Publisher: Elsevier   (Total: 3148 journals)

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Showing 1 - 200 of 3148 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: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, 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: 446, 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: 2)
Acta Ecologica Sinica     Open Access   (Followers: 12, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 324, 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 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   (Followers: 1)
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: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 190, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, 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: 1, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, 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: 11, 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: 21, 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: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 13)
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: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 68, 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: 8, 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: 4, 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: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, 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: 26)
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: 6, 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: 10, 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: 11)
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: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, 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: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 430, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 394, 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: 489, 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: 47, 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: 55, 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: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, 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: 15, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, 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: 37, 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: 266, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, 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: 30, 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: 6, 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: 216, 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: 236, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 8, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 3, SJR: 0.451, CiteScore: 1)

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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 - ISSN (Online) 1879-1883
Published by Elsevier Homepage  [3148 journals]
  • Examining healthcare inequities relative to United States safety net
           hospitals
    • Abstract: Publication date: Available online 26 January 2020Source: The American Journal of SurgeryAuthor(s): Anghela Z. Paredes, J. Madison Hyer, Adrian Diaz, Diamantis I. Tsilimigras, Timothy M. PawlikAbstractIntroductionThe impact of safety net (SN) hospitals relative to racial and healthcare disparities remains largely unknown.MethodsUsing the Nationwide Inpatient Sample, adults undergoing coronary artery bypass grafting, colectomy, or total hip arthroplasty were identified. Multivariable regression analysis was performed to determine association between SN burden and outcomes. Within each SN burden tier, the association between race/ethnic group and outcomes was defined.ResultsOverall 865,648 patients were identified. After adjustment for potential confounders, patients operated at the highest SN burden hospitals had increased odds of complications (OR 1.14, 95%CI 1.10–1.18), death (OR 1.41, 95%CI 1.31–1.52), FTR (OR 1.36, 95%CI 1.25–1.47) and a never event (OR 1.57, 95%CI 1.47–1.68). Irrespective of hospital SN burden, racial minorities had greater odds of a complication, and prolonged LOS compared to whites (p 
       
  • Impact of trauma center volume on major vascular injury: An analysis of
           the National Trauma Data Bank (NTDB)
    • Abstract: Publication date: Available online 25 January 2020Source: The American Journal of SurgeryAuthor(s): Sharven Taghavi, Glenn Jones, Juan Duchesne, Patrick McGrew, Chrissy Guidry, Rebecca Schroll, Charles Harris, Reginald Nkansah, Tomas Jacome, Danielle TatumAbstractBackgroundThe association of procedure volume and improved outcomes has been established with infrequently performed elective operations. However, effect of trauma center volume on outcomes in emergency surgery has not been defined. We hypothesized that high volume centers (HVC) would provide better outcomes for operative major vascular injuries (MVI) than low volume centers (LVC).MethodsThe NTDB was queried from 2010 to 2014. Patients with MVI were identified and HVC were compared to LVC. HVC were defined as>480 patients per year with ISS≥15.ResultsThere were 37,125 patients with MVI, with 16,461 (44.3%) managed operatively. Of these, 15,965 (97%) underwent surgery at HVC and 496 (3%) at LVC. There was no difference in shunt utilization, however, HVC were more likely to utilize endovascular repair (31.0% vs. 21.9%, p 
       
  • Techniques for intraoperative evaluation of bowel viability in mesenteric
           ischemia: A review
    • Abstract: Publication date: Available online 25 January 2020Source: The American Journal of SurgeryAuthor(s): Mitchell G. Bryski, Lydia G. Frenzel-Sulyok, Lewis Kaplan, Sunil Singhal, Jane J. KeatingAbstractAcute mesenteric ischemia (AMI) is a deadly and common surgical emergency. While several imaging modalities aid in the diagnosis of AMI preoperatively, there are limited intraoperative tools for surgeon decision making regarding bowel viability. Here we offer a review of the utility and limitations of the many extensively studied techniques. We classify each of these modalities into three hallmarks of healthy bowel: oxygenation, myoelectric activity and perfusion. Finally, we offer a brief discussion of emerging and promising techniques to assist surgeons in intraoperative decision making for patients with mesenteric ischemia.
       
  • Confidentiality concerns for surgical residents as educational research
           subjects: A pilot study
    • Abstract: Publication date: Available online 25 January 2020Source: The American Journal of SurgeryAuthor(s): Alicia M. Bonanno, Mackenzie R. Cook, Kelly Fair, Elizabeth Dewey, Laszlo KiralyAbstractBackgroundResearch within the field of surgical education has been expanding rapidly in order to guide future curricula. However, education studies often have minimal IRB oversight and evolving concerns exist regarding issues of informed consent of trainees.MethodsWe conducted an electronic, single center, anonymous survey of general surgery residents. The survey study was IRB approved and subjects were provided with information and opt-out sheets.ResultsThe response rate was 43.5% (37/85). Approximately 76% of residents felt that education research was important and that they should participate. If a faculty member conducted the study, 18% of residents would feel coerced to participate and 21% would feel uncomfortable refusing to participate. The majority (81%) felt uncomfortable with peers viewing their identifiable records and a sizeable minority (24%) were uncomfortable with peers viewing de-identified records.ConclusionSurgical residents believe that educational research is important, but researchers should be cognizant of unintended consequences on resident autonomy and confidentiality.
       
  • Association of complicated gallstone disease in pregnancy and adverse
           birth outcomes
    • Abstract: Publication date: Available online 24 January 2020Source: The American Journal of SurgeryAuthor(s): Jason M. Bowie, Richard Y. Calvo, Vishal Bansal, Lyndsey E. Wessels, William J. Butler, C. Beth Sise, Jennifer G. Shaw, Michael J. SiseAbstractBackgroundComplicated gallstone disease (CGD) is a common condition requiring intervention during pregnancy to avert adverse birth outcomes (ABO).MethodsCohort study using the California OSHPD 2007–2014 database. Records of pregnant patients were analyzed for gallbladder calculus within four months of delivery. Biliary system interventions were evaluated as the primary exposure.ResultsOf 7,597 patients, those with CGD had a greater likelihood of biliary system procedures than those with uncomplicated gallstone disease (36.6% vs. 2.5%, p 
       
