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Journal of the American College of Surgeons

William C Chapman, Melanie Subramanian, Senthil Jayarajan, Bilal Makhdoom, Matthew G Mutch, Steven Hunt, Matthew L Silviera, Sean Glasgow, Margaret A Olsen, Paul E Wise
BACKGROUND: While 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 (Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project) was queried for patients undergoing sphincter-preserving proctectomy for cancer (2005-2014)...
January 9, 2019: Journal of the American College of Surgeons
Panpan Chang, Aaron M Williams, Umar F Bhatti, Ben E Biesterveld, Baoling Liu, Vahagn C Nikolian, Isabel S Dennahy, Jessica Lee, Yongqing Li, Hasan B Alam
BACKGROUND: A single-dose (150mg/kg) of valproic acid (VPA) has been shown to decrease brain lesion size and improve neurologic recovery in pre-clinical models of traumatic brain injury (TBI). However, the longer-term (30 days) impact of single-dose VPA treatment has not been well evaluated following TBI. STUDY DESIGN: Yorkshire swine were subjected to TBI (cortical impact), hemorrhagic shock, and polytrauma. Animals remained in hypovolemic shock for two hours prior to resuscitation with normal saline (NS, volume = 3x hemorrhaged volume) or NS + VPA (150 mg/kg) (n=5/cohort)...
January 9, 2019: Journal of the American College of Surgeons
Alexander H Shannon, William P Robinson, John B Hanks, John R Potts
BACKGROUND: General surgery (GS) resident vascular surgery (VS) operations significantly declined over the last 15 years. We hypothesized that initiation of vascular surgery 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. STUDY DESIGN: GS-programs were reviewed if associated with VSFPs accredited since 7/1/2002 that had >1 matriculant (n...
January 9, 2019: Journal of the American College of Surgeons
John A Harvin, Charles Green, Claudia Pedroza, Jon E Tyson, Laura J Moore, Charles E Wade, John B Holcomb, Lillian S Kao
BACKGROUND: In a prior 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: 1) PreQI: 1/1/2011-10/31/2013 and 2) PostQI: 11/1/2013-06/30/2016...
January 9, 2019: Journal of the American College of Surgeons
Robin Detering, Sapho X Roodbeen, Stefan E van Oostendorp, Jan-Willem T Dekker, Colin Sietses, Willem A Bemelman, Pieter J Tanis, Roel Hompes, Jurriaan B Tuynman
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). STUDY DESIGN: Patients with rectal cancer who underwent curative TaTME or lapTME were selected from the nationwide and mandatory Dutch ColoRectal Audit (DCRA), between January 2015 and December 2017...
January 8, 2019: Journal of the American College of Surgeons
Ian L Valerio, Gregory A Dumanian, Sumanas W Jordan, Lauren M Mioton, J Byers Bowen, Julie M West, Kyle Porter, Jason H Ko, Jason M Souza, Benjamin K Potter
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. STUDY DESIGN: A multi-institutional cohort study was conducted between 2012 and 2018...
January 8, 2019: Journal of the American College of Surgeons
Jeremy A Warren, Alfredo M Carbonell, Lauren K Jones, Aaron Mcguire, William R Hand, Vito A Cancellaro, Joseph A Ewing, William S Cobb
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. Epidural use was routine for post-operative pain control in this protocol. Recently we have transitioned to transversus abdominis plane (TAP) block instead of epidural analgesia...
January 7, 2019: Journal of the American College of Surgeons
Sharon A Lawrence, Caitlin A McIntyre, Alessandra Pulvirenti, Kenneth Seier, Yuting Chou, Mithat Gonen, Vinod P Balachandran, T Peter Kingham, Michael I D'Angelica, Jeffrey A Drebin, William R Jarnagin, Peter J Allen
INTRODUCTION: Pancreaticoduodenectomy is historically associated with incisional surgical site infection (iSSI) rates between 15-20%. 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 significantly decrease the rate of iSSI. METHODS: An initial cohort of 150 consecutive post-pancreaticoduodenectomy patients were assessed within 2-4 weeks of operation to determine baseline iSSI rates...
January 7, 2019: Journal of the American College of Surgeons
Thomas M Scalea, David V Feliciano, Joseph J DuBose, Marcus Ottochian, James V O'Connor, Jonathan J Morrison
INTRODUCTION: 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. METHODS: The American College of Surgeons National Trauma Databank (2003-2013) was used to identify adults with BTAI. Management was categorized as non-operative (NON-OP), open (OAR) or endovascular repair (TEVAR)...
January 7, 2019: Journal of the American College of Surgeons
Melena D Bellin, Gregory J Beilman, David Er Sutherland, Hawa Ali, Arzu Petersen, Steven Mongin, Varvara Kirchner, Sarah J Schwarzenberg, Guru Trikudanathan, Martin L Freeman, Timothy L Pruett, Srinath Chinnakotla
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. STUDY DESIGN: Of the 742 patients who have undergone a TPIAT at our center, 215 who did so between 1998 and 2008 now have at least 10 years of follow-up time and were eligible for this single-center observational study...
