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Publisher: Elsevier   (Total: 3042 journals)

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Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 325, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 204, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 123, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 45, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 20, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 34, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 21, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 338, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 307, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 422, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 10, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 47, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 53, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 5)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 160, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 152, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Surgery
  [SJR: 1.286]   [H-I: 125]   [33 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9610
   Published by Elsevier Homepage  [3042 journals]
  • Letter to editor in response to article entitled “Recurrence in patients
           with clinically early-stage papillary thyroid carcinoma according to tumor
           size surgical extent” by Kim JW et al published in Am J Surg. 2016
           Sep;212(3):419-425.e1. doi: 10.1016/j.amjsurg.2015.12.015
    • Authors: Chandan Kumar Jha; Raouef Ahmed Bichoo; Sanjay Kumar Yadav
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Chandan Kumar Jha, Sanjay Kumar Yadav, Raouef Ahmed Bichoo


      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.12.024
       
  • An institutional analysis of unplanned return to the operating room to
           identify areas for quality improvement
    • Authors: Yihan Lin; Robert A. Meguid; Patrick W. Hosokawa; William G. Henderson; Karl E. Hammermeister; Richard D. Schulick; Ryan C. Shelstad; Trevor T. Wild; Robert C. McIntyre
      Pages: 1 - 6
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Yihan Lin, Robert A. Meguid, Patrick W. Hosokawa, William G. Henderson, Karl E. Hammermeister, Richard D. Schulick, Ryan C. Shelstad, Trevor T. Wild, Robert C. McIntyre
      Background Unplanned return to the operating room (uROR) has been suggested as a hospital quality indicator. The purpose of this study was to determine reasons for uROR to identify opportunities for patient care improvement. Methods uROR reported by our institution's American College of Surgeons National Surgical Quality Improvement Program underwent secondary review. Results The uROR rate reported by clinical reviewers was 4.3%. Secondary review re-categorized 64.7% as “true uROR” with the most common reasons for uROR being infection (30.9%) and bleeding (23.6%). Remaining cases were categorized as “false uROR” with the most common reasons being inadequate documentation (60.0%) and not directly related to index procedure (16.7%). Conclusions Strict adherence to NSQIP definitions results in misidentification of true uROR. This raises concerns for using NSQIP-identified uROR as a hospital quality metric. Improved processes of care to prevent infection and hemorrhage at our institution could reduce the rate of true uROR.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.10.021
       
  • Utility of clinical decision rule for intensive care unit admission in
           patients with traumatic intracranial hemorrhage
    • Authors: Brandt D. Whitehurst; Jared Reyes; Stephen D. Helmer; James M. Haan
      Pages: 14 - 18
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Brandt D. Whitehurst, Jared Reyes, Stephen D. Helmer, James M. Haan
      Background Recent literature suggests the majority of traumatic intracranial hemorrhage does not require intervention. One recently described clinical decision rule was sensitive in identifying patients requiring critical care interventions in an urban setting. We sought to validate its effectiveness in our predominately rural setting. Methods A retrospective study was conducted of adult patients with traumatic intracranial hemorrhage. The rule, based on age, initial Glasgow coma scale score, and presence of a non-isolated head injury, was applied to externally validate the previously reported findings. Results In our population, the rule displayed a sensitivity of 0.923, specificity of 0.251, positive predictive value of 0.393, and negative predictive value of 0.862. The area under curve was 0.587. While our population has a similar adjusted head injury severity score as that from which the rule was developed, significant differences in age and intracranial hemorrhage pattern were noted. Conclusions The rule displayed decreased performance in our population, most likely secondary to differences in age and intracranial hemorrhage patterns. Prospective evaluation and cost-savings analysis are appropriate subsequent steps for the rule.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.09.057
       
  • Clinical relevance of the routine daily chest X-Ray in the surgical
           intensive care unit
    • Authors: Shelby Resnick; Kenji Inaba; Efstathios Karamanos; Dimitra Skiada; James A. Dollahite; Obi Okoye; Peep Talving; Demetrios Demetriades
      Pages: 19 - 23
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Shelby Resnick, Kenji Inaba, Efstathios Karamanos, Dimitra Skiada, James A. Dollahite, Obi Okoye, Peep Talving, Demetrios Demetriades
      Introduction A daily Chest X-ray (CXR) is obtained in many surgical intensive care units (SICU). This study implemented a selective CXR protocol in a high volume, academic SICU and evaluated its impact on clinical outcomes. Methods All SICU patients admitted in 2/2010 were compared with patients admitted in 2/2012. Between the time periods, a protocol eliminating the routine daily CXRs was instituted. Results In 02/2010 and 02/2012, 107 and 90 patients were admitted to the SICU, respectively, for a total of 1384 patient days. CXRs decreased from 365 (57.1% of patient-days) in 2010 to 299 (40.9% of patient days; p < 0.001) in 2012. A greater proportion of Physician Directed CXRs (PDCXRs) had new findings (80.8%) compared to Automatic Daily CXRs (ADCXRs) (23.5%, p < 0.001). There was no difference in overall or SICU length of stay, ventilator-free days, morbidity or mortality. Conclusion Eliminating ADCXRs decreased the number of CXRs performed, without affecting LOS, mechanical ventilation, morbidity or mortality. Physician-directed ordering of CXRs increased the diagnostic value of the CXR and decreased the number of clinically irrelevant CXRs performed.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.09.059
       