  • Underwater endoscopic mucosal resection without submucosal injection
           (UEMR) for large colorectal polyps: A community-based series
    • Abstract: Publication date: Available online 23 January 2020Source: The American Journal of SurgeryAuthor(s): Robert L. Barclay, Dean PercyBackground: Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an appealing therapy for large colorectal polyps. However, this technique is not practiced widely and there are limited data evaluating UEMR in community settings.Methods: The study comprised patients undergoing UEMR of large (≥20 mm) sessile colorectal lesions at a community-based center. Residual neoplasia was assessed via follow-up colonoscopy.Results: Among 264 lesions (diameter 38 ± 18 mm; range 20–110 mm) 99% were successfully resected with UEMR. Two lesions involving the cecum/IC valve required multiple sessions. There were no cases of perforation or post-polypectomy syndrome. Delayed bleeding occurred in 1.6%, all managed conservatively. Residual neoplasia was present in 5.7% and was amenable to UEMR.Conclusions: This large community-based series demonstrated high efficacy and safety of UEMR for large sessile colorectal lesions. The results support UEMR as first-line therapy for these lesions.Summary: Underwater endoscopic mucosal resection without submucosal injection (UEMR) is a recently developed method that has advantages over conventional EMR for treatment of large colorectal lesions. However, UEMR is not practiced widely and there are limited data evaluating this technique in everyday practice. This large community-based series demonstrated high efficacy and safety of UEMR for large sessile colorectal lesions.Graphical abstractImage 1
       
  • Factors affecting salvage rate of infected prosthetic mesh
    • Abstract: Publication date: Available online 23 January 2020Source: The American Journal of SurgeryAuthor(s): Jeremy A. Warren, Michael Love, William S. Cobb, Lucas R. Beffa, Francisco J. Couto, B.H. Hancock, D. Morrow, Joseph A. Ewing, Alfredo M. CarbonellAbstractBackgroundProsthetic mesh infection (PMI) is a challenging complication of ventral hernia repair (VHR). The sparsity of data leaves only experience and judgment to guide surgical decision-making.MethodsRetrospective review of patients diagnosed with PMI. Subsequent abdominal operation (SAO) constitutes any intraabdominal operation occurring after the index hernia repair prior to PMI presentation. Any mesh removal was considered salvage failure. Analysis was performed using Chi-square test, Fishers Exact, or Mann-Whitney U test. Analyses completed using R Version 3.0.2.ResultsWe identified 213 instances of PMI. Most cases (58.7%) involved intraperitoneal mesh. Thirty-seven percent of patients had an SAO, only 25.3% of which were clean cases. Enteroprosthetic fistula occurred in 38 patients (17.8%). Mean time to presentation was 19.9 mos after index hernia repair or SAO for infection alone, and 48.1 mos when a fistula was present (p 
       
  • Reoperative laparoscopic rectal surgery: Another potential tool for the
           expert's toolbox
    • Abstract: Publication date: Available online 22 January 2020Source: The American Journal of SurgeryAuthor(s): Marc D. Basson
       
  • Comparing the effectiveness of simulation as adjuncts to standardized
           lectures, on the identification and reporting of intimidation during
           surgical clerkship: A mixed method randomized controlled trial
    • Abstract: Publication date: Available online 22 January 2020Source: The American Journal of SurgeryAuthor(s): Maureen Thivierge-Southidara, Samuel Rodriguez-Qizilbash, Christian Vincelette, Adam Dubrowski, Kerianne Boulva, Ramses Wassef, Véronique Godbout, Erica PatocskaiAbstractBackgroundIntimidation constitutes a learning barrier for undergraduates and its reporting rate to authorities remains suboptimal.MethodsA randomized controlled trial was conducted to evaluate the effectiveness of three interventions designed to increase reporting by undergraduates during their surgical rotation. As adjuncts to a standardized lecture, participants were assigned to a simulated intimidation scenario, a video of intimidation events, or a control group. Surveys were completed before the interventions, and at the end of the rotation.ResultsOf the 119 included participants, 17.6% reported that they had been intimidated during their previous rotation as compared to 37.0% after the surgical rotation. There were no statistically significant differences in the reporting of intimidation between the groups. However, 65.5% of all participants declared feeling more at ease to report intimidation, yet the reporting rate remained low.ConclusionIntimidation during clerkship persists as a frequent problem although the best method to increase its reporting remains unclear.
       
  • The mentor match: A new approach to implementing formal mentorship in
           general surgery residency
    • Abstract: Publication date: Available online 22 January 2020Source: The American Journal of SurgeryAuthor(s): Lauryn A. Ullrich, Rebecca M. Jordan, Joseph Bannon, Joseph Stella, Jacqueline OxenbergAbstractMentorship is a vital component within general surgery residency that fosters success extending into future practices. Recognizing the need for formalized mentorship within our general surgery residency, a survey based match process was developed. The “Mentor Match” was developed by creating resident and faculty surveys using the six ACGME core competencies of patient care, medical knowledge, communication skills, practice based learning, system based practice and professionalism. Surveys focused on resident areas of weakness correlating to areas in which faculty expressed subjective strength. Survey results were used to match faculty mentors with resident mentees. One year after implementation, residents were surveyed to evaluate the perceived success of the match process and mentorship program. Resident participation was 100% with a survey response of 78%. Ninety-two percent of residents were satisfied with the program, 83% saw improvement in their areas of weakness and 75% felt the match process was effective in pairing mentors with mentees. In conclusion, the “Mentor Match” was an effective tool in developing a formalized mentorship program with positive results after one year of implementation.
       
  • Outcomes with advanced versus basic life support in blunt trauma
    • Abstract: Publication date: Available online 22 January 2020Source: The American Journal of SurgeryAuthor(s): Michael S. Farrell, Benjamin Emery, Richard Caplan, John Getchell, Mark Cipolle, Kevin M. BradleyAbstractIntroductionThe role of advanced life support (ALS) versus basic life support (BLS) in blunt trauma is controversial. Previous studies have shown no mortality benefit with ALS for penetrating trauma but the blunt population has mostly remained unaddressed.MethodsA retrospective cohort study was conducted at a Level 1 trauma center comparing outcomes in blunt trauma patients managed by ALS versus BLS from July 1, 2014 to December 31, 2014. Both Injury Severity Score (ISS) and select Abbreviated Injury Score (AIS) were used to determine differences in mortality, length of stay (LOS) and complications based on mode of transportation, prehospital time, and number of prehospital interventions.Results698 total patients were identified. Mortality and complications were grossly higher in ALS patients (p = 0.01 and 
       
  • Translating motion tracking data into resident feedback: An opportunity
           for streamlined video coaching
    • Abstract: Publication date: Available online 21 January 2020Source: The American Journal of SurgeryAuthor(s): Kenneth H. Perrone, Su Yang, Hossein Mohamadipanah, Brett Wise, Anna Witt, Cassidi Goll, Carla PughAbstractBackgroundWe hypothesized that differences in motion data during a simulated laparoscopic ventral hernia repair (LVH) can be used to stratify top and lower tier performers and streamline video review.Materials and methodsSurgical residents (N = 94) performed a simulated partial LVH repair while wearing motion tracking sensors. We identified the top ten and lower ten performers based on a final product quality score (FPQS) of the repair. Two blinded raters independently reviewed motion plots to identify patterns and stratify top and lower tier performers.ResultsTop performers had significantly higher FPQS (23.3 ± 1.2 vs 5.7 ± 1.6 p 
       
  • The GRADE approach to appraising the evidence or how to increase the
           credibility of your research
    • Abstract: Publication date: Available online 21 January 2020Source: The American Journal of SurgeryAuthor(s): Stavros A. Antoniou, George A. Antoniou
       
