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American Journal of Surgery

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https://www.readbyqxmd.com/read/30639132/association-between-postoperative-opioid-use-and-outpatient-surgical-adverse-events
#1
Elise A Dasinger, Westyn Branch-Elliman, Steven D Pizer, Hassen Abdulkerim, Amy K Rosen, Martin P Charns, Mary T Hawn, Kamal M F Itani, Hillary J Mull
BACKGROUND: Opioid-related adverse drug events are common following inpatient surgical procedures. Little is known about opioid prescribing after outpatient surgical procedures and if opioid use is associated with short term risks of outpatient surgical adverse events (AEs). METHODS: VA Corporate Data Warehouse was used to identify opioid use within 48 h for FY2012-14 chart-reviewed cases from a larger VA study of AEs in outpatient surgeries. We estimated a multilevel logistic regression model to determine the effect of opioid exposure on risk of AEs between 2 and 30 days postoperatively...
January 4, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30638725/evaluation-of-general-surgery-residency-program-websites
#2
Scott M Stoeger, Hadley Freeman, Bradon Bitter, Stephen D Helmer, Jared Reyes, Kyle B Vincent
BACKGROUND: The purpose of this study was to evaluate the websites of general surgery residency programs in the United States and Puerto Rico. METHODS: Electronic Residency Application Service (ERAS) websites (n = 254) were accessed between October 2016 and January 2017 and evaluated for content, including: education, resident and faculty information, program environment and specific recruitment incentives. RESULTS: General information, such as conference information, rotations, and faculty information were available for more than 80% of programs...
January 4, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30639131/evaluation-of-white-blood-cell-count-at-time-of-discharge-is-associated-with-limited-oral-antibiotic-therapy-in-children-with-complicated-appendicitis
#3
Patrick C Bonasso, Melvin S Dassinger, Deidre L Wyrick, Samuel D Smith, Jeffrey M Burford
BACKGROUND: Variation exists for postoperative antibiotics in children with complicated appendicitis. We investigated the impact of white blood count (WBC) at discharge on oral antibiotic therapy, abscess rate, and readmission rate. MATERIAL/METHODS: We conducted a two year review of children with complicated appendicitis. In the pre-protocol group, total antibiotic therapy was ten days (IV and oral) and home oral antibiotics at discharge. In the post-protocol group, children with leukocytosis were prescribed oral antibiotics to complete seven days of total antibiotic therapy and children without leukocytosis were not prescribed oral home antibiotics...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635212/endoscopic-therapy-and-surveillance-versus-esophagectomy-for-early-esophageal-adenocarcinoma-a-review-of-early-outcomes-and-cost-analysis
#4
Andrea Wirsching, Piers R Boshier, Rajesh Krishnamoorthi, Michael C Larsen, Shayan Irani, Andrew S Ross, Donald E Low
BACKGROUND: Endoscopic therapy is considered to be comparable to esophagectomy with respect to oncologic outcomes in early (cT1) esophageal adenocarcinoma (EC). The current study aims to compare early outcomes and financial costs, associated with endoscopic versus surgical therapy for early esophageal adenocarcinoma. METHODS: Retrospective review of patients undergoing either endoscopic or surgical therapy for cT1 EC between 2010 and 2015. RESULTS: Age, BMI, and Charlson Comorbidity Scores were similar in patients undergoing endoscopic therapy (N = 20) and esophagectomy (N = 23)...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635211/surgical-resection-versus-ablation-for-early-stage-hepatocellular-carcinoma-a-retrospective-cohort-analysis
#5
Grace C Lee, Cristina R Ferrone, Parsia A Vagefi, Raul N Uppot, Kenneth K Tanabe, Keith D Lillemoe, Lawrence S Blaszkowsky, Motaz Qadan
BACKGROUND: The most appropriate treatment for early-stage hepatocellular carcinoma (HCC) remains unclear. This study compared the association of resection versus ablation with overall survival (OS) in patients with early-stage HCC. METHODS: Using the National Cancer Database (NCDB), patients diagnosed with stage I/II HCC between 2004 and 2014 were identified. Cox analysis was used to determine predictors of OS. RESULTS: We identified 53,161 patients, of whom 15...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635209/complicated-appendicitis-immediate-operation-or-trial-of-nonoperative-management
#6
Neha Nimmagadda, Kazuhide Matsushima, Alice Piccinini, Caroline Park, Aaron Strumwasser, Lydia Lam, Kenji Inaba, Demetrios Demetriades
BACKGROUND: The optimal treatment for complicated appendicitis remains controversial. We sought to compare clinical outcomes of patients with complicated appendicitis treated with an immediate operation or a trial of nonoperative management. METHODS: Adult patients (≥18 years) with complicated appendicitis were included. Patient characteristics and outcomes were compared between the immediate operation group and the nonoperative management group. RESULTS: A total of 101 patients met our inclusion criteria...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635208/acute-hyperglycemia-increases-sepsis-related-glycocalyx-degradation-and-endothelial-cellular-injury-a-microfluidic-study
