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Publisher: Elsevier   (Total: 3181 journals)

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Showing 1 - 200 of 3181 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 444, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, 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: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 320, 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: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, 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: 188, 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: 30, 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: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, 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: 34, 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: 11, 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: 44, 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: 52, 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: 67, 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: 11, 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: 26)
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: 37, 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: 15, 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: 25)
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: 19)
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: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, 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: 424, 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: 38, 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: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 385, 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: 483, 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: 32, 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: 8, 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: 12)
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: 11, 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: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
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: 267, 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: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, 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: 211, 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: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, 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  [3181 journals]
  • Use of error management theory to quantify and characterize residents’
           error recovery strategies
    • Abstract: Publication date: Available online 19 November 2019Source: The American Journal of SurgeryAuthor(s): Carla M. Pugh, Katherine E. Law, Elaine R. Cohen, Anne-Lise D. D'Angelo, Jacob A. Greenberg, Caprice C. Greenberg, Douglas A. WiegmannAbstractBackgroundTraditional checklist metrics for surgical performance can miss key intraoperative decisions that impact procedural outcomes. Error-based assessments may help identify important metrics for evaluating operative performance and resident readiness for independent practice.MethodsThis study utilized human factors error analysis and error management theory to investigate a previously collected video database of resident performance during a simulated laparoscopic ventral hernia (LVH) repair on a table-top simulator using standard laparoscopic tools and mesh. Errors were deconstructed and coded using a structured observation tool and video analysis software. Error detection events and error recovery events were categorized for each operative step of the ventral hernia repair.ResultsResidents made a total of 314 errors (M = 15.7, SD = 4.96). There were more technical errors (63%) than cognitive errors (37%) and more commission errors (69%) than omission errors (30%). Almost half (47%) of all errors went completely undetected by the residents for the entire LVH repair. Of the errors that residents attempted to recover (n = 136), 86.0% were successfully recovered. Technical errors were four times more likely to be successfully recovered than cognitive errors (p = .020).ConclusionsOur results revealed specific details regarding residents’ error management strategies and provides validity evidence for the use of human factors error frameworks in surgical performance assessments. Practice in simulation-based learning environments may improve resident decision-making and error management opportunities by providing a structured experience where errors are explicitly characterized and used for training and feedback. Error management training may play a major role in equipping residents and junior faculty with the skills required for independent, high-quality operative performance.
       
  • Enhanced recovery after surgery: A clinical review of implementation
           across multiple surgical subspecialties
    • Abstract: Publication date: Available online 16 November 2019Source: The American Journal of SurgeryAuthor(s): Thomas W. Smith, Xuanji Wang, Marc A. Singer, Constantine V. Godellas, Faaiza T. VainceAbstractEnhanced recovery after surgery (ERAS) is a multimodal protocol applied towards perioperative patient care. ERAS programs are implemented by a multidisciplinary team centered around the patient, incorporating outpatient clinical staff, preoperative nurses, anesthesiologists, operative nurses, postoperative recovery staff, floor inpatient nurses, dieticians, physical therapists, social workers, and surgeons. Initial studies on perioperative care measures focused on cardiac surgery. Subsequently, the development of the ERAS Study Group in 2001 focused on colorectal surgery and postoperative outcome measures. Today, ERAS protocols have been implemented across many surgical subspecialties including: bariatric, breast, plastic, cardiac, colorectal, esophageal, head and neck, hepatic, gynecologic, neurosurgical, orthopedic, pancreatic, thoracic, and urologic surgery. The goal of ERAS programs is to promote rapid recovery as quantified by decreasing the length of hospital stay, complications, and cost of specific surgical interventions. In the setting of the opioid crisis in America, there is also an increasing focus on minimizing perioperative narcotic use. The purpose of this review is to compare ERAS protocols across surgical subspecialties, focusing on quantified metrics of improvement, and to provide a clear and concise summary of the literature in regards to current ERAS practices and success rates.
       
  • Surgery service learning in preclinical years improves medical student
           attitudes toward surgery, clinical confidence, and social determinants of
           health screening
    • Abstract: Publication date: Available online 14 November 2019Source: The American Journal of SurgeryAuthor(s): Megan G. Janeway, Su Yeon Lee, Elisa Caron, Isabel K. Sausjord, Lisa Allee, Sabrina E. Sanchez, Tracey A. DechertAbstractIntroductionPatient health literacy is paramount for optimal outcomes. The Service Learning Project (SLP) aims to merge the need for patient education with the desire of medical students for early clinical experience.MethodsThis pretest-posttest study examined the effect of the SLP on medical students. First-year students spent 8 h each month educating inpatients and screening for social determinants of health (SDH). Students completed a 30-question survey pre- and post-SLP, and longitudinally throughout medical school. We used t-tests to assess changes in attitudes towards surgery, clinical confidence, and SDH screening.ResultsStudent self-perceived value on surgical teams increased significantly (2.49 vs 3.63 post-SLP, p 
       
  • Pilot implementation and evaluation of a national quality improvement
           taught curriculum for urology residents: Lessons from the United Kingdom
    • Abstract: Publication date: Available online 14 November 2019Source: The American Journal of SurgeryAuthor(s): Elena Pallari, Zarnie Khadjesari, Shekhar Biyani, Sunjay Jain, Dominic Hodgson, James Green, Nick SevdalisAbstractBackgroundWe report the immediate educational impact of a previously developed quality improvement (QI) curriculum for UK urology residents.Materials and methodsProspective pre/post-training evaluation, using the Kirkpatrick framework: residents’ QI knowledge, skills and attitudes were assessed via standardized assessments. We report descriptive/inferential statistics and scales psychometric analyses.ResultsNinety-eight residents from across the UK provided full datasets. Scale reliability was good (Cronbach-alphas = 0.485–0.924). Residents' subjective knowledge (Mpre = 2.71, SD = 0.787; Mpost = 3.97, SD = 0.546); intentions to initiate QI (Mpre = 3.65, SD = 0.643; Mpost = 4.09, SD = 0.642); attitudes towards doing QI (Mpre = 3.67, SD = 0.646; Mpost = 4.11, SD = 0.591); attitudes towards QI at work (Mpre = 3.80, SD = 0.511; Mpost = 4.00, SD = 0.495); and attitudes towards influencing QI (Mpre = 3.65, SD = 0.482; Mpost = 3.867, SD = 0.473) all improved post-training (all ps  0.05). Residents’ satisfaction was high.ConclusionsOur novel QI training is educationally sound and feasible to deliver. Longitudinal evaluation and scalability are planned.
       
  • Back so soon' Characterizing emergency department use after trauma
    • Abstract: Publication date: Available online 13 November 2019Source: The American Journal of SurgeryAuthor(s): Jameil Abou-Hanna, Nathan W. Kugler, Lisa Rein, Aniko Szabo, Thomas W. CarverAbstractBackgroundTrauma readmissions have been well studied but little data exists regarding Emergency Department (ED) utilization following an injury. This study was performed to determine the factors associated with a return to the ED after trauma.MethodsA retrospective review of all adult trauma patients evaluated between January and December of 2014 was performed. Demographics, follow-up plan, and characteristics of ED visits within 30 days of discharge were recorded. Predictive factors of ED utilization were identified using univariate analysis and multi-logistic regression.ResultsFourteen percent of 1,836 consecutive patients returned to the ED within 30 days of initial trauma. On multi-logistic regression, penetrating trauma (OR 2.15 p = 0.001), and scheduled follow-up (OR 1.81 p = 0.046) remained significant predictors.ConclusionsPenetrating trauma victims are at increased risk of returning to the ED, most often because of wound or pain issues. Recognizing these factors allows for targeted interventions to decrease ED resource utilization.
       
