Surgery Commons^™

Comparing Bilateral And Unilateral Metal Stabilizers: Incision Complications In Pectus Repair, Seth Saylors, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph, Nelimar Cruz-Centeno, Nitin Nadella

Research Days

Introduction: The use of metal stabilizers in minimally invasive pectus excavatum repair (MIPER) has been previously associated with multiple postoperative complications. We aimed to identify if bilateral metal stabilizers increase the risk of incision complications when compared to unilateral stabilizers.

Methods: Institutional Review Board approval was obtained. Patients that underwent MIPER with metal stabilizers from 2019 to 2022 and currently had the bar in place, at a single tertiary care pediatric center, were included. A telephone survey evaluated if they had incision-associated symptoms, and if the location was congruent with the stabilizer site. A retrospective chart review was performed to …

Case Of An Adolescent Girl With Familial Vulvar Leiomyoma, Madeline Ross, Charlene Dekonenko, Rebecca Rentea, Tazim Dowlut-Mcelroy

Research Days

Background

While uterine leiomyomas remain a common occurrence affecting nearly 30% of adult women above 35yo, leiomyomas can arise anywhere smooth muscle cells are located in the body. Vulvar leiomyomas are a particularly rare diagnosis, often misdiagnosed as Bartholin gland cyst, comprising 0.07% of vulvar tumors, and thought to arise from smooth muscle within the round ligament, erectile tissue, and dartos muscle. Even more rare is the presentation of vulvar leiomyoma in the adolescent population and family history of vulvar leiomyoma.

Case

We present the case of a 16yo girl who noticed a painless vulvar mass that had increased in …

Health Disparities In Slipped Capital Femoral Epiphysis (Scfe) Presentation, Rithika Ginjupalli, George Thomas, Rohit Siddabattula, Richard M. Schwend, Caleb Grote

Research Days

This study identifies various health disparities in SCFE presentations using neighborhood-level determinants COI and ICE in addition to sociodemographic determinants such as race and gender.

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Clinical Outcomes For Impella Procedure In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Sonika Vatsa, Kyrillos Girgis, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

The Impella, a vital ventricular assist device, has seen extensive use in managing severe heart failure and cardiogenic shock. However, the impact of this procedure on older individuals remains poorly understood. To address this gap, we scrutinized the National Inpatient Sample Database from 2019 to 2020 to elucidate in-hospital outcomes among older patients who underwent the Impella procedure. Among the 8233 patients who underwent Impella insertion, 1389 (16.8%) were in the older population, aged 80 years or older. This subgroup exhibited a higher prevalence of comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease compared to younger patients. Alarmingly, …

An Unexpected Finding During A Breast Excisional Biopsy: A Case Report, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.

Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. …

Outcomes Of Thoracic Endovascular Aortic Repair (Tevar) Procedure In Octogenarians, Nonagenarians And Centenarians: A Population-Based Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Limited data exists for patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure who are older than or equal to 80 years old (YO). This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these older patients.

Methods: The NIS was searched for hospitalizations of adults who underwent a TEVAR procedure in 2019 and 2020. The study compared those aged 80 YO and over to those younger than 80 YO. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included …

Sex Differences In Outcomes Among Patients Undergoing Thoracic Endovascular Aortic Repair (Tevar) Procedure: A Retrospective Cohort Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: There is limited data about sex differences in patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure. This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes by gender.

Methods: The NIS was searched for hospitalizations of adult patients who underwent TEVAR in 2019 and 2020. For this cohort, female patients were identified, and pregnant patients were excluded. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included 696 patients who underwent TEVAR. 255 (36.6%) females were identified, of which, 7 …

Comparative Analysis Of Health Outcomes In Gastric Cancer: Robotic Vs. Laparoscopic Gastrectomy, Maftuna Kurbonnazarova

Rowan-Virtua Research Day

Exploring the most effective surgical approach for gastrectomy is crucial for determining superior health outcomes in patients. This research compares robotic and laparoscopic techniques with the aim of pinpointing the optimal method, offering valuable insights for improved postoperative well-being.

Resection And Reconstruction Of Ewing Sarcoma Of The Cuboid Utilizing Vascularized Fibular Autograft: A Case Report, Brandon Cunha, Alexandre Arkader

Rowan-Virtua Research Day

Ewing Sarcoma (EWS) rarely presents in the bones of the foot, and particularly in the cuboid, making it an exceedingly rare occurrence. We present the case of a 7-year-old female diagnosed with EWS of the right cuboid, detailing the management and outcomes of this rare presentation. The patient, now almost 5 years post-initial local control, exhibits restored foot function, a normalized gait, and no evidence of disease recurrence. This case underscores the potential for preserving lower extremity function and improving postoperative quality of life in rare presentations of EWS through innovative reconstruction strategies.

Complications Following Hemivertebrectomy For Congenital Scoliosis, Sanjana Davuluri, Taemin Oh, Kyrillos Akhnoukh, Zachary Weingrad, Michael Lesgart, Terrence Ishmael, Joshua Pahys, Amer Samdani, Steven Hwang

Rowan-Virtua Research Day

Introduction:

Hemivertebrae are rare congenital anomalies that can cause severe scoliosis requiring surgical correction. We aimed to determine whether severity of deformities is associated with more long-term surgical complications following surgical correction.

Methods:

We performed a retrospective, single-institution review on patients who underwent hemivertebrectomy and spinal fusion for congenital scoliosis between 2008-2020. We extracted pertinent data on demographics, radiographic parameters, operative details, and complication rates. Subgroup analyses were also done by complication severity, deformity complexity, and construct length.

