Medicine and Health Sciences Commons^™

Trends Over Time In Incidence Of Bicuspid Aortic Valve Patients With Thoracic Aortic Aneurysms In New York, Sarah Marc, Jahnvi Bansal, Alexander Cove, Annet Kuruvilla, Joshua Helali, Ashutosh Yaligar, Junying Wang, Jie Yang, Jonathan Price, Thomas Bilfinger, Henry Tannous, Annie Laurie Shroyer, Allison Mclarty

Department of Surgery Faculty Publications

Aim: Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, with increased risk for early onset thoracic aortic aneurysms (TAA). This study aims to examine the trends over time in incidence of BAV patients with TAA, given imaging advancements and increased frequency of imaging.

Methods: Using administrative billing codes, this retrospective cohort study analyzed New York Statewide Planning and Research Cooperative System records from January 2007- December 2018, evaluating BAV+TAA incidence trends. Subgroups based on index admission were evaluated with a pre-identified 2014 inflection time point using an interrupted time series (ITS) analysis.

Results: Using a …

Thoracic Aortic Aneurysm Patients’ Diagnosis, Treatments, And Outcomes: The New York Experience, Ashutosh Yaligar, Annet Kuruvilla, Joshua Helali, Junying Wang, Mohammad Noubani, Sohaib Agha, Daniel Wolbrom, Jie Yang, Jonathan Price, Thomas Bilfinger, Henry Tannous, Annie-Laurie Shroyer, Allison Mclarty

Department of Surgery Faculty Publications

IMPORTANCE: Traditionally, thoracic aortic aneurysms (TAA) were diagnosed upon complications arising or post-mortem examination. Following 2014, asymptomatic new TAA diagnoses noticeably rose at increasing rates. In parallel, reductions in the rates of urgent/emergent TAA-related treatments and adverse risk-adjusted short-term outcomes were observed.

OBJECTIVES: For New York State adult residents, the trends from 2005 to 2018 in new thoracic aortic aneurysm (TAA) diagnoses, surgical treatments, percutaneous treatments, and risk-adjusted outcomes were examined.

DESIGN: This retrospective cohort study documented the quality of TAA care provided to New York adult residents.

SETTING: Using the 2005 to 2018 New York Statewide Planning and …

Surgical Stabilization Versus Nonoperative Treatment For Flail And Non-Flail Rib Fracture Patterns In Patients With Traumatic Brain Injury, Jonne T.H. Prins, Esther M. M. Van Lieshout, Francis Ali-Osman, Zachary M. Bauman, Eva-Corina Caragounis, Jeff Choi, D. Benjamin Christie Iii, Peter A. Cole, William B. Devoe, Andrew R. Doben, Evert A. Eriksson, Joseph D. Forrester, Douglas R. Fraser, Brendan Gontarz, Claire Hardman, Daniel G. Hyatt, Adam J. Kaye, Huan-Jang Ko, Kiara N. Leasia, Stuart Leon, Silvana F. Marasco, Allison G. Mcnickle, Timothy Nowack, Temi D. Ogunleye, Prakash Priya, Aaron P. Richman, Victoria Schlanser, Gregory Semon, Ying-Hao Su, Michael H. J. Verhofstad, Julie Whitis, Fredric M. Pieracci, Mathieu M. E. Wijffels

Department of Surgery Faculty Publications

Purpose: Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients.

Methods: A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes …

No Mental Illness Impact On Post-Aortic Valve Replacement Patients’ New-Onset Atrial Fibrillation, Natalie Kolba, Julia Dokko, Samantha Novotny, Sohaib Agha, Ashutosh Yaligar, Puja Parikh, Aurora Pryor, Henry Tannous, Laurie Shroyer, Thomas Bilfinger

Department of Surgery Faculty Publications

No abstract provided.

The Impact Of Perioperative Atrial Fibrillation On Patient Outcomes Following Repair Of Thoracic Aortic Aneurysms, Jennifer Morrone, Jonathan Price, Annie Laurie Shroyer

Department of Surgery Faculty Publications

No abstract provided.

Novel Repair Of Costal Margin Rupture With Preoperative 3d Planning, Casey T. Walk, Gregory Semon

Department of Surgery Faculty Publications

WHAT WOULD YOU DO? This is a 32-year-old man involved in a motor vehicle crash in 2019 with chronic left-sided rib pain since. He was initially treated with physical therapy and medical management with no improvement. CT imaging in 2021 noted displaced left lateral seventh and eighth ribs, noted chest wall deformity, and when three-dimensional (3D) reconstruction of his ribs was created, this noted a left- sided costal margin rupture at the sixth and seventh ribs.