  • Diabetes increases the risk of an appendectomy in patients with antibiotic
           treatment of noncomplicated appendicitis
    • Authors: Ming-Chieh Tsai; Herng-Ching Lin; Cha-Ze Lee
      Pages: 24 - 28
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Ming-Chieh Tsai, Herng-Ching Lin, Cha-Ze Lee
      Background This retrospective cohort study examined whether diabetic patients have a higher risk for recurrent appendicitis during a 1-year follow-up period after successful antibiotic treatment for patients with acute uncomplicated appendicitis than nondiabetic patients using a population-based database. Methods We included 541 appendicitis patients who received antibiotic treatment for acute appendicitis. We individually tracked each patient for a 1-year period to identify those who subsequently underwent an appendectomy during the follow–up period. Results Cox proportional hazard regressions suggested that the adjusted hazard ratio of an appendectomy during the 1-year follow-up period was 1.75 for appendicitis patients with diabetes than appendicitis patients without diabetes. We found that among females, the adjusted hazard ratio of an appendectomy was 2.18 for acute appendicitis patients with diabetes than their counterparts without diabetes. However, we failed to observe this relationship in males. Conclusions We demonstrated a relationship between diabetes and a subsequent appendectomy in females who underwent antibiotic treatment for noncomplicated appendicitis.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.07.026
       
  • Does drainage of the peritoneal cavity have an impact on the postoperative
           course of community-acquired, secondary, lower gastrointestinal tract
           peritonitis'
    • Authors: Lionel Rebibo; Ingrid Ebosse; Corina Iederan; Yazine Mahjoub; Hervé Dupont; Cyril Cosse; Jean-Marc Regimbeau
      Pages: 29 - 36
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Lionel Rebibo, Ingrid Ebosse, Corina Iederan, Yazine Mahjoub, Hervé Dupont, Cyril Cosse, Jean-Marc Regimbeau
      Background In the surgical management of lower gastrointestinal tract peritonitis (LGTP), drainage of the peritoneal cavity is often recommended. The objective of the study was to evaluate the impact of drainage of the abdominal cavity during management of LGTP. Methods From January 2009 to January 2012, patients undergoing surgery for LGTP were included. The study comprised 3 steps: (1) description of the overall population; (2) comparison of the “no drainage” and “drainage” groups; and (3) a propensity score-matched analysis. The primary end point was the major complications rate; secondary end points were the overall complication, risk factors for postoperative complications, and the length of hospital stay. Results A total of 205 patients underwent surgery for LGTP. Characteristics of the peritoneum were noted on the surgical report in 141 cases (68%). Abdominal drainage was implemented in 118 patients (83%). After propensity score matching, there was no difference between drainage and no drainage groups in the major postoperative complications (34.7% vs 34.8%; P = .89). Conclusions Drainage of the abdominal cavity had no impact on postoperative abscess and reoperation rates. Standardization of drainage in this context is required.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.09.031
       
  • Impact of long-acting local anesthesia on clinical and financial outcomes
           in laparoscopic colorectal surgery
    • Authors: Deborah S. Keller; Rodrigo Pedraza; Reena N. Tahilramani; Juan R. Flores-Gonzalez; Sergio Ibarra; Eric M. Haas
      Pages: 53 - 58
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Deborah S. Keller, Rodrigo Pedraza, Reena N. Tahilramani, Juan R. Flores-Gonzalez, Sergio Ibarra, Eric M. Haas
      Background Our objective was to assess clinical and financial outcomes with long-acting liposomal bupicavaine (LB) in laparoscopic colorectal surgery. Methods Patients that received local infiltration with LB were strictly matched to a control group, and compared for postoperative pain, opioid use, length of stay (LOS), hospital costs, and complication, readmission, and reoperation rates. Results A total of 70 patients were evaluated in each cohort. Operative times and conversion rates were similar. LB patients had lower post-anesthesia care unit pain scores (P = .001) and used less opioids through postoperative day 3 (day 0 P < .01; day 1 P = .03; day 2 P = .02; day 3 P < .01). Daily pain scores were comparable. LB had shorter LOS (mean 2.96 vs 3.93 days; P = .003) and trended toward lower readmission, complication, and reoperation rates. Total costs/patient were $746 less with LB, a savings of $52,200 across the cohort. Conclusions Using local wound infiltration with LB, opioid use, LOS, and costs were improved after laparoscopic colorectal surgery. The additional medication cost was overshadowed by the overall cost benefits. Incorporating LB into a multimodal pain regiment had a benefit on patient outcomes and health care utilization.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2015.10.035
       
  • 3D vision accelerates laparoscopic proficiency and skills are transferable
           to 2D conditions: A randomized trial
    • Authors: Stine Maya Dreier Sørensen; Lars Konge; Flemming Bjerrum
      Pages: 63 - 68
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Stine Maya Dreier Sørensen, Lars Konge, Flemming Bjerrum
      Background Laparoscopy is difficult to master, in part because surgeons operate in a three-dimensional (3D) space guided by two-dimensional (2D) images. This trial explores the effect of 3D vision during a laparoscopic training program, and examine whether it is possible to transfer skills acquired with 3D conditions to 2D conditions. Methods We designed a randomized controlled trial where residents (n = 34) were randomized to proficiency-based laparoscopic simulator training under either 3D or 2D conditions. Subsequently, participants completed a retention test under 2D conditions. Results Mean training time were reduced in the intervention group; 231 min versus 323 min; P = 0.012. There was no significant difference in the mean times to completion of the retention test; 92 min versus 95 min; P = 0.85. Conclusion 3D vision reduced time to proficiency on a virtual-reality laparoscopy simulator. Furthermore, skills learned with 3D vision can be transferred to 2D vision conditions. Clinicaltrials.gov (NCT02361463).

