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Publisher: Elsevier   (Total: 3123 journals)

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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, 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: 378, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
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   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, 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: 10, 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: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, 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: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 140, 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: 17, 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: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, 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: 26, 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: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, 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 Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
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: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
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: 36, 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: 6)
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: 10)
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: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, 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: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
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: 24, 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: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 371, 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: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, 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: 338, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 433, 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: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, 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: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
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   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, 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: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
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: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, 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: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 173, 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: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, 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: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover American Journal of Surgery
  [SJR: 1.286]   [H-I: 125]   [36 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9610
   Published by Elsevier Homepage  [3123 journals]
  • A model for a career in a specialty of general surgery: One surgeon's
           opinion
    • Authors: Bona Ko; Christopher R. McHenry
      Pages: 8 - 13
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Bona Ko, Christopher R. McHenry
      Background The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons. Methods Case logs collected from 1991–2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME “Major Case Categories” and there frequencies were determined. Results 10,324 operations were performed on 8209 patients. 412.9 ± 84.9 operations were performed yearly including 279.3 ± 42.7 general and 133.7 ± 65.5 endocrine operations. A high-volume endocrine surgery practice and a rank of tenured professor were achieved by years 11 and 13, respectively. At year 25, the frequency of endocrine operations exceeded general surgery operations. Conclusion Maintaining a foundation in broad-based general surgery with a specialty focus is a sustainable career model. Residents and fellows can use the model to help plan their careers with realistic expectations.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.08.006
       
  • Rothman Index variability predicts clinical deterioration and rapid
           response activation
    • Authors: Brian C. Wengerter; Kevin Y. Pei; David Asuzu; Kimberly A. Davis
      Pages: 37 - 41
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Brian C. Wengerter, Kevin Y. Pei, David Asuzu, Kimberly A. Davis
      Background The overall utility of the Rothman Index (RI), a global measure of inpatient acuity, for surgical patients is unclear. We evaluate whether RI variability can predict rapid response team (RRT) activation in surgical patients. Methods Surgical patients who underwent RRT activation from 2013 to 2015 were matched to four control cases. RI variability was gauged by maximum minus minimum RI (MMRI) and RI standard deviation (RISD) within a 24-h period before RRT. The primary outcome measured was RRT activation, and our secondary outcome was in-hospital mortality. Results Two hundred seventeen (217) patients underwent RRT. RISD (odds ratio, OR, 1.31, 95% confidence interval, CI, 1.23–1.38, P < 0.001; area under receiver operating characteristic, AUROC, curve 0.74, 95% CI 0.70–0.77) and MMRI (OR 1.10, 95% CI 1.08–1.12, P < 0.001; AUROC 0.76, 95% CI 0.72–0.79) predicted increased likelihood of RRT. Conclusions RISD is predictive of RRT.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.07.031
       
  • Development and evaluation of a trauma decision-making simulator in Oculus
           virtual reality
    • Authors: Cuan M. Harrington; Dara O. Kavanagh; John F. Quinlan; Donncha Ryan; Patrick Dicker; Dara O'Keeffe; Oscar Traynor; Sean Tierney
      Pages: 42 - 47
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Cuan M. Harrington, Dara O. Kavanagh, John F. Quinlan, Donncha Ryan, Patrick Dicker, Dara O'Keeffe, Oscar Traynor, Sean Tierney
      Background Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the entertainment-industry. We developed an innovative medical-training simulator on the Oculus™ Gear-VR platform. This novel application was developed utilising internationally recognised Advanced Trauma Life Support (ATLS) principles, requiring decision-making skills for critically-injured virtual-patients. Methods Participants were recruited in June, 2016 at a single-centre trauma-course (ATLS, Leinster, Ireland) and trialled the platform. Simulator performances were correlated with individual expertise and course-performance measures. A post-intervention questionnaire relating to validity-aspects was completed. Results Eighteen(81.8%) eligible-candidates and eleven(84.6%) course-instructors voluntarily participated. The survey-responders mean-age was 38.9(±11.0) years with 80.8% male predominance. The instructor-group caused significantly less fatal-errors (p < 0.050) and proportions of incorrect-decisions (p < 0.050). The VR-hardware and trauma-application's mean ratings were 5.09 and 5.04 out of 7 respectively. Participants reported it was an enjoyable method of learning (median-6.0), the learning platform of choice (median-5.0) and a cost-effective training tool (median-5.0). Conclusion Our research has demonstrated evidence of validity-criteria for a concept application on virtual-reality headsets. We believe that virtual-reality technology is a viable platform for medical-simulation into the future.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.02.011
       
  • Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue
           in geriatric emergency general surgery patients
    • Authors: Muhammad Khan; Asad Azim; Terence O'Keeffe; Faisal Jehan; Narong Kulvatunyou; Chelsey Santino; Andrew Tang; Gary Vercruysse; Lynn Gries; Bellal Joseph
      Pages: 53 - 57
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Muhammad Khan, Asad Azim, Terence O'Keeffe, Faisal Jehan, Narong Kulvatunyou, Chelsey Santino, Andrew Tang, Gary Vercruysse, Lynn Gries, Bellal Joseph
      Background Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods 3-year(2013–15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.08.002
       
  • Risk factors for surgical site infection after stoma closure comparison
           between pursestring wound closure and conventional linear wound closure:
           Propensity score matching analysis
    • Authors: Masashi Yamamoto; Keitaro Tanaka; Shinsuke Masubuchi; Masatsugu Ishii; Hiroki Hamamoto; Shigenori Suzuki; Yasuhiko Ueda; Junji Okuda; Kazuhisa Uchiyama
      Pages: 58 - 61
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Masashi Yamamoto, Keitaro Tanaka, Shinsuke Masubuchi, Masatsugu Ishii, Hiroki Hamamoto, Shigenori Suzuki, Yasuhiko Ueda, Junji Okuda, Kazuhisa Uchiyama
      Purpose Stoma closure has been associated with a high rate of surgical site infection (SSI) and the optimal skin closure method is still controversial. The aim of this study was to compare the short-term and long-term outcomes between the conventional linear closure (CC) and the persestring closure (PC) using propensity score matching analysis. Methods We analysed the data of 360 patients who underwent stoma closure with CC or PC between January 2000 and December 2014. The propensity score was calculated from age, gender, body mass index, primary disease, type of stoma, diabetes mellitus, history of smoking, steroid use, the American Society of Anesthesiologists score, Prognostic Nutritional Index and modified Glasgow Prognostic Score. Results There was no difference in operative variables between the two groups. The CC group and the PC group were comparable with regards to overall SSI (25.0 vs. 7.8%; P = 0.007), superficial SSI (21.9 vs. 4.7%; P = 0.003). Significant risk factor for SSI was conventional linear closure (OR, 4.14; 95% CI, 1.448–13.91). Conclusion Our study suggests that a pursestring stoma closure leads to less SSI.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.09.031
       