  • Robotic inguinal hernia repair is not superior to laparoscopic or open
           repair
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Jennie Meier, Sergio Huerta
       
  • Treatment for occult breast cancer: A propensity score analysis of the
           National Cancer Database
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Catherine Tsai, Beiqun Zhao, Theresa Chan, Sarah L. BlairAbstractBackgroundControversy exists regarding optimal treatment of occult breast cancer (OBC). Treatment options include mastectomy alone (MAST), radiation alone (XRT), or mastectomy with radiation (MXRT).MethodsWe queried the National Cancer Database from 2004 to 2014 for patients with OBC who underwent MXRT, XRT, or MAST. We utilized propensity score matching to perform three head-to-head comparisons. Kaplan-Meier analysis was performed to compare overall survival (OS).ResultsA total of 190 patients received XRT, 237 received MAST, and 244 received MXRT. In the MXRT vs. XRT comparison, 5-year OS was 78.2% and 82.8%, respectively. In the MXRT vs. MAST comparison, 5-year OS was 81.5% and 86.7%, respectively. In the MAST vs XRT comparison, 5-year OS was 83.2% and 82.5%, respectively. There was no difference in OS for all paired comparisons.ConclusionsThere were no OS differences in patients undergoing MAST, XRT, or MXRT, suggesting breast conservation can be considered in patients with OBC.
       
  • Residents entering Complex General Surgical Oncology fellowship lack
           confidence with pelvic MRI for rectal cancer: Results of a needs
           assessment survey
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Sara Nofal, Y. Nancy You, George J. Chang, Elizabeth E. Grubbs, Brian K. BednarskiAbstractBackgroundMagnetic resonance imaging (MRI) is essential for the multidisciplinary treatment of rectal cancer. However, baseline experience of surgical residents with MRI is unknown. Therefore, a needs assessment survey was conducted to examine confidence with pelvic MRI for residents entering Complex General Surgical Oncology (CSGO) fellowships.MethodsA multi-institutional survey evaluated incoming CGSO fellows’ experience with pelvic MRI for rectal cancer in residency. Additionally, confidence was assessed for essential components of pelvic MRI including T- and N-stage, circumferential resection margin (CRM), extramural venous invasion (EMVI), and pelvic anatomy.ResultsOf the twenty-four incoming fellows who completed the survey (response rate = 44%), 20 reported frequent use of pelvic MRI for rectal cancer in residency, but 16 reported rarely/never interpreting images themselves for staging or operative planning. Most respondents reported low confidence for T-stage, N-stage, CRM, EMVI, as well as pelvic anatomy, particularly for lateral and posterior pelvis.ConclusionsThe development of a pelvic MRI curriculum for residents entering CGSO fellowships could enhance their clinical training in the multidisciplinary management of patients with rectal cancer.
       
  • Resident training experience with robotic assisted transabdominal
           preperitoneal inguinal hernia repair
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Peter A. Ebeling, Katherine G. Beale, Kent Van Sickle, Mohammed J. Al-Fayyadh, Ross E. Willis, Juan Marcano, Dylan Erwin, Jason W. KempenichAbstractBackgroundGeneral surgery is the fastest growing field in the adoption of robotic assisted laparoscopic surgery. Here, we present the results of one institution's experience in training surgical residents in robotic assisted transabdominal preperitoneal inguinal hernia repairs.MethodsData were prospectively collected on patients undergoing robotic assisted laparoscopic inguinal hernia repair with residents. Data points included patient age, gender, complications, hernia difficulty, resident technical competency as measured by GEARS, Zwisch scores, operative time, and the number of robotic console cases reported by residents as primary surgeon.ResultsResidents who performed>30 robotic cases had significantly higher mean modified GEARS scores (p ≤ .002). Residents who completed 10 or fewer robotic cases achieved significantly lower mean modified GEARS and Zwisch scores than those who completed 11 or more (p 
       
  • What is global surgery' Identifying misconceptions among health
           professionals
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Mackenzie N. Abraham, Peter J. Abraham, Herbert Chen, Kimberly M. HendershotAbstractBackgroundGlobal surgery has emerged as a new field within academic surgery. Despite attempts to provide a common definition, it is unclear whether health professionals understand what is meant by the term “global surgery.” This study aims to characterize current understanding of global surgery among healthcare workers.MethodsOne hundred medical students, residents, physicians, nurses, and allied health professionals were interviewed on their perceptions of global surgery using a six-question qualitative survey. Responses were coded and analyzed for common themes.ResultsSixty-one percent of participants did not know the meaning of global surgery. Those under age 40 were more likely to relay an accurate definition. Of participants with knowledge of global surgery, 44% had previous exposure to global health and 85% expressed interest in global health or surgery.ConclusionsAlthough often used in academic surgical settings, the term “global surgery” is not well-understood among health professionals. There is no clear consensus on what it means to be a global surgeon or what constitutes a successful career in global surgery.
       
  • Modified frailty index predicts high-risk patients for readmission after
           colorectal surgery for cancer
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Cihad Tatar, Cigdem Benlice, Conor P. Delaney, Stefan D. Holubar, David Liska, Scott R. Steele, Emre GorgunAbstractBackgroundModified frailty index (mFI) has been proposed as a reliable tool in predicting postoperative outcomes after surgery. This study aims to evaluate whether mFI could be utilized to predict readmissions after colorectal resection for patients with cancer by using nationwide cohort.MethodsPatients undergoing elective abdominal colorectal resection for colorectal cancer were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) procedure-targeted database (2010–2012). A previously described mFI was calculated. Demographics, comorbidities, and 30-day postoperative complications were compared between patients who were readmitted or not after colorectal surgery.ResultsA total of 7337 patients were identified with a mean age of 65.8(±13.6) years. Eight hundred seventy-one (11.8%) patients were readmitted at least once within 30 days. Age, gender, BMI, and other comorbidities were comparable between the groups. O approach, current smoking, mFI(>3/11), disseminating cancer, bleeding disorder and longer operative time were found to independently associated with readmission.ConclusionsAn 11-point modified frailty index as measured in NSQIP correlates with readmissions after colorectal resection in patients with colon and rectal cancer.
       
  • Open abdomen and age; results from IROA (International Register of Open
           Abdomen)
    • Abstract: Publication date: Available online 11 November 2019Source: The American Journal of SurgeryAuthor(s): Federico Coccolini, Daniele Perrina, Marco Ceresoli, Yoram Kluger, Andrew Kirkpatrick, Massimo Sartelli, Luca Ansaloni, Fausto CatenaAbstractIntroductionNo definitive data exist regarding epidemiology and outcomes of patients treated with open abdomen (OA) linked to age.MethodsThis is a prospective, observational, cohort study that includes patients treated with OA. Patients were divided into 4 age groups: group 1: 16–40 y.o.; group 2: 41–60 y.o.; group 3:61–80 y.o.; group 4:> 80 y.o.Results760 patients were enrolled. Average age was 60 ± 18aa; 57.2% were males. Most frequent indication was peritonitis (50.9%). Mean open duration of open abdomen was8±18 days. Definitive closure was reached in 81.1% of patients. Complications were recorded in 84.8% of patients with significant differences between groups (p = 0.001). Overall mortality was41.2% with significant differences between groups (p 
       
  • Effective reduction in stress induced postoperative hyperglycemia in
           bariatric surgery by better carb loading
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of SurgeryAuthor(s): Patrick Knight, Jesse Chou, Melissa Dusseljee, Stuart Verseman, Alain ElianAbstractBackgroundPreoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP's), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics.MethodsUsing our ERP, a preoperative grape juice group (Grape) was compared to the use of 25 g maltodextrin/3 g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading.ResultsThe population included 171 patients (Grape n = 96; GED n = 75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; p 
       
  • Early postoperative small bowel obstruction: A review
    • Abstract: Publication date: Available online 8 November 2019Source: The American Journal of SurgeryAuthor(s): Adrian W. Ong, Stephan R. MyersAbstractEarly postoperative small bowel obstruction (ESBO) is a challenging problem. Although it is usually amenable to non-operative management, a significant proportion of patients will require re-operation. Certain causes of ESBO and types of index procedures should prompt consideration for early re-operation. A laparoscopic approach during the index operation, certain barrier agents and closure of mesenteric defects in bariatric surgery may reduce the risk of ESBO. There is no consensus regarding an acceptable length of time for initial non-operative management of ESBO but re-operation beyond two weeks may be associated with increased complications.
       