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2017.03.001
       
  • Portal vein thrombosis after reconstruction in 270 consecutive patients
           with portal vein resections in hepatopancreatobiliary (HPB) surgery
    • Authors: Masaru Miyazaki; Hiroaki Shimizu; Masayuki Ohtuka; Atsushi Kato; Hiroyuki Yoshitomi; Katsunori Furukawa; Tsukasa Takayashiki; Satoshi Kuboki; Shigetsugu Takano; Daisuke Suzuki; Taku Higashihara
      Pages: 74 - 79
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Masaru Miyazaki, Hiroaki Shimizu, Masayuki Ohtuka, Atsushi Kato, Hiroyuki Yoshitomi, Katsunori Furukawa, Tsukasa Takayashiki, Satoshi Kuboki, Shigetsugu Takano, Daisuke Suzuki, Taku Higashihara
      Backgrounds This study was aimed to evaluate the occurrence of portal vein thrombosis after portal vein reconstruction. Methods The portal veins were repaired with venorrhaphy, end-to-end, patch graft, and segmental graft in consecutive 270 patients undergoing hepato-pancreto-biliary (HPB) surgery. Results Portal vein thrombosis was encountered in 20 of 163 of end-to-end, 2 of 56 of venorrhaphy, and 2 of 5 of patch graft groups, as compared with 0 of 46 of segmental graft group (p < 0.05, N.S., p < 0001, respectively). Portal vein thrombosis occurred more frequently after hepatectomy than after pancreatectomy (p < 0.0001). The restoration of portal vein blood flow was more sufficiently achieved in the early re-operation within 3 days after surgery than in the late re-operation over 5 days after surgery (p < 0.05). Conclusions The segmental graft might have to be more preferred in the portal vein reconstruction. The revision surgery for portal vein thrombosis should be performed within 3 days after surgery.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.12.008
       
  • Trends in utilization of neoadjuvant therapy and short-term outcomes in
           resected pancreatic cancer
    • Authors: Katelin A. Mirkin; Christopher S. Hollenbeak; Niraj J. Gusani; Joyce Wong
      Pages: 80 - 88
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Katelin A. Mirkin, Christopher S. Hollenbeak, Niraj J. Gusani, Joyce Wong
      Background Surgical resection and chemotherapy offer the only chance of long-term survival for pancreatic cancer. Neoadjuvant therapy (NAT) is increasingly used to optimize outcomes. Trends in NAT utilization and short-term outcomes in resected pancreatic cancer were evaluated. Methods The National Cancer Database (2003 to 2011) was analyzed for pancreatic cancer patients who underwent surgery ± NAT, evaluating utilization, 30- and 90-day mortality, hospital readmissions, and length of stay (LOS). Results About 16,007 underwent initial surgery and 1,736 received NAT. Over the past decade, initial surgery and multimodality NAT have steadily decreased, whereas the use of neoadjuvant radiation has remained low and the use of neoadjuvant chemotherapy (neoCT) has steadily increased. Thirty- and 90-day mortality rates and hospital readmissions were significantly higher for NAT vs initial surgery on univariate analysis. There was no significant difference in LOS or readmission rate. On multivariate analysis, neoCT had no significant impact on odds of mortality at 30 and 90 days (hazard ratio = .68, P = .285, hazard ratio = 1.32, P = .161, respectively). Advanced age, greater comorbidities, greater clinical stage disease, and resection with pancreaticoduodenectomy or total pancreatectomy negatively impacted 30- and 90-day mortality. Conclusion The use of neoCT has increased over the past decade and does not appear to adversely affect short-term outcomes, including 30- and 90-day mortality, LOS, and readmission rates.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.08.015
       
  • Timing of unplanned admission following daycare laparoscopic
           cholecystectomy
    • Authors: N. Seyednejad; M. Goecke; D.E. Konkin
      Pages: 89 - 92
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): N. Seyednejad, M. Goecke, D.E. Konkin
      Background Outpatient laparoscopic cholecystectomy is the treatment of choice for symptomatic biliary colic. There is controversy regarding the optimal candidate, and postoperative observation time for patients receiving daycare laparoscopic cholecystectomy. Methods A retrospective, multi-centred, case-control chart review was performed from January 1, 2009 to December 31, 2011 on consecutive patients undergoing planned laparoscopic cholecystectomy. Patient demographics, surgical details, and postoperative details were analyzed. Results 1256 daycare laparoscopic cholecystectomies were performed. One-hundred and twenty-one (9.6%) required unplanned admission the day of surgery. Forty (3.2%) were re-admitted within one month of surgery. The median time from surgical procedure to unplanned day of surgery admission was 218 min ± 143. The unplanned admission patients were older (54.6 vs 45.1, p < 0.005), and had ASA scores 3 or higher (24% vs 3%, p < 0.005). Comorbid conditions associated with unplanned admissions included hypertension, cardiac conditions, and chronic pain. Conclusions The majority of patients can be successfully managed with daycare laparoscopic cholecystectomy. A median time of 4 h is sufficient for postoperative observation. Risk factors for unplanned admission include age, ASA, hypertension, diabetes, and chronic pain.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.11.001
       
  • Post-hepatectomy hyperbilirubinemia: The point of no return
    • Authors: Jessica Y. Liu; Lauren M. Postlewait; Joanna W. Etra; Malcolm H. Squires; Kenneth Cardona; Joshua H. Winer; Juan M. Sarmiento; Charles A. Staley; Shishir K. Maithel; David A. Kooby; Maria C. Russell
      Pages: 93 - 99
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Jessica Y. Liu, Lauren M. Postlewait, Joanna W. Etra, Malcolm H. Squires, Kenneth Cardona, Joshua H. Winer, Juan M. Sarmiento, Charles A. Staley, Shishir K. Maithel, David A. Kooby, Maria C. Russell
      Background Post-hepatectomy hyperbilirubinemia is associated with liver insufficiency and failure. The highest survivable peak total bilirubin (ptbili) is not defined. This study aimed to identify the postop ptbili beyond which survival is improbable or impossible. Methods An institutional database of major hepatectomies (≥3 segments, no biliary resections), 2000–2012 was reviewed. Data were analyzed to find ptbili in the first 45 postop days. Factors associated with 90-day mortality (90 DM) and those predictive of ptbili were determined. Results 603 pts were analyzed with 90DM of 4.5%. 90 DM for a ptbili ≥ 18 (n = 15) was 86.6%, but only 2.5% for a ptbili < 18. All 6 pts with a ptbili ≥ 30 died. On multivariate analysis, postop ptbili ≥ 18 (HR34.95, CI 3.8–324; p = 0.002) and cirrhosis (HR6.4, CI 1.2–33.2; p = 0.027) were associated with 90DM. Factors associated with a ptbili ≥ 18 were age >65 (HR14.24, CI 2.9–70.5; p = 0.001), preop chemotherapy (HR4.77, CI 1.3–18.2; p = 0.02) and postop FFP (HR12.5, CI 2.6–56.2; p = 0.001). Conclusion Postop ptbili ≥ 18 after major hepatectomy has an 86.6% risk of 90DM; there are no survivors for tbili ≥ 30. These values may guide postop counseling for prognosis. Future studies may evaluate tbili ≥ 18 as an indication for hepatic replacement therapy.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.11.031
       