  • Factors associated with portomesenteric venous thrombosis after total
           colectomy with ileorectal anastomosis or end ileostomy
    • Authors: Emre Gorgun; Ipek Sapci; Akin Onder; Gokhan Ozuner; David Liska; Luca Stocchi; Conor P. Delaney
      Pages: 62 - 65
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Emre Gorgun, Ipek Sapci, Akin Onder, Gokhan Ozuner, David Liska, Luca Stocchi, Conor P. Delaney
      Background Porto-mesenteric venous thrombosis (PMVT) is an uncommon but serious complication. Data on the risk factors for PMVT following total colectomy with ileorectal anastomosis or end ileostomy (TC/IRA or EI) is limited. This study aimed to evaluate the factors associated with PMVT after TC/IRA or EI. Methods Patients who underwent elective TC/IRA or EI between January 2010 and December 2014 were identified from institutional database. Patients who had CT proven PMVT within 30 days of surgery were included in the PMVT positive group. Demographics and perioperative/postoperative 30-day outcomes were compared between groups. Results Out of 832 patients, 34 patients (4.1%) were diagnosed with PMVT. PMVT positive group were younger (35.8vs.41 years, p = 0.03). Postoperative organ-space surgical site infection (17.6% vs. 4.8%, p = 0.007), deep venous thrombosis (8.8%vs.1.5%, p = 0.02), ileus (38.2%vs.20.8%, p = 0.018), and readmission (50.0%vs.12.7%, p < 0.001) were more common in patients with PMVT, who also had longer hospital stay (8.5vs.6 days, p = 0.002). Conclusions PMVT after TC/IRA or EI may occur in non-IBD patients. PMVT should be included in differential diagnosis after TC/IRA or EI in patients with intraabdominal infection or ileus, especially in younger patients.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.10.002
       
  • Local parastomal hernia repair with biological mesh is safe and effective
    • Authors: Theadore Hufford; Jean-Francois Tremblay; Mohammad Taha Mustafa Sheikh; Slawomir Marecik; John Park; Ina Zamfirova; Kunal Kochar
      Pages: 88 - 90
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Theadore Hufford, Jean-Francois Tremblay, Mohammad Taha Mustafa Sheikh, Slawomir Marecik, John Park, Ina Zamfirova, Kunal Kochar
      Purpose The goal of this study was to evaluate the efficacy, morbidity and safety of local parastomal hernia repair using biological mesh. Patients and methods A retrospective analysis of a prospectively maintained database was performed for parastomal hernia repairs. All patients who underwent local parastomal hernia repair with biological mesh between July 2006 and July 2015 were included in the study. Non-local (laparoscopic or midline incision) procedures were excluded. The type of repair, incision used, mesh placement and morbidity were analyzed. Time to recurrence was measured as an independent variable. Results 58 procedures with a median follow up of 3.8 years were analyzed. The majority (91%) of repairs were performed on an elective basis. Underlay technique was used in 24 patients (39%), overlay in 4 (7%) and both overlay and underlay (sandwich technique) in 33 (54%) of the cases. Overall, 11 patients (18.1%) experienced recurrence. Recurrence occurred in 8 patients in the underlay group (33%), 1 in the overlay group (25%), with 2 recurrences identified in the sandwich technique group (6%; p = 0.02). There was one occurrence of 30-day morbidity in our study population (0.016%). No difference was observed for recurrence or morbidity according to the type of biologic mesh used (human, bovine, or porcine). Conclusion Our results demonstrate that local parastomal hernia repairs are associated with moderate recurrence rates, very low morbidity and consistent with the current literature. The sandwich technique was found to have a significantly lower recurrence rate compared to underlay or overlay techniques. Keyhole incisions were associated with less recurrence than traditional circular incisions. Our findings further reveal biologic mesh type was not associated with any difference in outcomes. Local parastomal hernia repair with biologic mesh is a safe procedure with very low morbidity and acceptable recurrence rate, especially using the sandwich repair technique.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.05.005
       
  • Effects of laparoscopic cholecystectomy in normokinetic biliary dyskinesia
    • Authors: Kerent D. Pihl; Mark W. Jones; Jeffery G. Deppen; Troy M. Ferguson; Suzanne M. Hanses
      Pages: 116 - 119
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Kerent D. Pihl, Mark W. Jones, Jeffery G. Deppen, Troy M. Ferguson, Suzanne M. Hanses
      This is the largest single center retrospective study to date looking at response to laparoscopic cholecystectomy in patients with acalculous biliary disease. A chart review was completed on 1116 patients from 2009 to 2014 who had admitting diagnoses related to acalculous cholecystitis and biliary colic. Four hundred and seventy four patients were available for long term follow up (6 months or longer). Multiple factors were studied as related to cholescintigraphy scans with cholecystokinin administration (HIDA with CCK). Hyperkinetic, normokinetic and hypokinetic ejection fractions (EF), as well as reproduction of symptoms with administration of CCK were catagorized. ROME III criteria (Table 1) were used to describe cholecystitis/biliary colic symptoms. (1). It was found that rates of resolution of symptoms after laparoscopic cholecystectomy in normokinetic and hypokinetic were similar. It was also found that reproduction of symptoms after administration of CCK was a better predictor of favorable response to surgery than calculated ejection fraction.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.04.012
       
  • Operative outcomes of conventional specimen radiography versus
           in-operating room specimen radiography in radioactive seed-localized
           segmental mastectomies
    • Authors: Daniel Rhee; Barbara Pockaj; Nabil Wasif; Chee-Chee Stucky; Victor Pizzitola; Marina Giurescu; Bhavika Patel; Janice McCarthy; Richard Gray
      Pages: 151 - 154
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Daniel Rhee, Barbara Pockaj, Nabil Wasif, Chee-Chee Stucky, Victor Pizzitola, Marina Giurescu, Bhavika Patel, Janice McCarthy, Richard Gray
      Introduction In-operating room specimen radiography (ORSR) has not been studied among women undergoing radioactive seed localization (RSL) for breast cancer surgery and had the potential to decrease operative time and perhaps improve intraoperative margin management. Methods One hundred consecutive RSL segmental mastectomies among 98 patients using ORSR were compared to 100 consecutive segmental mastectomies among 98 patients utilizing conventional radiography (CSR) prior to the initiation of ORSR from December 2013 to January 2015 after radioactive seed localization. Final pathologic margins were considered to be 10 mm for all cases of no residual disease after biopsy or neoadjuvant therapy, but such patients were excluded from analyses involving tumor size. All patients' specimens were subjected to intraoperative pathologic consultation in addition to ORSR or CSR. Results The median age of the cohort was 65 years (range 36–97), and the median tumor size was 1 cm. There were no differences between the ORSR and CSR groups in age, tumor size, percentage of cases with only DCIS, and percentage of cases with microcalcifications. The ORSR group had a statistically significant lower BMI. Mean operative time from cut-to-close was not significantly different (ORSR 77 min, SD 24.8 vs CSR 76 min, SD 24.8, p = 0.75). There was no statistical difference in mean closest final pathologic margin (4.99 mm, SD 3.3 vs 4.88 mm, SD 3.5, p = 0.9). The percentage undergoing intraoperative margin re-excision (ORSR 40%, CR 47%, p = 0.31) and the mean total number of margins excised intraoperatively (ORSR 0.9, CR 1.0 p = 0.65) were similar. The rate of any margin <2 mm was 14% vs 12% for ORSR and CR, respectively (p = 0.64). The mean specimen volume for ORSR was 76cm3 (SD 101.8) vs 90cm3 (SD 61.2) for CSR; this difference was not statistically significant (p = 0.25). The mean ratio of segmental mastectomy volume to maximum tumor diameter was less for ORSR (82.7cm2 vs 139.4cm2, p = 0.014). Conclusion ORSR for RSL breast surgery, in the setting of routine intraoperative pathology consultation, does not significantly impact operative time, the rate or number of additional intraoperative margins excised, the number of reoperations for margins, or the width of final pathological margins. ORSR was associated with a decrease in the volume of segmental mastectomies relative to the tumor diameter.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.07.019
       