#7
Lawrence N Diebel, David M Liberati, Jonathan V Martin
BACKGROUND: Hyperglycemia promotes vascular inflammation; however its effect on endothelial dysfunction in sepsis is unknown. Microfluidic devices (MFD) may closely mimic the in vivo endothelial cell microenvironment. We hypothesized that stress glucose concentrations would increase sepsis related endothelial injury/activation. METHODS: Human umbilical vein endothelial cell (HUVEC) monolayers were established in microfluidic channels. TNF was added followed by glucose...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635207/%C3%AE-adrenergic-agonist-administration-is-not-associated-with-secondary-carcinoid-crisis-in-patients-with-carcinoid-tumor
#8
Kristen E Limbach, Mary E Condron, Ann E Bingham, SuEllen J Pommier, Rodney F Pommier
BACKGROUND: Patients with carcinoid tumors are at risk for profound intraoperative hypotension known as carcinoid crisis, which catecholamines are traditionally believed to trigger. However, data supporting this are lacking. METHODS: Anesthesia records were retrospectively reviewed for carcinoid patients treated with vasopressors. Hemodynamics for those with crisis were compared between those who received β-adrenergic agonists (B-AA) versus those who did not. RESULTS: Among 293 consecutive operations, 58 were marked by 161 crises...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635206/results-of-conversion-of-gastric-banding-to-gastric-bypass-in-patients-between-50-and-60-years-of-age-are-similar-to-those-observed-in-younger-patients
#9
Abbas Al-Kurd, Ronit Grinbaum, Ala'a Abubeih, Ido Mizrahi, Amram Kupietzky, Nachum Emil Eliezer Lourie, Haggi Mazeh, Nahum Beglaibter
BACKGROUND: The effect of age and gender on outcomes of revisional bariatric surgery has not been assessed. METHODS: A retrospective analysis of patients undergoing revision from laparoscopic adjustable gastric banding (LAGB) to laparoscopic roux en Y gastric bypass (LRYGB) between 2007 and 2017 was performed. Patients were divided according to gender and age (<50 and ≥ 50 years), and the outcomes of the subgroups were compared. RESULTS: During the study period, 161 revisional LRYGBs were performed...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30635205/imaging-utilization-affects-negative-appendectomy-rates-in-appendicitis-an-acs-nsqip-study
#10
Joshua Tseng, Tara Cohen, Nicolas Melo, Rodrigo F Alban
BACKGROUND: Negative appendectomy rates (NAR) historically ranged from 15 to 25%, but have decreased recently. METHODS: Using the 2016 ACS-NSQIP database, we identified patients who underwent appendectomies for appendicitis. Patients with and without appendicitis on pathology were compared. Multivariate analysis was used to identify predictors of negative appendectomies. RESULTS: 11,841 patients underwent appendectomies, with a NAR of 4.5%...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30621907/this-too-shall-pass-standardized-gastrografin-protocol-for-partial-small-bowel-obstruction
#11
S Long, B Emigh, J S Wolf, C Byrne, T B Coopwood, J Aydelotte
BACKGROUND: One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well as possibly therapeutic, reducing the need for operative intervention. There is a paucity of data on the use of Gastrografin in the community setting. We hypothesized that this standardized algorithm of Gastrografin administration would decrease the need for surgery and shorten a patient's length of stay, even outside the confines of a regulated clinical trial...
January 3, 2019: American Journal of Surgery
https://www.readbyqxmd.com/read/30616922/the-surgical-consult-entrustable-professional-activity-epa-defining-competence-as-a-basis-for-evaluation
#12
Ryland S Stucke, Meredith Sorensen, Alexandra Rosser, Sarah Sullivan
BACKGROUND: The American Board of Surgery has proposed a competency-based training model, which relies on entrustable professional activities (EPAs) to assess and document competence. No data exist defining competence for surgical consultation, one of five proposed trial EPAs. METHODS: Qualitative interviews performed with 23 surgical faculty at two academic institutions. Interviews were reviewed for thematic content. RESULTS: No explicit framework is currently used to evaluate the surgical consult...
December 31, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30639130/-en-trust-me-validating-an-assessment-rubric-for-documenting-clinical-encounters-during-a-surgery-clerkship-clinical-skills-exam
#13
Tess H Aulet, Jesse S Moore, Peter W Callas, Cate Nicholas, Michael Hulme
BACKGROUND: The AAMC developed 13 Core Entrustable Professional Activities (EPAs) for graduating medical students. EPA 5 is: Document a clinical encounter in the patient record. Our goal was to develop an assessment rubric and gather evidence to support its validity in measuring progress towards entrustability. METHODS: A rubric was developed for EPA 5. During the 2017 surgery clerkship, 57 students wrote a note for each of two standardized patient (SP) encounters...