  • Breast Cancer Risk Assessment In Patients Who Test Negative For A
           Hereditary Cancer Syndrome
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of SurgeryAuthor(s): C. Breit, E. Ablah, M. Ward, H. Okut, S.D. Helmer, P.L. Tenofsky
       
  • Surgical Treatment For Chronic Postoperative Inguinal Pain-Short Term
           Outcomes Of A Specialized Center
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of SurgeryAuthor(s): D.M. Krpata, L. Tastaldi, C.C. Petro, A. Fafaj, S. Rosenblatt, A.S. Prabhu
       
  • WHAT PREDICTS SUCCESSFUL NONOPERATIVE MANAGEMENT WITH BOTULINUM TOXIN FOR
           ANAL FISSURE'
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of SurgeryAuthor(s): J.W. Ogilvie, R. Kyriakakis, M. Luchtefeld
       
  • Resident involvement in minimally-invasive vs. open procedures
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of SurgeryAuthor(s): Susanna W.L. de Geus, Alaina D. Geary, Nkiruka Arinze, Sing Chau Ng, Cullen O. Carter, Teviah E. Sachs, Jason F. Hall, Donald T. Hess, Jennifer F. Tseng, Luise I.M. PernarAbstractBackgroundThe objective of this study was to evaluate the impact of resident involvement on surgical outcomes in laparoscopic compared to open procedures.MethodsThe American College of Surgeons National Surgical Quality Improvement Program 2007–2012 was queried for open and laparoscopic ventral hernia repair (VHR), inguinal hernia repair (IHR), splenectomy, colectomy, or cholecystectomy (CCY). Multivariable regression analyses were performed to assess the impact of resident involvement on surgical outcomes.ResultsIn total, 88,337 VHR, 20,586 IHR, 59,254 colectomies, 3,301 splenectomies, and 95,900 CCY were identified. Resident involvement was predictive for major complication during open VHR (AOR, 1.29; p 
       
  • MAKING ENCHANCED RECOVERY THE NORM NOT THE EXCEPTION
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of SurgeryAuthor(s): D.P. Slakey, D.S. Silver, S.M. Chazin, P. Katoozian, K.S. Sikora
       
  • INCREASING TREND OF 4-GLAND PARATHYROID EXPLORATION IN PRIMARY
           HYPERPARATHYROIDISM
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of SurgeryAuthor(s): A. Khokar, K. Kuchta, S. Abadin, T. Moo-Young, D. Winchester, R. Prinz
       
  • Feasibility and efficacy of gamification in general surgery residency:
           Preliminary outcomes of residency teams
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of SurgeryAuthor(s): John C. McAuliffe, Robert H. McAuliffe, Gustavo Romero-Velez, Mindy Statter, W. Scott Melvin, Peter MuscarellaAbstractBackgroundComprehensive studies evaluating the efficacy of team-based competition (“Gamification”) in surgery have not been performed. Board pass rates and resident satisfaction may improve if surgical residents are involved in competition.MethodsResidents at Montefiore Medical Center (Bronx, New York) were surveyed and separated into teams during a draft. Each resident's performance was converted into a point system. Resident scores were combined into a team score and presented as a leaderboard. Awards were given. ABSITE, ACGME residency satisfaction, and ABS qualifying exam pass rates were compared.ResultsSixty percent of residents are inspired to improve their performance during gamification. ABSITE average percentile score improved from 28 to 43. ABS qualifying exam pass rates improved from 73% to 100%. Resident satisfaction improved from 65% to 88%. The point system allowed for establishing “growth curves” for each resident enabling enhanced assessment of residents.ConclusionsA comprehensive team-based competition inspires performance, is feasible, and seems to improve ABSITE scores, ABS pass rates, and satisfaction while being a tool for assessment of performance.
       
  • TRENDS IN THE OUTCOMES OF CYTOREDUCTIVE SURGERY WITH HYPERTHERMIC
           INTRAPERITONEAL CHEMOTHERAPY FOR APPENDICEAL NEOPLASMS: A
           MULTI-INSTITUTIONAL ANALYSIS
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of SurgeryAuthor(s):
       
  • "&rft.title=American+Journal+of+Surgery&rft.issn=0002-9610&rft.date=&rft.volume=">Comments on article "Discrepancies between conventional and viscoelastic
           assays in identifying trauma induced coagulopathy"
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Karlijn J.P. van Wessem, Luke P.H. Leenen
       
  • Response to “individualized care in patients undergoing laparoscopic
           cholecystectomy”
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Stéphane Bourgouin, Julien Mancini, Tristan Monchal, Julien Bordes, Paul Balandraud
       
  • Letter to editor: “Thyroid surgery and obesity: Cohort study of surgical
           out comes and local specific complications”
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): VNSSVAMS Mahalakshmi, Mohd Rashid, Sapana Bothra, Aromal Chekavar, Sabaretnam Mayilvaganan
       
  • When rural is no longer rural: Demand for subspecialty trained surgeons
           increases with increasing population of a non-metropolitan area
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Mackenzie R. Cook, Dorothy Hughes, Shanley B. Deal, Michael D. Sarap, Tyler G. Hughes, Karen E. Deveney, Karen J. Brasel, Adnan A. AlseidiBackgroundSurgery in larger, non-metropolitan, communities may be distinct from rural practice. Understanding these differences may help guide training. We hypothesize that increasing community size is associated with a desire for subspecialty surgeons.MethodsWe designed a mixed methods study with the ACS Rural Advisory Council. Rural (100,000) communities were compared. Quantitative and qualitative data were analyzed.ResultsWe received 237 responses, and desire to hire subspecialty-trained surgeons was associated with practice in a large non-metropolitan community, OR 4.5, (1.2–16.5). Qualitative themes demonstrated that rural surgeons limit practices to align with available hospital resources while large non-metropolitan surgeons specialize according to interest and market pressures.ConclusionsSurgery in rural versus large non-metropolitan communities may be more distinct than previously understood. Rural practice requires broad preparation while large non-metropolitan practice favors subspecialty training.Graphical abstractImage 1
       
  • The effectiveness of using 3D reconstruction software for surgery to
           augment surgical education
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(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 lesions.MethodsFour 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.
       