  • Hospital esophagectomy volume and postoperative length of stay: A
           systematic review and meta-analysis
    • Authors: Femi Giwa; Aitua Salami; Ajibola I. Abioye
      Pages: 155 - 162
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Femi Giwa, Aitua Salami, Ajibola I. Abioye
      Background Much attention in the volume-outcomes literature has focused on the empirical impact of surgical caseload on outcomes. However, relevant studies on the association between surgical volume and variables that potentially contribute to healthcare costs are limited. The objective of this study was to systematically elucidate a contemporary analysis of the empirical relationship between hospital esophagectomy volume and postoperative length of stay, a cost-related outcome. Data sources OvidSP, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and OpenGrey were searched for relevant articles published from 2000 to 2016. Results High hospital esophagectomy volume was associated with reduced postoperative length of stay (mean: 3 days; 95%CI: 2.8, 3.2) and risk of prolonged length of stay (RR: 0.80, 95%CI: 0.74, 0.87) in a dose-response fashion. Conclusions Complex surgeries performed at high surgical volume centers may be associated with overall decrease in postoperative length of stay, a cost-related outcome.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2017.03.022
       
  • Discussion of "Protocolized warfarin reversal with 4-factor prothrombin
           complex concentrate versus 3-factor prothrombin complex concentrate with
           recombinant factor VIIa"
    • Authors: Rachel Van Dusen
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Rachel Van Dusen
      Introduction Life-threatening bleeding is the most feared complication of warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin K dependent clotting factors is essential for hemostasis. Methods A retrospective cohort study of warfarin-treated patients experiencing a life-threatening bleed treated with a warfarin reversal protocol comprised of 4F PCC (post-implementation group) and those who received the prior reversal protocol of 3F PCC and rFVIIa (pre-implementation group) was performed. Demographic and clinical information, anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded. Results 195 patients were included in final analysis; 118 in the pre-implementation group, 77 in the post-implementation group. While baseline SOFA and GCS scores were similar between groups, the pre-implementation group had a longer ICU LOS and higher in-hospital mortality (p <0.01, 0.01 respectively). The most common indication for anticoagulation reversal was intracranial hemorrhage in both groups. Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the pre-implementation group, 0.8 versus 1.3 (p<0.01). Significantly more patients experienced thromboembolic complications (TEC) in the pre-implementation group than the post-implementation group, 27.9% versus 6.5% of patients (p<0.01). The leading TEC in both groups was deep venous thrombosis. Differences in baseline characteristics (p ≤ 0.2) were entered into a Poisson log-linear regression model for association with TECs. Receipt of rFVIIa was the only characteristic significantly associated with TECs. Discussion A 4F PCC warfarin reversal strategy is efficacious at reversing INR while providing significantly lower thromboembolic risk as compared to 3F PCC with rVIIa.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.11.044
       
  • Discussion of "Nonatherosclerotic Vascular Causes of Acute Abdominal Pain"
    • Authors: James P. Dolan
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): James P. Dolan


      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.11.052
       
  • Neurocognitive assessment in patients with a minor traumatic brain injury
           and an abnormal initial CT scan: Can cognitive evaluation assist in
           identifying patients who require surveillance CT brain imaging'
    • Authors: Thomas W. Clements; Michael Dunham; Andrew Kirkpatrick; Ruphus Rajakumar; Carolyn Gratton; Rohan Lall; Paul McBeth; Chad G. Ball
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Thomas W. Clements, Michael Dunham, Andrew Kirkpatrick, Ruphus Rajakumar, Carolyn Gratton, Rohan Lall, Paul McBeth, Chad G. Ball
      Background Evidence for repeat computed tomography (CT) in minor traumatic brain injury (mTBI) patients with intracranial pathology is scarce. The aim of this study was to investigate the utility of clinical cognitive assessment (COG) in defining the need for repeat imaging. Methods COG performance was compared with findings on subsequent CT, and need for neurosurgery in mTBI patients (GCS 13-15 and positive CT findings). Results Of 152 patients, 65.8% received a COG (53.0% passed). Patients with passed COG underwent fewer repeat CT (43.4% vs. 78.7%;p=0.001) and had shorter LOS (8.7 vs. 19.5;p<0.05). Only 1 patient required neurosurgery after a passed COG. The negative predictive value of a normal COG was 90.6% (95%CI=81.8%-95.4%). Conclusion: mTBI patients with an abnormal index CT who pass COG are less likely to undergo repeat CT head, and rarely require neurosurgery. The COG warrants further investigation to determine its role in omitting repeat head CT.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.11.046
       
  • Traumatic Thoracic Rib Cage Hernias: Operative Management and Proposal for
           a New Anatomic-Based Grading System
    • Authors: John Kuckelman; Riyad Karmy-Jones; Elizabeth Windell; Seth Izenberg; Jean-Stephane David; William Long; Matthew J. Martin
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): John Kuckelman, Riyad Karmy-Jones, Elizabeth Windell, Seth Izenberg, Jean-Stephane David, William Long, Matthew J. Martin
      Background Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management. Methods Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location. Results Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60.25cm. Types of operation were well clustered by assigned TRCH grade. The majority required mesh (75%) and/or rib plating (79%). Complex tissue flap reconstruction was required in 10%. Full range-of-motion was maintained in 88% with79% returning to pre-injury activity levels. Five patients had continued pain at final follow up (mean=7months). Conclusion The size and degree of injury has important implications in the optimal surgical management of TRCHs. These operative grades effectively direct surgical care for these rare and complex injuries.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.013
       
  • Protocolized warfarin reversal with 4-factor prothrombin complex
           concentrate versus 3-factor prothrombin complex concentrate with
           recombinant factor VIIa
    • Authors: Cassie A. Barton; Marissa Hom; Nathan B. Johnson; Jon Case; Ran Ran; Martin Schreiber
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Cassie A. Barton, Marissa Hom, Nathan B. Johnson, Jon Case, Ran Ran, Martin Schreiber
      Introduction Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal. Methods A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded. Results 195 patients were included in final analysis. While baseline demographics were similar between groups, the 3F-PCC group had a longer ICU LOS and higher in-hospital mortality (p <0.01, 0.01). Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the 3F-PCC group, 0.8 versus 1.3 (p<0.01). Significantly more patients experienced thromboembolic complications in the 3F-PCC group than the 4F-PCC group (p<0.01). Receipt of rFVIIa was significantly associated with thromboembolic complications. Discussion A 4F PCC reversal strategy is efficacious in INR reversal and provdes lower thromboembolic risk as compared to 3F PCC with rFVIIa.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.011
       
  • “Mammographic Screening in Women Under 50: Low risk is Not
           Protective” - Sutton et al
    • Authors: Elaine McKevitt
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Elaine McKevitt


      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.11.042
       
  • Patient navigation reduces time to care for patients with breast symptoms
           and abnormal screening mammograms
    • Authors: Elaine McKevitt; Carol Dingee; Rebecca Warburton; Jin-Si Pao; Carl J. Brown; Christine Wilson; Urve Kuusk
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Elaine McKevitt, Carol Dingee, Rebecca Warburton, Jin-Si Pao, Carl J. Brown, Christine Wilson, Urve Kuusk
      Introduction Concern has been raised about delays for patients presenting with breast symptoms in Canada. Our objective was to determine if our Rapid Access Breast Clinic (RABC) improved care for patients presenting with breast symptoms compared to the traditional system (TS). Methods A retrospective chart review tabulated demographic, surgical, pathology and radiologic information. Wait times to care were determined for patients presenting with symptomatic and screen detected breast problems. Results Time from presentation to surgeon evaluation was shorter in the RABC group for patients with breast symptoms (81 vs 35 days, p<0.0001) and abnormal screens (72 vs 40 days, p=0.092). Cancer patients with abnormal screens had shorter wait times than patients with breast symptoms in the TS (47 vs 70 days, p=0.036). Conclusion Coordination of imaging and clinical care reduces wait times in patients with both abnormal screening mammograms and symptomatic breast presentations and should be expanded in our province.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.016
       
