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Alexander T Hawkins, Molly M Ford, Timothy M Geiger, M Benjamin Hopkins, Lisa A Kachnic, Roberta L Muldoon, Sean C Glasgow
BACKGROUND: Resection of T4 colon cancer remains challenging compared to lower T stages. Data on the effect of neoadjuvant radiation to improve resectability and survival are lacking. The purpose of this study is to describe the use and outcomes of neoadjuvant radiation therapy in clinical T4 colon cancer. METHODS: Adults with clinical evidence of T4 locally advanced colon cancer were included from the National Cancer Database (2004-2014). Bivariate and multivariable analyses were used to examine the association between neoadjuvant radiation therapy and R0 resection rate, multivisceral resection, and overall survival...
July 14, 2018: Surgery
Merin Kuruvilla, Francis Wolf, Marybeth Sexton, Zanthia Wiley, Jamie Thomas
No abstract text is available yet for this article.
July 9, 2018: Surgery
Brian K Yorkgitis, Olubode A Olufajo, Lori A Gurien, Edward Kelly, Ali Salim, Reza Askari
BACKGROUND: Percutaneous endoscopic gastrostomy tubes are a means of providing an alternative enteric route of nutrition. This study sought to identify risk factors for the prolonged need of a percutaneous endoscopic gastronomy tube (≥90 days) in adult trauma patients. METHODS: The trauma database of a level 1 trauma center was queried retrospectively to identify patients who had percutaneous endoscopic gastronomy tubes placed. RESULTS: A total of 9,772 charts were reviewed with 282 patients (2...
July 5, 2018: Surgery
Salvatore Paiella, Matteo De Pastena, Fabio Casciani, Teresa Lucia Pan, Selene Bogoni, Stefano Andrianello, Giovanni Marchegiani, Giuseppe Malleo, Claudio Bassi, Roberto Salvia
BACKGROUND: Chyle leak is an uncommon complication after pancreatic surgery. The chyle leak incidence, definition, diagnosis, and treatment had been reported heterogeneously so far. Recently a consensus definition and grading system was published by the International Study Group for Pancreatic Surgery. This study aims to evaluate the differences in the clinical and economic burden of chyle leak applying the new definition. METHODS: All data from patients who underwent pancreatic surgery for any disease from January 2014 to December 2016 were retrieved from the institutional prospective database...
June 26, 2018: Surgery
Thomas Peponis, Josefine S Baekgaard, Jordan D Bohnen, Kelsey Han, Jarone Lee, Noelle Saillant, Peter Fagenholz, David R King, George C Velmahos, Haytham M A Kaafarani
BACKGROUND: The true incidence of intraoperative adverse events (iAEs) remains unknown. METHODS: All patients undergoing abdominal surgery at an academic institution between January and July 2016 were included in a prospective fashion. At the end of surgery, using a secure REDCap database, the surgeon was given the Institute of Medicine definition of intraoperative adverse events and asked whether an intraoperative adverse event had occurred. Blinded reviewers systematically examined all operative reports for intraoperative adverse events and their severity...
June 23, 2018: Surgery
Jamie N Bakkum-Gamez, William A Cliby
No abstract text is available yet for this article.
June 23, 2018: Surgery
David T Asuzu, Grace F Chao, Kevin Y Pei
BACKGROUND: The number of patients undergoing preoperative risk stratification in the United States is expected to increase as the population ages. A large percentage of patients undergo some form of preoperative testing, and society guidelines suggest that up to 50% of the testing in lower risk surgical subgroups is unnecessary. The Revised Cardiac Risk Index and the risk calculator of the American College of Surgeons National Surgical Quality Improvement Program are widely used tools as the first step of preoperative cardiac evaluation...
June 23, 2018: Surgery
Donald E Fry, Susan M Nedza, Michael Pine, Agnes M Reband, Chun-Jung Huang, Gregory Pine
BACKGROUND: Risk-adjusted outcomes of elective major vascular surgery that is inclusive of inpatient and 90-day post-discharge adverse outcomes together have not been well studied. METHODS: We studied 2012-2014 Medicare inpatients who received open aortic procedures, open peripheral vascular procedures, endovascular aortic procedures, and percutaneous angioplasty procedures of the lower extremity for risk-adjusted adverse outcomes of inpatient deaths, 3-sigma prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day post-discharge associated readmissions after excluding unrelated events...
June 22, 2018: Surgery
Sarah P Shubeck, Arielle E Kanters, Gurjit Sandhu, Caprice C Greenberg, Justin B Dimick
BACKGROUND: Many coaching methods have been well studied and formalized, but the approach most commonly used in the continuing education of surgeons is peer coaching. Through a qualitative thematic analysis, we sought to determine if surgeons can comfortably and effectively transition to a co-learner dynamic for effective peer coaching. METHODS: This qualitative study evaluated 20 surgeons participating in a video review coaching exercise in October 2015. Each conversation was coded by 2 authors focusing on the dynamics of the coach and coachee relationship...
June 19, 2018: Surgery
Yas Sanaiha, Yen-Yi Juo, Esteban Aguayo, Young-Ji Seo, Vishal Dobaria, Boback Ziaeian, Peyman Benharash
INTRODUCTION: Cardiovascular complications are the leading cause of death after noncardiac surgery. Major abdominal operations represent the largest category of procedures considered to have an increased risk of cardiovascular complications. The current aim was to examine trends in the incidence of mortality, perioperative myocardial infarction, and cardiac arrest to determine the presence of potential volume-outcome relationships. METHODS: We performed a retrospective analysis of the Nationwide Inpatient Sample for patients undergoing elective, open abdominal esophagectomy, gastrectomy, pancreatectomy, nephrectomy, hepatectomy, splenectomy, and colectomy (major abdominal surgery) during 2008-2014...