  • Local VS. other forms of anesthesia for open inguinal hernia repair: A
           meta-analysis of randomized controlled trials
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Madison Argo, Juan Favela, Tri Phung, Sergio HuertaAbstractBackgroundThere is variation in the anesthetic technique for open inguinal hernia repair (OIHR) worldwide. Factors determining the anesthetic technique remains equivocal. We hypothesize that outcomes and operative room times are superior with local anesthesia (LA) compared to AO [all others (general and spinal anesthesia)].MethodsFollowing PRISMA guidelines and set inclusion and exclusion criteria, various databases were reviewed and 18 RCT's were isolated. Using ReviewManager 5.3, multiple parameters were used to test for overall effect between the included studies.ResultsOverall complication rate was similar in LA vs. AO (p = 0.06). Wound infection and hematomas were similar between LA vs. OA, but urinary retention was significantly decreased in LA (p = 0.0002). Patient satisfaction was not inferior with LA (p = 0.10). Surgical time was similar in LA vs. AO (p = 0.86), but operating room time was significantly decreased with LA (p 
       
  • Current evidence on the relation between gut microbiota and intestinal
           anastomotic leak in colorectal surgery
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Roy Hajjar, Manuela M. Santos, François Dagbert, Carole S. RichardAbstractBackgroundAnastomotic leak (AL) is a major complication in colorectal surgery. It worsens morbidity, mortality and oncological outcomes in colorectal cancer. Some evidence suggests a potential effect of the intestinal microbiome on wound healing. This review aims to provide a comprehensive review on historical and current evidence regarding the relation between the gastrointestinal microbiota and AL in colorectal surgery, and the potential microbiota-modifying effect of some perioperative commonly used measures.Data sourcesA comprehensive search was conducted in Pubmed, Medline and Embase for historical and current clinical and animal studies addressing perioperative intestinal microbiota evaluation, intestinal healing and AL.ConclusionsEvidence on microbes' role in AL is mainly derived from animal experiments. The microbiota's composition and implications are poorly understood in surgical patients. Elaborate microbiota sequencing is required in colorectal surgery to identify potentially beneficial microbial profiles that could lead to specific perioperative microbiome-altering measures and improve surgical and oncological outcomes.
       
  • Prediction of hypocalcemia after total thyroidectomy using indocyanine
           green angiography of parathyroid glands: A simple quantitative scoring
           system
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Silvia Gálvez-Pastor, Nuria M. Torregrosa, Antonio Ríos, Beatriz Febrero, Rafael González-Costea, María A. García-López, María D. Balsalobre, Patrícia Pastor-Pérez, Pablo Moreno, José L. Vázquez-Rojas, José M. RodríguezAbstractBackgroundHypocalcemia is one of the most common complications after total thyroidectomy. Recently, indocyanine green (ICG) angiography of the parathyroid glands (PGs) has been suggested as a reliable tool for predicting postoperative hypocalcemia. The aim of our study was to evaluate the performance of a simple quantitative score based on ICG angiography of the PGs (4-ICG score) for predicting postoperative hypocalcemia.MethodsThirty nine consecutive patients who underwent total thyroidectomy for multinodular goiter were included. For each patient, the 4-ICG score was calculated, adding the individual viability value of the four PGs. Discrimination and correlation analyses were performed.ResultsIn 32/39 patients, the four PGs were identified. Patients with postoperative hypocalcemia (n = 6, 19%) had a lower 4-ICG score (2.5 [1.8–3.3] vs. 4.0 [3.0–6.0]; p = 0.003). The 4-ICG score showed good discrimination in terms of predicting postoperative hypocalcemia (AUC = 0.875 (0.710–0.965); p = 0.001) and a good correlation with postoperative parathyroid function.ConclusionsThe 4-ICG score predicts postoperative hypocalcemia and correlates well with postoperative parathyroid function in patients undergoing total thyroidectomy for multinodular goiter.
       
  • Unplanned readmissions following breast cancer surgery
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Ted A. James, Gyulnara Kasumova, Amuyla Alapati, Anita MamtaniAbstractBackgroundUnderstanding the underlying factors associated with unplanned readmissions is an important first step toward interventions designed to improve quality of care. This study aimed to identify predictors of unplanned 30-day readmission using a national breast surgery cohort.Study designUsing the National Cancer Database, we performed a review of patients undergoing surgery for breast cancer from 2006 to 2014. A multivariatble logistic regression model was generated to assess predictors of 30-day unplanned readmission.ResultsOf 944,092 patients identified, 15,695 (1.7%) had an unplanned readmission within 30 days. Significant predictors of readmission included: increased procedure complexity, high co-morbidity score, Medicaid or lack of insurance, and low annual hospital volume; p 
       
  • Donor age is the most important predictor of long term graft function in
           donation after cardiac death simultaneous pancreas-kidney transplantation:
           A retrospective study
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Jingwen Chen, David M. Mikhail, Hemant Sharma, Jeffrey Jevnikar, Matthew Cooper, Patrick P. Luke, Alp SenerAbstractBackgroundAllografts donated after cardiac death (DCD) are the fastest growing organ source worldwide. Unfortunately, information is lacking on how to judge these organs’ viability. Here, we analyzed the effects of donor characteristics, including age and BMI, on outcomes of DCD simultaneous-pancreas-kidney transplantation (SPK).MethodsWe evaluated UNOS DCD-SPK transplants from 1988 to 2012. Effects of donor characteristics on graft and recipient survival were evaluated using Cox Regression and the Kaplan-Meier method, and compared to predictions from the pancreas and kidney donor risk indices (PDRI, KDRI).ResultsCompared to grafts≤40(n = 38), grafts>40(n = 189) had lower 1-year (73.4% ± 7.2% vs 88.2% ± 2.4%) and 10-year (50.3% ± 10% vs 66.3% ± 6.9%) pancreas survival, and twice the rate of kidney failure (HR2.1, 95%CI 1.15–3.83, p 
       
  • Emergency general surgery procedures in hematopoietic stem cell transplant
           recipients
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Sharven Taghavi, Manuel Castillo-Angeles, Tarsicio Uribe-Leitz, Sameer Hirji, Philippe Armand, Deepika Nehra, Zara Cooper, Edward Kelly, Joaquim Havens, Adil Haider, Ali Salim, Reza AskariAbstractBackgroundOutcomes of emergency general surgery (EGS) procedures on hematopoietic stem cell transplant (HST) recipients have not been defined in a large, national database. Whether EGS during HST engraftment admission, or in HST patients with graft versus host disease (GVHD) results in worse outcomes is unknown.MethodsThe National Inpatient Sample (NIS) was examined for patients with a history of BMT between 2001 and 2014.ResultsThere were 520,000 HST admissions meeting inclusion criteria, of which, 14,143 (2.7%) required EGS. Of those requiring EGS, 378 (2.7%) were during engraftment admission and 13,765 (97.3%) on subsequent admission. For those requiring EGS during subsequent admission, 9,920 (72.1%) had a history of GVHD and 3,845 (27.9%) did not. On multivariate analysis, requirement of EGS was associated with mortality (OR: 1.71, 95%CI: 1.47–1.99, p 
       
  • Predictors of adjuvant treatment and survival in patients with
           intrahepatic cholangiocarcinoma who undergo resection
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Grace C. Lee, Cristina R. Ferrone, Kenneth K. Tanabe, Keith D. Lillemoe, Lawrence S. Blaszkowsky, Andrew X. Zhu, Theodore S. Hong, Motaz QadanAbstractBackgroundAdministration of adjuvant therapy (AT) in patients with intrahepatic cholangiocarcinoma (ICC) remains inconsistent despite recent trial data. This study investigates predictors of receipt of AT and survival.MethodsPatients with ICC who underwent resection were identified using the NCDB (2004–2014). Logistic regression and Cox analysis were used to determine predictors of AT and survival, respectively. “High-risk” was defined as positive margins/nodes or stage III/IVa disease.Results2813 patients were identified, of whom 42.3% received AT. Patients with positive margins, positive nodes, and higher stage tended to receive AT (p 
       