  • The Presence of Papillary Features In Thyroid Nodules Diagnosed As Atypia
           of Undetermined Significance or Follicular Lesion of Undetermined
           Significance Increases Cancer Risk and Should Influence Treatment
    • Authors: Jean L. Oosthuizen; Blair Walker; Hamid Masoudi; Sam M. Wiseman
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Jean L. Oosthuizen, Blair Walker, Hamid Masoudi, Sam M. Wiseman
      Background The objective of this study was to evaluate the influence of papillary features on risk of malignancy (ROM) within the Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS-FLUS) Bethesda System for Reporting Thyroid Cytopathology (BSRTC) diagnostic category. Methods A Retrospective review of cases with an AUS-FLUS diagnosis that underwent a thyroidectomy was carried out, and cases were subcategorized based upon the presence of papillary features. Results For the entire study population there were 93 (22%) of 427 FNAB specimens that had an AUS-FLUS diagnosis, and a 32% associated ROM. Papillary features were identified in 44 FNAB specimens (47% of the AUS-FLUS cases or 10% of the entire study population), and when present had a 45% ROM. The 49 FNAB specimens (53%) that did not exhibit papillary features had a significantly lower ROM (20%) than those that did have papillary features (p=0.0069). Conclusions The presence of papillary features in a thyroid FNAB with an AUS-FLUS diagnosis is common, and is associated with a higher ROM than is currently suggested by the BSRTC.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.018
       
  • Dual energy computed tomography should be the first line preoperative
           localization imaging test for primary hyperparathyroidism patients
    • Authors: Jake Hiebert; Cameron Hague; Shangmei Hou; Sam M. Wiseman
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Jake Hiebert, Cameron Hague, Shangmei Hou, Sam M. Wiseman
      Background The objective of this study was to evaluate the performance of dual-energy computed tomography (DECT) for preoperative parathyroid tumor (PT) localization in primary hyperparathyroid (PHP) patients. Methods A retrospective review was carried out of the medical records of all PHP patients who underwent ultrasound (US), Tc-99m sestamibi noncontrast single photon emission computed tomography (CT-MIBI), DECT and parathyroidectomy at a single center. Results The sensitivities and accuracies for preoperative PT localization in the 97 patient study population were: US 40% and 93%, CT-MIBI 64.0% and 97%, and DECT 84% and 96%, respectively. In the one third of the study population that did not localize preoperatively with CT-MIBI and US, DECT correctly localized a PT in 21 cases (66%). DE-CT and US correctly localized a PT in 86% of cases, and only 5 (8%) of the cases that were accurately localized by a combination of CT-MIBI and US were not identified by DE-CT. Conclusions DECT should be utilized as a first line preoperative PT localization study in PHP patients, and is also a sensitive salvage localization test.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.11.048
       
  • Evaluation of a novel thoracic entry device versus needle decompression in
           a tension pneumothorax swine model
    • Authors: John Kuckelman; Mike Derickson; Cody Phillips; Morgan Barron; Shannon Marko; Matthew Eckert; Matthew Martin
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): John Kuckelman, Mike Derickson, Cody Phillips, Morgan Barron, Shannon Marko, Matthew Eckert, Matthew Martin
      Introduction Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate. Methods Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n = 25), bladed trocar with 36Fr cannula (BTW, n = 16), bladed trocar alone (BTWO, n = 16) and surgical thoracostomy (ST = 11). Simulated tPTX was created to a pressure(p) of 20 mmHg. Results Success (p < 5 mmHg by 120 s) was seen in 41 of 68 (60%) interventions. BTW and BTWO were consistently more successful than ND with success rates of 88% versus 48% in ND (p < .001). In successful deployments, ND was slower to reach p < 5 mmHg, average of 82s versus 26s and 28s for BTW and BTWO respectively (p < .001). Time to implement procedure was faster for ND with an average of 3.6s versus 16.9s and 15.3s in the BTW and BTWO (p < .001). Final pressure was significantly less in BTW and BTWO at 1.7 mmHg versus 7 mmHg in ND animals (p < .001). Conclusion Bladed trocars can safely and effectively tPTX with a significantly higher success rates than needle decompression.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.014
       
  • Commentary to accompany “Neurocognitive assessment in minor traumatic
           brain injury: Can cognitive evaluation assist in selecting for patients
           who require surveillance CT brain imaging'”
    • Authors: Matthew J. Martin
      Abstract: Publication date: Available online 5 January 2018
      Source:The American Journal of Surgery
      Author(s): Matthew J. Martin


      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.11.047
       
  • Nonatherosclerotic vascular causes of acute abdominal pain
    • Authors: Gregory J. Landry; Alla Yarmosh; Timothy K. Liem; Enjae Jung; Amir F. Azarbal; Cherrie Z. Abraham; Erica L. Mitchell; Gregory L. Moneta
      Abstract: Publication date: Available online 4 January 2018
      Source:The American Journal of Surgery
      Author(s): Gregory J. Landry, Alla Yarmosh, Timothy K. Liem, Enjae Jung, Amir F. Azarbal, Cherrie Z. Abraham, Erica L. Mitchell, Gregory L. Moneta
      Background To examine the epidemiology, treatments, and outcomes of acute symptomatic non-atherosclerotic mesenteric vascular disease. Methods Subjects were reviewed over a six year period. Categories included embolism(EM), dissection(DI), and aneurysm(AN). Presentation, demographics, treatment and outcomes were compared. Results 46 patients were identified (EM:20,AN:15,DI:11). Age at presentation differed (EM: 66.3,AN 62.4,DI 54.6,p<0.05). EM more likely affected the superior mesenteric artery (EM80%,AN20%,DI45%,p=0.002), DI hepatic artery (EM20%,AN13%,DI55%,p<0.05), and AN mesenteric branches (EM5%,AN47%,DI0%;p=0.001). EM more likely had history of arrhythmia (EM40%,AN7%,DI0%,p,0.05) and diarrhea (EM30%,AN7%,DI0%,p<0.05). Treatment was most often surgical in EM (EM85%,AN33%,DI9%,p<0.001), endovascular in AN (EM5%,AN40%,DI 9%,p<0.02), and conservative in DI (EM15%,AN 33%,DI82%,p<0.05). In hospital mortality was infrequent (EM10%,AN7%,DI0%,p=ns). Mean hospital length of stay differed by mechanism (EM13.6days,AN9.2,DI2.3,p=0.005). Median follow up was 61 months. Survival at 1, 3 and 5 years for emboli was 75%, 70% and 59%, for aneurysms 93%, 86%, and 77%, and for dissections 100% at all time points (p=0.043 log rank). Conclusions Patients with EM, AN, and DI differ in age, anatomic distribution and method of treatment. The etiology significantly affects long term survival.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.019
       
  • Retro-peritoneal cooling for kidney preservation from multi-organ cadaver
           donors
    • Authors: Anastasio Salazar-Bañuelos; Mauricio Monroy-Cuadros; Hoover Henriquez-Cooper
      Abstract: Publication date: Available online 4 January 2018
      Source:The American Journal of Surgery
      Author(s): Anastasio Salazar-Bañuelos, Mauricio Monroy-Cuadros, Hoover Henriquez-Cooper
      Background Minimizing ischemia is paramount in the procurement of kidneys for transplantation. A fast cooling and expeditious removal is ideal to minimize damage from warm ischemia, however, since the removal of kidneys is delayed in cadaver donation until all other organs are harvested, the risk of kidney damage increases due to contact with the warmer soft body tissues. Surgical techniques that expedite organ retrieval were developed to avoid organ damage. Methods We test a modification of Thomas Starzl's improved technique for multi-organ harvesting by interposing an ice bag between the posterior aspect of the kidney and the psoas muscle in a randomized trial with 21 multi-organ cadaver donors. Results The modified technique decreases the extraction temperature of the kidneys significantly in comparison with the controls, p < .001. Conclusions This simple technique improves the preservation of kidneys from cadaver donors, and can potentially have more impact on multi-organ donation after cardiac death.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.015
       
