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Publisher: Elsevier   (Total: 3184 journals)

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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 39, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 6)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 435, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 308, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 183, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 29, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 65, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 24)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 18)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 421, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 53, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 383, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 473, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 7, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 63, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 46, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 249, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 66, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 24, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 210, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 221, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Surgery
Journal Prestige (SJR): 1.141
Citation Impact (citeScore): 2
Number of Followers: 39  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9610
Published by Elsevier Homepage  [3184 journals]
  • Laparoscopic Omental Patch for Perforated Peptic Ulcer Disease Reduces
           Length of Stay and Complications, Compared to Open Surgery: a SWSC
           Multicenter Study
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of SurgeryAuthor(s): Adel Alhaj Saleh, Esteban C. Esquivel, John T. Lung, Barbara C. Eaton, Brandon R. Bruns, Galinos Barmparas, Daniel R. Margulies, Alexander Raines, Cressilee Bryant, Christopher E. Crane, Elizabeth P. Scherer, Thomas J. Schroeppel, Eliza Moskowitz, Justin Regner, Richard Frazee, Eric M. Campion, Matthew Bartley, Jared Mortus, Jeremy Ward, Mhd Hasan AlmekdashAbstract:RCTs showed benefits in Lap repair of perforated peptic ulcer (PPU).The SWSC Multi-Center Trials Group sought to evaluate whether Lap omental patch repairs compared to Open improved outcomes in PPU in general practice.Data was collected from 9 SWSC Trial Group centers. Demographics, operative time, 30-day complications, length of stay and mortality were included.461 patientsOpen in 311(67%) patients, Lap in 132(28%) with 20(5%) patients converted from Lap to Open. Groups were similar at baseline. Significant variability was found between centers in their utilization of Lap (0 – 67%).Complications at 30 days were lower in Lap (18.5% vs. 27.5%, p
       
  • It’s sooner than you think: blunt solid organ injury patients are
           already hypercoagulable upon hospital admission - results of a
           bi-institutional, prospective study
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Julia R. Coleman, Annika B. Kay, Ernest E. Moore, Hunter B. Moore, Eduardo Gonzalez, Sarah Majercik, Mitchell J. Cohen, Thomas White, Fredric M. PieracciAbstractIntroductionThe optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 hours of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC).Material and methodsThis is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers’ trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents.ResultsOn ICU admission, all patients (n=95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 hours and higher clot strength at 48 hours.ConclusionsBSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG.
       
  • Single versus double experimental bile duct ligation model for inducing
           bacterial translocation
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): J.M. Seguí-Ripoll, P. Zapater-Hernández, A. Candela-Gomis, L. Compañ-Catalá, R. Francés-Guarinos, A. Payá-Romá, A. Compañ-Rosique, J. Such-RondaAbstractBackgroundDouble common bile duct ligation plus section in rats is used as a model for bacterial translocation, a phenomenon that has been correlated with the degree of liver damage. This study analyzes whether a simpler variant of the technique is also a valid model to study bacterial translocation.MethodsFifty-six male Sprague Dawley rats underwent one of three surgical interventions: a) proximal double ligation and section of the common bile duct; b) proximal simple ligation of the bile duct; and c) sham operation. Bacterial translocation was measured by cultures of mesenteric lymph nodes, blood, spleen and liver. Stool culture and histological analysis of liver damage were also performed.ResultsThe incidence of bacterial translocation in SBL and DBDL groups was 23,5% and 25% respectively. Mortality was similar between ligation groups (11.2% versus 10%). Liver cirrhosis developed in the group of double ligation and section (100% of the animals at 4 weeks), while portal hypertension appeared starting at week 3. None of the animals submitted to simple ligation developed liver cirrhosis.ConclusionsSimple bile duct ligation is associated with a similar incidence of bacterial translocation as double ligation, but without cirrhosis or portal hypertension.
       
  • An evaluation of blood product utilization rates with massive transfusion
           protocol: Before and after thromboelastography (TEG) use in trauma
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Mitchell Unruh, Jared Reyes, Stephen D. Helmer, James M. HaanAbstractPurposeThe purpose of this study was to determine if thromboelastography (TEG) is associated with reduced blood product utilization for trauma patients undergoing massive transfusion protocol (MTP) compared to traditional coagulation tests.MethodsA retrospective review was conducted on an intent-to-treat basis of trauma patients undergoing MTP (Pre-TEG=Period I vs. Post-TEG=Period II). Traditional coagulation tests guided transfusion during Period I (n=20) and the intent was that TEG guided transfusions during Period II (n=47). Blood product administration and outcomes were compared.ResultsIntent-to-treat analysis demonstrated a significant reduction in red blood cell transfusions (11 vs. 6 units, P=0.001), number of patients receiving fresh frozen plasma (85.0 vs. 17.0%, P
       
  • Trauma Video Review Utilization: A Survey of Practice in the United States
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Dumas RP, M.A. Vella, JS Hatchimonji, L Ma, Maher Z, D.N. HolenaAbstract:IntroductionTrauma video review (TVR) for quality improvement and education in the United States has been described for nearly three decades. The most recent information on this practice indicated a declining prevalence. We hypothesized that TVR utilization has increased since most recent estimates.MethodsWe conducted a survey of TVR practices at level I and level II US trauma centers. We distributed an electronic survey covering past, current, and future TVR utilization to the Eastern Association for the Surgery of Trauma membership.Results45.0% of US level I and level II trauma centers completed surveys. 71/249 centers (28.5%) had active TVR programs. The use of TVR did not differ between level I and level II centers (28.8% vs. 27.8%, p= 0.87). Respondents using TVR were overwhelmingly positive about its perception (median score 8, [IQR 6-9]; 10 = ‘best’) at their institutions.ConclusionsTVR use at Level I centers has increased over the past decade. Increased TVR utilization may form the basis for multicenter studies comparing processes of care during trauma resuscitation.
       
  • Surgical Management of Medically-Refractory Hyperinsulinism
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Michael J. Zobel, Carrie McFarland, Christine T. Ferrera-Cook, Benjamin E. PadillaAbstractBackgroundCongenital hyperinsulinism (CHI) and insulinomas are the most common causes of medically-refractory pediatric hyperinsulinism.MethodsChildren with CHI or insulinoma treated from 1/1/2014-1/1/2019 at an academic center were retrospectively analyzed. Primary outcome was persistent intravenous dextrose requirement at discharge.ResultsEleven patients were identified: six with diffuse-type CHI, three with focal-type CHI, two with insulinoma. Median age at diagnosis was 20 days (1 day-16 years). Preoperative functional imaging (18F-Fluoro-L-DOPA PET-CT scan) accurately localized 66% of focal-type CHI lesions. All patients with focal-type CHI and insulinoma were cured by local resection. All patients with diffuse-type CHI underwent near-total pancreatectomy (NTP): four patients were cured of hyperinsulinism, of which 2 developed insulin-dependent diabetes, while two patients were palliated to home enteral glucose infusion.ConclusionsLocalized resection cures children with focal, insulin-secreting lesions. NTP may cure diffuse-type CHI; potential complications include diabetes, exocrine insufficiency, and persistent hypoglycemia from retained hypersecreting pancreatic tissue.SummaryCongenital hyperinsulinism (CHI) and insulinomas are the most common causes of medically-refractory pediatric hyperinsulinism, causing potential complications including permanent brain injury. 18F-Fluoro-L-DOPA PET-CT scan can be used to localize focal insulin-secretion lesions preoperatively. Focal-type CHI and insulinoma are cured by localized resection. Diffuse-type CHI requires near-total pancreatectomy for cure, but complications include diabetes, exocrine insufficiency, or persistent hypoglycemia from retained foci of hypersecreting pancreatic tissue.
       