  • Incoming residents’ knot-tying and suturing skills: Are medical school
           boot camps sufficient'
    • Abstract: Publication date: Available online 21 January 2020Source: The American Journal of SurgeryAuthor(s): Robert McMillan, Philip N. Redlich, Robert Treat, Matthew I. Goldblatt, Thomas Carver, Christopher M. Dodgion, Jacob R. Peschman, Christopher S. Davis, Shahriar Alizadegan, Jeremy Grushka, Lisa Olson, Theresa Krausert, Brian Lewis, Michael J. MalinowskiAbstractIntroductionMany medical schools offer M4 boot camps to improve students’ preparedness for surgical residencies. For three consecutive years, we investigated the impact of medical school boot camps on intern knot-tying and suturing skills when measured at the start of residency.MethodsForty-two interns completed questionnaires regarding their boot camp experiences. Their performance on knot-tying and suturing exercises was scored by three surgeons blinded to the questionnaire results. A comparison of these scores of interns with or without boot camp experiences was performed and statistical analysis applied.Results26 of 42 (62%) interns reported boot camp training. There were no differences in scores between interns with or without a M4 boot camp experience for suturing [9.6(4.6) vs 9.8(4.1), p 
       
  • Is obesity a factor of surgical difficulty in transanal endoscopic
           surgery'
    • Abstract: Publication date: Available online 20 January 2020Source: The American Journal of SurgeryAuthor(s): Xavier Serra-Aracil, Esther Gil-Barrionuevo, Raquel Lobato-Gil, Anna Gonzalez-Costa, Laura Mora-López, Anna Pallisera-Lloveras, Sheila Serra-Pla, Salvador Navarro-SotoAbstractBackgroundThe aim of this study is to assess the feasibility of transanal endoscopic surgery (TES) in obese patients.MethodsObservational descriptive study evaluating the feasibility of TES in obese rectal tumors between June 2004 and January 2019. Patients were assigned to two groups: body mass index (BMI) 
       
  • Applying a novel cost-evaluation framework to assess video-based
           neurosurgery education
    • Abstract: Publication date: Available online 17 January 2020Source: The American Journal of SurgeryAuthor(s): Axelsson Carl Gustaf S, Michael G. Healy, Traci A. Wolbrink, Julia King, Evan S. Sanders, Roy PhitayakornAbstractBackgroundAnalysis of comparative effectiveness uses different metrics to ensure that a new treatment is both effective and economical. However, there is a lack of financial frameworks to estimate the costs of introducing new technologies in medical and surgical education.MethodsAfter literature review, we created and applied a framework (‘REC’) for the evaluation of three recent neurosurgery video modules aimed at medical students at Harvard Medical School.ResultsThe most expensive component of these video-based education (VBE) modules was time cost. This cost was highly variable depending on the level of clinical seniority of the individuals involved in the video production process.ConclusionApplication of the ‘REC’ framework to the three modules showed highly variable time and monetary cost differences between the modules. Usage of the ‘REC’-framework will enable educators to institute effective planning, to efficiently use resources, and clearly define a minimal viable education product to achieve desired learning outcomes.
       
  • Rectal prolapse surgery in males and females: An ACS NSQIP-based
           comparative analysis of over 12,000 patients
    • Abstract: Publication date: Available online 17 January 2020Source: The American Journal of SurgeryAuthor(s): Jon D. Vogel, Luiz Felipe de Campos-Lobato, Brandon C. Chapman, Michael R. Bronsert, Elisa H. Birnbaum, Robert A. MeguidAbstractBackgroundRectal prolapse is relatively uncommon in male patients. The aim of this study was to compare males and females who underwent rectal prolapse surgery.Study designRetrospective analysis of the ACS NSQIP public use file.ResultsAmong 12,220 patients, 978 (8%) were male and 11,242 (92%) were female. Males were younger, 56 (38–73) vs. 71 (58–83) years, less often white (83% vs. 71%), had lower ASA scores, and underwent more laparoscopic (33% vs. 27%), more open (33% vs. 29%), and less perineal (33% vs 44%) procedures (all p 
       
  • The impact of rater training on the psychometric properties of
           standardized surgical skill assessment tools
    • Abstract: Publication date: Available online 15 January 2020Source: The American Journal of SurgeryAuthor(s): Reagan L. Robertson, Jason Park, Lawrence Gillman, Ashley VergisAbstractIntroductionCompetency-based frameworks are common in surgical training. However, the optimal use of standardized technical assessments is not well defined. We investigated the effect of rater training (RT) on the reliability and validity of four assessment tools.Materials and methodsForty-Seven surgeons were randomized to RT (N = 24) and no training (N = 23) groups. A task-specific checklist, pass-fail, visual analog, and OSATS global rating scale (GRS) were used to assess trainee knot-tying and suturing tasks. Delayed assessment was performed two weeks later. Internal consistency, intra/inter-rater reliability, and construct validity were measured.ResultsThe GRS had superior reliability and validity compared to the other tools regardless of training. No significant differences between training groups was found. However, the RT group trended to improved reliability for all tools at both assessments.ConclusionsRT did not lead to significant improvements in skills assessments. Standardized assessments (OSATS GRS) are preferred due to their superior reliability and validity over other methods. Despite findings, we believe more effective training methods or repeated sessions may be required for sustained and significant effects.
       
  • Efficacy of telehealth visits for postoperative care at the Minneapolis VA
    • Abstract: Publication date: Available online 13 January 2020Source: The American Journal of SurgeryAuthor(s): Jack Dirnberger, Steven WaisbrenAbstractBackgroundAbout half of Minneapolis VA patients reside in rural areas, receiving their primary care at a Community Based Outpatient Clinic (CBOC). Although some CBOC's are over 200 miles away, patients must travel to the Twin Cities for surgical services.MethodsThe 167 consecutive patients who opted for telehealth postoperative visits were surveyed. Data collected included travel time and distance to the Minneapolis VA and their local CBOC, need for transportation assistance to the clinic/VA, complications as a result of telehealth and a 1–10 overall satisfaction score.ResultsRespondents reported a mean ± SD satisfaction score of 9.60 ± 1.20, with a mean cost savings of $51.94 ± $40.92, decrease in travel time of 99.4 ± 76.58 min and no post-surgical complications missed.ConclusionsThe telehealth program appears to be safe, saves time and money for veterans and results in extremely high patient satisfaction.
       