  • Barriers to genetic testing in newly diagnosed breast cancer patients: Do
           surgeons limit testing'
    • Authors: Laura Hafertepen; Alyssa Pastorino; Nichole Morman; Jennifer Snow; Deepa Halaharvi; Lindsey Byrne; Mark Cripe
      Pages: 105 - 110
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Laura Hafertepen, Alyssa Pastorino, Nichole Morman, Jennifer Snow, Deepa Halaharvi, Lindsey Byrne, Mark Cripe
      Background Genetic testing results influence treatment recommendations in newly diagnosed breast cancer patients. However, at-risk patients do not uniformly undergo genetic testing. The goal of this study was to identify barriers to genetic testing in newly diagnosed breast cancer patients. Methods A prospective database of newly diagnosed breast cancer patients meeting specific criteria over an 18-month period was created and retrospectively reviewed. Results A total of 532 patients were identified at risk for genetic mutation. Of these 313 (59%) patients completed a genetic counseling appointment and 292 (55%) underwent genetic testing. One hundred seven (24%) were never referred to genetic counselors and 89 (17%) were referred but did not complete an appointment. Patients referred to genetics were younger than the nonreferred patients (50.9 vs 60.6 years, P < .001). The 89 women referred to genetics who did not complete an appointment were surveyed and had varied reasons for not completing an appointment. Conclusions The largest barrier to genetic testing was lack of physician referral; therefore, provider education must be improved. Appointments should be convenient and providers should proactively discuss the significant implications of testing results.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.08.012
       
  • Surgical excision without whole breast irradiation for complete resection
           of ductal carcinoma in situ identified using strict, unified criteria
    • Authors: Takehiko Sakai; Takuji Iwase; Natsuki Teruya; Akemi Kataoka; Dai Kitagawa; Eri Nakashima; Akiko Ogiya; Yumi Miyagi; Kotaro Iijima; Hidetomo Morizono; Masujiro Makita; Naoya Gomi; Masahiko Oguchi; Yoshinori Ito; Rie Horii; Futoshi Akiyama; Shinji Ohno
      Pages: 111 - 116
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Takehiko Sakai, Takuji Iwase, Natsuki Teruya, Akemi Kataoka, Dai Kitagawa, Eri Nakashima, Akiko Ogiya, Yumi Miyagi, Kotaro Iijima, Hidetomo Morizono, Masujiro Makita, Naoya Gomi, Masahiko Oguchi, Yoshinori Ito, Rie Horii, Futoshi Akiyama, Shinji Ohno
      Background The definition of complete resection of ductal carcinoma in situ (DCIS) is difficult to standardize because of the high variety of surgical breast conserving procedures, specimen handling, and pathological examinations. Using strictly controlled criteria in a single institute, the present study aimed to determine the ipsilateral breast cancer rate when radiotherapy is omitted following complete resection of DCIS. Methods We retrospectively examined 363 consecutive DCIS patients who underwent breast-conserving surgery, and of these, 125 (34.4%) had complete resection according to the criteria. We finally included 103 patients who omitted radiotherapy. Ipsilateral and contralateral breast cancer events were assessed. Results The median follow-up period was 118 months. The incidences of ipsilateral and contralateral breast cancer and ipsilateral invasive breast cancer at 10 years were 10.8%, 9.1%, and 3.6%, respectively. No patient died of breast cancer. Conclusion If complete resection of DCIS can be ensured, the annual incidence of ipsilateral breast cancer, even without irradiation, can be limited to approximately 1%, which equals the incidence of contralateral breast cancer.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.10.024
       
  • Single-incision laparoscopy versus standard laparoscopy for colorectal
           surgery: A systematic review and meta-analysis
    • Authors: Carlos Hoyuela; Montserrat Juvany; Fernando Carvajal
      Pages: 127 - 140
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Carlos Hoyuela, Montserrat Juvany, Fernando Carvajal
      The aim of this meta-analysis was to evaluate if the advantages of single-incision laparoscopic surgery (SILS) to perform a colorectal resection justify a broad application of this approach. A total of 32 studies including 3863 patients, comparing colorectal procedures performed with SILS or multi-port laparoscopy (LCS) were analyzed after a systematic review. Colorectal SILS had comparable outcomes to multi-port LCS in terms of operating time (P = 0.44), conversion rate (2.0% vs 3.0%; P = 0.52), reoperations (1.1% vs 1.7%; P = 0.26), postoperative complications (14.4% vs 13.6%; P = 0.10) and mortality (0.24% vs 0.68%; P = 0.46). Mean hospital stay was significantly shorter in CSILS group, (MD = −0.88 [−1.33, −0,42], 95% CI, P = 0.0001), but heterogeneity was found (I2 = 65%; P < 0.0001). The oncological results of SILS for colorectal cancer were satisfactory, as demonstrated by similar average lymph node retrieval (P = 0.72) and adequate resection margins (negative in all cases) compared to those obtained with LCS. Nevertheless, there are currently no available long-term follow-up data comparing the survival rates and local recurrence between both approaches. Insufficient data were available for evaluating long-term incisional hernia rates, and other potential benefits associated with colorectal SILS (cosmesis, postoperative pain) remain to be objectively proved. To date there is insufficient evidence to recommend widespread use of SILS instead of LCS for colorectal surgery.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2017.03.002
       