  • Narrowed Pulse Pressure Predicts Massive Transfusion and Emergent
           Operative Intervention following Penetrating Trauma
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Jonathan Warren, Ashkan Moazzez, Vincent Chong, Brant Putnam, Angela Neville, George Singer, Molly Deane, Dennis Y. KimAbstractIntroductionThe early identification of hemorrhagic shock may be challenging. The objective of this study was to examine the utility of a narrowed pulse pressure in identifying the need for emergent interventions following penetrating trauma.MethodsIn this 2.5-year retrospective study of adult patients with a penetrating mechanism, patients with a narrowed pulse pressure (
       
  • Assessing Long Term Quality of Life in Geriatric Patients after Elective
           Laparoscopic Cholecystectomy
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Alexandra Z. Agathis, Jeffrey J. Aalberg, Amy Garvey, Celia M. DivinoAbstractIntroductionWhile cholecystectomy is shown to be safe in older patients, few existent studies investigate associated quality of life. This study examines quality of life in symptomatic geriatric patients after elective laparoscopic cholecystectomy.MethodsPatients > 65 years of age who underwent elective laparoscopic cholecystectomy at a tertiary care center were administered the 12-Item Short Form Survey (SF-12) and a gastrointestinal survey pre-operatively and post-operatively (within 6 and 18 months of surgery). Quality of life characteristics were compared amongst visit type in univariate and multivariate settings, with a mixed-model regression.ResultsOur sample included 30 patients. Pain frequency (p = 0.004) and pain severity (p = 0.013) scores improved with each subsequent visit type. SF-12 mental health aggregate score improved overall from pre-operative to long term follow-up (p = 0.0403).DiscussionOur findings suggest that health-related quality of life in geriatric patients improves after elective laparoscopic cholecystectomy in the short and long term.SummaryQuality of life was assessed in symptomatic geriatric patients undergoing elective laparoscopic cholecystectomy. Pain frequency, pain severity, and the SF-12 mental health aggregate scores improved overall from pre-operative to post-operative visit types.
       
  • DISPARITIES INFLUENCING RATES OF URGENT/EMERGENT SURGERY FOR
           DIVERTICULITIS IN THE STATE OF FLORIDA
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Riccardo Lemini, Aaron C. Spaulding, Osayande Osagiede, Jordan J. Cochuyt, James M. Naessens, Marie Crandall, Robert R. Cima, Dorin T. ColibaseanuAbstractBackgroundPatients with diverticulitis have a 20% risk of requiring urgent/emergent treatment. Since morbidity and mortality rates differ between elective and urgent/emergent care, understanding associated disparities is critical. We compared factors associated with treatment setting for diverticulitis and evaluated disparities regarding access to Minimally Invasive Surgery (MIS) and development of complications.MethodsThe Florida Inpatient Discharge Dataset was queried for patients diagnosed with diverticulitis. Three multivariate models were utilized: 1) elective vs urgent/emergent surgery, 2) MIS vs open and 3) presence of complications.ResultsThe analysis included 12,654 patients. Factors associated with increased odds of urgent/emergent care included being uninsured or covered by Medicaid, African American, obese, or more comorbid. MIS was associated with reduced odds of complications. Patients treated by high-volume or colorectal surgeons had increased odds of receiving MIS.ConclusionsPatients were more likely to receive MIS if they were treated by a colorectal surgeon, or a high-volume surgeon (colorectal, or general surgeon). Additionally, patients that were older, had increased comorbidities, or did not have health insurance were less likely to receive MIS.
       
  • Blunt Versus Penetrating Trauma: Is There a Resource Intensity
           Discrepancy' AUTHOR NAMES AND AFFILIATIONS
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): LCDR. Jamie L. Fitch, Paul T. Albini, Anish Y. Patel, Matthew S. Yanoff, LT. Christian S. McEvoy, Chad T. Wilson, James Suliburk, Stephanie D. Gordy, S. Rob ToddAbstractBackgroundThe rising cost of healthcare requires responsible allocation of resources. Not all trauma centers see the same types of patients. We hypothesized that patients with blunt injuries require more resources than patients with penetrating injuries.MethodsThis was a retrospective analysis of all highest-level activation trauma patients at our busy urban Level I Trauma Center over five years. Data included demographics, injuries, hospital charges, and resources used. A p value < 0.05 was significant.Results4,578 patients were included (2,037 blunt and 2,541 penetrating). Blunt patients were more severely injured, more often admitted, required more radiographic studies, had longer hospital, intensive care unit, and mechanical ventilation days, and therefore, higher hospital charges.ConclusionsWithin one center, patients with blunt injuries required more resources than those with penetrating injuries. Understanding this pattern will allow trauma systems to better allocate limited resources based on each center’s mechanism of injury distribution.
       
  • Pre-hospital Shock Index Correlates with Transfusion, Resource Utilization
           and Mortality; The Role of Patient First Vitals.
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): Faisal Jehan, Jorge Con, Matthew McIntyre, Muhammad Khan, Asad Azim, Kartik Prabhakaran, Rifat LatifiAbstractIntroductionThe aim of our study was to evaluate if pre-hospital shock index (SI) can predict transfusion requirements, resource utilization and mortality in trauma patients.MethodsWe performed a 2-year analysis of all adult trauma patients in the TQIP database. Shock index was calculated by dividing heart-rate over systolic blood pressure. Patients were divided into two groups pre-hospital SI1. Regression and ROC curve analyses were performed.Results144951 patients were included in the study. Mean age was 45±34 years, 61% were male, 84.7% had blunt injuries and median ISS was 13[9-17]. Overall 9.1% of the patients had a pre-hospital SI>1. Patients with pre-hospital SI>1 had higher likelihood of requiring massive transfusion (25% vs. 0.012%, p
       
  • Marijuana Use and Outcomes in Adult and Pediatric Trauma Patients After
           Legalization in California
    • Abstract: Publication date: Available online 10 September 2019Source: The American Journal of SurgeryAuthor(s): A. Grigorian, E. Lester, M. Lekawa, C. Figueroa, C.M. Kuza, M. Dolich, S.D. Schubl, C. Barrios, J. NahmiasAbstractBackgroundMarijuana has become legal in eight states since 2012. We hypothesized the incidence of marijuana-positive trauma patients and rate of mortality has increased post-legalization.MethodsA single level-I trauma center was used to identify patients screening positive for marijuana on urine-toxicology. Patients in the pre-legalization and post-legalization periods were compared.ResultsIn the pre-legalization cohort 9.4% were marijuana-positive versus 11.0% in the post-legalization cohort (p=0.001). Marijuana-positive patients post-legalization had higher rates of critical trauma activation (20.0% vs. 15.0%, p=0.01) and mortality (2.6% vs. 1.2%, p=0.03). In the pediatric (age 12-17) subgroup, the incidence of marijuana-positive patients did not change after legalization (pre: 39.3%, post: 46.4%, p=0.24).ConclusionThe incidence of marijuana-positive trauma patients increased post-legalization. Adult marijuana-positive trauma patients post-legalization were more likely to meet criteria for critical trauma activation and have a higher mortality rate. A subgroup of pediatric patients had an alarmingly high rate of marijuana use.SummaryThe rate of marijuana use among trauma patients increased post-legalization in California. The rate of critical trauma activation also increased as well as the mortality rate.
       