  • Sarcopenia is not associated with morbidity, mortality, or recurrence
           after esophagectomy for cancer
    • Authors: Steve R. Siegal; James P. Dolan; Elizabeth N. Dewey; Alexander R. Guimaraes; Brandon H. Tieu; Paul H. Schipper; John G. Hunter
      Abstract: Publication date: Available online 4 January 2018
      Source:The American Journal of Surgery
      Author(s): Steve R. Siegal, James P. Dolan, Elizabeth N. Dewey, Alexander R. Guimaraes, Brandon H. Tieu, Paul H. Schipper, John G. Hunter
      Background Sarcopenia is associated with increased morbidity and mortality in hepatic, pancreatic and colorectal cancer. We examined the effect of sarcopenia on morbidity, mortality, and recurrence after resection for esophageal cancer. Methods Retrospective review of consecutive esophagectomies from 2010 to 2015. Computed tomography studies were analyzed for sarcopenia. Morbidity was analyzed using Fischer's test and survival data with Kaplan Meier curves. Results The sarcopenic group (n = 127) had lower BMI, later stage disease, and higher incidence of neoadjuvant radiation than those without sarcopenia (n = 46). There were no differences in morbidity or mortality between the groups (p = .75 and p = .31, respectively). Mean length of stay was similar (p = .70). Disease free and overall survival were similar (p = .20 and p = .39, respectively). Conclusion There is no association between sarcopenia and increased morbidity, mortality and disease-free survival in patients undergoing esophagectomy for cancer. Sarcopenia in esophageal cancer may not portend worse outcomes that have been reported in other solid tumors.

      PubDate: 2018-01-09T18:04:25Z
      DOI: 10.1016/j.amjsurg.2017.12.017
       
  • Medical Student Perceptions of a Mistreatment Program During the Surgery
           Clerkship
    • Authors: Brittany N. Hasty; Sarah E. Miller; Sylvia Bereknyei Merrell; Dana T. Lin; Edward S. Shipper; James N. Lau
      Abstract: Publication date: Available online 4 January 2018
      Source:The American Journal of Surgery
      Author(s): Brittany N. Hasty, Sarah E. Miller, Sylvia Bereknyei Merrell, Dana T. Lin, Edward S. Shipper, James N. Lau
      Background Medical student mistreatment remains a concern, particularly in the surgery clerkship. This is a single academic institution’s report of medical student perceptions of a mistreatment program embedded in the surgery clerkship. Methods Students who completed the surgery clerkship and the mistreatment program volunteered to be interviewed individually or in focus groups. The interviews were transcribed and qualitatively analyzed. Results Twenty-four medical students were interviewed and nine transcripts were obtained. Codes were identified independently then nested into four codes: Student Growth, Faculty Champion and Team, Student Perspectives on Surgical Culture, and Program Methods. Rank orders were then calculated for each major code. Conclusion Our mistreatment program has shown that providing students with an opportunity to define mistreatment, a safe environment for them to debrief, and staff to support and advocate for them, empowers them with the knowledge and skillset to confront what is too often considered part of the hidden curriculum.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2018.01.001
       
  • Cancer care in the developed world: A comparison of surgical oncology
           training programs
    • Authors: Motaz Qadan; Andrew R. Davies; Hiram C. Polk; William H. Allum; Murray F. Brennan
      Pages: 1 - 7
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Motaz Qadan, Andrew R. Davies, Hiram C. Polk, William H. Allum, Murray F. Brennan


      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.05.004
       
  • The impact of positive and negative intraoperative surgeons' leadership
           behaviors on surgical team performance
    • Authors: Julian Barling; Amy Akers; Darren Beiko
      Pages: 14 - 18
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Julian Barling, Amy Akers, Darren Beiko
      Background The effects of surgeons' leadership on team performance are not well understood. The purpose of this study was to examine the simultaneous effects of transformational, passive, abusive supervision and over-controlling leadership behaviors by surgeons on surgical team performance. Methods Trained observers attended 150 randomly selected operations at a tertiary care teaching hospital. Observers recorded instances of the four leadership behaviors enacted by the surgeon. Postoperatively, team members completed validated questionnaires rating team cohesion and collective efficacy. Multiple regression analyses were computed. Data were analyzed using the complex modeling function in MPlus. Results Surgeons' abusive supervision was negatively associated with psychological safety (unstandardized B = −0.352, p < 0.01). Both surgeons' abusive supervision (unstandardized B = −0.237, p < 0.01), and over-controlling leadership (unstandardized B = −0.230, p < 0.05) were negatively associated with collective efficacy. Conclusions This study is the first to assess the simultaneous effects of surgeons' positive and negative leadership behaviors on intraoperative team performance. Significant effects only surfaced for negative leadership behaviors; transformational leadership did not positively influence team performance.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.07.006
       
  • Picking apart surgical pick lists – Reducing variation to decrease
           surgical costs
    • Authors: Kathleen L. Simon; Matthew J. Frelich; Jon C. Gould
      Pages: 19 - 22
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Kathleen L. Simon, Matthew J. Frelich, Jon C. Gould
      Background Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity. Methods De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list. Results 280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%. Conclusions Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.06.024
       
  • Near-perfect compliance with SCIP Inf-9 had no effect on catheter
           utilization or urinary tract infections at an academic medical center
    • Authors: Jennifer A. Kaplan; Jonathan T. Carter
      Pages: 23 - 27
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Jennifer A. Kaplan, Jonathan T. Carter
      Background The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown. Methods Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9. Results A total of 1036 patients were included (468 pre-intervention; 568 post-intervention). POUR occurred in 13% of patients and CAUTI in 0.8%. There was no change in POUR, CAUTI, or catheter utilization after the Best Practice Advisory was initiated. Both POUR and CAUTI predicted longer lengths of stay. Conclusions Near-perfect SCIP Inf-9 compliance had no effect on the CAUTI rate at our institution.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.03.039
       
  • Implementation of a standardized handoff protocol for post-operative
           admissions to the surgical intensive care unit
    • Authors: Dhriti Mukhopadhyay; Katie C. Wiggins-Dohlvik; Mary M. MrDutt; Jeffrey S. Hamaker; Graham L. Machen; Matthew L. Davis; Justin L. Regner; Randall W. Smith; David P. Ciceri; Jay G. Shake
      Pages: 28 - 36
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Dhriti Mukhopadhyay, Katie C. Wiggins-Dohlvik, Mary M. MrDutt, Jeffrey S. Hamaker, Graham L. Machen, Matthew L. Davis, Justin L. Regner, Randall W. Smith, David P. Ciceri, Jay G. Shake
      Background The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. Methods A prospective intervention study was designed to observe thirty one patient handoffs from OR to SICU for 49 critical parameters including caregiver presence, peri-operative details, and time required to complete key steps. Following a six month implementation period, thirty one handoffs were observed to determine improvement. Results A significant improvement in presence of physician providers including intensivists and surgeons was observed (p = 0.0004 and p < 0.0001, respectively). Critical details were communicated more consistently, including procedure performed (p = 0.0048), complications (p < 0.0001), difficult airways (p < 0.0001), ventilator settings (p < 0.0001) and pressor requirements (p = 0.0134). Conversely, handoff duration did not increase significantly (p = 0.22). Conclusions Implementation of a standardized protocol for handoffs between OR and SICU significantly improved caregiver involvement and reduced information omission without affecting provider time commitment.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.08.005
       
