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Raval surgery

Kurt F Heiss, Mehul V Raval
For over 20 years enhanced recovery protocols (ERPs) have been used to decrease the physiologic stress and inflammation of surgery using evidence-based principles. ERPs include optimizing patient preparation, creating less trauma using minimally invasive anesthetic and surgical techniques, and regular audit of outcomes. A critical aspect of ERPs is patient engagement in all phases of care, which facilitates effective team function and focused oversight of patient flow through the system. Counseling extends beyond traditional review of surgical risks and benefits, by creating clear daily patient goals, establishing pain management plans, optimizing nutrition, and defining criteria for discharge...
April 2018: Seminars in Pediatric Surgery
Laura L Stafman, Ilan I Maizlin, Matthew Dellinger, Kenneth W Gow, Melanie Goldfarb, Jed G Nuchtern, Monica Langer, Sanjeev A Vasudevan, John J Doski, Adam B Goldin, Mehul Raval, Elizabeth A Beierle
BACKGROUND: In many cancers, racial and socioeconomic disparities exist regarding the extent of surgery. For ovarian dysgerminoma, fertility-sparing (FS) surgery is recommended whenever possible. The aim of this study was to investigate rates of FS versus non-fertility-sparing (NFS) procedures for stage I ovarian dysgerminoma in adolescents and young adults (AYAs) by ethnicity/race and socioeconomic status. MATERIALS AND METHODS: The National Cancer Data Base was queried for patients with ovarian dysgerminoma from 1998 to 2012...
April 2018: Journal of Surgical Research
Katherine J Baxter, Bonnie F Gale, Curtis D Travers, Kurt F Heiss, Mehul V Raval
BACKGROUND: The American College of Surgeons in 2015 instituted the Children's Surgery Verification (CSV) program delineating requirements for hospitals providing pediatric surgical care. Our purpose was to examine possible effects of the CSV program by evaluating neonates undergoing high-risk operations. STUDY DESIGN: Using the Kid's Inpatient Database 2009, we identified infants undergoing surgery for five high risk neonatal conditions. We considered all children's hospitals and children's units Level I centers and considered all others Level II/III...
February 16, 2018: Journal of the American College of Surgeons
Amandeep Ghuman, Naomi Kasteel, Ahmer A Karimuddin, Carl J Brown, Manoj J Raval, P Terry Phang
BACKGROUND: High urinary infection (UTI) rate (12%) for our rectal surgery prompted practice change to early catheter removal (postoperative day 2) and prophylactic tamsulosin. Here we report urinary retention (UR) and UTI after this change. METHODS: Retrospective cohort study in male patients 50+ years undergoing elective colorectal surgery from July 2015 to July 2017. Multivariate regression was used to determine risk factors for urinary retention. RESULTS: 157 patients, 57 without and 100 with tamsulosin had UR 11...
January 29, 2018: American Journal of Surgery
Linda Wang, Xiaodong Wang, Ada Lo, Manoj Raval, Carl Brown, Ahmer Karimuddin, P Terry Phang
Pre-operative radiotherapy (PRT) and total mesorectal excision surgery (TME) for rectal cancer yield the lowest risk for local recurrence. However, both treatments negatively impact quality of life (QOL). To understand individual treatment effects, we ask whether PRT affects function and quality of life before TME. Function and QOL were prospectively assessed in 26 patients using EORTC QLQ-C30/-CR38, and Wexner scale at three time points: before PRT, 6 weeks after PRT and before TME, and one year after stoma closure...
January 31, 2018: American Journal of Surgery
Heather L Short, Samir Sarda, Curtis Travers, Jason M Hockenberry, Ian McCarthy, Mehul V Raval
PURPOSE: Though growth in children's surgical expenditures has been documented, procedure-specific differences in volume and costs at children's hospitals (CH) and non-hildren's hospitals (NCH) have not been explored. Our purpose was to compare trends in volume and costs of common pediatric surgical procedures between CH and NCH. METHODS: We performed a review of the 2000-2009 Kids' Inpatient Database identifying all cases of appendectomy for uncomplicated appendicitis (AP), tonsillectomy and adenoidectomy (TA), fundoplication (FP), humeral fracture repair (HFR), pyloromyotomy (PYL), and cholecystectomy (CHOLE)...
November 23, 2017: Journal of Pediatric Surgery
Heather L Short, Natalie Taylor, Kaitlin Piper, Mehul V Raval
PURPOSE: Despite Enhanced Recovery After Surgery (ERAS) protocols demonstrating improved outcomes in a wide variety of adult surgical populations, these protocols are infrequently and inconsistently being used in pediatric surgery. Our purpose was to develop a pediatric-specific ERAS protocol for use in adolescents undergoing elective intestinal procedures. METHODS: A modified Delphi process including extensive literature review, iterative rounds of surveys, and expert panel discussions was used to establish ERAS elements that would be appropriate for children...