  • Advanced laparoscopic skills: Understanding the relationship between
           simulation-based practice and clinical performance
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Dmitry Nepomnayshy, Jim Whitledge, Shimae Fitzgibbons, Biba Nijjar, Aimee Gardner, Adnan Alseidi, Richard Birkett, Shanley Deal, Rafia Rodney Duvra, Nicholas Anton, Dimitrios StefanidisAbstractIntroductionThe advanced laparoscopic skills (ALS) curriculum was created to address the need for improved laparoscopic training for senior surgical trainees. It focuses on the domain of laparoscopic suturing and consists of 6 tasks with established proficiency benchmarks. Tasks are performed using a standard laparoscopic box trainer. This study examines whether practicing on the ALS curriculum could translate to improved clinical suturing.MethodsSurgery residents from four institutions participated in the study. Performance of the 6 ALS tasks and performance of a porcine gastrojejunostomy (GJ) and Nissen fundoplication were assessed before and after training. Video-recorded performance was de-identified and scored by three experts using both time and a previously published assessment instrument. Paired t-tests examined performance differences before and after the curriculum. Pearson correlations examined the relationship between performance on the porcine and ALS tasks.ResultsTwelve residents (PGY1-8) from 4 institutions completed the study. Average practice time on ALS tasks was 6.25 weeks (range 1–14 weeks) and 254 min (range 140–600min). Combined ALS task time decreased from 2748s ± 603s to 1756s ± 281s (p 
       
  • Corrigendum to ‘Stereotype threat and working memory among surgical
           residents’ [Am J Orthop Surg 216 (2018) 824–829]
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Laurel A. Milam, Geoffrey L. Cohen, Claudia Mueller, Arghavan Salles
       
  • “Tweet’’-format reflective writing: A modern needs
           assessment
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Jhia Teh, James Ashcroft
       
  • Advanced age does not increase morbidity after total thyroidectomy. Result
           of a prospective study
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): V. Sasi Mouli, M. Shreyamsa, Kushagra Gaurav, Kul Ranjan Singh, Pooja Ramakant, Anand K. Mishra
       
  • Prevalence and predictors of C. difficile infections in hospitalized
           patients with major surgical procedures in the USA: Analysis using
           traditional and machine learning methods
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Veerajalandhar Allareddy, Tong Wang, Sankeerth Rampa, Jennifer Caplin, Romesh Nalliah, Aditya Badheka, Veerasathpurush Allareddy
       
  • Needs assessment can guide creation of a “resident-optimized
           clinic” in surgery
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): M. Barrett, K. Holt, A. Haley, L. Leininger, C.J. Sonnenday, G. Sandhu, P.G. GaugerAbstractBackgroundThere is limited data on deliberate teaching of residents in the clinic setting; we sought to investigate the clinic experience at our institution and improve education through creation of a novel “Resident-Optimized Clinic” (ROC).MethodsAn online survey was sent separately to residents and faculty. Based on the results of this survey a modified ROC was developed to try to improve the obstacles to learning in clinic.ResultsQualitative analysis revealed the barriers in clinic were inconsistencies in expectations, lack of autonomy, time, and facility limitations. The modified ROC was rated positively with 100% of participants expressing they had sufficient time and autonomy; and 90% felt the environment was optimized for teaching.ConclusionsMultiple themes have been identified as problematic for the clinic education experience. The ROC was rated positively by trainees suggesting thoughtful intervention to improve clinic results in a better clinic experience and more educational gain from the clinic environment.
       
  • Surgery for patients with Alpha 1 Antitrypsin Deficiency: A review
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Martin ZamoraAbstractBackgroundAlpha 1 Antitrypsin Deficiency (AATD) is a genetic cause of emphysema/chronic obstructive pulmonary disease (COPD) and liver disease, making AATD patients a high-risk surgical group. Additionally, patients may eventually require lung and/or liver transplantation or lung volume reduction surgery (LVRS). This narrative review discusses perioperative considerations for elective procedures in AATD patients, and reviews patient outcomes in AATD-related transplantation and LVRS.Data sourcesPubMed search terms included: “pre-/peri-/post-operative management”; “COPD”; “AATD”; “lung/liver transplant”; “lung volume reduction.”ConclusionsLung and liver transplantation in AATD patients are associated with very good long-term survival rates that are comparable to, and sometimes superior to, other transplant indications. Although not currently recommended in AATD, LVRS may have a role in a minority of patients. The value of Alpha 1 Antitrypsin (AAT) augmentation therapy following lung transplantation requires further study. Wherever possible, AAT therapy should be continued in the period around elective surgeries.
       
  • Advancement in the quality of operative documentation: A systematic review
           and meta-analysis of synoptic versus narrative operative reporting
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Shannon Stogryn, Krista M. Hardy, Ahmed M. Abou-Setta, Kathleen M. Clouston, Jennifer Metcalfe, Ashley S. VergisAbstractBackgroundThe operative report is vital for patients and central to surgical quality assessment. Narrative operative reports are often poor quality. Synoptic reporting can improve documentation. The objective was to identify and appraise studies comparing synoptic and narrative operative reporting.Data sourcesA systematic review of the literature was performed. The primary outcome was completion of critical elements for an operative report. Additional secondary outcomes were measured. Meta-analysis was performed where possible. Quality analysis was performed using Newcastle-Ottawa Scale (NOS).Results1471 citations were identified; 16 studies included. Mean NOS was 7.09 out of 9 (+/−- SD 1.73). Meta-analysis demonstrated that synoptic reporting was significantly more complete (SMD 1.70, 95% CI 1.13 to 2.26; I2 98%). Completion time was shorter with synoptic reporting (mean difference −0.86, 95% CI -1.17 to −0.55). Secondary outcomes favoured synoptic reporting.ConclusionsSynoptic reporting platforms outperform narrative reporting and should be incorporated into surgical practice.
       
  • Changes in serum FGF23 and Klotho levels and calcification scores of the
           
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Fong-Fu Chou, Jin-Bor Chen, Shun-Cheng Huang, Yi-Chai Chan, Shun-Yu Chi, Wei-Ting ChenAbstractBackgroundChanges of calcification scores of the abdominal aorta (CSAA) after total parathyroidectomy plus autotransplantation (TPX + AT) for symptomatic secondary hyperparathyroidism (SSHP) have never been reported.MethodsForty-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. One year postoperatively, these data were measured again. In the control group, these data were recorded and measured before and one year later.ResultsSerum iPTH, Alk-ptase and FGF23 levels and CSAA of the study group were significantly higher than those of the control group.One year postoperatively, serum Ca, P, Alk-ptase, iPTH, and FGF23 levels and CSAA were significantly lower than those before surgery. Except for FGF23 levels, other items of the control group did not change significantly one year later, whereas the study group decreased CSAA more than the control group.ConclusionOne year postoperatively, CSAA decreased.
       
