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Journal of the American College of Surgeons

Edward A Levine, Konstantinos I Votanopoulos, Perry Shen, Greg Russell, Joyce Fenstermaker, Paul Mansfield, David Bartlett, John H Stewart
BACKGROUND: Appendiceal cancer is a rare disease, which has proven difficult to study in prospective trials. Cytoreductive surgery with HIPEC is an established therapy for peritoneal dissemination from appendiceal cancer. The optimal chemotherapeutic agent to use in the HIPEC is not clear. Mitomycin has long been the utilized, however our previous phase I experience, and European retrospective studies suggest oxaliplatin as an alternative. Therefore, we initiated a multicenter randomized trial to compare mitomycin to oxaliplatin HIPEC for appendiceal cancer...
January 10, 2018: Journal of the American College of Surgeons
Kyle J Kalkwarf, Shane D Jensen, Myron Allukian, Matthew T Harting, Charles S Cox, Erin E Fox, Charles E Wade, Bryan A Cotton
BACKGROUND: Objective parameters predicting futility of care in severely injured pediatric patients are lacking. While futility of care has been investigated in a limited number of studies in trauma patients, none of these studies achieves a 100% success rate in a large cohort of pediatric patients. The purpose of the current study was to identify extreme laboratory values that could be used to predict 100% mortality in severely injured children. STUDY DESIGN: Registry-based, historical cohort of all severely injured children (level 1 trauma, <16 years old), who were not dead on arrival, between January 2010 and December 2016 from a single level 1 trauma center...
January 8, 2018: Journal of the American College of Surgeons
Jessica M Hasak, Carrie L Roth Bettlach, Katherine B Santosa, Ellen L Larson, Jean Stroud, Susan E Mackinnon
BACKGROUND: Our country is in the midst of an opioid epidemic. Although the problem is multifactorial, one issue is the presence of excess prescription opioid medications circulating in our communities. Our objective was to determine whether dissemination of an educational brochure would improve the disposal of unused opioids after surgery. STUDY DESIGN: Eligible surgery patients from an upper extremity/peripheral nerve clinic were enrolled into this prospective before and after study between February 2017 and September 2017...
January 5, 2018: Journal of the American College of Surgeons
Marty T Sellers, H Scott McGinnis, Melissa Alperin, John F Sweeney, Thomas F Dodson
BACKGROUND: Though successful on many fronts, solid organ transplantation fails patients that die on waitlists. Too few organ donors beget this failure. Dispelling misperceptions associated with donation and transplantation wound expectedly increase donation and decrease waitlist mortality; recipients would also be transplanted earlier in their disease process, leading to better post-transplant outcomes. STUDY DESIGN: Survey responses to seven questions pertaining to organ donation and transplantation were analyzed to determine their association with willingness to donate...
January 5, 2018: Journal of the American College of Surgeons
Alex B Blair, Vincent P Groot, Georgios Gemenetzis, Jishu Wei, John L Cameron, Matthew J Weiss, Michael Goggins, Christopher L Wolfgang, Jun Yu, Jin He
BACKGROUND: The outcomes of sporadic pancreatic adenocarcinoma (PDAC) patients with germline mutations of BRCA1/BRCA2 remains unclear. The prognostic significance of BRCA1/BRCA2 mutations on survival is not well established. STUDY DESIGN: We performed targeted next-generation sequencing (NGS) to identify BRCA1/BRCA2 germline mutations in resected sporadic PDAC cases from 2000-2015. Germline BRCA mutation-carriers were matched by age and tumor location to those with BRCA1/BRCA2 wild-type genes from our institutional database...
January 5, 2018: Journal of the American College of Surgeons
Margaux N Mustian, Robert M Cannon, Paul A MacLennan, Rhiannon D Reed, Brittany A Shelton, Deanna M McWilliams, Mark H Deierhoi, Jayme E Locke
BACKGROUND: Widespread implementation of ABO incompatible (ABOi) living donor kidney transplantation (LDKT) has been proposed as a means to partially ameliorate the national shortage of deceased donor kidneys. The acceptance of this practice has been encouraged by reports from experienced centers demonstrating acute rejection (AR) rates similar to those obtained with ABO compatible (ABOc) LDKT. AR rate and graft survival following ABOi LDKT on a national level have yet to be fully determined...
January 5, 2018: Journal of the American College of Surgeons
James N Fleming, David J Taber, Nicole A Pilch, Caitlin R Mardis, Rachael E Gilbert, Lytani Z Wilson, Neha Patel, Sarah Ball, Patrick Mauldin, Prabhakar K Baliga
BACKGROUND: Up to 77% of liver transplant candidates experience pain, with the majority prescribed opioids. Previous studies have shown increased readmissions and mortality in liver transplant recipients who were prescribed opioids prior to transplant. Our aim was to identify specific populations that are at the highest risk of deleterious outcomes with opioid use prior to transplant. STUDY DESIGN: This was a single-center retrospective cohort study of adult liver transplant recipients transplanted between 2010 and 2016 to assess the impact of pre-transplant opioid use on mortality and graft loss following liver transplantation...