Blood-Based Multi-Cancer Detection Using A Novel Variant Calling Assay (Deepgentm): Early Clinical Results, Rebecca M. Tuttle, Frederic Ris, Minia Hellan, Jonathan Douissard, Jorge J. Nieva, Frederic Triponez, Yanghee Woo, David Geller, Nicolas C. Buchs, Leo Buehler, Stefan Moenig, Christope E. Iselin, Wolfram Karenovics, Patrick Petignat, Giang Thanh Lam, Manuela Undurraga Malinervo, James R. Ouellette, Debashish Bose, Nael Ismail, Christian Toso

Department of Surgery Faculty Publications

This is an early clinical analysis of the DEEPGENTM platform for cancer detection. Newly diagnosed cancer patients and individuals with no known malignancy were included in a prospective open-label case-controlled study (NCT03517332). Plasma cfDNA that was extracted from peripheral blood was sequenced and data were processed using machine-learning algorithms to derive cancer prediction scores. A total of 260 cancer patients and 415 controls were included in the study. Overall, sensitivity for all cancers was 57% (95% CI: 52, 64) at 95% specificity, and 43% (95% CI: 37, 49) at 99% specificity. With 51% sensitivity and 95% specificity for all stage …

Outcome After Surgical Stabilization Of Rib Fractures Versus Nonoperative Treatment In Patients With Multiple Rib Fractures And Moderate To Severe Traumatic Brain Injury (Cwis-Tbi), Jonne T.H. Prins, Esther M. M. Van Lieshout, Francis Ali-Osman, Zachary M. Bauman, Eva-Corina Caragounis, Jeff Choi, D. Benjamin Christie Iii, Peter A. Cole, William B. Devoe, Andrew R. Doben, Evert A. Eriksson, Joseph D. Forrester, Douglas R. Fraser, Brendan Gontarz, Claire Hardman, Daniel G. Hyatt, Adam J. Kaye, Huan-Jang Ko, Kiara N. Leasia, Stuart Leon, Silvana F. Marasco, Allison G. Mcnickle, Timothy Nowack, Terri D. Ogunleye, Prakash Priya, Aaron P. Richman, Victoria Sschlanser, Gregory Semon, Ying-Hao Su, Michael H. J. Verhofstad, Julie Whitis, Fredric M. Pieracci, Mathieu M. E. Wijffels

Department of Surgery Faculty Publications

BACKGROUND

Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI.

METHODS

A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, …

Preoperative Atrial Fibrillation/Flutter Impact On Risk-Adjusted Repeat Aortic Intervention Patients[Protocol], Samantha Novotny, Julia Dokko, Xiaoyue Zhang, Sohaib Agha, Ashutosh Yaligar, Natalie Kolba, Vineet Tummala, Puja Parikh, Aurora Pryor, Henry Tannous, A. Laurie Shroyer, Thomas Bilfinger

Department of Surgery Faculty Publications

No abstract provided.

Predictors And Risk-Adjusted Outcomes Of New-Onset Postoperative Atrial Fibrillation In Surgical And Transcatheter Aortic Valve Replacement [Post-Af Ravr Protcol], Julia Dokko, Samantha Novotny, Xiaoyue Zhang, Sohaib Agha, Ashutosh Yaligar, Natalie Kolba, Vineet Tummala, Puja Parikh, Aurora Pryor, Henry Tannous, A. Laurie Shroyer, Thomas Bilfinger

Department of Surgery Faculty Publications

No abstract provided.

A Comparison Between The Teg 6s And Teg 5000 Analyzers To Assess Coagulation In Trauma Patients, Matthew D. Neal, Ernest E. Moore, Mark Walsh, Scott Thomas, Rachael A. Callcut, Lucy Z. Kornbilth, Martin Schreiber, Akpofure Peter Ekeh, Adam J. Singer, Lawrence Lottenberg, Michael Foreman, Susan Evans, Robert D. Winfield, Michael D. Goodman, Carl Freeman, David Milia, Noelle Saillant, Jan Hartmann, Hardean E. Achneck

Department of Surgery Faculty Publications

BACKGROUND

Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients.

METHODS

Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum …

Single Versus Multi-Center Surgeons' Risk-Adjusted Mitral Valve Repair Procedural Outcomes, Anne Bennett, Thomas Bogue, Samuel Greenberg, Joshua Zhu, Samantha Novotny, Joseph Pizzuti, Lee A. Santore, Robert H. Habib, Annie Laurie Laurie Shroyer, Jonathan Price, Henry Tannous, Thomas Bilfinger

Department of Surgery Faculty Publications

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions.

In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC …

Totally Robotic Vs Hybrid Abdominoperineal Resection: A Retrospective Multicenter Analysis, Jonathan Douissard, Vincent Obias, Craig S. Johnson, Monika E. Hagen, Deborah Keller, James R. Ouellette, Minia Hellan

Department of Surgery Faculty Publications

Introduction

Laparoscopic abdominoperineal resection (APR) for low rectal cancers is technically demanding. Robotic assistance may be of help and can be hybrid (HAPR) or totally robotic (RAPR). The present study describes outcomes of robotic APR and compares both approaches.

Material and methods

A multicentric retrospective analysis of rectal cancer patients undergoing either HAPR or RAPR was conducted. Patients' demographics, surgeons' experience, oncologic results, and intraoperative and postoperative outcomes were collected.