  • Human leukocyte antigens class I and II in patients with idiopathic
           granulomatous mastitis
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Hande KoksalAbstractBackgroundTo determine the distribution of human leukocyte antigens (HLA) in patients with idiopathic granulomatous mastitis (IGM).MethodsThe study included 48 patients diagnosed with IGM and 50 controls consisting of healthy donor candidates.ResultsThe frequencies of HLA-A*10, HLA-A*2403, HLA-B*18 and HLA-DR*17 antigens were significantly higher in the patient group than control group (p = 0.012, p = 0.012, p = 0.0001 and p = 0.005, respectively). However, the frequencies of HLA-A*29, HLA-B*14 and HLA-DR*1 were lower in the patient group than control group (p = 0.027, p = 0.013 and p = 0.015, respectively).When patients without/with relapse were compared, there was a significant difference in HLA-A*3 (p = 0.048) and HLA-A*32 (p = 0.011).Also, the patients with relapse and control group were compared in respects of HLA-A*10 (p = 0.0006), HLA-A*24 (p = 0.035), HLA-A*32 (p = 0.011), HLA-B*18 (p = 0.035), HLA-B*103 (p = 0.035) and HLA-DR*17 (p = 0.006).ConclusionThese findings may help to explain etiopathogenesis but still, further studies on this subject with more patients in different geographic regions are needed.
       
  • A cost-utility analysis comparing large volume displacement oncoplastic
           surgery to mastectomy with free flap reconstruction in the treatment of
           breast cancer
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Abhishek Chatterjee, Ammar Asban, Michael Jonczyk, Lilian Chen, Brian Czerniecki, Carla S. FisherAbstractPurposeBreast cancer surgical treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with free flap reconstruction (MFFR). We investigated the cost-utility between LVOS versus MFFR to determine which approach was most cost-effective.MethodsA literature review was performed to calculate probabilities for clinical outcomes for each surgical option (LVOS versus MFFR), and to obtain utility scores that were converted into quality adjusted life years (QALYs) as measures for clinical effectiveness. Average Medicare payments were surrogates for cost. A decision tree was constructed and an incremental cost-utility ratio (ICUR) was used to calculate cost-effectiveness.ResultsThe decision tree demonstrates associated QALYs and costs with probabilities used to calculate the ICUR of $3699/QALY with gain of 2.7 QALY at an additional cost of $9987 proving that LVOS is a cost-effective surgical option. One-way sensitivity analysis showed that LVOS became cost-ineffective when its clinical effectiveness had a QALY of less than 30.187. Tornado Diagram Analysis and Monte-Carlo simulation supported our conclusion.ConclusionLVOS is cost-effective when compared to MFFR for the appropriate breast cancer patient.Clinical question/level of evidenceII
       
  • Reliability and accuracy of duplex ultrasound vein mapping for dialysis
           access
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Jashank Sharma, Garima Dosi, Joseph D. Ayers, Frank T. Padberg, Peter J. Pappas, Brajesh K. LalAbstractBackgroundDuplex ultrasound vein mapping (DUVM) may increase autogenous dialysis access procedures but has not been universally adopted by surgeons.MethodsWe determined reliability and accuracy of arm vein measurements on physical examination (PE) and DUVM, compared to direct measurements in the operating room (OR, gold standard). Operative plans were developed from each set of measurements and we evaluated which approach identified more options for autogenous procedures.ResultsVein diameters measured on DUVM correlated well with OR measurements but those made on PE did not. Autogenous access options were identified in 34.8% of patients based on PE and in 96.6% based on their DUVM. The 6-month primary-patency was 86.4%; assisted primary-patency was 89.8%.ConclusionsDuplex ultrasound vein mapping is more reliable and accurate for assessing arm vein anatomy than physical examination. It identifies more autogenous options than physical-examination alone. It is essential for the preoperative evaluation for dialysis access.
       
  • The effect of increasing body mass index on wound complications in open
           ventral hernia repair with mesh
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Luciano Tastaldi, David M. Krpata, Ajita S. Prabhu, Clayton C. Petro, Steven Rosenblatt, Ivy N. Haskins, Molly A. Olson, Thomas G. Stewart, Michael J. Rosen, Jacob A. GreenbergAbstractBackgroundThere is a paucity of data delineating the relationship between body mass index (BMI) and wound complications. We investigated the association between BMI and wound morbidity following open ventral hernia repair with mesh (OVHR).DesignPatients undergoing elective OVHR were identified within the Americas Hernia Society Quality Collaborative. Multivariate logistic regression identified predictors of 30-day surgical site infection (SSI) and surgical site occurrences requiring procedural intervention (SSOPI). BMI was treated as a continuous variable in the models.Results8949 patients were included (median age 58, median BMI 31.3 kg/m2, median defect width of 7 cm). Repairs typically included synthetic mesh (89%), placed as a sublay (70%). SSI rate was 4.5% and SSOPI was 6.7%. BMI was associated with increased relative log-odds for SSI (p = 0.01) and SSOPI (
       
  • Socioeconomic disparities in the complexity of hernias evaluated at
           Emergency Departments across the United States
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Maria F. Nunez, Gezzer Ortega, Lucas G. Souza Mota, Olubode A. Olufajo, Derek W. Altema, Terrence M. Fullum, Daniel TranBackgroundHernias represent one of the most common surgical conditions with a high-burden on health expenditures. We examined the impact of socioeconomic-status and complexity of presentation among patients in the Emergency Department (ED).MethodsRetrospective analysis of 2006–2014 data from the Nationwide Emergency Department Sample, identified adult discharges with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized: complicated and uncomplicated. Unadjusted and adjusted analyses were used to determine factors that influence ED presentation.ResultsAmong 264,484 patients included, 73% presented as uncomplicated hernias and were evaluated at urban hospitals (86%). Uncomplicated presentation was more likely in Medicaid (OR 1.56 95%CI1.50–1.61) and uninsured (OR 1.73 95%CI 1.67–1.78), but less likely for patients within the third and fourth MHI quartile (OR 0.82 95%CI 0.80–0.84 and OR 0.77 95%CI 0.75–0.79), respectively.ConclusionUninsured, publicly-insured, and low-MHI patients were more likely to present to ED with uncomplicated hernias. This finding might reflect a lack of access to primary surgical care for non-urgent surgical diseases.Graphical abstractImage 1
       
  • Extended thromboprophylaxis with low-molecular weight heparin (LMWH)
           following abdominopelvic cancer surgery
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Marc Carrier, Alon D. Altman, Normand Blais, Artemis Diamantouros, Deanna McLeod, Uthaman Moodley, Christine Nguyen, Stephanie Young, Frank SchwenterAbstractBackgroundVenous 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.Data sourcesSix eligible randomized controlled trials (RCTs), seven meta-analyses (MAs), and five non-randomized cohort studies were identified evaluating extended versus standard thromboprophylaxis following abdominopelvic cancer surgery.Findings and conclusionsAvailable evidence showed significantly reduced rates of VTE for extended versus standard LMWH thromboprophylaxis following abdominopelvic cancer surgery, with some studies showing trends toward reduced rates of symptomatic VTE events. Many of these studies showed significantly reduced rates of proximal DVT and some showed trends toward reduced PE, suggesting potentially important clinical benefits.
       