January 5, 2018: Journal of the American College of Surgeons
Mark E Cohen, Yaoming Liu, Jason Liu, Clifford Y Ko, Bruce L Hall
BACKGROUND: American College of Surgeons (ACS) NSQIP risk-adjustment models rely on the designated "principal" Common Procedural Terminology (CPT®) code to account for procedure-related risk. However, if hospitals differ in their propensity to undertake multiple major operations under the same anesthetic, then risk adjustment using only a single code could bias hospital quality estimates. This study investigated this possibility for bias. STUDY DESIGN: We examined hospital odds ratios (ORs) when either the principal CPT code was used for risk adjustment (along with other standard NSQIP predictor variables) or when this code was used in addition to the remaining reported CPT code with the highest associated risk...
January 5, 2018: Journal of the American College of Surgeons
Arinbjorn Jonsson, Edward Lin, Lava Patel, Ankit D Patel, Jamil L Stetler, Heather Prayor-Patterson, Arvinpal Singh, Jahnavi K Srinivasan, John F Sweeney, S Scott Davis
BACKGROUND: Enhanced recovery (ERAS) protocols lead to expedited discharges and decreased cost. Bariatric centers have adopted such programs for safely discharging patients after sleeve gastrectomy (LSG) on the first postoperative day (POD1). Despite pathways, some bariatric patients cannot be discharged on POD1. METHODS: Retrospective review of patients undergoing LSG, between 2013 through 2016, in a center of excellence utilizing a standardized enhanced recovery pathway...
January 5, 2018: Journal of the American College of Surgeons
Darren R Cullinan, Paul E Wise, Keith A Delman, John R Potts, Michael M Awad, Timothy J Eberlein, Mary E Klingensmith
BACKGROUND: The Flexibility in Surgical Training (FIST) consortium project was designed to evaluate the feasibility and resident outcomes of optional subspecialty-focused training within general surgery residency training. STUDY DESIGN: Following approval by the American Board of Surgery, R4 and R5 residents were permitted to customize up to 12 of the final 24 months of residency for early tracking into one of nine subspecialty tracks. A prospective IRB-approved study was designed across seven institutions to evaluate the impact of this option on operative experience, in-service exam (ABSITE) and ACGME milestone performance, and resident and program director (PD) perceptions...
January 5, 2018: Journal of the American College of Surgeons
Nicholas L Bandy, Rebecca C Britt, Sarah C DeShields, Tina D Cunningham, L D Britt
BACKGROUND: The Acute Care Surgery (ACS) model has been widely implemented, with single institution studies demonstrating improved outcomes but multi-center studies questioning the efficiency. ACS programs care for sicker and more economically disadvantaged patients. This study compares outcomes between ACS and traditional models in the management of diverticulitis across an entire state. STUDY DESIGN: The Virginia Health Information administrative database for adults discharged with diverticulitis from January 2008 through September 2015 was reviewed...
January 4, 2018: Journal of the American College of Surgeons
Zhi Ven Fong, Henry A Pitt, Steven M Strasberg, Andrew P Loehrer, Jason K Sicklick, Mark A Talamini, Keith D Lillemoe, David C Chang
BACKGROUND: The increased incidence of bile duct injuries (BDI) following the adoption of laparoscopic cholecystectomy has been well documented. However, the longitudinal impact of bile leaks and BDIs on survival and health care utilization have not been adequately studied. The aims of this analysis were to determine the incidence, long-term outcomes and costs of bile leaks and ductal injuries in a large population. STUDY DESIGN: The California Office of Statewide Health Planning and Development database was queried from 2005-14...
January 4, 2018: Journal of the American College of Surgeons
Sherif Saleh, Margaret A Plymale, Daniel L Davenport, John Scott Roth
BACKGROUND: Ventral hernia repair (VHR) is associated with complications that significantly increase healthcare costs. This study explores the associations between hospital costs for VHR and surgical complication risk-assessment scores, need for cardiac or pulmonary evaluation, and smoking or obesity counseling. STUDY DESIGN: An IRB-approved retrospective study of patients having undergone open VHR over 3 years was performed. Ventral Hernia Risk Score (VHRS) for surgical site occurrence (SSO) and surgical site infection (SSI), and the Ventral Hernia Working Group (VHWG) grade were calculated for each case...