Results:

In our series, 30 patients underwent hemivertebrectomy and fusion. Mean age was 9±4.2 years and there was 2:1 male preponderance, with …

Interactive Distraction Techniques Versus Midazolam In Anxiolysis In Pediatric Patients: A Systematic Review And Meta-Analysis, Uzay Cagatay, Jon Elias, Alexander King

Rowan-Virtua Research Day

Background: Many pediatric patients experience high levels of anxiety prior to undergoing surgery. Midazolam is currently one of the most commonly used sedative drugs in the pediatric preoperative environment. A number of studies have evaluated the use of non-pharmacological methods of relaxing pediatric patients prior to surgery, known as ‘Interactive Distraction’. These techniques involve using various methods of distracting the child from the preoperative anesthetic procedures. Some examples of these methods involve giving the patient an iPad with which they can play video games. There have yet to be any systematic reviews comparing the usage of Midazolam alone against utilizing …

Preventing Postoperative Cognitive Dysfunction Through Preoperative Exercise, John Andre Socci

Rowan-Virtua Research Day

Introduction: Postoperative cognitive dysfunction (POCD) is a common problem in the elderly population after undergoing anesthesia that results in sometimes irreversible cognitive and physical impairment that can increase mortality and decrease quality of life.

Methods: To see the relationship between preoperative fitness capacity and how this relates to postoperative cognitive ability a literature review was performed. Studies that were included involved populations older than sixty years old that had undergone anesthesia. Additionally, animal studies were included to show inflammatory marker levels and how they increased in relation to physical activity.

Results: Various fitness scales were used such as the Timed …

Effects Of Obesity On Patients Undergoing Cardiomems Procedure: Retrospective Cohort Study, Tony Elias, Mena Elmalh, Priya Brahmbhatt, Kyrillos Girgis, Taha Syed, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

★ Remote hemodynamic monitoring (CardioMEMs) is becoming increasingly important for management of chronic heart failure patients.

★ There is limited data looking specifically for obese patients who undergo CardioMEMs implantation.

★ We sought to examine the national inpatient sample database to describe in-hospital outcomes for this demographic

Splenic Artery Aneurysm Masquerading As Chest Pain: A Case Report Of A Rare Clinical Presentation, Emily Forester, Anjeanette Brown Md

Rowan-Virtua Research Day

Background: Splenic artery aneurysms most commonly present with vague epigastric or left upper quadrant abdominal pain that may radiate to the left shoulder. Chest pain associated with splenic artery aneurysm is an unusual phenomena. This case presents a rare occurrence of a splenic artery aneurysm originally presenting as atypical chest pain. Case Presentation: A 46 year old G3P2 AAF patient with family history of hypertension presented to the ER with pleuritic left chest pain, episodes of shortness of breath, and new onset hypertension. Chest x-ray and ECG were unremarkable. Pertinent labs included a hemoglobin of 10.6 and D-dimer of 4.10. …

Dermoid Cyst – Presenting With Llq Abdominal Pain, Mohammad A. Rattu, James A. Espinosa

Rowan-Virtua Research Day

Ovarian cysts are fluid-filled structures that may be defined as simple or complex and are often discovered incidentally on imaging. Their etiology can range from physiologically normal (such as follicular or luteal cysts) to ovarian malignancies. They are more common in the reproductive years secondary to endogenous hormonal production however may also occur at any age. Simple cysts more commonly occur among all age groups; mixed cystic and solid and completely solid ovarian lesions however have rates of increased malignancy. The most independent risk factor is age; therefore, post-menopausal women should have proper follow-up secondary to this risk. Some risk …

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

Rowan-Virtua Research Day

Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

Effects Of Dexmedetomidine As An Adjunct To General Anesthesia On Postoperative Pain And Opioid Consumption In Major Abdominal Surgery, Ahmad H. Elrefahy

Rowan-Virtua Research Day

This review examines the impact of dexmedetomidine, an alpha-2 adrenergic receptor agonist, on postoperative pain and opioid consumption in major abdominal surgery. Dexmedetomidine, known for its sedative, analgesic, and opioid-sparing properties, is increasingly used as an adjunct to anesthesia. Analyzing existing literature, the review found that dexmedetomidine administration alongside general anesthesia significantly improves postoperative pain management and reduces opioid consumption. Patients receiving dexmedetomidine reported decreased postoperative pain ratings and required fewer opioids during the recovery phase. Additionally, intraoperative dexmedetomidine use correlated with reduced postoperative pain severity and increased patient satisfaction compared to control groups. However, potential side effects such as …

Case Report: Hidden Posterior Dislocation Of The Clavicular Head, David F. Koziel

Rowan-Virtua Research Day

Reported is a case of a 24-year-old male who presented with left shoulder pain and decreased range of motion of the same shoulder upon awakening, diagnosed with a posterior dislocation of the proximal clavicle, with the clavicular head residing in the mediastinum. In the conscious, ambulatory, young adult it is arguably much more common for major bony trauma involving the upper extremity and shoulder to present with pain, deformity, and a known mechanism. This is an example that lacks all three of these characteristics and highlights the importance of details in the physical examination as well as clinical gestalt.

Risky Business: Creating A Process To Review Accuracy Of American Society Of Anesthesia (Asa) Classification And To Improve Overall Quality Risk Adjustment Of Surgical Patients, Jane Kinney, Sonja Orff, Robyn Begin, Nicholas Flavin, Eira Hyrkas, Christopher Adams, Ian Neilson

Costas T. Lambrew Research Retreat 2024

Through interdisciplinary education and the creation of an audit process, we have observed a 30.6% reduction in the number of ASA assignment misclassifications.