  • Is release of the posterior lamella enough' A cadaveric exploration of
           posterior component separation techniques
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): N. Moores, H. Conway, D. Donato, B. Gociman, C.J. Pannucci, J. AgarwalAbstractBackgroundAs posterior component separation techniques continue to gain popularity there is uncertainty regarding the degree of fascial advancement afforded by the various techniques. Our study seeks to compare the degree anterior rectus sheath translation seen in full transversus abdominus release compared to simple release of the posterior lamella of the rectus sheath.MethodsTen hemi-abdomens in five fresh cadavers were dissected. One hemi-abdomen underwent external oblique release. The contralateral hemi-abdomen underwent retrorectus dissection and initial release of the internal lamella of the internal oblique, followed by full transversus abdominus release. A 4 kg weight was suspended from the fascia and excursion was measured after 1) external oblique separation, 2) posterior lamella of the internal oblique separation, and 3) transversus abdominis separation.ResultsAverage unilateral hemifascial translation after release of the external oblique provided an average unilateral hemi-fascial translation of 3.38 cm (+/- 0.69). Release of the posterior lamella of the internal oblique provided 3.98 cm (+/- 0.94). After transversus release the average translation increased to 4.31 cm (+/- 0.89).ConclusionsIn this cadaveric study, the majority (92%) of fascial advancement afforded by posterior component separation was achieved by an intermediate step in the transversus abdominus release operation: division of the posterior lamella of the internal oblique.
       
  • Patient-centered surgical prehabilitation
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Juliane Bingener, Susanne M. Cutshall, Pamela E. Skaran, Brent A. Bauer
       
  • Predictors of palliative treatment in stage IV colorectal cancer
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Osayande Osagiede, Aaron C. Spaulding, Ryan D. Frank, Amit Merchea, Ryan Uitti, Sikander Ailawadhi, Scott Kelley, Dorin ColibaseanuAbstractBackgroundPalliative treatment may be associated with prolonged survival and improved quality of life, but remains underutilized in stage IV colorectal (CRC). We examined a national cohort of stage IV CRC patients to determine the factors associated with palliative treatment.MethodsStage IV CRC patients, classified based on their survival length ( 20 miles from treating institutions were associated with increased likelihood of palliative treatment.ConclusionsPalliative treatment in stage IV CRC is associated with a more recent year of diagnosis, Medicaid, academic centers, Mountain and Pacific regions of the US.
       
  • Trends in potentially preventable trauma deaths between 2005-2006 and
           2012–2013
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Ezra Y. Koh, Blessing T. Oyeniyi, Erin E. Fox, Michelle Scerbo, Jeffrey S. Tomasek, Charles E. Wade, John B. HolcombAbstractBackgroundMost studies of trauma deaths include non-preventable deaths, potentially limiting successful intervention efforts. In this study we aimed to compare the potentially preventable trauma deaths between 2 time periods at our institution.MethodsTrauma patients who died in our hospital in 2005–2006 or 2012–2013 were included, non-preventable deaths were excluded from analysis. The Mann-Whitney and chi square test were used to compare variables between both time periods.Results80% of deaths were non-preventable. Between the study time periods there was a decrease in potentially preventable deaths, from 29% to 12%, p 
       
  • Predictors of discharge destination in patients with major traumatic
           injury: Analysis of Oklahoma Trauma Registry
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Zhamak Khorgami, Kaily L. Ewing, Nasir Mushtaq, Geoffrey S. Chow, C. Anthony HowardAbstractBackgroundThe ability to predict the need for discharge of trauma patients to a facility may help shorten hospital stay. This study aimed to determine the predictors of discharge to a facility and develop and validate a predictive scoring model, utilizing the Oklahoma Trauma Registry (OTR).MethodsA multivariate analysis of the OTR 2005–2013 determined independent predictors of discharge to a facility. A scoring model was developed, and positive and negative predictive values (PPV and NPV) were evaluated for 2014 patients.Results101,656 patients were analyzed. The scoring model included age≥50 years, lower extremity fracture, ICU stay≥5 days, pelvic fracture, intracranial hemorrhage, congestive heart failure, cardiac dysrhythmia, history of CVA or TIA, and ISS≥15, spine fracture, diabetes mellitus, hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. Applying the model to 2014 patients, PPV for predicting discharge to a facility was 84.9% for scores≥15, and NPV was 90.5% for scores
       
  • Outcomes of rural trauma patients who undergo damage control laparotomy
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Paige A. Harwell, Jared Reyes, Stephen D. Helmer, James M. HaanAbstractBackgroundThe majority of motor vehicle crashes occur in a rural setting and those patients have double the mortality of their urban counterparts. These trauma patients are at times stabilized at rural hospitals before transfer to a Level 1 trauma center. The purpose of this study was to determine the outcomes of rural damage control laparotomy used as a means of pre-transfer stabilization.MethodsA nearly 7-year retrospective review was conducted of rural trauma patients who had laparotomies before or after transfer to Level 1 center. They were grouped into three categories: damage control laparotomy at rural hospital, patients unstable during transfer or stable during transfer with subsequent laparotomy.ResultsForty-seven patients met study criteria. Overall mortality was significantly different between patients who had damage control laparotomy at a rural hospital (14.3%), were unstable transfer patients (75.0%), and stable transfer patients (3.3%; P 
       
  • Frailty as a prognostic factor for the critically ill older adult trauma
           patients
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Mohammad Hamidi, Muhammad Zeeshan, Valeria Leon-Risemberg, Janko Nikolich-Zugich, Kamil Hanna, Narong Kulvatunyou, Abdul Tawab Saljuqi, Mindy Fain, Bellal JosephAbstractBackgroundFrailty is highly prevalent in the elderly and confers high risk for adverse outcomes. We aimed to assess the impact of frailty on critically ill older adult trauma patients.MethodsWe analyzed the ACS-TQIP(2010–2014) including all critically-ill trauma patients ≥65y. The modified frailty index (mFI) was calculated. Following stratified into frail and non-frail, propensity score matching was performed. Our primary outcome measure was in-hospital complications. Secondary outcome measures included mortality and discharge disposition.ResultsWe identified 88,629 patients, of which 34,854 patients (frail: 17,427, non-frail: 17,427) were matched. Overall 14% died. Frail patients had higher rates of complications (34% vs. 18%, p 
       
  • Perioperative risk factors of acute kidney injury after non-cardiac
           surgery: A multicenter, prospective, observational study in patients with
           low grade American Society of Anesthesiologists physical status
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Müzeyyen Iyigun, Güclü Aykut, Melis Tosun, Meltem Kilercik, Ugur Aksu, Tayfun Güler, Fevzi ToramanAbstractBackgroundThe aim of this study was to determine the incidence and the perioperative risk factors of acute kidney injury (AKI) using “Kidney Disease: Improving Global Outcomes” (KDIGO) guidelines, in patients with low grade American Society of Anesthesiologists physical status (ASA-PS) undergoing non-cardiac surgery.MethodsIn this multicenter, prospective, observational study, 870 surgical patients older than 40 years with ASA-PS I-II who underwent noncardiac surgery, were included. The primary outcome of this study was perioperative AKI defined by the KDIGO criteria.ResultsAKI was detected in 49 (5.63%) of the patients. Multivariate analysis detected the presence of preoperative hypertension (aOR = 0.130; CI = 0.030–0.566; p = 0.007) and intraoperative transfusion of erythrocytes (aOR = 0.076; CI = 0.008–0.752; p = 0.028) as independent predictors of postoperative AKI development.ConclusionApproximately, 6% of patients with ASA I-II presenting for noncardiac surgery developed postoperative AKI. Preoperative hypertension and intraoperative erythrocyte transfusion are independent predictors of AKI after non-cardiac surgery in this patient population.
       