  • Dementia as a predictor of mortality in adult trauma patients
    • Authors: Benjamin C. Jordan; Joseph Brungardt; Jared Reyes; Stephen D. Helmer; James M. Haan
      Pages: 48 - 52
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Benjamin C. Jordan, Joseph Brungardt, Jared Reyes, Stephen D. Helmer, James M. Haan
      Background The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls. Methods A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay. Results A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05). Conclusions Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.07.012
       
  • The appropriateness of 30-day mortality as a quality metric in colorectal
           cancer surgery
    • Authors: Mohamed Abdelgadir Adam; Megan C. Turner; Zhifei Sun; Jina Kim; Brian Ezekian; John Migaly; Christopher R. Mantyh
      Pages: 66 - 70
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Mohamed Abdelgadir Adam, Megan C. Turner, Zhifei Sun, Jina Kim, Brian Ezekian, John Migaly, Christopher R. Mantyh
      Background Our study compares 30-day vs. 90-day mortality following colorectal cancer surgery (CRS), and examines hospital performance ranking based on this assessment. Methods Mortality rates were compared between 30 vs. 90 days following CRS for patients with stage I-III colorectal cancers from the National Cancer Database (2004–2012). Risk-adjusted hierarchical regression models evaluated hospital performance based on mortality. Hospitals were ranked into top (10%), middle (80%), and lowest (10%) performance groups. Results Among 185,464 patients, 90-day mortality was nearly double the 30-day mortality (4.4% vs. 2.5%). Following risk adjustment 176 hospitals changed performance ranking: 39% in the top 30-day mortality group changed ranking to the middle group; 37% of hospitals in the lowest 30-day group changed ranking to the middle 90-day group. Conclusions Evaluation of hospital performance based on 30-day mortality is associated with misclassification for 15% of hospitals. Ninety-day mortality may be a better quality metric in oncologic CRS.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.04.018
       
  • Tumor size as a prognostic factor in patients with stage IIa colon cancer
    • Authors: Francesco Santullo; Alberto Biondi; Ferdinando C.M. Cananzi; Valeria Fico; Flavio Tirelli; Riccardo Ricci; Gianluca Rizzo; Claudio Coco; Claudio Mattana; Domenico D'Ugo; Roberto Persiani
      Pages: 71 - 77
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Francesco Santullo, Alberto Biondi, Ferdinando C.M. Cananzi, Valeria Fico, Flavio Tirelli, Riccardo Ricci, Gianluca Rizzo, Claudio Coco, Claudio Mattana, Domenico D'Ugo, Roberto Persiani
      Background The aim of this study was to identify stage II colon cancer patients with a high risk of recurrence. Methods All patients who underwent surgery for stage II colon cancer (CC) were retrospectively enrolled and sub-grouped according to TNM staging (IIa-b-c) and stage IIa in high (IIaHR) and low risk (IIaLR) according to pathologic features. The primary outcomes measured were the 5-year overall survival (OS) and disease-free survival (DFS). Results A total of 214 patients were reviewed. Only a maximum tumor diameter<4 cm in the IIaLR group was associated with a higher recurrence rate than a large tumor size (5-year DFS 71.7%vs.87.6%, p = 0.028). The DFS in the large IIaLR CC group was better than that in the IIaHR and IIb-c groups (5-year DFS: 92.7%vs.79.3%, p = 0.023). In contrast, the recurrence rate in the small IIaLR CC group was similar to that in the IIaHR, IIb-c stage CC group. Conclusions In stage IIa CC evaluation of the tumor size as a prognostic factor may help identify patients who could benefit from additional postoperative therapy.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.03.038
       
  • Preoperative anemia and outcomes in patients undergoing surgery for
           inflammatory bowel disease
    • Authors: M. Michailidou; V.N. Nfonsam
      Pages: 78 - 81
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): M. Michailidou, V.N. Nfonsam
      Background Anemia is the most common extraintestinal manifestation in patients with inflammatory bowel disease (IBD), and has been linked to severity of the disease. The aim of the study was to assess the impact of anemia on postoperative outcomes in patients with IBD. Methods We retrospectively reviewed patients with IBD from the NSQIP database over an 8-year period. Patients were grouped based on the presence of anemia. The impact of anemia on postoperative morbidity, mortality and length of stay was assessed. Results A total of 15,761 patients met our criteria. Half of the patients were anemic upon presentation. Anemic patients were more likely to have a history of steroid use, present with sepsis and require an emergency operation. In multivariate analysis, anemia was a significant predictor of overall morbidity, serious morbidity and increased length of stay. Conclusions Anemic patients with IBD present more often with sepsis and require emergency surgery compared to their peers. In addition, anemia serves as an independent predictor of overall complications, serious morbidity and increased length of stay following abdominal operations.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.02.016
       
  • Stapled Transabdominal Ostomy Reinforcement with retromuscular mesh
           (STORRM): Technical details and early outcomes of a novel approach for
           retromuscular repair of parastomal hernias
    • Authors: Arnab Majumder; Sean B. Orenstein; Heidi J. Miller; Yuri W. Novitsky
      Pages: 82 - 87
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Arnab Majumder, Sean B. Orenstein, Heidi J. Miller, Yuri W. Novitsky
      Background Parastomal hernia repair (PHR) remains a challenge with no optimal repair technique. During retromuscular hernia repair, traversing the stomal conduit through the abdominal wall can result in angulation and compression. Widening of traditional cruciate incisions in mesh and/or fascia likely contributes to recurrences. To address these pitfalls, the Stapled Transabdominal Ostomy Reinforcement with Retromuscular Mesh (STORRM) technique utilizing a circular stapler was developed. Methods A prospective registry of consecutive patients undergoing STORRM was analyzed. We characterized demographics, hernia characteristics, and perioperative results. Primary outcomes were complications, surgical site events (SSEs) and hernia recurrence. Results 12 patients underwent PHR with STORRM; mean age 64 and BMI 36 kg/m2. Synthetic mesh was used in 92% of patients. We observed two (17%) SSEs, one case of cellulitis and one organ space infection. With mean 12.8-month follow-up, we documented two recurrences. Conclusions STORRM represents a safe method to repair parastomal hernias. The unified aperture with stapled reinforcement results in reproducible repairs, minimizing intestinal angulation associated with traditional stoma passage. Early outcomes evidenced minimal complications and favorable recurrence rate.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.07.030
       
  • A three-step method for modular lymphadenectomy in gastric cancer surgery:
           The ability to retrieve sufficient lymph nodes and improve survival
    • Authors: Maolan Li; Xu-an Wang; Lei Wang; Xiangsong Wu; Wenguang Wu; Xiaoling Song; Shuai Zhao; Fei Zhang; Qiang Ma; Haibin Liang; Shanshan Xiang; Zheng Wang; Wei Gong; Ping Dong; Yingbin Liu
      Pages: 91 - 96
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Maolan Li, Xu-an Wang, Lei Wang, Xiangsong Wu, Wenguang Wu, Xiaoling Song, Shuai Zhao, Fei Zhang, Qiang Ma, Haibin Liang, Shanshan Xiang, Zheng Wang, Wei Gong, Ping Dong, Yingbin Liu
      Background Systematic lymphadenectomy for the resection of sufficient lymph nodes is the most important part of curative resection in gastric cancer surgery. Here, we explore the outcomes of the three-step method for modular lymphadenectomy (TSMML) and determine its safety and efficacy, compared with the conventional method for lymphadenectomy (CML). Methods From 2008 to 2011, 270 patients with gastric cancer were divided into 2 subgroups: the TSMML group and the CML group. Results Patients in the TSMML group had a significantly higher median number of retrieved lymph nodes (rLNs), lower median metastatic lymph node ratios (MLRs), and superior 5-year relapse-free survival (RFS) than the CML group. Moreover, the use of the TSMML procedure was an independent protective factor for RFS. No significant intergroup differences were found in morbidity or mortality in these two groups. Conclusion The TSMML procedure is safe and effective and is easy to learn.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.01.042
       