  • Resident training in a teaching hospital: How do attendings teach in the
           real operative environment'
    • Authors: Carly E. Glarner; Katherine E. Law; Amy B. Zelenski; Robert J. McDonald; Jacob A. Greenberg; Eugene F. Foley; Douglas A. Wiegmann; Caprice C. Greenberg
      Pages: 141 - 146
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Carly E. Glarner, Katherine E. Law, Amy B. Zelenski, Robert J. McDonald, Jacob A. Greenberg, Eugene F. Foley, Douglas A. Wiegmann, Caprice C. Greenberg
      Background The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs. Methods Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions. Flow disruptions (FDs) are considered deviations from natural case progression. Results Across 10 cases (20.4 operative hours), attendings spent 11.2 hours (54.7%) teaching, using directing (M = 250.1), and confirming (M = 236.1) most. FDs occurred 410 times, accounting for 4.4 hours of case time (21.57%). Teaching occurred with FD events for 2.4 hours (22.2%), whereas 77.8% of teaching happened outside FD occurrence. Teaching methods shifted from active to passive during FD events to compensate for patient safety. Conclusions Understanding how FDs impact operative learning will inform faculty development in managing interruptions and improve its integration into resident education.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2015.12.024
       
  • Does implementing a general surgery residency program and resident
           involvement affect patient outcomes and increase care-associated
           charges'
    • Authors: Trevor Wexner; Armando Rosales-Velderrain; Steven D. Wexner; Raul J. Rosenthal
      Pages: 147 - 151
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Trevor Wexner, Armando Rosales-Velderrain, Steven D. Wexner, Raul J. Rosenthal
      Background Variable results regarding general surgery residency program (GSRP) impact on patient outcomes and charges are reported. The aim of this study was to determine any significant differences in patient outcomes and cost with a new GSRP. Methods We analyzed all laparoscopic appendectomies (lap-ap), cholecystectomies (lap-chole), and inguinal hernia repairs (IHR) performed before and after implementing a GRSP. Results Operative time significantly increased for lap-ap (p < 0.0001), lap-chole (p < 0.0001) and IHR (p = 0.03). Time to close the incision significantly increased for lap-ap (p < 0.0001), lap-chole (p = 0.006) and IHR (p = 0.03). Length of stay only increased for lap-ap (p = 0.04). Complication rates did not increase for any procedure. However, charges significantly increased for lap-ap (p < 0.0001), lap-chole (p < 0.0001), and IHR (p = 0.03). Conclusions Although a newly implemented GSRP caused increases in overall operative times, times to close incisions, and charges, it did not negatively impact patient outcomes.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.11.016
       
  • Construct validity of a novel, objective evaluation tool for the basics of
           open laparotomy training using a simulated model
    • Authors: Lawrence Greenawald; Jorge Uribe; Faiz Shariff; Mashaal Syed; Mohammad Shaikh; Barry Mann; Christopher Pezzi; Richard Damewood; Patricia A. Shewokis; Andres Castellanos; David Scott Lind
      Pages: 152 - 157
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Lawrence Greenawald, Jorge Uribe, Faiz Shariff, Mashaal Syed, Mohammad Shaikh, Barry Mann, Christopher Pezzi, Richard Damewood, Patricia A. Shewokis, Andres Castellanos, David Scott Lind
      Background We describe initial success in designing and implementing an objective evaluation for opening and closing a simulated abdomen. Methods (1) An assessment for laparotomy was created using peer-reviewed literature, texts, and the input of academic surgeons nationally; (2) the assessment was evaluated for construct validity, comparing the videotaped performance of laparotomy by surgical experts and novices on a viscoelastic model; and (3) the basics of open laparotomy training (BOLT) curriculum was piloted with junior residents to evaluate efficacy at improving performance. Results Experts performed better than novices opening (.94 vs .51; P < .001), closing (.85 vs .16; P < .001), and overall performance (.88 vs .27; P < .001). Novices caused bowel injury more frequently (5 vs 1; P < .05) and took longer to open the abdomen (6:06 vs 3:43; P = .01). After completing the BOLT curriculum, novices improved for opening (1.00 vs .50; P = .014), closing (.80 vs .10; P = .014), and overall score (.87 vs .23; P = .014). Conclusions We demonstrate construct validity of an evaluation tool for simulated laparotomy, and pilot efforts with the BOLT curriculum have shown promise.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2015.12.022
       
  • A nonsignificant difference in mortality does not mean equally safe and
           effective care
    • Authors: Rosalee Zackula
      Pages: 158 - 161
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Rosalee Zackula


      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.11.047
       
  • Comment on article entitled “Is intraoperative parathyroid hormone
           monitoring necessary for primary hyperparathyroidism with concordant
           preoperative imaging'”
    • Authors: Chandan Kumar Jha; Sanjay Kumar Yadav; Raouef Ahmed Bichoo
      Pages: 161 - 162
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Chandan Kumar Jha, Sanjay Kumar Yadav, Raouef Ahmed Bichoo


      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.12.013
       
  • Letter to editor in response to article entitled “The clinical
           implication of the number of lymph nodes harvested during sentinel lymph
           node biopsy and its effects on survival outcome in patients with
           node-negative breast cancer”
    • Authors: Chandan Kumar Jha; Raouef Ahmed Bichoo; Goonj Johri; Sanjay Kumar Yadav
      First page: 162
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Chandan Kumar Jha, Raouef Ahmed Bichoo, Goonj Johri, Sanjay Kumar Yadav


      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.12.021
       
  • Differences in vitamin D status might help explain the outcome disparities
           between African Americans and Caucasians in contemporary kidney transplant
           recipients
    • Authors: Gerardo Sarno; Giovanna Muscogiuri; William B. Grant
      First page: 163
      Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1
      Author(s): Gerardo Sarno, Giovanna Muscogiuri, William B. Grant


      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2016.12.022
       
  • Outcomes after laparoscopic or robotic colectomy and open colectomy when
           compared by operative duration for the procedure
    • Authors: Sunu Philip; Nancy Jackson; Vijay Mittal
      Abstract: Publication date: Available online 19 June 2017
      Source:The American Journal of Surgery
      Author(s): Sunu Philip, Nancy Jackson, Vijay Mittal
      Laparoscopic colectomy is associated with important early postoperative advantages. These procedures can however increase total operative duration. Our hypothesis is that increased operative duration is associated with post-operative complications that may outweigh the benefits of a minimally invasive approach. We analyzed data from the Michigan Surgical Quality Collaborative (MSQC)R. This is a statewide database of patients who have undergone colon or rectal resections. Colorectal procedures were divided into four groups by surgical approach: open, laparoscopic, robotic and laparoscopic and robotic procedures converted to open. The sample was divided into three groups by operative duration: less than 2 h, between 2 and 4 h and greater than 4 h and compared by selected preoperative variables and outcomes. Small but significant differences in perioperative outcomes were noted in colectomies with a >4 h operative duration. However, laparoscopic procedures exceeding 4 h were not associated with significant differences perioperative outcomes.