  • Prevalence of posttraumatic stress disorder (PTSD) in patients with an
           incisional hernia
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Hemasat Alkhatib, Luciano Tastaldi, David M. Krpata, Judith Scheman, Clayton C. Petro, Aldo Fafaj, Steven Rosenblatt, Michael J. Rosen, Ajita S. PrabhuAbstractBackgroundWe investigate the prevalence of PTSD in patients with an incisional hernia presenting for evaluation at our institution.MethodsStudy patients were screened for PTSD using the PCL-5 checklist for DSM-5. Patient-reported quality of life and pain scores were assessed using validated tools (HerQLes and PROMIS Pain Intensity 3a survey).ResultsThe prevalence of PTSD in 131 patients was 32.1% [95% CI 24%–40%]. Patients screening positive (PTSD+) reported lower quality of life scores on HerQles (17.3 ± 14.3 vs. 47.7 ± 29.6, P 
       
  • Total abdominal colectomy is cost-effective in treating colorectal cancer
           in patients with genetically diagnosed Lynch Syndrome
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Boxiang Jiang, Asya Ofshteyn, Jay J. Idrees, Matthew Giglia, Carlos Gallego, Sharon L. Stein, Emily Steinhagen, University Hospitals Research in Surgical Outcome & Effectiveness (UH-RISES)AbstractBackgroundLynch syndrome (LS) has a 80% lifetime risk of developing colorectal cancer and metachronous cancer. No studies have examined the quality adjusted life expectancy after SEG or TAC for LS patients, which this study was aiming for. If TAC offers a higher quality adjusted life year (QALY) to SEG in LS patients, preoperative diagnosis of LS is critical as it alters the recommended surgical procedure.MethodsA Markov decision tree was constructed using Treeage software to compare QALY of LS patients following SEG or TAC. Probabilities, cost, and utility were obtained from literature. Cost-effectiveness analyses were performed.ResultsTAC dominates SEG as both the life-saving and cost-saving strategy. TAC dominated SEG on QALY (17.80 vs 17.13 QALY) for a cohort of LS patients diagnosed at an average of 30 year old and followed every 2 years after initial surgery.ConclusionsWe conclude that TAC as the primary surgical option for LS patients diagnosed with Stage I-III colon cancer is cost-effective. Further cost-effectiveness study is recommended to include extra-colonic malignancies in LS patients.
       
  • Outcomes of Hartmann's procedure and subsequent intestinal restoration.
           Which patients are most likely to undergo reversal'
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): D. Moro-Valdezate, A. Royo-Aznar, J. Martín-Arévalo, V. Pla-Martí, S. García-Botello, C. León-Espinoza, M.C. Fernández-Moreno, E. Espín-Basany, A. Espí-MacíasAbstractBackgroundAim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration.MethodsRetrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP.Results533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction.ConclusionsHP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.
       
  • Obstruction reduction: Use of water-soluble contrast challenge to
           differentiate between partial and complete small bowel obstruction
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Eliza Moskowitz, Eric M. Campion, Clay Cothren Burlew, Laura J. Helmkamp, Erik D. Peltz, Brittany L. Gansar, Robert C. McIntyreAbstractDifferentiating SBO that will resolve conservatively from those requiring surgery remains challenging. Water-soluble contrast administration may be diagnostic and therapeutic. Our study evaluated use of a WSC challenge protocol. We hypothesize that protocol use discriminates between surgical SBO and obstructions which can be managed non-operatively.Demographics, prior surgeries, time to operation, complications, and LOS were analyzed.108 patients were admitted with SBO. 13% underwent immediate laparotomy with concern for bowel compromise; these had a median LOS of 8.5 days. 91 received WSC protocol. Of these, 77% had contrast passage to the colon. Of the 48 in whom contrast passed between 0 and 12 h, LOS was 2 days. Of the 22 patients in whom contrast passed between 12 and 24 h, LOS was 4.5 days. 21 had failure of contrast passage; 18 of those underwent surgery after 24 h as a result. Of the 21 patients who failed WSC challenge, median LOS was 8 days.WSC protocol implementation facilitates early recognition of partial from complete obstruction and may decrease LOS. Our findings warrant further evaluation with a multicenter trial.
       
  • Incidence of and risk factors for delayed acute kidney injury in patients
           undergoing colorectal surgery
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Youn Kyung Kee, Hyoungnae Kim, Jong Hyun Jhee, Seung Hyeok Han, Tae-Hyun Yoo, Shin-Wook Kang, Jung Tak ParkAbstractBackgroundThe risk of delayed AKI (AKI development beyond the perioperative period) in patients undergoing colorectal surgery is greater than that in patients undergoing other major operations. However, the characteristics of and risk factors for delayed AKI are unclear.MethodsWe investigated 683 patients who underwent colorectal surgery with intestinal resection at a single tertiary hospital. All patients were followed-up for a year postoperatively. The primary outcome was the development of AKI during follow-up.ResultsAKI occurred in 177 (25.9%) during the first postoperative year. Patients who developed AKI were significantly older, showed a lower body mass index, and significantly lower preoperative hemoglobin and serum albumin levels. AKI occurred most commonly during the first 3 months postoperatively. However, AKI occurred persistently even after this initial period. Older age, lower preoperative serum albumin levels, and late ostomy closure were independently associated with a higher risk of delayed AKI.ConclusionAKI commonly occurs beyond the perioperative period. Careful risk stratification and modification of risk factors may prevent delayed AKI in patients undergoing colorectal cancer surgery.
       
  • Safety evaluation of simultaneous resection of colorectal primary tumor
           and liver metastasis after neoadjuvant therapy: A propensity score
           matching analysis
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Yuchen Wu, Fangqi Liu, Wang Song, Fei Liang, Lu Wang, Ye XuAbstractBackgroundConsidering the surgical safety and perioperative complications, simultaneous resection after neoadjuvant therapy is not commonly recommended.MethodsA total of 253 patients were included in study. Comparison of the short-term outcomes was performed after propensity score adjustment in Group A (n = 96) and Group B (neoadjuvant therapy, n = 96).ResultsThere was no postoperative mortality. After matching, the differences from surgical confounders were well-balanced. Morbidity (15.6% vs. 15.6%, p = 0.981), and Clavien-Dindo grade of complications (p = 0.710) were similar. No difference was found when the complications were divided according to the origin (general, colorectal and hepatic). Length of the hospital stays also did not differ between the groups (p = 0.482). More importantly, there was no increase in the number of patients with delayed adjuvant treatment after surgery in Group B.ConclusionsNeoadjuvant treatment did not increase morbidity, length of hospital stays and influence adjuvant treatment after simultaneous resection.
       
  • Hospital and surgeon variation in positive circumferential resection
           margin among rectal cancer patients
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Carla F. Justiniano, Christopher T. Aquina, Fergal J. Fleming, Zhaomin Xu, Francis P. Boscoe, Maria J. Schymura, Larissa K. Temple, Adan Z. BecerraAbstractBackgroundThe objective of this study was to evaluate variation in positive CRM at the surgeon and hospital levels and assess impact on disease-specific survival.MethodsPatients with stage I-III rectal cancer were identified in New York State. Bayesian hierarchical regressions estimated observed-to-expected (O/E) ratios for each surgeon/hospital. Competing-risks analyses estimated disease-specific survival among patients who were treated by surgeons/hospitals with O/E > 1 compared to those with O/E ratio ≤ 1.ResultsAmong 1,251 patients, 208 (17%) had a positive CRM. Of the 345 surgeons and 118 hospitals in the study, 99 (29%) and 48 (40%) treated a higher number of patients with CRM than expected, respectively. Patients treated by surgeons with O/E > 1 (HR = 1.38, 95% CI = 1.16, 1.67) and those treated at hospitals with O/E > 1 (HR = 1.44, 95% CI = 1.11, 1.85) had worse disease-specific survival.DiscussionSurgeon and hospital performance in positive CRM is associated with worse prognosis suggesting opportunities to enhance referral patterns and standardize care.
       