  • Liposomal bupivacaine versus thoracic epidural: We need more evidence
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Dominic V. Pisano
       
  • Teaching in the robotic environment: Use of alternative approaches to
           guide operative instruction
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Courtney A. Green, Simon N. Chu, Emily Huang, Hueylan Chern, Patricia O'SullivanAbstractBackgroundWith the rapid growth of robotic-assisted surgery, surgical educators recognize the need to develop appropriate curriculum for trainees. However, the unique robotic learning environment challenges educators to determine the most appropriate ways to instruct surgical residents. The purpose of this study was to characterize the instructional techniques used in the robotic teaching environment by observing attending surgeon's language and behaviors during resident robotic dissection.Study designAttending robotic surgeons guided senior residents through robotic dissection of live porcine tissue. Three observers documented the language, gestures and behaviors occurring at three different stations, and at a fourth station, they obtained video and audio recordings of the instructional interaction. Afterwards, instructors and residents met in separate focus groups. The authors used qualitative content analysis to summarize the type and frequency of teaching behaviors and focus group information to clarify the analysis. We compared the frequency of the behaviors to an existing taxonomy of 16 operative teaching behaviors in open and laparoscopic surgery.ResultsRobotic instructors used 11 of the 16 behaviors previously described for surgical instruction. Frequency of use differed in the robotic environment due to relevance and application of new techniques. New, unique robotic teaching behaviors involved disengaging the resident from the operative console for either onscreen direction or for gesturing with verbal instruction. Focus group participants highlighted these behaviors as essential.ConclusionRobotic instruction uses a different set of instructional approaches compared to open and laparoscopic surgery. New teaching behaviors emerged driven by physical separation within the robotic environment. Robotic faculty development should emphasize these unique features.
       
  • Making EPAs a 59 minute objective measure for surgical trainees – A
           pilot study
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Yazan N. Aljamal, David R. FarleyAbstractIntroductionAccurately confirming surgical trainees have met the requirements of entrusted professional activities (EPAs) will require rigorous staff input. We pondered whether such simulation-driven evaluations might prove useful to the current ABS/APDS pilot effort on EPA analysis.MethodsOur surgical trainees participate biannually in a 59-min simulation-based assessment (X-Games) which covers surgical technique, knowledge and critical thinking in a host of domains. The content and difficulty of the stations differed between the PGY levels. Only 4 EPA topics (inguinal hernia repair, appendectomy, cholecystectomy, and trauma resuscitation) were tabulated for this study.Results16-PGY-2s, 8-PGY-3s, 10-PGY-4s, and 10-PGY-5s surgical residents completed the X-Games. Performance within and between PGY levels was variable. The mean(SD) EPA scores for all PGY levels are listed in Table- 1.ConclusionAnalysis gleaned from a 59-min OSCE in a simulated-setting offers objective data that appears to have construct-validity. Refining our Surgical X-Games to cater to the specific EPA scoring system may better allow objective analysis of when trainees cross the threshold from “can do with some help” to “can do autonomously”.
       
  • Prophylactic intra-abdominal drainage following colorectal anastomoses. A
           systematic review and meta-analysis of randomized controlled trials
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Mauro Podda, Salomone Di Saverio, R. Justin Davies, Jenny Atzeni, Francesco Balestra, Francesco Virdis, Isabella Reccia, Kumar Jayant, Ferdinando Agresta, Adolfo PisanuBackgroundClinically evident Anastomotic Leakage (AL) remains one of the most feared complications after colorectal resections with primary anastomosis. The primary aim of this systematic review and meta-analysis was to determine whether Prophylactic Drainage (PD) after colorectal anastomoses confers any advantage in the prevention and management of AL.MethodsSystematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized studies comparing clinical outcomes of patients with Drained (D) or Undrained (UD) colorectal anastomoses performed for any cause.ResultsFour randomized controlled trials comparing D and UD patients undergoing colorectal resections with primary anastomosis were included for quantitative synthesis. In total, 1120 patients were allocated to group D (n = 566) or group UD (n = 554). The clinical AL rate was 8.5% in the D group and 7.6% in the UD group, with no statistically significant difference (P = 0.57). Rates of radiological AL (D: 4.2% versus UD: 5.6%; P = 0.42), mortality (D: 3.6% versus UD: 4.4%; P = 0.63), overall morbidity (D: 16.6% versus UD: 18.6%, P = 0.38), wound infection (D: 5.4% versus UD: 5.3%, P = 0.95), pelvic sepsis (D: 9.7% versus UD: 10.5%, P = 0.75), postoperative bowel obstruction (D: 9.9% versus UD: 6.9%, P = 0.07), and reintervention for abdominal complication (D: 9.1% versus UD: 7.9%, P = 0.48) were equivalent between the two groups.ConclusionsThe present meta-analysis of randomized controlled trials investigating the value of PD following colorectal anastomoses does not support the routine use of prophylactic drains.Graphical abstractImage 1
       
  • Neutrophil-to-lymphocyte ratio predicts acute appendicitis and
           distinguishes between complicated and uncomplicated appendicitis: A
           systematic review and meta-analysis
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Shahab Hajibandeh, Shahin Hajibandeh, Nicholas Hobbs, Moustafa MansourAbstractObjectivesto investigate whether Neutrophil-to-lymphocyte ratio (NLR) can predict acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis.MethodsA search of electronic information sources was conducted to identify all studies reporting NLR in patients with clinical suspicion or confirmed diagnosis of acute appendicitis. We considered two comparisons:1) appendicitis versus no appendicitis; 2) uncomplicated appendicitis versus complicated appendicitis. ROC curve analysis was performed to determine cut-off values of NLR for appendicitis and complicated appendicitis.ResultsSeventeen studies, enrolling 8,914 patients were included. NLR of 4.7 was cut-off value for appendicitis with sensitivity of 88.89% and specificity of 90.91% with AUC of 0.96. NLR of 8.8 was cut-off value for complicated appendicitis with sensitivity of 76.92% and specificity 100% with AUC of 0.91. NLR>4.7 was predictor of acute appendicitis (OR:128,P 8.8 was predictor of complicated appendicitis (OR:43,P 
       
  • Rate of BRCA mutation in patients tested under NCCN genetic testing
           criteria
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Anna C. Beck, Haimiao Yuan, Junlin Liao, Pamela Imperiale, Krysten Shipley, Lillian M. Erdahl, Sonia L. Sugg, Ronald J. Weigel, Ingrid M. LizarragaAbstractBackgroundBRCA genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) in breast cancer patients who meet specific criteria. Limited data are available on the likelihood of detecting a mutation when these guidelines are followed.MethodsA retrospective chart review examined patients with breast cancer who underwent BRCA testing based on NCCN guidelines.ResultsTwelve (6.0%) of the 199 patients had a deleterious BRCA mutation. Family history of BRCA mutations (50%, p = 0.019), age ≤45 at diagnosis (9.7%, p = 0.034) and meeting ≥3 NCCN criteria (13.3%, p = 0.03) yielded the highest rates of BRCA mutation. Having a family history of BRCA mutation and age ≤45 were associated with increased rate of BRCA mutation on multivariate analysis (OR 14.3, CI 1.2–166.3; OR 11.6, CI 1.2–108.6).ConclusionSelect NCCN criteria are associated with higher rates of BRCA mutations. Waiting for genetic testing results to guide surgical management may be warranted in this subset of patients.
       