  • Long-term outcomes of laparoscopic adjustable gastric banding
    • Authors: Jad Khoraki; Marilia G. Moraes; Adriana P.F. Neto; Luke M. Funk; Jacob A. Greenberg; Guilherme M. Campos
      Pages: 97 - 103
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Jad Khoraki, Marilia G. Moraes, Adriana P.F. Neto, Luke M. Funk, Jacob A. Greenberg, Guilherme M. Campos
      Background Laparoscopic adjustable gastric banding (LAGB) is an option for the treatment of severe obesity. Few US studies have reported long-term outcomes. We aimed to present long-term outcomes with LAGB. Methods Retrospective study of patients who underwent LAGB at an academic medical center in the US from 1/2005 to 2/2012. Outcomes included weight loss, complications, re-operations, and LAGB failure. Results 208 patients underwent LAGB. Mean BMI was 45.4 ± 6.4 kg/m2. Mean follow-up was 5.6 (0.5–10.7) years. Complete follow-up was available for 90% at one year (186/207), 80% at five years (136/171), and 71% at ten years (10/14). Percentage of excess weight loss at one, five, and ten years was 29.9, 30, and 16.9, respectively. Forty-eight patients (23.1%) required a reoperation. LAGB failure occurred in 118 (57%) and higher baseline BMI was the only independently associated factor (OR 1.1; 95%CI 1.0–1.1; p = 0.016). Conclusion LAGB was associated with poor short and long-term weight loss outcomes and a high failure rate. With the increased safety profile and greater efficacy of other surgical techniques, LAGB utilization should be discouraged.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.06.027
       
  • Quality of life, functional status and adhesiolysis during elective
           abdominal surgery
    • Authors: Chema Strik; Martijn W.J. Stommel; Jeroen C. Hol; Harry van Goor; Richard P.G. ten Broek
      Pages: 104 - 112
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Chema Strik, Martijn W.J. Stommel, Jeroen C. Hol, Harry van Goor, Richard P.G. ten Broek
      Background Adhesiolysis during abdominal surgery can cause iatrogenic organ injury, increased operative time and a more complicated convalescence. We assessed the impact of adhesiolysis and adhesiolysis-related complications on quality of life and functional status following elective abdominal surgery. Methods Prospective cohort study, comparing patients requiring and not requiring adhesiolysis during an elective laparotomy or laparoscopy using the SF-36 and DASI questionnaire scores. Results 518 patients were included. Pre- and postoperative quality of life did not significantly differ between both groups. Patients with adhesiolysis had a significantly lower pre- and postoperative functional status (p < 0.01). Higher age, concomitant pulmonary disease, postoperative complications, readmissions and chronic abdominal pain 6 months after surgery were all associated with a significant and independent decline in quality of life and functional status six months after surgery. Conclusion Adhesiolysis in itself does not affect functional status and quality of life six months after surgery. Postoperative complications, readmissions and chronic abdominal pain are associated with a lower health status.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.08.001
       
  • Evaluation of negative pressure wound therapy to closed laparotomy
           incisions in acute care surgery
    • Authors: Elleson Schurtz; Jerome Differding; Eric Jacobson; Christopher Maki; Mentor Ahmeti
      Pages: 113 - 115
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Elleson Schurtz, Jerome Differding, Eric Jacobson, Christopher Maki, Mentor Ahmeti
      Background Surgical site complications in the form of wound infections are a major burden to the healthcare system. Negative pressure wound therapy (NPWT) as delivered by a surgical incision management system (SIMS) is a novel approach to improve wound healing when applied to closed incisions. However, data is limited in its application to laparotomy incisions in the acute care surgery setting. Methods A retrospective case-control study was performed to evaluate the outcomes of SIMS with regard to surgical site infections in a series of 48 consecutive patients in which SIMS was applied to closed laparotomy incisions in the acute care surgery setting. Results 48 cases were matched with equivalent controls without significant differences between groups. Patients who received the SIMS had significantly lower rates of surgical site infection and readmission rates. Conclusions Negative pressure surgical incision management systems may be a novel approach to reduce surgical site infections in acute care surgery.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.08.009
       
  • Community health indicators associated with outcomes of pancreatectomy
    • Authors: Lauren Slakey Pointer; Zaid Al-Qurayshi; David Taylor Pointer; Emad Kandil; Douglas Philip Slakey
      Pages: 120 - 124
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Lauren Slakey Pointer, Zaid Al-Qurayshi, David Taylor Pointer, Emad Kandil, Douglas Philip Slakey
      Purpose This study evaluates the association of environmental, social and health risk factors in relation to outcomes of pancreatic surgery. Methods Patients who underwent pancreatectomy with a 30 day postoperative follow up in Florida, New York and Washington states were identified using the State Inpatient Databases (SID) from 2010 to 2011. This data was merged with community health indicators complied from the County Health Ranking database. Fourteen community health indicators were used to determine higher risk communities. Communities were then divided into low and high risk communities based on a scoring system using accumulative community risk. Results Among 3494 patients included recipients in high-risk communities were more likely African American (p < 0.001), younger (age 40–59; p = 0.001), and had Medicaid as primary insurance (p = 0.001). Management of patients in high-risk communities was associated with increased risk of postoperative complications (p < 0.001), ICU admissions (p < 0.001), increased length of stay (p < 0.001). Conclusion Health indicators from patients' communities are predictors of increased risk of perioperative complications for individuals undergoing pancreas surgery.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.02.010
       
  • Liver resection for metastases not of colorectal, neuroendocrine,
           sarcomatous, or ovarian (NCNSO) origin: A multicentric study
    • Authors: Ismail Labgaa; Ksenija Slankamenac; Erik Schadde; Ghalib Jibara; Kutaiba Alshebeeb; Gilles Mentha; Pierre-Alain Clavien; Myron Schwartz
      Pages: 125 - 130
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Ismail Labgaa, Ksenija Slankamenac, Erik Schadde, Ghalib Jibara, Kutaiba Alshebeeb, Gilles Mentha, Pierre-Alain Clavien, Myron Schwartz
      Background Liver resection is a well-established treatment for colorectal, neuroendocrine and sarcomatous metastases but remains ill-defined for metastases from other primary sites. This study aimed to analyze the outcomes of hepatic resection for metastases not of colorectal, neuroendocrine, sarcomatous, or ovarian (NCNSO) origin and to identify predictors of outcome. Methods Retrospective analysis of patients undergoing resection for NCNSO metastases in three western centers. Patients were analyzed according to the primary cancer. Outcomes were recurrence and survival. Results We analyzed 188 patients, divided in: gastrointestinal (59), breast (59) and “others” (70). Median time to recurrence was 15.3 months, while median survival was 52 months. Survival at 1, 3, and 5 years was 78%, 60.4% and 47.8%, respectively. In term of prognostic factors, metastases >35 mm from gastrointestinal tumors were associated with lower survival (p = 0.029) and age>60 years was associated with better survival in breast metastases (p = 0.018). Conclusions Liver resection for NCNSO metastases is feasible and results in long-term survival are similar to colorectal metastases. In gastrointestinal metastases, size (<35 mm) could be used to select patients.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.09.030
       