  • It still hurts! Persistent pain and use of pain medication one year after
           injury
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Constantine S. Velmahos, Juan P. Herrera-Escobar, Syeda S. Al Rafai, Shelby Chun Fat, Haytham Kaafarani, Deepika Nehra, George Kasotakis, Ali Salim, Adil H. HaiderAbstractBackgroundGiven the scarce literature data on chronic post-traumatic pain, we aim to identify early predictors of long-term pain and pain medication use after major trauma.MethodsMajor trauma patients (Injury Severity Score ≥ 9) from three Level I Trauma Centers at 12 months after injury were interviewed for daily pain using the Trauma Quality of Life questionnaire. Multivariate logistic regression models identified patient- and injury-related independent predictors of pain and use of pain medication.ResultsOf 1238 patients, 612 patients (49%) felt daily pain and 300 patients (24%) used pain medication 1 year after injury. Of a total of 8 independent predictors for chronic pain and 9 independent predictors for daily pain medication, 4 were common (pre-injury alcohol use, pre-injury drug use, hospital stay ≥ 5 days, and education limited to high school). Combinations of independent predictors yielded weak predictability for both outcomes, ranging from 20% to 72%.ConclusionsOne year after injury, approximately half of trauma patients report daily pain and one-fourth use daily pain medication. These outcomes are hard to predict.
       
  • The effects of propranolol and clonidine on bone marrow expression of
           hematopoietic cytokines following trauma and chronic stress
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Tyler J. Loftus, Elizabeth S. Miller, Jessica K. Millar, Kolenkode B. Kannan, Ines G. Alamo, Philip A. Efron, Alicia M. MohrAbstractBackgroundAttenuating post-injury neuroendocrine stress abrogates persistent injury-associated anemia. Our objective was to examine the mechanisms by which propranolol and clonidine modulate this process. We hypothesized that propranolol and clonidine would decrease bone marrow expression of high-mobility group box-1 (HMGB1) and increase expression of stem cell factor (SCF) and B-cell lymphoma-extra large (Bcl-xL).MethodsMale Sprague-Dawley rats were allocated to naïve control, lung contusion followed by hemorrhagic shock (LCHS), or LCHS plus daily chronic restraint stress (LCHS/CS) ±propranolol, ±clonidine. Day seven bone marrow expression of HMGB1, SCF, and Bcl-xL was assessed by polymerase chain reaction.ResultsFollowing LCHS, HMGB1 was decreased by propranolol (49% decrease, p = 0.012) and clonidine (54% decrease, p 
       
  • Injury patterns and incidence of intra-abdominal injuries in elderly
           ground level fall patients: Is the PAN-SCAN warranted'
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Christopher G. Gartin, Jared Reyes, Stephen D. Helmer, James M. HaanAbstractBackgroundThis study aimed to determine the incidence of intra-abdominal injuries in elderly patients after a ground-level fall.MethodsA 6-year retrospective review was conducted on patients 65 years of age or older involved in a fall from standing and evaluated at a level 1 trauma center. Each patient presented with a pelvic, thoracolumbar, and/or lower rib fracture. Data collection included demographics, injury characteristics, FAST exam results, CT imaging results, and hospitalization outcomes.ResultsA total of 324 patients met study inclusion criteria. The majority of patients were white (95.1%) females (65.4%) with an average age of 82.0 ± 7.3 years. Only 22 patients (6.8%) reported abdominal pain, although an abdominal CT was performed in 91 patients (28.1%). Only 1 patient (0.3%) was found to have an intra-abdominal injury when no abdominal pain was reported and the FAST exam was negative. This injury was not clinically significant enough to warrant surgical intervention.ConclusionElderly patients who suffer a ground-level fall do not benefit from PAN-SCAN, even when presenting with rib, thoracolumbar, and/or pelvic fractures.
       
  • Racial disparities in post-discharge healthcare utilization after trauma
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Shelby Chun Fat, Juan P. Herrera-Escobar, Anupamaa J. Seshadri, Syeda S. Al Rafai, Zain G. Hashmi, Elzerie de Jager, Constantine Velmahos, George Kasotakis, George Velmahos, Ali Salim, Adil H. Haider, Deepika NehraAbstractBackgroundRacial disparities in trauma outcomes have been documented, but little is known about racial differences in post-discharge healthcare utilization. This study compares the utilization of post-discharge healthcare services by African-American and Caucasian trauma patients.MethodsTrauma patients with an Injury Severity Score (ISS)≥9 from three Level-I trauma centers were contacted between 6 and 12 months post-injury. Utilization of trauma-related healthcare services was asked. Coarsened exact matching (CEM) was used to match African-American and Caucasian patients. Conditional logistic regression then compared matched patients in terms of post-discharge healthcare utilization.Results182 African-American and 1,117 Caucasian patients were followed. Of these, 141 African-Americans were matched to 628 Caucasians. After CEM, we found that African-American patients were less likely to use rehabilitation services [OR:0.64 (95% CI:0.43–0.95)] and had fewer injury-related outpatient visits [OR:0.59 (95% CI:0.40–0.86)] after discharge.ConclusionsThis study shows the existence of racial disparities in post-discharge healthcare utilization after trauma for otherwise similarly injured, matched patients.
       
  • Preoperative opioid use and postoperative pain associated with surgical
           readmissions
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Elise A. Dasinger, Laura A. Graham, Tyler S. Wahl, Joshua S. Richman, Samantha J. Baker, Mary T. Hawn, Tina Hernandez-Boussard, Amy K. Rosen, Hillary J. Mull, Laurel A. Copeland, Jeffrey C. Whittle, Edith A. Burns, Melanie S. MorrisAbstractBackgroundThe extent of preoperative opioid utilization and the relationship with pain-related readmissions are not well understood.MethodsVA Surgical Quality Improvement Program data on general, vascular, and orthopedic surgeries (2007–2014) were merged with pharmacy data to evaluate preoperative opioid use and pain-related readmissions. Opioid use in the 6-month preoperative period was categorized as none, infrequent, frequent, and daily.ResultsIn the six-month preoperative period, 65.7% had no opioid use, 16.7% had infrequent use, 6.3% frequent use, and 11.4% were daily opioid users. Adjusted odds of pain-related readmission were higher for opioid-exposed groups vs the opioid-naïve group: infrequent (OR 1.17; 95% CI:1.04–1.31), frequent (OR 1.28; 95% CI:1.08–1.52), and daily (OR 1.49; 95% CI:1.27–1.74). Among preoperative opioid users, those with a pain-related readmission had higher daily preoperative oral morphine equivalents (mean 44.5 vs. 36.1, p 
       
  • Letter to editor in response to article entitled “Feeding jejunostomy
           after esophagectomy cannot be routinely recommended. Analysis of
           nutritional benefits and catheter-related complications”
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Joydeep Purkayastha, Jitin Yadav, Srishti Madhav, Abhijit Talukdar
       