  • Financial burden amongst cancer patients treated with curative intent
           surgery alone
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Natalie Allcott, Lisette Dunham, David Levy, Jacquelyn Carr, Karyn StitzenbergAbstractBackgroundThe costs of cancer care in the US continue to increase and may have serious consequences for patients. We hypothesize that even cancer patients treated with curative-intent surgery alone experience substantial financial burden.MethodsA questionnaire was administered to adult cancer patients who were treated with curative-intent surgery. Survey items included a validated instrument for measuring financial toxicity, the COST score. Demographic variables and survey responses were examined using Chi-square and Fisher exact tests. A multivariate general linear model was performed to examine the relationship between age and COST score.ResultsCOST scores varied widely. 30% of respondents had a COST score of ≤24 (high burden). Younger participants reported more financial burden (p = 0.008). Respondents reported that financial factors influenced their decisions regarding surgery (14%) and caused them to skip recommended care (4.7%). Cancer care influenced overall financial health (38%) and contributed to medical debt (26%).ConclusionCurative-intent cancer care places a substantial portion of patients at risk for financial toxicity even when they don't require chemotherapy. Interventions should not be limited to patients receiving chemotherapy.
       
  • Emeritus Editorial Board
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s):
       
  • Letter to the Editor Re: Racial disparities in burn patients despite
           insurance coverage
    • Abstract: Publication date: September 2019Source: The American Journal of Surgery, Volume 218, Issue 3Author(s): Lauren Okafor, Miriam Nathan
       
  • The Metabolic Time Line of Pancreatic Cancer: Opportunities to Improve
           Early Detection of Adenocarcinoma
    • Abstract: Publication date: Available online 27 August 2019Source: The American Journal of SurgeryAuthor(s): Hunter B. Moore, Rachel Culp-Hill, Julia A. Reisz, Peter J. Lawson, Angela Sauaia, Richard D. Schulick, Marco Del Chiaro, Trevor L. Nydam, Ernest E. Moore, Kirk C. Hansen, Angelo D’AlessandroAbstractBackgroundA reliable biomarker to detect pancreatic ductal adenocarcinoma (PDAC) continues to be elusive. With employing metabolomics we hypothesize that a broader analysis of systemic blood can differentiate different stages of PDAC.MethodsPatients undergoing pancreatic resection had plasma samples grouped by diagnosis and assayed with mass spectrometry. 10 per group [neuroendocrine (PNET), intraductal papillary mucinous neoplasm (IPMN), localized PDAC, locally advanced PDAC, and metastatic] were analyzed to assess if metabolites could delineation different stages of adenocarcinoma.ResultsOf the 215 metabolites measured, four had a stronger correlation to disease burden than CA19-9. However, none of these metabolites differentiated stepwise progression in malignancy. Principal component analysis identified five metabolic components. Each cancer cohort was characterized by a unique combination of components, two components were predictors of PDCA stages.ConclusionsEnhanced metabolomic analysis identified metabolic pathways that may assist in differentiating PDCA stages that do not occur in a linear stepwise progression.
       
  • Follow-up Trends after Emergency Department Discharge for Acutely
           Symptomatic Hernias: A Southwestern Surgical Congress Multi-Center Trial
    • Abstract: Publication date: Available online 20 August 2019Source: The American Journal of SurgeryAuthor(s): Jillian L. Angelo, Amy H. Kaji, Lara H. Spence, David S. Plurad, Marlo Asis, Annabel Barber, Thomas J. Schroeppel, Emma C. Callaghan, Brandon T. Grover, Justin L. Regner, Michael Truitt, Dennis Y. KimAbstractBackgroundThe objective of this multi-center study was to examine the follow-up trends after emergency department (ED) discharge in a large and socioeconomically diverse patient population.MethodsWe performed a 3-year retrospective analysis of adult patients with acutely symptomatic hernias who were discharged from the EDs of five geographically diverse hospitals.ResultsOf 674 patients, 288 (43%) were evaluated in the clinic after discharge from the ED and 253 (37%) underwent repair. Follow-up was highest among those with insurance. A total of 119 patients (18%) returned to the ED for hernia-related complaints, of which 25 (21%) underwent urgent intervention.ConclusionThe plan of care for patients with acutely symptomatic hernias discharged from the ED depends on outpatient follow-up, but more than 50% of patients are lost to follow-up, and nearly 1 in 5 return to the ED. The uninsured are at particularly high risk.
       
  • Pursing a Career in Academic Surgery among African American Medical
           Students
    • Abstract: Publication date: Available online 17 August 2019Source: The American Journal of SurgeryAuthor(s): S.E. Roberts, J.A. Shea, M. Sellers, P. Butler, R.R. KelzBackgroundThere are few African American students in medical school, and even fewer are choosing academic surgical careers. The objective of this study is to provide insight into what barriers URM students perceive when considering a career in academic surgery.MethodsThis qualitative, descriptive study was conducted at the University of Pennsylvania. Sixteen African American students with an interest in surgery were recruited to participate in the study. The outcomes reported are themes of how participants perceive the challenges of pursuing an academic surgical career.ResultsBarriers to pursuing a career in academic surgery cited by students included lifestyle concerns, financial pressures, having to work in a predominantly white environment, lack of mentorship, feelings of having to prove oneself, stressful environments and concerns of being a minority female in surgery.ConclusionsThese study findings indicate that the persistent dearth of African-Americans in academic surgery is likely multi-factorial. Some ways surgical leadership can begin addressing these issues is through establishment of formal mentorship programs, ensuring non-discriminatory recruiting processes, having explicit goals of improving diversity and supporting pipeline programs.Graphical abstractImage 1
       
  • Factors Associated with General Surgery Residents’ Decisions Regarding
           Fellowship and Subspecialty Stratified by Burnout and Quality of Life
    • Abstract: Publication date: Available online 8 August 2019Source: The American Journal of SurgeryAuthor(s): Natalie C. McClintock, Kelsey E. Gray, Angela L. Neville, Amy H. Kaji, Mary M. Wolfe, Kristine E. Calhoun, Farin F. Amersi, Timothy R. Donahue, Tracey D. Arnell, Benjamin T. Jarman, Kenji Inaba, Marc L. Melcher, Jon B. Morris, Brian R. Smith, Mark E. Reeves, Jeffrey M. Gauvin, Edgardo S. Salcedo, Richard A. Sidwell, Daniel L. Dent, Kenric M. MurayamaAbstractBackgroundAlthough most surgery residents pursue fellowships, data regarding those decisions are limited. This study describes associations with interest in fellowship and specific subspecialties.MethodsAnonymous surveys were distributed to 607 surgery residents at 19 US programs. Subspecialties were stratified by levels of burnout and quality of life using data from recent studies.Results407 (67%) residents responded. 372 (91.4%) planned to pursue fellowship. Fellowship interest was lower among residents who attended independent or small programs, were married, or had children. Residents who received AOA honors or were married were less likely to choose high burnout subspecialties (trauma/vascular). Residents with children were less likely to choose low quality of life subspecialties (trauma/transplant/cardiothoracic).ConclusionsSurgery residents’ interest in fellowship and specific subspecialties are associated with program type and size, AOA status, marital status, and having children. Variability in burnout and quality of life between subspecialties may affect residents’ decisions.
       