September 23, 2017: Journal of Pediatric Surgery
L V Bownes, L L Stafman, I I Maizlin, M Dellinger, K W Gow, A B Goldin, M Goldfarb, M Langer, M V Raval, J J Doski, J G Nuchtern, S A Vasudevan, E A Beierle
BACKGROUND: Malignant ovarian germ cell tumors (MOGCTs) are a rare form of ovarian malignancy. Socioeconomic status (SES) has been shown to affect survival in several gynecologic cancers. We examined whether SES impacted survival in adolescent and young adults (AYAs) with MOGCT. MATERIALS AND METHODS: The National Cancer Data Base was used to identify AYAs (aged 15-39 years) with MOGCT from 1998 to 2012. Three SES surrogate variables identified were as follows: insurance type, income quartile, and education quartile...
October 5, 2017: Journal of Surgical Research
François Letarte, Mitch Webb, Manoj Raval, Ahmer Karimuddin, Carl J Brown, P Terry Phang
BACKGROUND: Because small colonic tumours may not be visualized or palpated during laparoscopy, location of the lesion must be identified before surgery. The aim of this study was to evaluate the effectiveness of the current recommendation of endoscopic tattooing of lesions prior to laparoscopic colonic resections. METHODS: All consecutive patients who underwent elective laparoscopic resection for a colonic lesion at a single tertiary institution between 2013 and 2015 were identified for chart review...
December 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Heather L Short, Nikolay P Braykov, James E Bost, Mehul V Raval
BACKGROUND: Despite the availability of objective tests, gastroesophageal reflux disease (GERD) diagnosis and management in infants remains controversial and highly variable. Our purpose was to characterize national variation in diagnostic testing and surgical utilization for infants with GERD. METHODS: Using the Pediatric Health Information System, we identified infants <1 year old diagnosed with GERD between January 2011 and March 2015. Outcomes included progression to antireflux surgery (ARS) and use of relevant diagnostic testing...
July 28, 2017: Pediatrics
Jimmy Toussaint, Chirag Bharavi Raval, Tieuvi Nguyen, Hadi Fadaifard, Shripad Joshi, George Wolberg, Steven Quarfordt, Kung-Ming Jan, David S Rumschitzki
Numerous studies have examined the role of aquaporins in osmotic water transport in various systems, but virtually none have focused on the role of aquaporin in hydrostatically driven water transport involving mammalian cells save for our laboratory's recent study of aortic endothelial cells. Here, we investigated aquaporin-1 expression and function in the aortic endothelium in two high-renin rat models of hypertension, the spontaneously hypertensive genetically altered Wistar-Kyoto rat variant and Sprague-Dawley rats made hypertensive by two-kidney, one-clip Goldblatt surgery...
November 1, 2017: American Journal of Physiology. Heart and Circulatory Physiology
Sarah B Cairo, Mehul V Raval, Marybeth Browne, Holly Meyers, David H Rothstein
Importance: Appendectomy is the most common abdominal operation performed in pediatric patients in the United States. Studies in adults have suggested that same-day discharge (SDD) after appendectomy is safe and does not result in higher-than-expected hospital readmissions. Objective: To evaluate the influence of SDD on 30-day readmission rates following appendectomy for acute appendicitis in pediatric patients. Design, Setting, and Participants: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database to evaluate 30-day readmission rates among pediatric patients who underwent an appendectomy for acute, nonperforated appendicitis...
December 1, 2017: JAMA Surgery
Heather L Short, Natalie Taylor, Mitali Thakore, Kaitlin Piper, Katherine Baxter, Kurt F Heiss, Mehul V Raval
PURPOSE: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve outcomes in adult abdominal surgical populations. Our purpose was to survey pediatric surgeons' opinions regarding applicability of individual ERAS elements to children's surgery. METHODS: A survey of the American Pediatric Surgical Association was conducted electronically. Using a 5-point Likert scale, respondents rated their willingness to implement 21 adult ERAS elements in an adolescent undergoing elective colorectal surgery...