  • Analysis of operating room efficiency between a hospital-owned ambulatory
           surgical center and hospital outpatient department
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Jonathan B. Imran, Tarik D. Madni, Luis R. Taveras, Holly B. Cunningham, Audra T. Clark, Michael W. Cripps, YPaul GoldenMerry, Waqaar Diwan, Steven E. Wolf, Ali A. Mokdad, Herb A. PhelanAbstractBackgroundAmbulatory surgery centers (ASCs) are frequently utilized; however some ambulatory procedures may be performed in hospital outpatient departments (HOPs). Our aim was to compare operating room efficiency between our ASC and HOP.MethodsWe reviewed outpatient general surgery procedures performed at our ASC and HOP. Total case time was divided into five components: ancillary time, procedure time, exit time, turnover time, and nonoperative time.ResultsOverall, 220 procedures were included (114 ASC, 106 HOP). Expressed in minutes, the mean turnover time (29.8 ± 9.6 vs. 24.5 ± 12.7; p 
       
  • Emeritus Editorial Board
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s):
       
  • Contralateral prophylactic mastectomy: Warnings for a difficult decision
           to make with caution!
    • Abstract: Publication date: November 2019Source: The American Journal of Surgery, Volume 218, Issue 5Author(s): Gianluca Franceschini, Alba Di Leone, Riccardo Masetti
       
  • Women surgeons and the emergence of acute care surgery programs
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Wendelyn M. Oslock, Anghela Z. Paredes, Holly E. Baselice, Amy P. Rushing, Angela M. Ingraham, Courtney Collins, Kevin B. Ricci, Vijaya T. Daniel, Adrian Diaz, Victor M. Heh, Scott A. Strassels, Heena P. SantryBackgroundIn parallel to women entering general surgery training, acute care surgery (ACS) has been developing as a team-based approach to emergency general surgery (EGS). We sought to examine predictors of women surgeons in EGS generally, and ACS particularly.MethodsFrom our national survey, we determined the proportion of women surgeons within EGS hospitals. We compared the proportion of women surgeons based on hospitals characteristics using chi-squared tests, then used regression models to measure odds of ACS relative to the proportion of women.Results779 (50.4%) hospitals had zero women surgeons. These hospitals were more likely non-ACS and non-teaching with
       
  • Barriers to careers identified by women in academic surgery: A grounded
           theory model
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Amalia Cochran, Leigh A. Neumayer, William B. ElderBackgroundFaculty attrition has been widely acknowledged and poorly understood throughout academic medicine. To date, barriers to career advancement in academic surgery have been identified and described in a limited fashion using only survey data. The authors sought to characterize career barriers for women academic surgeons using grounded theory methodology.Methods
      Authors conducted semi-structured interviews with 15 mid-career and senior female academic surgeons in the United States. Data were drawn together using grounded theory analysis of interview transcripts to develop a conceptual model.ResultsInterviewees identified barriers constituting two intersecting categories: (1) obstacles within the system of academic surgery and (2) impediments based in broader culture and its power structures. Interviewees’ robust description of the challenges of integrating clinical and non-clinical professional responsibilities is novel.ConclusionsCareer barriers identified by women in academic surgery are complex and include cultural factors from within and outside of the profession. Identifying and dismantling barriers, particularly those that negatively impact perceptions of belonging, is imperative to creating a culture of sustained excellence in academic surgery.SummaryThe authors used grounded theory method to develop a conceptual model of barriers to careers in academic surgery as described by successful female academic surgeons. The authors identified intersecting cultural barriers specific to academic surgery and derived from cultural power differentials.
       
  • Current policies and practicing surgeon perspectives on parental leave
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Tyler Gaines, Nina Harkhani, Hegang Chen, Rena D. MalikAbstractBackgroundThe aim of this study is to evaluate the components of current parental leave policies in surgical practice and evaluate surgeon perceptions of parental leave.MethodsPracticing surgeons were recruited to complete a survey via social media outlets and e-mail. Participants were asked questions regarding existing policies and their perspectives towards parental leave.ResultsThe survey was completed by 431 surgeons, of which 90% were female and 45% in academics. The majority (84%) of women took
       
  • Telemedicine and telementoring in the surgical specialties: A narrative
           review
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Eunice Y. Huang, Samantha Knight, Camila Roginski Guetter, Catherine Hambleton Davis, Mecker Moller, Eliza Slama, Marie CrandallAbstractBackgroundThe field of telemedicine has grown tremendously over the last decade. We present a systematic review of publications on telemedicine as it pertains to surgery, addressing six facets: 1) telerobotics, 2) telementoring, 3) teleconsulting, 4) telemedicine in post-operative follow-up, 5) tele-education, and 6) current technology.Data sourcesA search of relevant literature querying PubMed, Web of Science, and Science Direct was performed using the following keywords: telecommunication, telemedicine, telehealth, virtual health, virtual medicine, general surgery, surgery, surgical or surgical patients.ConclusionsTelemedicine is being used to care for patients in remote areas, to help expert surgeons assist other specialists in the office or novice surgeons in the operating room, as well as to help teach the next generation of surgeons. There are many opportunities for surgeons to utilize this technology to optimize their practice.
       
  • Is clinician assessment accurate or is routine pan-body CT needed in the
           stable intoxicated trauma patient'
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Shannon Marie Foster, Alison Muller, Jeremy Conklin, Vicente Cortes, Forrest B. Fernandez, Thomas A. Geng, Eugene F. Reilly, Adam Sigal, Adrian W. OngAbstractBackgroundWe sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients.MethodsWe prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as “low index” or “more than a low index”. The reference standard was the presence of any pre-defined significant finding (SF) on CT. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios were calculated.ResultsEnrollment of 103 patients was completed. Sensitivity, specificity, LR+ and LR-for clinician index of suspicion were: 56%, 68%, 1.75, 0.64 (head/face), 50%, 92%, 6.18, 0.54 (neck), 10%, 96%, 2.60, 0.94 (thorax) and 67%, 93%, 9.56, 0.36 (abdomen/pelvis).ConclusionClinician judgement was most useful to guide need for CT imaging in the neck and abdomen/pelvis. Routine PBCT may not be necessary.SummaryFor awake, stable intoxicated patients after falls and assaults, clinician index of suspicion was most useful to guide the need for CT imaging in the neck and abdomen/pelvis. Our findings support selective use of CT if the index of suspicion is low. Routine PBCT may not be necessary.
       
  • Outcomes of selective whole breast irradiation following lumpectomy with
           intraoperative radiation therapy for hormone receptor positive breast
           cancer
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Kristy Broman, Weihong Sun, Jun-min Zhou, Brooke Fridley, Roberto Diaz, Christine LarongaAbstractBackgroundFor low risk breast cancer, the TARGIT-A randomized trial supported lumpectomy with intraoperative radiation therapy (IORT) and selective whole breast radiation (WBXRT). Selection criteria for WBXRT vary.MethodsWomen with hormone-receptor positive, clinically node-negative breast cancer were categorized retrospectively as suitable for IORT alone or also needing WBXRT by TARGIT-A or expanded TARGIT criteria (TARGIT-MCC). We evaluated local recurrence (LR) by selection criteria and receipt of WBXRT.ResultsAmong 194 cases followed a median of 44 months, 54 (27.8%) met TARGIT-MCC criteria for WBXRT (34 met TARGIT-A criteria). Thirty patients were recommended and 21 (10.8%) received WBXRT. Of 13 patients with LR, none received WBXRT. LR was 10.5% in patients meeting TARGIT-MCC criteria who did not receive WBXRT versus 0% after WBXRT (p = 0.299).ConclusionsSelective WBXRT may have mitigated LR. Nearly all LR were in patients not recommended WBXRT. Further work should refine criteria for WBXRT after IORT.SummaryPrior work among women with early breast cancer supported lumpectomy with intraoperative radiation therapy and selective adjuvant radiation using a risk-adapted approach. An expanded set of criteria for adjuvant radiation appear to further mitigate local recurrence risk. Local recurrence after lumpectomy with IORT could be further minimized by identification of additional high-risk features, as well as greater adherence to adjuvant endocrine therapy.
       