  • Is Non-Operative Management Warranted in Ventral Hernia Patients With
           Comorbidities' A Case-Matched, Prospective 3 year Follow-up,
           Patient-Centered Study
    • Abstract: Publication date: Available online 7 August 2019Source: The American Journal of SurgeryAuthor(s): Karla Bernardi, Alexander C. Martin, Julie L. Holihan, Oscar A. Olavarria, Juan R. Flores-Gonzalez, Deepa V. Cherla, Nicole B. Lyons, Puja Shah, Lillian S. Kao, Tien C. Ko, Mike K. LiangAbstractBackgroundWe hypothesized that long-term quality of life (QoL) is improved among patients with ventral hernias(VHs) and comorbid conditions managed operatively than with non-operative management.MethodsThis was the 3-year follow-up to a prospective observational study of patients with comorbid conditions and VHs. Primary outcome was change in QoL measured utilizing the modified Activities Assessment Scale(AAS), a validated, hernia-specific survey. Outcomes were compared using: (1)paired t-test on matched subset and (2)multivariable linear regression on the overall cohort.ResultsIn the matched cohort (n=80;40/group), the operative group experienced a significantly greater improvement in QoL compared to the non-operative group (28.4±27.1 vs. 11.8±23.8,p=0.005). The operative group, had 10(25.0%) reported recurrences while the non-operative group, reported 4/15(26.7%) recurrences among the 15(37.5%) patients that underwent repair. On multivariable analysis of the whole cohort(n=137), operative management was associated with a 19.5(95% CI7.0-31.9) point greater improvement in QoL compared to non-operative management.ConclusionsThis is the first long term prospective study showing the benefits of operative as opposed to non-operative management of patients with comorbid conditions and VHs.
       
  • The Effectiveness of Using 3D Reconstruction Software for Surgery to
           Augment Surgical Education
    • Abstract: Publication date: Available online 6 August 2019Source: The American Journal of SurgeryAuthor(s): Ryan Bailer, Robert C.G. MartinAbstractBackgroundAssimilating diagnostic radiology education into undergraduate medical education remains a challenge. This challenge places a greater emphasis in surgical residency to ensure this education occurs. The objective of this study is to determine whether a 3D-reconstruction may improve surgical residents’ assessment of resectability of pancreatic lesionsMethodsFour cases were identified of patients with a pancreatic lesion; high-quality, triphasic abdominal CT scans were obtained and evaluated to ensure sufficient resolution and slice thickness. The images then were used for 3D-reconstruction of the cases.ResultsPGY3-5 residents had a statistically-significant higher percentage of correct answers on objective questionnaire items using CT in conjunction with 3D-reconstruction software versus CT only. PGY1-2 residents had a higher percentage of correct answers using 3D-reconstruction software, but the difference was not statistically significant.Conclusions3D-reconstruction software could be a viable tool to augment radiology education within a surgery residency, especially in CT interpretation, but there appears to be a minimum threshold of knowledge needed for meaningful improvement; therefore, this software may be more useful for PGY3-5 residents than PGY1-2 residents.
       
  • Traumatic Brain Injuries in Elderly Patients; To Be Transferred or
           Not'
    • Abstract: Publication date: Available online 5 August 2019Source: The American Journal of SurgeryAuthor(s): Mohammad Hossein Khosravi
       
  • PREVENTING DISTRACTED DRIVING: A PROGRAM FROM INITIATION THROUGH TO
           EVALUATION
    • Abstract: Publication date: Available online 5 August 2019Source: The American Journal of SurgeryAuthor(s): Peter F. Ehrlich, Beth Costello, Amy RandallAbstractBackgroundDistracted driving(DD) is a public health threat. We initiated a DD program where the objective was to attract parents to a website to download a parent tool box. We report the effectiveness of media strategy.MethodsAn evidence based interactive DD website was developed which provided a parent tool box. Two different digital media strategies were used. Parent(P)/Teen(T) focus groups were used. Analytics, orders during each media strategy are reported as well the results of the focus group.ResultsThere were 73972 visits (> 2 minutes) to the site. The tool box was downloaded/ordered from 10 different countries and 50 states. There were 603 requests via the internet for tools kits, 159 in the first campaign and 444 in the second campaign. Average website time increased from 2.33 minutes in media campign 1 to 5.29 minutes in campaign 2. The focus groups reported the: website was “very useful” in 9/15-P vs 10/15- T.ConclusionContextual placement digital advertising and focused social media was more effective in attracting parents to the website, and increased downloads.Level of EvidenceIIIType of Studyprospective/retrospective study with economic and valued based evaluations
       
  • Enhanced Recovery After Surgery Pathways Benefit Patients With Soft
           Pancreatic Texture Following Pancreaticoduodenectomy
    • Abstract: Publication date: Available online 5 August 2019Source: The American Journal of SurgeryAuthor(s): Jiqiao Zhu, Xianliang Li, Han Li, Zixi Liu, Jun Ma, Jiantao Kou, Qiang HeAbstractBackgroundWe aimed to compare the enhanced recovery after surgery pathway with the standard perioperative care protocol concerning complications, postoperative length of stay and 1-year survival rate.MethodsUsing a before–after cohort study design, data from patients with pancreatic head cancer, who consecutively underwent pancreaticoduodenectomy, were retrospectively collected.ResultsCompared to the control group, patients with soft pancreas in the enhanced recovery after surgery group had a lower incidence of delayed gastric emptying (36.7% vs 13.3%, P = 0.026) and respiratory complications (46.7% vs 20.0%, P = 0.028), and shorter postoperative length of stay (All: 10.9±3.4 d vs13.5±3.8 d, P = 0.002; Soft: 11.2±3.8 d vs14.0±4.5 d, P = 0.001). The 1-year survival rates were similar between the groups.ConclusionThe enhanced recovery after surgery pathways can significantly reduce the incidence of certain surgical complications and decrease the postoperative length of stay. It does not affect 1-year survival.
       
  • EAST Multicenter Trial of Simulation-Based Team Training for Pediatric
           Trauma: Resuscitation Task Completion is Highly Variable during Simulated
           Traumatic Brain Injury Resuscitation
    • Abstract: Publication date: Available online 5 August 2019Source: The American Journal of SurgeryAuthor(s): Aaron R. Jensen, Francesca Bullaro, Richard A. Falcone, Margot Daugherty, L.Caulette Young, Cory McLaughlin, Caron Park, Christianne Lane, Jose M. Prince, Daniel J. Scherzer, Tensing Maa, Julie Dunn, Laura Wining, Joseph Hess, Mary C. Santos, James O'Neill, Eric Katz, Karen O'Bosky, Timothy Young, Emily Christison-LagayAbstractBackgroundBest practices for benchmarking the efficacy of simulation-based training programs are not well defined. This study sought to assess feasibility of standardized data collection with multicenter implementation of simulation-based training, and to characterize variability in pediatric trauma resuscitation task completion associated with program characteristics.MethodsA prospective multicenter observational cohort of resuscitation teams (N=30) was used to measure task completion and teamwork during simulated resuscitation of a child with traumatic brain injury. A survey was used to measure center-specific trauma volume and simulation-based training program characteristics among participating centers.ResultsNo task was consistently performed across all centers. Teamwork skills were associated with faster time to computed tomography notification (r=-0.51, p
       
  • Identifying risk factors of acute kidney injury after noncardiac surgery:
           methodology is important
    • Abstract: Publication date: Available online 2 August 2019Source: The American Journal of SurgeryAuthor(s): Hua Jiang, Shao-Hua Liu, Fu-Shan Xue
       
  • Letter to the editor: “Coexistent thyroid nodules in patients with
           graves’ disease: What is the frequency and the risk of
           malignancy'”
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): S. Mattoo, A. Agarwal, M. Sabaretnam, A. Chekavar
       
