 28, 2018: American Journal of Surgery
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