      PubDate: 2017-06-21T20:41:35Z
      DOI: 10.1016/j.amjsurg.2017.04.020
       
  • Laparotomy and intraoperative enteroscopy for obscure gastrointestinal
           bleeding before and after the era of video capsule endoscopy and deep
           enteroscopy: A tertiary center experience
    • Authors: Wuttiporn Manatsathit; Usah Khrucharoen; Dennis M. Jensen; O. Joe Hines; Thomas Kovacs; Gordon Ohning; Rome Jutabha; Kevin Ghassemi; Gareth S. Dulai; Gustavo Machicado
      Abstract: Publication date: Available online 19 June 2017
      Source:The American Journal of Surgery
      Author(s): Wuttiporn Manatsathit, Usah Khrucharoen, Dennis M. Jensen, O. Joe Hines, Thomas Kovacs, Gordon Ohning, Rome Jutabha, Kevin Ghassemi, Gareth S. Dulai, Gustavo Machicado
      Background To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). Methods We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. Results 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36.4% (4/11) had preoperative presumptive diagnoses while in the post VCE/DE era presumptive diagnoses were made in 48.8% (20/41) (p = 0.18). Preoperative evaluation led to correct diagnoses in 18.2% (2/11) in the pre and 51.2% (21/41) in the post VCE/DE era (p = 0.09). Vascular lesions and ulcers were the most common diagnoses, but rebleeding was common. No rebleeding was found among patients with tumors, Meckel's diverticulum, and aortoenteric fistula. Conclusions Presumptive diagnoses in the post VCE/DE era were usually accurate. If VCE or DE are negative, the probability of negative IOE is high. Patients with tumors and Meckel's diverticulum were the best candidates for IOE.

      PubDate: 2017-06-21T20:41:35Z
      DOI: 10.1016/j.amjsurg.2017.05.018
       
  • Emeritus Editorial Board
    • Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1


      PubDate: 2017-06-16T20:46:07Z
       
  • TOC
    • Abstract: Publication date: July 2017
      Source:The American Journal of Surgery, Volume 214, Issue 1


      PubDate: 2017-06-16T20:46:07Z
       
  • A novel laparoscopic transcystic approach using an ultrathin
           choledochoscope and holmium laser lithotripsy in the management of
           cholecystocholedocholithiasis: An appraisal of their safety and efficacy
    • Authors: Hong-tian Xia; Yang Liu; Hao Jiang; Tao Yang; Bin Liang; Jian-Ping Zeng; Jia-Hong Dong
      Abstract: Publication date: Available online 16 June 2017
      Source:The American Journal of Surgery
      Author(s): Hong-tian Xia, Yang Liu, Hao Jiang, Tao Yang, Bin Liang, Jian-Ping Zeng, Jia-Hong Dong
      Background Although laparoscopic transcystic common bile duct exploration (LTCBDE) is the preferred approach for CBD stone clearance, the success rate can vary between 55% and 85%. This study evaluated if ultrathin choledochoscope and holmium laser lithotripsy could improve the success rate of LTCBDE. Methods Records of 126 patients (average age, 46.1 ± 13.8 years) with cholecystocholedocholithiasis treated with laparoscopic cholecystectomy (LC) and LTCBDE were retrospectively reviewed. Results LC+LTCBDE was performed successfully in 118 of 126 patients, with a surgical success rate of 93.7%. An ultrathin choledochoscope was used in 75 (63.5%) patients, and holmium lithotripsy was performed in 38 (32.2%) patients. The stone clearance rate was 99.2% (117/118). No significant complications occurred. One hundred (84.7%) patients had excellent and 13 (11%) had good outcomes for an overall success rate (excellent plus good) of 95.7%. Conclusion Ultrathin choledochoscope and holmium laser lithotripsy can improve the surgical outcomes of LC+LTCBDE with minimal complications.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2017.05.020
       
  • Disparities in compliance with the Oncotype DX breast cancer test in the
           United States: A National Cancer Data Base assessment
    • Authors: Zachary Kozick; Ammar Hashmi; James Dove; Marie Hunsinger; Tania Arora; Jeffrey Wild; Mohsen Shabahang; Joseph Blansfield
      Abstract: Publication date: Available online 14 June 2017
      Source:The American Journal of Surgery
      Author(s): Zachary Kozick, Ammar Hashmi, James Dove, Marie Hunsinger, Tania Arora, Jeffrey Wild, Mohsen Shabahang, Joseph Blansfield
      Background Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk. Methods We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base. Results A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001). Conclusions ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate. Summary This study uses the National Cancer Data Base to analyze compliance with the NCCN guidelines for Oncotype DX. Compliance with testing was thirty-six percent. Several factors influenced testing in our study, including facility type, racial and socio-economic factors.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2017.05.008
       
  • Systematic review of randomized controlled trials on the role of coaching
           in surgery to improve learner outcomes
    • Authors: Louise-Helene Gagnon; Nimrah Abbasi
      Abstract: Publication date: Available online 13 June 2017
      Source:The American Journal of Surgery
      Author(s): Louise-Helene Gagnon, Nimrah Abbasi
      Background Surgical coaching, with the goal of improving operative performance, has been introduced into residency and fellowship programs. This is the first systematic review on surgical coaching limited to randomized controlled trials. The objective of this review is to synthesize the existing evidence that addresses the following question: “What are the effects of surgical coaching to improve learner outcomes'” Methods A comprehensive literature search was performed through the following databases: MEDLINE, EMBASE, ERIC, and Cochrane Central Register of Controlled Trials. The methodological quality of the selected randomized controlled trials was evaluated using the Cochrane Collaboration tool for assessing risk of bias. Results Five randomized controlled trials were included in our final analysis. All five RCTs showed improvement in technical surgical performance after coaching. Two studies provided further evidence that skills were retained and one described the high satisfaction of learners. The risk of bias was low in 3 trials. Conclusions Surgical coaching is associated with high learner satisfaction and improvements of skills and knowledge. The current evidence for surgical coaching programs is overwhelmingly positive.