  • Making a case for routine high resolution ultrasonography (HRUSG) of
           thyroid in Graves' disease
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Surya Vikram, Prashant Kumar, Muhsin, Ravi Bhushan Singh, Chandan Kumar Jha
       
  • How can we measure quality of D2 lymphadenectomy'
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Sadettin Er, Mesut Tez
       
  • Is oncoplastic breast surgery truly associated with a lower rate of
           surgical site complications compared to standard breast conserving
           surgery'
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Mona P. Tan
       
  • Cognitive challenges of junior residents attempting to learn surgical
           skills by observing procedures
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Isabelle Raîche, Stanley Hamstra, Wade Gofton, Fady Balaa, Éric DionneAbstractBackgroundSurgical observation is an integral part of surgical training. Junior residents, who have limited understanding of the procedures being performed, use observation to gain an initial exposure to surgical techniques. This study explores the challenges junior residents face from a cognitive standpoint when they are observing surgery.MethodsFour focus groups were conducted with 18 general surgery junior residents. Transcripts from these focus groups were analyzed using a qualitative interpretative approach and the findings were explored through the lenses of discovery learning and cognitive load theory.ResultsSurgical observation is perceived by residents as a learning activity with rich potential. However, two main challenges were identified: directing their attention to the most pertinent element during observation and making sense of what is happening during procedures.ConclusionsThis study can inform strategies to help junior residents observe surgeries more efficiently to help make surgical observation a better learning experience.
       
  • Medical students’ perceptions and motivations prior to their surgery
           clerkship
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Sophia K. McKinley, Michael Kochis, Cynthia M. Cooper, Noelle Saillant, Alex B. Haynes, Emil Petrusa, Roy PhitayakornAbstractBackgroundThis study aims to determine the effect of a pre-clerkship workshop on medical students’ perceptions of surgery and surgeons and to describe their concerns and learning goals.MethodsThirty-nine medical students completed surveys before and after a workshop preceding their surgery clerkship. Quantitative data and free responses that were inductively coded were used to assess effectiveness.ResultsPerceptions from 38 students (response rate = 97.4%) significantly improved for 11 of 21 items. At pre-workshop, the most frequently cited learning goals were improving technical skills (58%), surgical knowledge (53%), and understanding surgical culture and work (53%). Students’ top concerns were meeting clerkship demands (68%) and being evaluated (55%). After the workshop, student learning objectives and concerns remained largely unchanged.ConclusionsA pre-clerkship workshop improved student perceptions of surgery and surgeons. Understanding students’ intrinsic motivations may facilitate future clerkship curriculum improvement via better alignment of educator and student goals and objectives.
       
  • Redefining the sensitivity of screening mammography: A review
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Alan B. HollingsworthAbstractFrom its inception, screening mammography has enjoyed a perceived level of sensitivity that is inconsistent with available evidence. The original data that imparted erroneous beliefs about sensitivity were based on a variety of misleading definitions and approaches, such as the inclusion of palpable tumors, using the inverse of interval cancer rates (often tied to an arbitrary 12 month interval), and quoting prevalence screen sensitivity wherein tumors are larger than those found on incidence screens. This review addresses the background for the overestimation of mammographic sensitivity, and how a major adjustment in our thinking is overdue now that multi-modality imaging allows us to determine real time mammographic sensitivity. Although a single value for mammographic sensitivity is disingenuous, given the wide range based on background density, it is important to realize that a sensitivity gap between belief and reality still exists in the early detection of breast cancer using mammography alone, in spite of technologic advances. Failure to recognize this gap diminishes the acceptance of adjunct methods of breast imaging that greatly complement detection rates.
       
  • Concomitant cholecystectomy during bariatric surgery: The jury is still
           out
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Ilias P. Doulamis, George Michalopoulos, Vasileios Boikou, Dimitrios Schizas, Eleftherios Spartalis, Evangelos Menenakos, Konstantinos P. EconomopoulosAbstractBackgroundWe sought to compare clinical outcomes of concomitant cholecystectomy during four different types of bariatric surgery vs. bariatric surgery alone.Data sourcesA systematic literature search of PubMed and Cochrane databases was conducted in accordance with the PRISMA guidelines. Thirty studies were included in this study, reporting data on 13,675 patients. Our findings suggest a higher rate of anastomotic leak/stricture in the case of concomitant cholecystectomy with gastric bypass compared to those who had gastric bypass alone. The scarcity of data concerning sleeve gastrectomy, adjustable gastric banding and biliopancreatic diversion prevented us from quantifying possible difference of outcomes between the examined treatment groups.ConclusionsThis study highlights the small number and poor quality of available studies referring to the role of simultaneous cholecystectomy during bariatric surgery.
       
  • Returns to the operating room after breast surgery at a tertiary care
           medical center
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Brittany L. Murphy, Amy E. Glasgow, Elizabeth B. Habermann, Tina J. HiekenAbstractBackgroundEvaluation of returns to the operating room (RORs) may spur practice modifications to improve patient outcomes and hospital practices. We determined the frequency and indications for RORs after breast operations.MethodsWe identified patients ≥18 years who underwent a breast operation at our institution 1/1/14-1/13/17 and assessed ROR within 45-days. RORs were categorized as unplanned/planned, staged/unstaged, or unrelated procedures. Univariate and multivariable analyses compared variables between patients who did and did not have an ROR.Results2,914 patients underwent a breast operation of whom 117 (4.0%) had 121 RORs. Planned staged procedures accounted for 48 RORs (39.7%), while unplanned complications accounted for 65 (53.7%). On multivariable analysis, ROR was more common among patients undergoing total, skin-sparing, or nipple-sparing mastectomy (versus lumpectomy) all p 
       
  • Simulation training results in improvement of the management of operating
           room fires—A single-blinded randomized controlled trial
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s): Tomokazu Kishiki, Bailey Su, Brandon Johnson, Brittany Lapin, Kristine Kuchta, Laurie Sherman, JoAnn Carbray, Michael B. UjikiAbstractBackgroundOperating room (OR) fires are a preventable danger. Our aim is to examine the effectiveness of OR fire simulation scenarios as a supplement to classroom-based training for managing OR fires.MethodsEighty-two participants were randomly divided into 14 groups. Eight groups (Group S) participated in two simulations: one prior to the classroom-based fire training and another after the classroom. Six groups (Group D) participated in the identical classroom training, but only one simulation, which followed the classroom session. Confidence surveys were completed before classroom training and after the final simulation. All simulations were assessed by a blinded evaluator.ResultsCompetency scores within Group S were significantly higher after the second simulation. Competency scores for Group S were significantly higher than Group D for the final test scenario. Prior to the classroom-based training, confidence scores regarding fire safety-related OR tasks were significantly higher in S group.ConclusionsSimulation training significantly improves both the competency and confidence of medical professionals in managing fires in the OR, with more simulation training showing a greater degree of benefit.
       
  • Emeritus Editorial Board
    • Abstract: Publication date: August 2019Source: The American Journal of Surgery, Volume 218, Issue 2Author(s):
       
  • 2018 SBAS Presidential Address: Sustainability, Relevancy and the Society
           of Black Academic Surgeons: The making of an academic surgeon - Is the old
           paradigm enough'
    • Abstract: Publication date: Available online 13 July 2019Source: The American Journal of SurgeryAuthor(s): Anthony Stallion, Anthony Stallion
       
 
 
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