  • Greater hypertrophy can be achieved with associating liver partition with
           portal vein ligation for staged hepatectomy compared to conventional
           staged hepatectomy, but with a higher price to pay'
    • Authors: Daryl K.A. Chia; Zachery Yeo; Stanley E.K. Loh; Shridhar Ganpathi Iyer; Glenn Kunnath Bonney; Krishnakumar Madhavan; Alfred W.C. Kow
      Pages: 131 - 137
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Daryl K.A. Chia, Zachery Yeo, Stanley E.K. Loh, Shridhar Ganpathi Iyer, Glenn Kunnath Bonney, Krishnakumar Madhavan, Alfred W.C. Kow
      Background Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and conventional staged hepatectomy (CSH) are options for patients with unresectable liver tumors due to insufficient future liver remnant (FLR). Methods A retrospective comparison of clinical data, liver volumetry and surgical outcomes between 10 ALPPS and 29 CSH patients was performed. Results Patient demographics and disease characteristics were similar between both groups. ALPPS induced superior FLR growth (ALPPS vs. CSH, 48.1% (IQR 39.4–96.9%) vs. 11.8% (IQR 4.3–41.9%), p = 0.013). However, post-operative day 5 international normalized ratio (INR) (ALPPS vs. CSH, 1.6 (IQR 1.5–1.8) vs. 1.4 (IQR 1.3–1.6), p = 0.015) and rate of post-hepatectomy liver failure (ALPPS vs. CSH, 25 vs. 0%, p = 0.032) was higher in the ALPPS group. 90-day mortality (ALPPS vs. CSH, 12.5% vs. 0%, p = 0.320) was similar in both groups. Conclusion ALPPS was superior in inducing FLR growth but associated with increased post-hepatectomy liver failure compared to CSH.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.08.013
       
  • Analgesia with continuous wound infusion of local anesthetic versus
           saline: Double-blind randomized, controlled trial in hepatectomy
    • Authors: Antònia Dalmau; Noelia Fustran; Imma Camprubi; Resurrección Sanzol; Susana Redondo; Emilio Ramos; Jaume Torras; Antoni Sabaté
      Pages: 138 - 143
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Antònia Dalmau, Noelia Fustran, Imma Camprubi, Resurrección Sanzol, Susana Redondo, Emilio Ramos, Jaume Torras, Antoni Sabaté
      Background Surgical wound is source of pain in hepatectomy with laparotomy. Continuous wound infusion of ropivacaine may provide effective analgesia. Methods This prospective, randomized trial, patients scheduled for hepatectomy received a 48-h preperitoneal continuous wound infusion of either 0.23% ropivacaine or 0.9% saline at 5 ml/h. Primary endpoint was 48 h morphine consumption. Results 53 patients included in the ropivacaine group and 46 in the saline group. Morphine consumption was 24.63 mg in the ropivacaine group, and 26.78 mg (p = 0.669) in the saline group. Pain was comparable between groups and there were no differences in solid food intake, ambulation, or length of hospital stay. No local or systemic complications were recorded. Conclusions Continuous wound infusion with ropivacaine is safe, but it neither reduced morphine consumption nor enhanced recovery in patients undergoing hepatectomy. Success of enhanced recovery in hepatectomy is not influenced by the analgesic regimen if pain is well controlled.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.09.007
       
  • Impact of screening for metabolic syndrome on the evaluation of obese
           living kidney donors
    • Authors: Daniel P. Marcusa; Douglas E. Schaubel; Kenneth J. Woodside; Randall S. Sung
      Pages: 144 - 150
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Daniel P. Marcusa, Douglas E. Schaubel, Kenneth J. Woodside, Randall S. Sung
      Background We report our experience with metabolic syndrome screening for obese living kidney donor candidates to mitigate the long-term risk of CKD. Methods We retrospectively reviewed 814 obese (BMI≥30) and 993 nonobese living kidney donor evaluations over 12 years. Using logistic regression, we explored interactions between social/clinical variables and candidate acceptance before and after policy implementation. Results Obese donor candidate acceptance decreased after metabolic syndrome screening began (56.3%, 46.3%, p < 0.01), while nonobese candidate acceptance remained similar (59.6%, 59.2%, p = 0.59). Adjusting for age, gender, race, BMI, and number of prior evaluations, acceptance of obese candidates decreased significantly more than nonobese (p = 0.025). In candidates without metabolic syndrome, there was no significant change in how age, sex, race, or BMI affected a donor candidate's probability of acceptance. Conclusion Metabolic syndrome screening is a simple stratification tool for centers with liberal absolute BMI cut-offs to exclude potentially higher-risk obese candidates.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.08.019
       
  • The cost of intraoperative adverse events in abdominal and pelvic surgery:
           A systematic review
    • Authors: A. Garbens; M. Goldenberg; C.J.D. Wallis; A. Tricco; T.P. Grantcharov
      Pages: 163 - 170
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): A. Garbens, M. Goldenberg, C.J.D. Wallis, A. Tricco, T.P. Grantcharov
      Background The assessment of intra-operative adverse events (iAEs) is a vastly under researched area with the potential to provide new methods on how to improve patient outcomes and hospital costs. Our objective was to determine the relationship between iAEs and total hospital costs in abdominal and pelvic surgery. Data sources We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Embase, MEDLINE and EBM Reviews online databases were searched to identify all studies that reported iAE rates and total hospital costs. We then analyzed the costing approach used in each article using the Drummond tool and evaluated articles quality using the GRADE method. Conclusions In total, 1709 unique references were identified through our literature search. After review, 23 were included. All studies that reported iAE rates and cost as the primary outcome found that iAEs significantly increased total hospital costs. We identified a relationship between iAEs and increased hospital costs. Future studies need to be performed to further evaluate the relationship between iAEs and cost as current studies are of low quality.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.06.025
       
  • Do online prognostication tools represent a valid alternative to genomic
           profiling in the context of adjuvant treatment of early breast cancer'
           A systematic review of the literature
    • Authors: Hiba El Hage Chehade; Umar Wazir; Kinan Mokbel; Abdul Kasem; Kefah Mokbel
      Pages: 171 - 178
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Hiba El Hage Chehade, Umar Wazir, Kinan Mokbel, Abdul Kasem, Kefah Mokbel
      Introduction Decision-making regarding adjuvant chemotherapy has been based on clinical and pathological features. However, such decisions are seldom consistent. Web-based predictive models have been developed using data from cancer registries to help determine the need for adjuvant therapy. More recently, with the recognition of the heterogenous nature of breast cancer, genomic assays have been developed to aid in the therapeutic decision-making. Methods We have carried out a comprehensive literature review regarding online prognostication tools and genomic assays to assess whether online tools could be used as valid alternatives to genomic profiling in decision-making regarding adjuvant therapy in early breast cancer. Results and conclusions Breast cancer has been recently recognized as a heterogenous disease based on variations in molecular characteristics. Online tools are valuable in guiding adjuvant treatment, especially in resource constrained countries. However, in the era of personalized therapy, molecular profiling appears to be superior in predicting clinical outcome and guiding therapy.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.05.006
       
  • Comparison of topical mupirocin and gentamicin in the prevention of
           peritoneal dialysis-related infections: A systematic review and
           meta-analysis
    • Authors: Chia-Chi Tsai; Po-Sheng Yang; Chien-Liang Liu; Chih-Jen Wu; Yi-Chiung Hsu; Shih-Ping Cheng
      Pages: 179 - 185
      Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1
      Author(s): Chia-Chi Tsai, Po-Sheng Yang, Chien-Liang Liu, Chih-Jen Wu, Yi-Chiung Hsu, Shih-Ping Cheng
      Background Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin. Methods Multiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis. Results Seven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate. Conclusions Topical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection.

      PubDate: 2017-12-17T17:52:55Z
      DOI: 10.1016/j.amjsurg.2017.03.005
       
  • Emeritus Editorial Board
    • Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1


      PubDate: 2017-12-17T17:52:55Z
       
  • TOC
    • Abstract: Publication date: January 2018
      Source:The American Journal of Surgery, Volume 215, Issue 1


      PubDate: 2017-12-17T17:52:55Z
       
 
 
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