December 25, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30638727/the-heavy-price-of-conversion-from-laparoscopic-to-open-procedures-for-emergent-cholecystectomies
#14
Adil A Shah, Umar F Bhatti, Mikael Petrosyan, George Washington, Wasay Nizam, Mallory Williams, Daniel Tran, Edward E Cornwell, Terrence M Fullum
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard operative intervention for gallbladder disease. Complications may necessitate conversion to an open cholecystectomy (OC). This study aims to determine the cost-consequences of laparoscopic-to-open conversion using a nationally-representative sample. METHODS: Using the National Inpatient Sample (2007-2011), adult patients undergoing emergent LC were identified. Patients undergoing secondary-conversion to OC were subsequently identified...
December 21, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30635210/thoracoabdominal-gastrectomy-and-distal-2-3-esophageal-resection-with-wide-lymph-node-dissection-for-type-ii-and-iii-adenocarcinoma-at-the-gastro-esophageal-junction
#15
Martin Jeremiasen, Bruno Walther, Pauline Djerf, Christer Staël von Holstein, Thomas Zilling, Michael Hermansson, Dan Falkenback, Jan Johansson
BACKGROUND: For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the level of the azygos vein or above. The aim of the study was to investigate short- and long-term results for this rarely used procedure. METHODS: Retrospective study of 83 radio-chemotherapy naïve patients with adenocarcinoma at the gastro-esophageal junction (Siewert type II n = 65 and type III n = 18) operated upon 1986-2011...
December 18, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30606450/eraritjaritjaka-revisited-the-future-of-trauma-and-acute-care-surgery-a-symposium-of-the-2018-north-pacific-surgical-association-annual-meeting
#16
Timothy Bax, Ernest E Moore, Joel Macalino, Frederick A Moore, Matthew Martin, John Mayberry
No abstract text is available yet for this article.
December 18, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30594298/changes-in-serum-fgf23-and-klotho-levels-and-calcification-scores-of-the-abdominal-aorta-after-parathyroidectomy-for-secondary-hyperparathyroidism
#17
Fong-Fu Chou, Jin-Bor Chen, Shun-Cheng Huang, Yi-Chai Chan, Shun-Yu Chi, Wei-Ting Chen
BACKGROUND: Changes of calcification scores of the abdominal aorta (CSAA) after total parathyroidectomy plus autotransplantation (TPX + AT) for symptomatic secondary hyperparathyroidism (SSHP) have never been reported. METHODS: Forty-nine patients who successfully underwent TPX + AT for SSHP were enrolled; 13 patients who had regular hemodialysis were enrolled as controls. Preoperatively, patients' age, gender, and duration of dialysis were recorded. Serum Ca, P, alkaline phosphatase (Alk-ptase), intact parathyroid hormone (iPTH), vitamin D, FGF23, and Klotho levels, and CSAA were measured...
December 18, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30591181/surgeons-expertise-during-critical-event-in-laparoscopic-cholecystectomy-an-expert-novice-comparison-using-protocol-analysis
#18
Lev N Korovin, Timothy M Farrell, Chiu-Hsieh Hsu, McKenna White, Iman Ghaderi
BACKGROUND: The purpose of this study was to examine differences in thought processes between novice and experienced surgeons when they were presented with a critical situation during laparoscopic cholecystectomy. METHODS: A group of experienced and novice surgeons were shown a recording of a laparoscopic cholecystectomy with an intraoperative bleeding event. The think-aloud method was used to capture surgeons' thought processes. Verbal reports were recorded, transcribed and analyzed using the protocol analysis method...
December 18, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30611396/atypical-ductal-hyperplasia-clinicopathologic-factors-are-not-predictive-of-upgrade-after-excisional-biopsy
#19
Thomas Sutton, Maryam Farinola, Nathalie Johnson, Jennifer R Garreau
INTRODUCTION: National Comprehensive Cancer Network (NCCN) guidelines currently recommend excisional biopsy for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) due to the possibility of pathologic upgrade to breast cancer upon excisional biopsy. We aimed to quantify the current rate of upgrade and identify risk factors. METHODS: A retrospective review of women in the Legacy Health Care System with a diagnosis of ADH was performed for 2014 through 2015...
December 17, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30595331/extended-thromboprophylaxis-with-low-molecular-weight-heparin-lmwh-following-abdominopelvic-cancer-surgery
#20
Marc Carrier, Alon D Altman, Normand Blais, Artemis Diamantouros, Deanna McLeod, Uthaman Moodley, Christine Nguyen, Stephanie Young, Frank Schwenter
BACKGROUND: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Certain abdominopelvic cancer surgeries are associated with a six to 14-fold increased risk of DVT versus surgeries for benign disease, and extended thromboprophylaxis using perioperative LMWHs may further reduce VTE rates over standard duration administration. This review assesses the value of extended low molecular weight heparin (LMWH) thromboprophylaxis as a recommended strategy after abdominopelvic cancer surgery...
December 16, 2018: American Journal of Surgery
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