      PubDate: 2017-06-16T20:46:07Z
      DOI: 10.1016/j.amjsurg.2017.05.003
       
  • Boarding ICU patients: Are our rounding practices subpar?
    • Authors: Andrew M. Nunn; Justin S. Hatchimonji; Daniel N. Holena; Mark J. Seamon; Brian P. Smith; Lewis J. Kaplan; Niels D. Martin; Patrick M. Reilly; C. William Schwab; Jose L. Pascual
      Abstract: Publication date: Available online 10 June 2017
      Source:The American Journal of Surgery
      Author(s): Andrew M. Nunn, Justin S. Hatchimonji, Daniel N. Holena, Mark J. Seamon, Brian P. Smith, Lewis J. Kaplan, Niels D. Martin, Patrick M. Reilly, C. William Schwab, Jose L. Pascual
      Introduction Surgical Intensive Care Unit (SICU) patients “boarding” in ICUs other than the designated home unit have been shown to suffer increased rates of complications. We hypothesized that ICU rounding practices are different when SICU patients are housed in home vs. boarding ICUs. Material and methods SICU rounds were observed at an academic quaternary medical center. Individual patient rounding time and order seen on rounds along with patient data and demographics were recorded. Multivariable regression analysis was used for comparison between patients. Results Non-boarders were older, observed on a later post ICU admission day and were more likely to be mechanically ventilated. Boarded patients were often seen at the end of rounds and for less time. Not being a boarder, age, APACHE II score on admission, vasopressor use, and positive pressure ventilation all predicted increased rounding time. Conclusions Surgical ICU patients boarding in non-preferred units are often seen at the end of rounds, result in a greater reliance upon telephone communication, and receive less bedside attention from ICU provider teams.

      PubDate: 2017-06-12T11:13:13Z
      DOI: 10.1016/j.amjsurg.2017.04.019
       
  • Post-operative Management of Perforated Appendicitis: Can Clinical
           Pathways Improve Outcomes?
    • Authors: Robert R. Gerard; Barrett A. Kielhorn; Laurence E. McCahill; Brent Petersen; Andrew J. Mullard
      Abstract: Publication date: Available online 10 June 2017
      Source:The American Journal of Surgery
      Author(s): Robert R. Gerard, Barrett A. Kielhorn, Laurence E. McCahill, Brent Petersen, Andrew J. Mullard
      Background We sought to decrease organ space infection (OSI) following appendectomy for perforated acute appendicitis (PAA) by minimizing variation in clinical management. Objective A postoperative treatment pathway was developed and four recommendations were implemented: 1) clear documentation of post-operative diagnosis, 2) patients with unknown perforation status to be treated as perforated pending definitive diagnosis, 3) antibiotic therapy to be continued post operatively for 4-7 days after SIRS resolution, and 4) judicious use of abdominal computed tomography (CT) scanning prior to post-operative day 5. Patient demographics and potential clinical predictors of OSI were captured. The primary end point was development of OSI within 30 days of discharge. Secondary endpoints included length of stay (LOS), readmission rate, other complications and secondary procedures performed. Results A total of 1246 appendectomies were performed and we excluded patients <18 years (n=205), interval appendectomies (n=51) or appendectomies for other diagnosis (n=37). Among the remaining 953 patients, 133 (14.0%) were perforated and 21 of these (15.8%) developed OSI. Comparing pre (n=91) to post (n=42) protocol patients, we saw similar rates of OSI (16.5 vs 14.3%, p=0.75) with a peak in OSI development immediately prior to protocol implementation which dropped to baseline levels 1 year later based on CUSUM analysis. Readmission rates fell by 49.7% (14.3 vs 7.1%, p=0.39) without increase in LOS (5.3 vs 5.7 days, p=0.55) comparing patients pre and post protocol, although these results did not reach clinical significance. Conclusions The implementation of and compliance with a post-operative protocol status post appendectomy for PAA demonstrated a trend towards diminishing readmission rates and decreased utilization of CT imaging, but did not affect OSI rates. Additional approaches to diminishing OSI following management of perforated appendicitis need to be evaluated.

      PubDate: 2017-06-12T11:13:13Z
      DOI: 10.1016/j.amjsurg.2017.06.003
       
  • Institutional variants for lymph node counts after pancreatic resections
    • Authors: Roderich E. Schwarz
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Surgery
      Author(s): Roderich E. Schwarz
      Background Lymph node (LN) counts from pancreatectomy are postulated as quality metric for surgical therapy of pancreatic malignancy. Methods Prospectively collected data from a single surgeon's pancreatectomy experience were analyzed for predictors of LN counts. Results Of 315 consecutive patients (54% female, median age: 65, range 18–88), 239 had a proven cancer diagnosis (76%). Operations included pancreatoduodenectomy (69%), distal pancreatectomy (26%), total pancreatectomy (1%) and others (4%). Patients were treated in 4 different tertiary cancer center settings (Institution A: 11%; B: 46%; C: 27%; D: 16%) with consistent regional dissection standards. Mean total LN counts differed between institutions for malignancies (A: 18, B: 13, C: 26, D: 26, p < 0.0001) and benign diseases (p = 0.003). At least 15 LNs were reported in 63% of cancer patients (institution range: 34–92%, p < 0.0001). Conclusions Pathologic processing should be standardized if LN numbers are to be adopted as quality metric for pancreatic cancer resections.