  • Catheter distances and balloon inflation volumes for the ER-REBOA™
           catheter: A prospective analysis
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): David E. Meyer, Megan T. Mont, John A. Harvin, Lillian S. Kao, Charles E. Wade, Laura J. MooreAbstractIntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct used to temporize uncontrolled abdominopelvic hemorrhage. No published clinical data exist that describe average catheter lengths or balloon fill volumes necessary to occlude the aorta.MethodsA prospective, single-institution registry was queried for patients who underwent placement of a Prytime ER-REBOA™ catheter. Demographic, catheter, hemodynamic, and morphometric data were measured. Linear regression analyses were performed to identify variables associated with insertion distances and balloon volumes.Results45 patients underwent supraceliac REBOA: median catheter insertion distance 45 cm [IQR 42–46], balloon inflation volume 14 mL [IQR 8–19], systolic blood pressure (SBP) augmentation 50 mmHg [IQR 35–55]. 14 patients underwent infrarenal deployment: median catheter insertion distance 28.5 cm [IQR 26.5–32.5], balloon volume 10 mL [IQR 5–15]; SBP augmentation 55 mmHg [IQR 40–65]. Patient body metrics were not associated with catheter length or balloon volume.ConclusionA wide range of catheter insertion distances and balloon fill volumes were necessary for correct REBOA positioning and occlusion. No single patient metric accurately correlated with catheter distance or balloon volume.Level of evidenceLevel IV, Prognostic.
       
  • MAGIC versus MacDonald treatment regimens for gastric cancer: Trends and
           predictors of multimodal therapy for gastric cancer using the National
           Cancer Database
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Mark Jayanathan, Ryan P. Erwin, Nicholas Molacek, Marcus Fluck, Marie Hunsinger, Jeffrey Wild, Tania K. Arora, Mohsen M. Shabahang, Jan Franko, Joseph A. BlansfieldAbstractBackgroundMultimodal therapy is beneficial in gastric cancer, however this practice is not universal. This study examines trends, identifies associative factors, and examines overall survival (OS) benefit from multimodal therapy in gastric cancer.MethodsGastric cancer patients staged IB-III from 2005 to 2014, identified using the National Cancer Database, were categorized by treatment: surgery alone, perioperative chemotherapy, and adjuvant chemoradiation. Groups were analyzed to identify associative factors of perioperative therapy.ResultsWe examined 9243 patients, with the majority receiving multimodal therapy (57%). The proportion of those receiving perioperative chemotherapy rose dramatically from 7.5% in 2006 to 46% in 2013. Academic center treatment was strongly associated with perioperative over adjuvant therapy (p 
       
  • Reinforcement of intrathoracic oesophago-gastric anastomosis with fibrin
           sealant (Tisseel®) in oesophagectomy for cancer: A prospective
           comparative study
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Elias Sdralis, Anna Tzaferai, Spyridon Davakis, Athanasios Syllaios, Ali Kordzadeh, Bruno Lorenzi, Alexandros CharalabopoulosAbstractPurposeFibrin sealant (Tisseel) is a human protein and thrombin soluble fibrinogen that has been indicated for reinforcement of gastro-intestinal anastomoses to prevent leakage. The objective of this study is to examine the impact of fibrin sealant regarding anastomotic leak, following Ivor-Lewis procedure.MethodsThis is a prospective comparative study on 2-stage oesophagectomy for cancer of the distal oesophagus or oesophagogastric junction. N = 57 individuals were randomly subjected; n = 22 patients to Tisseel in combination to surgical anastomosis versus n = 35 patients to surgical anastomosis alone. The test of probability was assessed through Chi-Square, independent samples paired T-Test and Log-Rank analysis.ResultsOf the 57 cases included, 56 underwent hybrid and 1 open oesophagectomy. In the Tisseel group, n = 5(22.7%) developed anastomotic leak comparing to n = 3(8.6%) of the control group. No statistically significant difference in leak rate was shown between the two groups; the test of probability was rejected.ConclusionsOur results are not supportive of Tisseel tissue sealing property on the intrathoracic oesophago-gastric anastomosis and fibrin sealant's use cannot be justified.
       
  • The impact of surgical complications on the outcome of total
           pancreatectomy with islet autotransplantation
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Rauf Shahbazov, Bashoo Naziruddin, Osmaan Salam, Giovanna Saracino, Marlon F. Levy, Ernest Beecherl, Nicholas OnacaAbstractTotal pancreatectomy with islet autotransplantation is a promising treatment for refractory chronic pancreatitis. We analyzed postoperative complications in 83 TPIAT patients and their impact on islet graft function. We examined patient demographics, preoperative risk factors, intraoperative variables, and 30- and 90-day postoperative morbidity and mortality. Daily insulin requirement, HbA1c, C-peptide levels, and narcotic requirements were analyzed before and after surgery. Adverse events were recorded, with postoperative complications graded according to the Clavien-Dindo classification. There was no mortality in this patient group. Postoperative complications occurred in 38 patients (45.7%). Patients with postoperative complications were readmitted significantly more often within 30 days (p = 0.01) and 90 days posttransplant (p 
       
  • Preoperative neutrophili-to-lymphocyte ratio is useful for stratifying the
           prognosis of tumor markers-negative pancreatic cancer patients
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Takatsugu Matsumoto, Takehiro Okabayashi, Kenta Sui, Sojiro Morita, Jun Iwata, Yasuhiro ShimadaAbstractBackgroundElevated levels of preoperative tumor markers (TMs), including carcinoembryonic antigen and carbohydrate antigen 19–9 are risk factors for the survival of patients with pancreatic cancer (PC). However, TMs are not always applicable in various conditions. This study aimed to investigate the prognostic value of systemic inflammatory marker (SIM) in such patients.MethodsSeventy-seven patients who underwent curative surgery for PC with negative TMs were included in this study. Various SIMs for each patient were examined to determine the most reliable one. Using the most superior SIM, the patients were divided into two groups and their characteristics and postoperative results were compared.ResultsThe NLR was superior to other SIMs. Despite no significant intergroup differences were observed between the groups, the overall survival (OS) rate was significantly higher in the low NLR group than in the high NLR group (5-year OS rate: 81.2% vs. 24.2%, p 
       
  • The utility of the delphi method in defining anastomotic leak following
           colorectal surgery
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Vijaya T. Daniel, Karim Alavi, Jennifer S. Davids, Paul R. Sturrock, Cristina R. Harnsberger, Scott R. Steele, Justin A. MaykelAbstractBackgroundAlmost a decade after international guidelines defining anastomotic leak (AL) were published, the definition of AL remains inconsistent.MethodsA 3-round modified Delphi study was conducted among a national panel of 8 surgeon experts to assess consensus related to the definition of AL following colorectal resection. Consensus was defined when a scenario was rated as very important or absolutely essential by at least 85% of the experts in round 3.ResultsSeven of fifteen (47%) clinical and radiological scenarios of AL achieved consensus. 80% of clinical scenarios reached consensus. 30% of radiological scenarios reached consensus including CT demonstrating air bubbles around the anastomosis. No consensus was achieved in 70% of radiological scenarios.ConclusionsConsensus on the definition of AL is difficult to reach, in relation to international guidelines; which implies that further refinement of the definition of AL is needed to compare patient outcomes.
       