January 7, 2019: Journal of the American College of Surgeons
Florence E Turrentine, Caitlin N Dreisbach, Amanda R St Ivany, John B Hanks, Anneke T Schroen
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. STUDY DESIGN: Recommendation letters for 2016-2017 surgery resident applicants selected for interview at an academic institution were analyzed using qualitative text analysis, quantitative text mining, and topic modeling...
January 7, 2019: Journal of the American College of Surgeons
Jeffrey Rogers, Alan C Farney, Giuseppe Orlando, David Harriman, Amber Reeves-Daniel, Colleen L Jay, William Doares, Scott Kaczmorski, Michael D Gautreaux, Robert J Stratta
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 (DKTs) from adult marginal deceased donors (MDDs) in the context of the Kidney Donor Profile index (KDPI). STUDY DESIGN: Single center retrospective review. Recipient selection included primary transplant, low BMI, low immunologic risk, and informed consent. All patients received antibody induction with FK/MPA/± prednisone...
January 7, 2019: Journal of the American College of Surgeons
Zhan Li, JoAnn Coleman, Christopher R D'Adamo, Joshua Wolf, Mark Katlic, Nita Ahuja, David Blumberg, Vanita Ahuja
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). The prognostic value of the risk calculator was evaluated using the predicted mortality variable code...
January 7, 2019: Journal of the American College of Surgeons
Thomas J Birdas, Grace F Rozycki, Gary L Dunnington, Larry Stevens, Vanessa Liali, C Max Schmidt
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 in order to engage surgeons in collaborative quality improvement. Its key features were the development of a comprehensive Department Quality Dashboard and the creation of a Clinical Operations Council that oversaw quality. The purpose of this study was to assess the impact of those efforts...
January 6, 2019: Journal of the American College of Surgeons
Sandra R DiBrito, Carla M Lopez, Christian Jones, Aarti Mathur
No abstract text is available yet for this article.
January 3, 2019: Journal of the American College of Surgeons
Jack P Silva, Megan N Maurina, Susan Tsai, Kathleen Christians, Callisia N Clarke, Harveshp Mogal, Kia Saeian, T Clark Gamblin
BACKGROUND: Liver transplantation (LT) is the preferred treatment for early hepatocellular carcinoma (HCC) in select patients. Differences in outcomes following LT has 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 following liver transplantation for HCC in African American patients (AA). STUDY DESIGN: Adult AA patients with HCC undergoing liver transplantation were identified using the Organ Procurement and Transplantation Network database (1994-2015)...
January 2, 2019: Journal of the American College of Surgeons
Justin A Steggerda, Irene K Kim, Tsuyoshi Todo, Darren Malinoski, Andrew S Klein, Matthew B Bloom
BACKGROUND: The Share 35 policy for liver allocation prioritizes patients with MELD scores ≥35 for regional sharing of liver allografts. To better assess donor-recipient interactions and inform expectations, this study identifies factors affecting graft survival independent of MELD score and derives a risk index for transplantation in the MELD ≥35 population. STUDY DESIGN: The UNOS STAR database was evaluated for deceased donor liver transplants with recipients' MELD ≥35 between January 2006 and June 2016...
December 27, 2018: Journal of the American College of Surgeons
Dimitrios Xourafas, Aslam Ejaz, Allan Tsung, Mary Dillhoff, Timothy M Pawlik, Jordan M Cloyd
BACKGROUND: Recent studies on postoperative pancreatic fistula (POPF) prevention suggest that omission of perioperative drains is safe for negligible- or low-risk patients undergoing pancreatoduodenectomy (PD). However, this proposed pathway has not been validated in a nationwide cohort. STUDY DESIGN: The ACS-NSQIP targeted pancreatectomy database from 2014-2016 was queried to identify patients who underwent PD. Using a previously validated modified fistula risk score (mFRS), patients were stratified as negligible/low- or intermediate/high-risk...
December 23, 2018: Journal of the American College of Surgeons
Chad Hall, Justin Regner, Stephen Abernathy, Claire Sbell, Travis Isbell, Stan Kurek, Randall Smith, Richard Frazee
BACKGROUND: We hypothesized that the universal adoption of closed wounds with negative pressure wound therapy (NPWT) in emergency general surgery patients would result in low superficial surgical infection (SSI) rates. STUDY DESIGN: A retrospective observational study utilizing primary wound closure with external NPWT from May 2017 to May 2018 was performed. Patients with active soft tissue infection of the abdominal wall were excluded. Data were analyzed by Fisher's exact tests and Wilcoxon-Mann-Whitney tests with significance is set at p- value<0...
December 23, 2018: Journal of the American College of Surgeons
Robert M Cannon, Christopher M Jones, Eric G Davis, Devin E Eckhoff
BACKGROUND: Simultaneous liver-kidney transplantation(SLK) is lifesaving; however, the utility of allocating two organs to a single recipient remains controversial, particularly in the face of potentially inferior survival. This study aims to determine the effect of renal indication for transplant on SLK outcomes. METHODS: All adult recipients of combined whole liver-kidney transplant in the UNOS database from 2003-2016 with a renal diagnosis of hypertension(HTN), diabetes(DM), acute tubular necrosis(ATN), or hepatorenal syndrome(HRS) were examined...
December 23, 2018: Journal of the American College of Surgeons
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