      PubDate: 2017-06-12T11:13:13Z
      DOI: 10.1016/j.amjsurg.2017.06.001
       
  • Morbid obesity and functional status as predictors of surgical
           complication after renal transplantation
    • Authors: Tara M. Veasey; James N. Fleming; Sara E. Strout; Ryan Miller; Nicole A. Pilch; Holly B. Meadows; Caitlin R. Mardis; Benjamin A. Mardis; Sunil Shenvi; John McGillicuddy; Kenneth D. Chavin; Prabhakar Baliga; David J. Taber
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Surgery
      Author(s): Tara M. Veasey, James N. Fleming, Sara E. Strout, Ryan Miller, Nicole A. Pilch, Holly B. Meadows, Caitlin R. Mardis, Benjamin A. Mardis, Sunil Shenvi, John McGillicuddy, Kenneth D. Chavin, Prabhakar Baliga, David J. Taber
      Background This study evaluated the impact of body mass index (BMI) and patient functional status on the risk for surgical complications after kidney transplant. Methods This retrospective cohort study of adult kidney transplant recipients grouped patients by baseline Karnofsky status (low function ≤ 70%) and further stratified by morbid obesity (BMI ≥ 35 kg/m2) to assess surgical complication risk. Results 736 patients were included with surgical complications occurring in 25%. Logistic regression analysis with interaction terms demonstrated that morbid obesity and low functional status conditionally impact risk with an OR of 2.8 [95% CI (1.1-7.3)]. Within the functional status cohort, BMI ≥ 35 kg/m2 was associated with increased risk of surgical complication, superficial wound infection, and DGF. Independent predictors for surgical complications included diabetes and morbid obesity with low functional status. There was no significant difference in graft loss or death across the cohorts. Conclusions While neither morbid obesity nor poor functional status alone predicts increased complications, the combined presence is associated with significant increase in risk for surgical complications after renal transplantation.

      PubDate: 2017-06-12T11:13:13Z
      DOI: 10.1016/j.amjsurg.2017.05.009
       
  • Risk assessment of the blunt trauma victim: The role of the quick
           Sequential Organ Failure Assessment Score (qSOFA)
    • Authors: Randeep S. Jawa; James A. Vosswinkel; Jane E. McCormack; Emily C. Huang; Henry C. Thode; Marc J. Shapiro; Adam J. Singer
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Surgery
      Author(s): Randeep S. Jawa, James A. Vosswinkel, Jane E. McCormack, Emily C. Huang, Henry C. Thode, Marc J. Shapiro, Adam J. Singer
      Background A number or risk assessment tools are used in trauma victims. Because of its simplicity, we examined the ability of the recently described quick Sequential Organ Failure Assessment Score (qSOFA) to predict outcomes in blunt trauma patients presenting to the Emergency Department. Methods We queried the trauma registry at a Level 1 Trauma Center for all adult blunt trauma admissions between 1/1/10 and 9/30/15. qSOFA scores were the sum of binary scores for 3 variables (RR ≥ 22, SBP≤100 mmHg, and GCS≤13). Results There were 7064 admissions (5664 admissions had qSOFA = 0, 1164 had qSOFA = 1, 223 had qSOFA = 2, and 13 had qSOFA = 3). Higher qSOFA scores were associated with greater injury severity, increased ICU admission, and higher complication rates. qSOFA scores were associated with in-hospital mortality (1.7% with qSOFA = 0; 8.7% with qSOFA = 1; 22.4% with qSOFA = 2; 23.1% with qSOFA = 3; p < 0.001). On multivariate analysis, qSOFA score was an independent predictor of mortality. Conclusions qSOFA scores are directly associated with adverse outcomes in blunt trauma victims. Summary QSOFA score can be easily calculated in the Emergency Department. It can be quickly used to identify patients at high risk for adverse outcomes.

      PubDate: 2017-06-12T11:13:13Z
      DOI: 10.1016/j.amjsurg.2017.05.011
       
  • The correlation between fundamental characteristics and first-time
           performance in laparoscopic tasks
    • Authors: Cuan M. Harrington; Richard Bresler; Donncha Ryan; Patrick Dicker; Oscar Traynor; Dara O. Kavanagh
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of Surgery
      Author(s): Cuan M. Harrington, Richard Bresler, Donncha Ryan, Patrick Dicker, Oscar Traynor, Dara O. Kavanagh
      Background The ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure. Methods Participants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university. Participants completed four visuospatial, one psychomotor aptitude test and an electronic survey, followed by four laparoscopic tasks on a validated Virtual Reality simulator (LAP Mentor™). Results Twenty eligible individuals participated with a mean age of 20.8 (±3.8) years. Significant intra-aptitude performance correlations were present amongst 75% of the visuospatial tests. These visuospatial aptitudes correlated significantly with multiple laparoscopic task metrics: number of movements of a dominant instrument (rs ≥ −0.46), accuracy rate of clip placement (rs ≥ 0.50) and time taken (rs ≥ −0.47) (p < 0.05). Musical Instrument experience predicted higher average speed of instruments (rs ≥ 0.47) (p < 0.05). Participant's revised competitive index level predicted lower proficiency in laparoscopic metrics including: pathlength, economy and number of movements of dominant instrument (rs ≥ 0.46) (p < 0.05). Conclusion Multiple visuospatial aptitudes and innate competitive level influenced laparoscopic performances across several tasks in surgically naïve individuals.
      Teaser Fundamental predictors of first time laparoscopic performance are not well documented with the exception of video games experience. This study examined for predictors of laparoscopic performance with a number of innate factors including visuospatial/psychomotor aptitude and inherent competitive levels. Multiple factors including visuospatial aptitudes and innate competitive level significantly influenced laparoscopic-performances across several tasks on a previously validated VR simulator.

      PubDate: 2017-06-12T11:13:13Z
      DOI: 10.1016/j.amjsurg.2017.04.015
       
 
 
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