  • Suspected appendicitis pathway continues to lower CT rates in children two
           years after implementation
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Lori A. Gurien, Samuel D. Smith, Melvin S. Dassinger, Jeffrey M. Burford, Joseph J. Tepas, Marie CrandallAbstractBackgroundWe implemented a protocol to evaluate pediatric patients with suspected appendicitis using ultrasound as the initial imaging modality. CT utilization rates and diagnostic accuracy were evaluated two years after pathway implementation.MethodsThis was a retrospective observational study of patients
       
  • Variations in the utilization of immediate post-mastectomy breast
           reconstruction
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Apoorve Nayyar, Paula D. Strassle, Karishma G. Reddy, Danielle I. Jameison, Cara G. Moses, Michelle C. Roughton, Kandace P. McGuire, Kristalyn K. GallagherAbstractBackgroundFor female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical location of the patient.MethodsWomen ≥18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2014 were eligible. Women with inflammatory BC, Stage IV BC diagnoses, and bilateral BC were excluded. Multivariable logistic regression, adjusting for patient and cancer characteristics, were used to assess the association between of race, marital status, and region on immediate PMBR utilization.Results321,206 women were included and 24% underwent immediate PMBR (
       
  • Completion thyroidectomy: A risky undertaking'
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Kristina J. Nicholson, Cindy Y. Teng, Kelly L. McCoy, Sally E. Carty, Linwah YipAbstractBackgroundCompletion thyroidectomy (cT) is sometimes necessary after thyroid lobectomy (TL), and it remains controversial whether 2-stage thyroidectomy adds operative risk. This study compares complication rates for TL, total thyroidectomy (TT), and cT.MethodsUsing a cohort design, we reviewed 100 consecutive cases each of TL, TT, and cT. Complications examined included reoperation for hematoma, temporary/permanent recurrent laryngeal nerve (RLN) dysfunction, and hypoparathyroidism.ResultsTwo patients had reoperation for hematoma, both in the TT cohort (p = 0.33). No patients in any cohort had permanent hypoparathyroidism or RLN injury, but transient RLN paresis occurred in three (3%) TL, two (2%) TT, and no (0%) cT patients (p = 0.38). Transient hypoparathyroidism occurred in 3% following TT versus 0% after cT (p = 0.12). Overall complication rate was higher after TT (7%) compared to TL (3%) and cT (0%, p = 0.02).ConclusionsAt a high-volume center, the observed complication rates were equivalently low for TL, TT, and cT.SummaryCompletion thyroidectomy is occasionally needed after lobectomy, but its procedure-specific risks are not well characterized. In a cohort study at a high-volume center, operative outcomes for patients undergoing thyroid lobectomy, total thyroidectomy, and completion thyroidectomy were compared and equivalently low complication rates were observed for all 3 procedures.
       
  • The effect of modifiable risk factors on breast cancer aggressiveness
           among black and white women
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Brigid K. Killelea, Emily J. Gallagher, Sheldon M. Feldman, Elisa Port, Tari King, Susan K. Boolbol, Rebeca Franco, Kezhen Fei, Derek Le Roith, Nina A. BickellAbstractIntroductionAlthough breast cancer incidence is higher among white women, black women are more likely to have aggressive tumors with less favorable histology, and to have a worse prognosis. Obesity and alcohol consumption have been identified as two modifiable risk factors for breast cancer, while physical activity may offer protection. Little however is known about the association of these factors with race on the severity of breast cancer.MethodsData collected as part of a large prospective study looking at insulin resistance and race among women with breast cancer was queried for patient characteristics, lifestyle factors and tumor characteristics. The association with Nottingham Prognostic Index (NPI) was assessed with different models using univariate and multivariate linear regression.ResultsAmong 746 women in our cohort, 82% (n = 615) were white and 18% (n = 131) were black, mean age 58 years. Black patients were more likely to have high BMI (31.0 vs. 26.7, p 
       
  • Chronic stress induces persistent low-grade inflammation
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Elizabeth S. Miller, Camille G. Apple, Kolenkode B. Kannan, Zackary M. Funk, Jessica M. Plazas, Philip A. Efron, Alicia M. MohrAbstractIntroductionThis study sought to determine if the systemic cytokine profile of rodents subjected to chronic restraint stress leads to persistent low-grade inflammation.MethodsMale Sprague-Dawley rats were subjected to restraint stress for a total of seven or fourteen days. Urine norepinephrine (NE), plasma interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) were assessed with ELISA. Liver expression of IL-6 and TNF-α were assessed with real time PCR.ResultsChronic stress at 7 and 14 days sequentially increased plasma acute phase reactants (NE, IL-6, TNF-α, and CRP), liver IL-6 expression, hematopoietic progenitor cell mobilization, and decreased erythroid progenitor colony growth. Weight gain was reduced by chronic stress compared to each models’ naïve counterpart.ConclusionsCombining this model with trauma and sepsis models will allow evaluation of the contribution of persistent inflammation in disease progression and outcomes.
       
  • Clinical and pathological stage discordance among 433,514 breast cancer
           patients
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Jennifer K. Plichta, Samantha M. Thomas, Amanda R. Sergesketter, Rachel A. Greenup, Oluwadamilola M. Fayanju, Laura H. Rosenberger, Nina Tamirisa, Terry Hyslop, E. Shelley HwangAbstractBackgroundWe aim to determine clinical and pathological stage discordance rates and to evaluate factors associated with discordance.MethodsAdults with clinical stages I-III breast cancer were identified from the National Cancer Data Base. Concordance was defined as cTN = pTN (discordance: cTN≠pTN). Multivariate logistic regression was used to identify factors associated with discordance.ResultsComparing clinical and pathological stage, 23.1% were downstaged and 8.7% were upstaged. After adjustment, factors associated with downstaging (vs concordance) included grade 3 (OR 10.56, vs grade 1) and HER2-negative (OR 3.79). Factors associated with upstaging (vs concordance) were grade 3 (OR 10.56, vs grade 1), HER2-negative (OR 1.25), and lobular histology (OR 2.47, vs ductal). ER-negative status was associated with stage concordance (vs downstaged or upstaged, OR 0.52 and 0.87).ConclusionsAmong breast cancer patients, nearly one-third exhibit clinical-pathological stage discordance. This high likelihood of discordance is important to consider for counseling and treatment planning.
       
  • Emeritus Editorial Board
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s):
       
  • Policies and practice regarding pregnancy and maternity leave: An
           international survey
    • Abstract: Publication date: October 2019Source: The American Journal of Surgery, Volume 218, Issue 4Author(s): Danielle S. Walsh, Nancy L. Gantt, William Irish, Hilary A. Sanfey, Sharon L. SteinAbstractBackgroundAs women become a larger part of the surgical workforce, policies surrounding maternity and parental leave play a role in professional practice. Little is known about leave policies worldwide.MethodsA de novo survey distributed internationally to women surgeons assessed leave polices for surgeons, inclusive of the regulatory body or source of applicable policies, changes in surgical practice due to pregnancy, and duration of leave for both parents.ResultsThe 1111 survey respondents in 53 different countries describe diverse policies ranging from loss of operating room privileges early in pregnancy to maintenance of full surgical schedules until term delivery. Policy creators include national governments (42.38%), employers/hospitals (60.46%), supervisors (18.06%). Self-determined (9.12%), and unknown (8.7%). Paid parental leave was available to 64.44% of women surgeons and 38.68% of partners.ConclusionMaternity and parental leave policies vary markedly across the global surgical workforce with implications for professional practice.
       
 
 
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