  • Investigating the effect of discordant clinical and pathological diagnoses
           of complicated appendicitis on clinical outcomes
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Janell J. Holloway, Lanair Amaad Lett, Dennis Y. Kim, Darin J. Saltzman, Michael P. Ferebee, Ian T. Macqueen, Christian M. de VirgilioAbstractBackgroundFollowing appendectomy, management is often guided by surgeon determination of whether the appendicitis is uncomplicated or complicated. Our objectives were to determine the incidence of discordance between intraoperative and pathological findings and determine effect on outcomes.MethodsWe performed a retrospective five-year cohort analysis of adults who underwent appendectomy for acute appendicitis. Outcomes examined were length of stay (LOS), return to ED, and 30-day readmission. We reported p-values from logistic regression.ResultsOf 1479 cases, 36.4% were labeled complicated appendicitis, among which, 58.2% were discordant. When intraoperative findings underestimated pathological findings, there was a decreased LOS (p 
       
  • In-hospital perforation risk in acute appendicitis: Age matters
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Keith A. Hanson, Daron Jacob, Adel Alhaj Saleh, Sharmila DissanaikeAbstractBackgroundControversy exists regarding how quickly an adult with appendicitis requires surgery to prevent perforation, and recent literature on antibiotic use as definitive treatment has complicated this question further. Since perforation is associated with worse outcomes, particularly in the elderly, efforts to prevent this complication are warranted. We studied risk factors for in-hospital perforation in patients diagnosed by admission CT with non-perforated acute appendicitis.MethodsWe evaluated baseline demographics, symptom duration, and time from admission to antibiotics and surgery. Outcome measure was perforation diagnosed intra-operatively by attending surgeon.ResultsOf 700 patients, 84 (12%) sustained in-hospital perforation; time from admission to operation or antibiotics were not associated. Duration of symptoms>24 h (aOR = 2.23, 95% CI = 1.33–3.72, p 
       
  • Trauma video review utilization: A survey of practice in the United States
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): R.P. Dumas, M.A. Vella, J.S. Hatchimonji, L. Ma, Z. Maher, D.N. HolenaAbstractIntroductionTrauma video review (TVR) for quality improvement and education in the United States has been described for nearly three decades. The most recent information on this practice indicated a declining prevalence. We hypothesized that TVR utilization has increased since most recent estimates.MethodsWe conducted a survey of TVR practices at level I and level II US trauma centers. We distributed an electronic survey covering past, current, and future TVR utilization to the Eastern Association for the Surgery of Trauma membership.Results45.0% of US level I and level II trauma centers completed surveys. 71/249 centers (28.5%) had active TVR programs. The use of TVR did not differ between level I and level II centers (28.8% vs. 27.8%, p = 0.87). Respondents using TVR were overwhelmingly positive about its perception (median score 8, [IQR 6–9]; 10 = ‘best’) at their institutions.ConclusionsTVR use at Level I centers has increased over the past decade. Increased TVR utilization may form the basis for multicenter studies comparing processes of care during trauma resuscitation.
       
  • Geriatric patients on antithrombotic therapy as a criterion for trauma
           team activation leads to over triage
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Zachary M. Callahan, Stephen P. Gadomski, Deepika Koganti, Pankaj H. Patel, Alec C. Beekley, Patricia Williams, Julie Donnelly, Murray J. Cohen, Joshua A. MarksAbstractBackgroundOur institution amended its trauma activation criteria to require a Level II activation for patients ≥65 years old on antithrombotic medication presenting with suspected head trauma.MethodsOur institutional trauma registry was queried for geriatric patients on antithrombotic medication in the year before and after this criteria change. Demographics, presentation metrics, level of activation, and outcomes were compared between groups.ResultsAfter policy change, a greater proportion of patients received a trauma activation (19.9 vs. 74.9%, P 
       
  • Assessing quality and resources during campus-wide simulation integration
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Joshua J. Weis, Deborah C. Hogg, Melanie Sulistio, Deborah E. Farr, Charles Ginsburg, Oren T. Guttman, Kim Hoggatt Krumwiede, Kimberly A. Kho, Joseph Martinez, Gary Reed, Robert V. Rege, Dwain Thiele, James M. Wagner, Daniel J. ScottAbstractIntroductionOur simulation center, supported by four departments (Surgery, OB/GYN, Urology, and Anesthesiology), is accredited as a comprehensive Accredited Educational Institute (AEI) and is now expanding to accommodate all departments on campus.MethodsA 61-point questionnaire was administered to 44 stakeholders, representing all of UME and GME. Data were compared for AEI vs. non-AEI activities.ResultsResponses were collected from all 44 groups (100% response rate). Overall, 43 simulation activities were hosted within the AEI and 40 were hosted by non-AEI stakeholders. AEI activities were more likely to be mandatory (93% vs. 75%, p = 0.02), have written learning objectives (79% vs 43%, p 
       
  • How important is the 4-ICG score for a thyroid surgeon'
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): S. Shekhar, P.K. Singh, S. Vikram, C.K. Jha
       
  • The impact of the affordable care act (ACA) Medicaid Expansion on access
           to minimally invasive surgical care
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Emanuel Eguia, Marshall S. Baker, Bipan Chand, Patrick J. Sweigert, Paul C. KuoAbstractIntroductionThis study aims to evaluate the effect of the ACA Medicaid expansion on the utilization of minimally invasive (MIS) approaches to common general surgical procedures.MethodsWe queried five Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates of utilization and costs of MIS and open approaches pre and post Medicaid expansion.Results117,241 patients met the inclusion criteria. Following the enactment of the ACA, use of both laparoscopic gastric bypass (IRR 1.08; 95% CI: [1.02, 1.15]) and Nissen fundoplication (IRR 1.17; 95% CI [1.09, 1.26]) increased in Medicaid patients treated in expansion states than in those treated in non-expansion states. Simultaneously, the costs reported for self-pay patients increased in expansion states more than in non-expansion states (+$1669; 95% CI [$655, $2682]).ConclusionsMedicaid expansion was associated with increased rates of utilization of MIS approaches to several surgical procedures and a shifting of costs toward patients who were self-insured.
       