June 17, 2017: Journal of Pediatric Surgery
Heather L Short, Wanzhe Zhu, Courtney McCracken, Curtis Travers, Lance A Waller, Mehul V Raval
BACKGROUND: There is significant variation surrounding the indications, surgical approaches, and outcomes for children undergoing antireflux procedures (ARPs) resulting in geographic variation of care. Our purpose was to quantify this geographic variation in the utilization of ARPs in children. METHODS: A cross-sectional analysis of the 2009 Kid's Inpatient Database was performed to identify patients with gastroesophageal reflux disease or associated diagnoses. Regional surgical utilization rates were determined, and a mixed effects model was used to identify factors associated with the use of ARPs...
June 15, 2017: Journal of Surgical Research
Vikas Aneja, Rushik Raval, Parul Aneja, K K Rai, Sumit Agarwal, Satyapal Chuadhary
BACKGROUND: Condylar resorption as a cause of relapse after orthognathic surgery is well known. Several authors have presented evidence of the relation between orthognathic surgery and condylar remodeling and resorption. This study was done to appraise the condylar changes along with the form and function following orthognathic surgery, as well as to assess what factors may have contributed to the problems. METHODOLOGY: A diagnosis of progressive condylar resorption (PCR) was made by comparison of preoperative and postoperative radiographs (cephalometric radiograms), as well as clinical evaluations...
January 2017: Nigerian Journal of Surgery: Official Publication of the Nigerian Surgical Research Society
Heather L Short, Kurt F Heiss, Katelyn Burch, Curtis Travers, John Edney, Claudia Venable, Mehul V Raval
PURPOSE: Enhanced recovery protocols (ERPs) have been shown to improve outcomes in adult surgical populations. Our purpose was to compare outcomes before and after implementation of an ERP in children undergoing elective colorectal surgery. METHODS: A pediatric-specific colorectal ERP was developed and implemented at a single center starting in January 2015. A retrospective review was performed including 43 patients in the pre-ERP period (2012-2014) and 36 patients in the post-ERP period (2015-2016)...
May 12, 2017: Journal of Pediatric Surgery
Eric W Etchill, Sara P Myers, Lauren M McDaniel, Matthew R Rosengart, Jay S Raval, Darrell J Triulzi, Andrew B Peitzman, Jason L Sperry, Matthew D Neal
OBJECTIVES: Although balanced resuscitation has become integrated into massive transfusion practice, there is a paucity of evidence supporting the delivery of high ratios of plasma and platelet to RBCs in the nontrauma setting. This study investigated the administration of blood component ratios in the massively transfused nontrauma demographic. DESIGN: Retrospective analysis of a prospective, observational cohort of massively bleeding patients. SETTING: Surgical and critically ill patients at a tertiary medical center between 2011 and 2015...
August 2017: Critical Care Medicine
Christopher L Sudduth, Julia K Shinnick, Zhi Geng, Courtney E McCracken, Matthew S Clifton, Mehul V Raval
BACKGROUND: Numerous thoracoscopic techniques have been used in the management of primary spontaneous pneumothorax (PSP), including wedge resection, pleurectomy, pleural abrasion, chemical pleurodesis, and staple line covering. The purpose of this systematic review was to compare outcomes for the most commonly reported techniques. MATERIALS AND METHODS: A systematic literature search looking at pneumothorax recurrence rate, length of stay, and chest tube duration after surgery was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed database...
April 2017: Journal of Surgical Research
Catherine Tsai, Cameron Hague, Wei Xiong, Manoj Raval, Ahmer Karimuddin, Carl Brown, P Terry Phang
ERUS and MRI are used for preoperative imaging of rectal cancer. Here, we compare ERUS and MRI for accuracy of CRM prediction at mid- and distal rectal locations. In retrospective review, 20 rectal cancer patients having TME surgery had both ERUS and MRI preoperatively: 8 mid rectum and 12 in distal rectum. Predicted CRM by ERUS and MRI were compared to TME pathology. Overall, predicted CRM was 6.5 ± 3.6 mm by ERUS, 7.7 ± 5.0 mm by MRI, and 6.0 ± 4.6 mm by pathology. Overall, correlation coefficients to pathology were 0...
May 2017: American Journal of Surgery
Heather L Short, Helene B Fevrier, Jonathan A Meisel, Matthew T Santore, Kurt F Heiss, Mark L Wulkan, Mehul V Raval
INTRODUCTION: Prolonged operative time (OT) is considered a reflection of procedural complexity and may be associated with poor outcomes. Our purpose was to explore the association between prolonged OT and complications in children's surgery. METHODS: 182,857 cases from the 2012-2014 NSQIP-Pediatric were organized into 33 groups. OT for each group was analyzed by quartile, and regression models were used to determine the relationship between prolonged OT and complications...
March 20, 2017: Journal of Pediatric Surgery
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