January 4, 2018: Journal of the American College of Surgeons
Taylor S Riall, Joshua Teiman, Michelle Chang, Denzel Cole, Tambre Leighn, Hilary McClafferty, Valentine N Nfonsam
BACKGROUND: There have been few programs designed to improve surgical resident wellbeing and such efforts often lack formal evaluation. STUDY DESIGN: General Surgery residents participated in the Energy Leadership Wellbeing and Resiliency Program. They were assessed at baseline and one year after implementation using the Energy Leadership Index (ELI, measures emotional intelligence), Maslach Burnout Inventory (MBI) General Survey, Perceived Stress Scale (PSS), the Beck Depression Inventory (BDI), and the annual required ACGME resident survey...
December 28, 2017: Journal of the American College of Surgeons
Katherine A Morgan, William P Lancaster, Stefanie M Owczarski, Hongjun Wang, Jeffrey Borckardt, David B Adams
BACKGROUND: Best practice to select patients with chronic pancreatitis for surgical management with total pancreatectomy with islet autotransplantation (TPIAT) is in evolution as new discoveries are made in the pathogenesis of chronic pancreatitis. METHODS: A prospectively maintained database of patients undergoing TPIAT is reviewed. Islet function is inferred from daily insulin requirement. Pain relief is evaluated by healthcare utilization and narcotic use. Quality of life (QOL) is measured with SF-12...
December 28, 2017: Journal of the American College of Surgeons
Yanghee Woo, Bryan Goldner, Taeil Son, Kijun Song, Yuman Fong, Woo Jin Hyung
BACKGROUND: A novel prediction model for accurate determination of 5-year overall survival of gastric cancer patients was developed by an international collaborative group (G6+). This prediction model was created using a single institution's database of 11,851 Korean patients and included readily available and clinically relevant factors. Already validated using external East Asian cohorts; its' applicability in the American population was yet to be determined. STUDY DESIGN: Using the SEER dataset, 2014 release, all patients diagnosed with gastric adenocarcinoma who underwent surgical resection between 2002 and 2012 were selected...
December 22, 2017: Journal of the American College of Surgeons
Kazunari Sasaki, Georgios A Margonis, Nikolaos Andreatos, Fabio Bagante, Matthew Weiss, Carlotta Barbon, Irinel Popescu, Hugo P Marques, Luca Aldrighetti, Shishir K Maithel, Carlo Pulitano, Todd W Bauer, Feng Shen, George A Poultsides, Oliver Soubrane, Guillaume Martel, B Groot Koerkamp, Alfredo Guglielmi, Endo Itaru, Federico N Aucejo, Timothy M Pawlik
BACKGROUND: Accurate prediction of prognosis for patients with intrahepatic cholangiocarcinoma(ICC) remains a challenge. We sought to define a preoperative risk tool to predict long-term survival following resection of ICC. METHODS: Patients who underwent hepatectomy for ICC at one of 16 major hepatobilliary centers between 1990-2015 were identified. Clinico-pathological data were analyzed and a prognostic model was developed based on the regression beta-coefficients on data in training set...
December 21, 2017: Journal of the American College of Surgeons
Richard Frazee, Anthony Manning, Stephen Abernathy, Claire Isbell, Travis Isbell, Stanley Kurek, Justin Regner, Randall Smith, Harry Papaconstantinou
BACKGROUND: A new proprietary negative pressure wound device has been developed to apply negative pressure therapy to closed wounds (Closed-NPWT). We postulated that Closed-NPWT management of contaminated and dirty wounds would lead to faster wound healing and no significant difference in wound complications. STUDY DESIGN: An IRB approved, prospective randomized trial was performed. Patients were consented preoperatively, but not entered nor assigned treatment until intraoperative findings were known...
December 21, 2017: Journal of the American College of Surgeons
Deepa V Cherla, Oscar A Olavarria, Karla Bernardi, Cristina P Viso, Maya L Moses, Julie L Holihan, Tien C Ko, Lillian S Kao, Mike K Liang
BACKGROUND: Discordance exists between author self-disclosure and the Open Payments Database in various surgical fields but the effects of this discordance on study design and presentation are unknown. We hypothesized that among ventral hernia publications, 1) discordance exists between industry and physician self-reported conflicts of interest (COI), 2) authors disclose relevant COI, and 3) disclosure and relevant COI affect study favorability. STUDY DESIGN: Double-blinded, prospective, observational study of published manuscripts...
December 21, 2017: Journal of the American College of Surgeons
Pichamol Jirapinyo, Andrew C Thompson, Paul T Kröner, Walter W Chan, Christopher C Thompson
BACKGROUND: Type 2 diabetes mellitus (T2DM) resolves in over 80% of patients after Roux-en-Y gastric bypass (RYGB). It has been hypothesized that foregut exclusion is mechanistically important to this observation. This study aims (1) to determine if GG fistula, with a loss of foregut exclusion, is associated with T2DM relapse, and (2) to assess if closure of GG fistula is associated with T2DM resolution. STUDY DESIGN: A matched cohort study of patients who experienced T2DM remission after RYGB...
December 21, 2017: Journal of the American College of Surgeons
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