  • Emeritus Editorial Board
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s):
       
  • Extreme oncoplastic breast conserving surgery: Is surgical dexterity all
           that is need'
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Gianluca Franceschini, Riccardo Masetti
       
  • Anatomical considerations for transversus abdominis plane block in
           laparoscopic surgery
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Hytham K.S. Hamid, Iqbal Z. Khan
       
  • Letter to the Editor: “Prediction of hypocalcemia after total
           thyroidectomy using indocyanine green angiography of parathyroid glands: A
           simple quantitative scoring system”
    • Abstract: Publication date: January 2020Source: The American Journal of Surgery, Volume 219, Issue 1Author(s): Suneel Mattoo, Amit Agarwal
       
  • Evaluation of a water-soluble contrast protocol for small bowel
           obstruction: A southwestern surgical congress multicenter trial
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Eliza E. Moskowitz, Robert C. McIntyre, Clay Cothren Burlew, Laura J. Helmkamp, Erik D. Peltz, Julia R. Coleman, Alexandra Kovar, Michael Truitt, Vaidehi Agrawal, Edwin Onkendi, Rushabh Dev, Jose J. Diaz, Barbara Eaton, Eric M. CampionAbstractDifferentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge.A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed.283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery.Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
       
  • Narrowed pulse pressure predicts massive transfusion and emergent
           operative intervention following penetrating trauma
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Jonathan Warren, Ashkan Moazzez, Vincent Chong, Brant Putnam, Angela Neville, George Singer, Molly Deane, Dennis Y. KimAbstractIntroductionThe early identification of hemorrhagic shock may be challenging. The objective of this study was to examine the utility of a narrowed pulse pressure in identifying the need for emergent interventions following penetrating trauma.MethodsIn this 2.5-year retrospective study of adult patients with a penetrating mechanism, patients with a narrowed pulse pressure (
       
  • Physiologic stress among surgeons who take in-house call
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Caitlin Robinson, Ryan Lawless, Ben L. Zarzaur, Lava Timsina, David V. Feliciano, Jamie J. ColemanAbstractIntroductionBurnout and depression is higher in trauma surgeons as compared to surgeons in other specialties. Clinical practice for many acute care surgeons (ACS) includes in-house call (IHC). The goal of this study was to quantitate physiologic stress among ACS who take IHC.MethodsACS with IHC responsibilities from two Level I trauma centers were studied. Participants wore a fitness and heart rate variability (HRV) device over 3 months. HRV was categorized as normal if 85% of baseline, moderate stress when HRV 50%, and high stress when HRV< 50%.Results1421 nights were recorded among 17 surgeons (35.3% female; mean age 45.5 years). Excluding IHC, mean HRV = 32.23, and 95.63% of days were consistent with moderate or high stress. Post-call day 2 had significantly highest percentage of high stress (65.82%, p = 0.0495). High and moderate stress levels returned to baseline on post-call day 3.ConclusionsHigh and moderate stress beyond IHC is common among ACS. Future study is needed to determine consequences of persistent stress and identify factors which impact recovery after IHC.
       
  • An evaluation of blood product utilization rates with massive transfusion
           protocol: Before and after thromboelastography (TEG) use in trauma
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Mitchell Unruh, Jared Reyes, Stephen D. Helmer, James M. HaanAbstractPurposeThe purpose of this study was to determine if thromboelastography (TEG) is associated with reduced blood product utilization for trauma patients undergoing massive transfusion protocol (MTP) compared to traditional coagulation tests.MethodsA retrospective review was conducted on an intent-to-treat basis of trauma patients undergoing MTP (Pre-TEG = Period I vs. Post-TEG = Period II). Traditional coagulation tests guided transfusion during Period I (n = 20) and the intent was that TEG guided transfusions during Period II (n = 47). Blood product administration and outcomes were compared.ResultsIntent-to-treat analysis demonstrated a significant reduction in red blood cell transfusions (11 vs. 6 units, P = 0.001), number of patients receiving fresh frozen plasma (85.0 vs. 17.0%, P 
       
  • Trends in resident operative trauma: How to train future trauma
           surgeons'
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Tashinga Musonza, S. Rob Todd, Bradford Scott, M. Andrew Davis, John PottsAbstractBackgroundTrauma is an essential content area of general surgery residency. The objective of this study was to assess trends in the operative trauma experience by general surgery residents.MethodsThis was a retrospective review of available ACGME case log reports (the past 29 years) for general surgery residents.ResultsOver the study period, the total operative trauma cases as surgeon decreased from 79.6 to 29.9, (p 
       
  • Protocol driven management of suspected common duct stones: A Southwestern
           Surgical Congress multi-centered trial
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Chad Hall, Justin L. Regner, Thomas Schroeppel, Joe Rodriguez, Robert McIntyre, Franklin Wright, Sharmila Dissanaike, Robyn Richmond, Ariel Santos, Richard C. FrazeeAbstractBackgroundSeveral options exist for the diagnosis and management of suspected common duct stones. We hypothesized that a protocol-directed approach would shorten length of stay in this patient population.MethodsPatients from four participating institutions with a peak bilirubin
       
  • The role of the American Society of anesthesiologists physical status
           classification in predicting trauma mortality and outcomes
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Catherine M. Kuza, Kazuhide Matsushima, Wendy J. Mack, Christopher Pham, Talia Hourany, Jessica Lee, Thang D. Tran, Roman Dudaryk, Michelle B. Mulder, Miguel A. Escanelle, Babatunde Ogunnaike, M. Iqbal Ahmed, Xi Luo, Alexander Eastman, Jonathan B. Imran, Emily Melikman, Abu Minhajuddin, Anne Feeler, Richard D. Urman, Ali SalimAbstractBackgroundTrauma prediction scores such as Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS)) are used to predict mortality, but do not include comorbidities. We analyzed the American Society of Anesthesiologists physical status (ASA PS) for predicting mortality in trauma patients undergoing surgery.MethodsThis multicenter, retrospective study compared the mortality predictive ability of ASA PS, RTS, Injury Severity Score (ISS), and TRISS using a complete case analysis with mixed effects logistic regression. Associations with mortality and AROC were calculated for each measure alone and tested for differences using chi-square.ResultsOf 3,042 patients, 230 (8%) died. The AROC for mortality for TRISS was 0.938 (95%CI 0.921, 0.954), RTS 0.845 (95%CI 0.815, 0.875), and ASA PS 0.886 (95%CI 0.864, 0.908). ASA PS + TRISS did not improve mortality predictive ability (p = 0.18).ConclusionsASA PS was a good predictor of mortality in trauma patients, although combined with TRISS it did not improve predictive ability.
       