June 18, 2018: Surgery
Martin Smith
No abstract text is available yet for this article.
June 18, 2018: Surgery
Yoon Young Cho, Mi Kyung Kwak, Seung-Eun Lee, Seong Hee Ahn, Hyeonmok Kim, Sunghwan Suh, Beom-Jun Kim, Kee-Ho Song, Jung-Min Koh, Jae Hyeon Kim, Seung Hun Lee
BACKGROUND: Malignant pheochromocytoma and paraganglioma can be defined only after the development of metastases in nonchromaffin tissues. There is no single clinical parameter that is sufficiently reliable to predict metastatic potential, so our goal was to develop a prediction model based on multiple clinical parameters. METHODS: The baseline age, size, extra-adrenal location, secretory type score was calculated in a retrospective cohort study comprising 333 patients with pheochromocytoma and paraganglioma...
June 18, 2018: Surgery
Bernadette J Goudreau, Taryn E Hassinger, Traci L Hedrick, Craig L Slingluff, Anneke T Schroen, Lynn T Dengel
BACKGROUND: Identifying factors that impact progression of surgery trainees into academic versus non-academic practices may permit tailoring residency experiences to promote academic careers in institutions charged with the training of future surgeon scientists. The aim of this study was to identify factors associated with progression of surgery trainees into academic versus non-academic practice. METHODS: A survey was distributed to 135 surgeons graduating from the University of Virginia residency program from 1964-2016, a single academic institution...
June 18, 2018: Surgery
Alexander R Cortez, Gianna D Katsaros, Vikrom K Dhar, F Thurston Drake, Timothy A Pritts, Jeffrey J Sussman, Michael J Edwards, R Cutler Quillin
BACKGROUND: Although overall operative volume has remained stable since the implementation of duty hours, more detailed analyses suggest shifts in the resident operative experience. Understanding these differences allows educators to better appreciate the impact of the current training environment on resident preparation for practice. METHODS: National Accreditation Council for Graduate Medical Education case logs from 1990 to 2016 were reviewed. Statistical analysis was performed using analysis of variance and linear regression analysis...
June 18, 2018: Surgery
Reed G Williams, Brian C George, Jordan D Bohnen, Shari L Meyerson, Mary C Schuller, Andreas H Meier, Laura Torbeck, Samuel P Mandell, John T Mullen, Douglas S Smink, Jeffrey G Chipman, Edward D Auyang, Kyla P Terhune, Paul E Wise, Jennifer Choi, Eugene F Foley, Michael A Choti, Chandrakanth Are, Nathaniel Soper, Joseph B Zwischenberger, Gary L Dunnington, Keith D Lillemoe, Jonathan P Fryer
BACKGROUND: We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality. METHODS: Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous...
June 18, 2018: Surgery
Jessica L Evans, Roberto J Vidri, Dougald C MacGillivray, Timothy L Fitzgerald
BACKGROUND: Tumor mitotic rate is a known prognostic variable in Stage I melanoma; however, its importance is unclear in Stages II and III. METHODS: Patients diagnosed with nonmetastatic cutaneous melanoma from 2010 to 2014 were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. RESULTS: Of a total of 71,235 patients, the majority were white (94.7%), male (58.5%), and had a Stage I tumor (79...
June 18, 2018: Surgery
Oswaldo Renteria, Zain Shahid, Sergio Huerta
BACKGROUND: Some studies indicate that noncomplicated acute appendicitis might be treated exclusively with antibiotics instead of an appendectomy. This study was undertaken to assess outcomes in elderly veterans and to determine if operative intervention would lead to substantial complications such that a nonoperative strategy should be investigated. METHODS: A retrospective, single-institution analysis was conducted of patients who underwent an appendectomy at the VA North Texas Health Care System over a period of 12 years (from July 2005 to June 2017)...
June 16, 2018: Surgery
Giovanni Marchegiani, Giampaolo Perri, Alessandra Pulvirenti, Elisabetta Sereni, Anna Maria Azzini, Giuseppe Malleo, Roberto Salvia, Claudio Bassi
BACKGROUND: Policies concerning the management of operatively placed drains after pancreatic surgery are still under debate. Open passive drains and closed-suction drains are both used currently in clinical practice worldwide, but there are no reliable data regarding potential differences in the postoperative outcomes associated with each drain type. The aim of the present study was to compare open passive drains and closed-suction drains with regard to postoperative contamination of the drainage fluid and overall morbidity and mortality...
June 11, 2018: Surgery
Michael N Mongelli, Benjamin J Peipert, Sneha Goswami, Irene Helenowski, Susan E Yount, Cord Sturgeon
BACKGROUND: Patient-reported outcomes are measured in chronic disease states to inform intervention and management decisions while minimizing negative outcomes. We hypothesized that health-related quality of life in patients with multiple endocrine neoplasia type 2A would be worse than the general US population but similar to other chronic diseases. METHODS: Adults ≥18 years with multiple endocrine neoplasia type 2A were recruited to complete the Patient-Reported Outcomes Measurement Information System 29-item questionnaire (n = 45)...
June 11, 2018: Surgery
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