  • Utilization of endovascular and open surgical repair in the United States:
           A 10-year analysis of the National Trauma Databank (NTDB)
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): AN Romagnoli, M Zeeshan, B Joseph, ML BrennerAbstractBackgroundEndovascular therapy provides a less invasive alternative to open surgery for critically ill patients who have sustained arterial injuries. The purpose of this study was to evaluate recent trends in the management of arterial injuries in the United States with specific reference to the use of endovascular strategies and to examine the outcomes of endovascular vs open therapy for the treatment of civilian arterial traumatic injuries.MethodsWe performed a 10-year (2004–2014) analysis of ACS-NTDB and identified all adult trauma patients who had arterial injuries. Data regarding demographics, injury parameters, endovascular or open vascular repair and outcomes were extracted. Cochran-Armitage trend analysis and multivariate logistic regression analysis were performed.ResultsA total of 111,061 patients with arterial injuries were identified and included in our analysis. Mean age was 39 ± 19y, 82% were male and 79% were white. The most common artery injured was iliac artery followed by brachial artery and thoracic aorta. Overall 6.7% (7434) patients underwent endovascular repair while 38.8% (42,495) had open vascular repair. The rate of endovascular repair increased from 3.1% to 8.9% while the incidence of open vascular repair decreased from 47% to 32% over the study period. Patients in endovascular group had lower ISS compared to patients in open vascular repair group (17 + 10 vs 24 + 10, p 
       
  • The use of component separation during abdominal wall reconstruction in
           contaminated fields: A case-control analysis
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Sean R. Maloney, Vedra A. Augenstein, Erling Oma, Kathryn A. Schlosser, Tanushree Prasad, Kent W. Kercher, Ronald F. Sing, Paul D. Colavita, B. Todd HenifordAbstractBackgroundComponent separation technique (CST) allows fascial medialization during abdominal wall reconstruction (AWR). Wound contamination increases the incidence of wound complications, which multiplies the incidence of repair failure. The aim of this study was to compare the impact of CST on AWR outcomes in contaminated fields in comparison to those operations without CST.MethodsA prospective, single institution hernia database was queried for patients undergoing AWR with CST and contamination. A case control cohort was identified using propensity score matching.ResultsThere were 286 CSTs performed in contaminated cases. After propensity score matching, 61 CSTs were compared to 61 No-CSTs. These groups were matched by defect area (CST:287.1 ± 150.4 vs No-CST:277.6 ± 218.4 cm2, p = 0.156), BMI (32.0 ± 7.0 vs 32.2 ± 6.0 kg/m2, p = 0.767), diabetes (26.2% vs 32.8%, p = 0.427), and panniculectomy (52.5% vs 36.1%, p = 0.068). Groups had similar rates of wound complications (42.6% vs 40.7%, p = 0.829) and recurrence (4.9% vs 13.1%, p = 0.114).ConclusionsThe use of CST in the face of contamination is not associated with an increase in wound complications, mesh complications, or recurrence.
       
  • Factors associated with general surgery residents’ decisions regarding
           fellowship and subspecialty stratified by burnout and quality of life
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Natalie C. McClintock, Kelsey E. Gray, Angela L. Neville, Amy H. Kaji, Mary M. Wolfe, Kristine E. Calhoun, Farin F. Amersi, Timothy R. Donahue, Tracey D. Arnell, Benjamin T. Jarman, Kenji Inaba, Marc L. Melcher, Jon B. Morris, Brian R. Smith, Mark E. Reeves, Jeffrey M. Gauvin, Edgardo S. Salcedo, Richard A. Sidwell, Daniel L. Dent, Kenric M. MurayamaAbstractBackgroundAlthough most surgery residents pursue fellowships, data regarding those decisions are limited. This study describes associations with interest in fellowship and specific subspecialties.MethodsAnonymous surveys were distributed to 607 surgery residents at 19 US programs. Subspecialties were stratified by levels of burnout and quality of life using data from recent studies.Results407 (67%) residents responded. 372 (91.4%) planned to pursue fellowship. Fellowship interest was lower among residents who attended independent or small programs, were married, or had children. Residents who received AOA honors or were married were less likely to choose high burnout subspecialties (trauma/vascular). Residents with children were less likely to choose low quality of life subspecialties (trauma/transplant/cardiothoracic).ConclusionsSurgery residents' interest in fellowship and specific subspecialties are associated with program type and size, AOA status, marital status, and having children. Variability in burnout and quality of life between subspecialties may affect residents’ decisions.
       
  • Follow-up trends after emergency department discharge for acutely
           symptomatic hernias: A southwestern surgical congress multi-center trial
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Jillian L. Angelo, Amy H. Kaji, Lara H. Spence, David S. Plurad, Marlo Asis, Annabel Barber, Thomas J. Schroeppel, Emma C. Callaghan, Brandon T. Grover, Justin L. Regner, Michael Truitt, Dennis Y. KimAbstractBackgroundThe objective of this multi-center study was to examine the follow-up trends after emergency department (ED) discharge in a large and socioeconomically diverse patient population.MethodsWe performed a 3-year retrospective analysis of adult patients with acutely symptomatic hernias who were discharged from the EDs of five geographically diverse hospitals.ResultsOf 674 patients, 288 (43%) were evaluated in the clinic after discharge from the ED and 253 (37%) underwent repair. Follow-up was highest among those with insurance. A total of 119 patients (18%) returned to the ED for hernia-related complaints, of which 25 (21%) underwent urgent intervention.ConclusionThe plan of care for patients with acutely symptomatic hernias discharged from the ED depends on outpatient follow-up, but more than 50% of patients are lost to follow-up, and nearly 1 in 5 return to the ED. The uninsured are at particularly high risk.
       
  • It's sooner than you think: Blunt solid organ injury patients are already
           hypercoagulable upon hospital admission - Results of a bi-institutional,
           prospective study
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Julia R. Coleman, Annika B. Kay, Ernest E. Moore, Hunter B. Moore, Eduardo Gonzalez, Sarah Majercik, Mitchell J. Cohen, Thomas White, Fredric M. PieracciAbstractIntroductionThe optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC).Material and methodsThis is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers’ trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents.ResultsOn ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 hConclusionsBSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG.
       
  • Laparoscopic omental patch for perforated peptic ulcer disease reduces
           length of stay and complications, compared to open surgery: A SWSC
           multicenter study
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Adel Alhaj Saleh, Esteban C. Esquivel, John T. Lung, Barbara C. Eaton, Brandon R. Bruns, Galinos Barmparas, Daniel R. Margulies, Alexander Raines, Cressilee Bryant, Christopher E. Crane, Elizabeth P. Scherer, Thomas J. Schroeppel, Eliza Moskowitz, Justin Regner, Richard Frazee, Eric M. Campion, Matthew Bartley, Jared Mortus, Jeremy Ward, Mhd Hasan AlmekdashAbstractsRCTs showed benefits in Lap repair of perforated peptic ulcer (PPU).The SWSC Multi-Center Trials Group sought to evaluate whether Lap omental patch repairs compared to Open improved outcomes in PPU in general practice.Data was collected from 9 SWSC Trial Group centers. Demographics, operative time, 30-day complications, length of stay and mortality were included.461 patientsOpen in 311(67%) patients, Lap in 132(28%) with 20(5%) patients converted from Lap to Open. Groups were similar at baseline. Significant variability was found between centers in their utilization of Lap (0–67%).Complications at 30 days were lower in Lap (18.5% vs. 27.5%, p 
       
  • SWSC 2019 Presidential address “Putting Patients First”
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s): Courtney Scaife
       
  • Emeritus Editorial Board
    • Abstract: Publication date: December 2019Source: The American Journal of Surgery, Volume 218, Issue 6Author(s):
       
 
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