Results

One hundred twenty‐five patients were included, 48 in HAPR group and 77 in RAPR group. Demographics and comorbidities were comparable. Operative time was reduced in RAPR group (266.9 ± …

Management Of Traumatic Subarachnoid Hemorrhage By The Trauma Service: Is Repeat Ct Scanning And Routine Neurosurgical Consultation Necessary?, Stephen W. Cooper, Kimberly B. Bethea, Trevor J. Skrobut, Rod G. Gerardo, Juan Torres-Reveron, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

Subarachnoid hemorrhage (SAH) results frequently from traumatic brain injury (TBI). The standard management for these patients includes brief admission by the acute care surgery (trauma) service with neurological checks, neurosurgical consultation and repeat head CT within 24 hours to identify any progression or resolution. Recent studies have questioned the need for repeat CT imaging and specialty consultation in mild TBI. We reviewed patients with mild TBI specifically with isolated SAH to determine progression of the pathology and need for neurosurgical involvement. All patients with SAH secondary to mild TBI (Glasgow Coma Score (GCS) of 13-15) who presented over a 5-year …

Laparoscopic Cholecystectomy In The Acute Care Surgery Model: Risk Factors For Complications, Emily Fletcher, Erica Seabold, Ronald J. Markert, Alyssa J. Gans, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

Background: The Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting. Methods: All patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher's exact test, χ ² test, and Mann-Whitney U Test. Results: During the study period, 547 patients (70.2% female, mean age 46.1±18.1, …

Crossbow Bolt Injury To The Heart, Deanne Jacobs, Claire Hardman, Syed A. Zaman, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

Case summary A 33-year-old woman was transferred from an outside hospital with a penetrating injury to her right chest. The patient was shot with a crossbow with the entry site to the right breast/chest and a transmediastinal trajectory. She was intubated prior to arrival due to difficulty breathing. Her vital signs remained stable and within normal limits, with good breath sounds, and no evidence of pneumothorax on chest X-ray. The tip of the bolt was palpable at the patient’s left midaxillary line. Chest X-ray in trauma bay showed the transmediastinal trajectory, and the bolt appeared to have a field point …

Staged Reconstruction Of The Inferior Vena Cava After Gunshot Injury, Nathan M. Droz, John K. Bini, Kamran A. Jafree, John H. Matsuura

Department of Surgery Faculty Publications

A 23-year-old man with a gunshot injury to the abdomen and cardiac arrest requiring emergency department thoracotomy had a transection of the distal inferior vena cava (IVC) and small bowel injury. Because of persistent hemorrhagic shock, the IVC was ligated. During the next 3 days, he developed worsening bilateral leg edema. He was taken back for reanastomosis of his small bowel and reconstruction of the IVC using autologous femoral vein harvested from the right leg. We think that patients requiring ligation of the vena cava with worsening leg edema can benefit from a staged reconstruction of the IVC.

Irreversible Electroporation Of Locally Recurrent Pancreatic Cancer With 5-Year Survival, Alyssa Deiters, Minia Hellan, Rebecca N. Tuttle, James R. Ouellette

Department of Surgery Faculty Publications

Background: Isolated local recurrence after surgical resection for pancreatic cancer is rare. Current common therapies for recurrence include chemotherapy or chemoradiation. There are few, if any, reports regarding surgical resection of local pancreatic cancer recurrence. This is the first report of using irreversible electroporation (IRE) to treat a pancreatic adenocarcinoma local recurrence and represents a true 5-year survivor and possible cure.

Case report: A 50-year-old female initially presented with 2.5 cm mass in the uncinate process of the pancreas suspicious for malignancy. Preoperative endoscopic guided fine needle aspirate (FNA) confirmed adenocarcinoma. She underwent pylorus preserving pancreaticoduodenectomy with the finding of …

Amaurosis Fugax Associated With Congenital Vascular Defect, John Giltner, Edward R. Thomas, William K. Rundell

Department of Surgery Faculty Publications

No abstract provided.

Career Services Focus: Surgery, Boonshoft School Of Medicine Career Services

Department of Surgery Faculty Publications

A seven page newsletter from the Boonshoft School of Medicine's Career Services highlighting interviews with Department of Surgery faculty and students.

Current And Desired Practice Patterns Of Trauma And Acute Care Surgeons (T/Acs), Nathan M. Droz, Melissa L. Whitmill, Priti Parikh, Kimberly M. Hendershot

Department of Surgery Faculty Publications

Resident hour restrictions and the addition of emergency general surgery (EGS) have changed how the T/ACS team functions and their work patterns. The purpose of our study is to report current practice patterns of T/ACS and compare those to desired practice patterns of the future workforce in the field (residents/fellows).

Preoperative Incidence Of Penile Abnormalities Found During Voluntary Male Medical Circumcision In Swaziland, Anthony R. Oddo, Elizabeth Ruedrich, Christopher Zust, Lindsey Marugg, Echo Vanderwal, Rebekah Sartori, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

The Anatomy Of Nursing Interruptions: Who-What-When-Where, Pratik J. Parikh, Nicole Craker, Robert A. Myers, Jessy M. Eid, Priti Parikh, Kathy Zink, Mary C. Mccarthy

Department of Surgery Faculty Publications

Although interruptions experienced by nurses during intensive care have been indicated to affect patient safety, not much is known regarding the complex situations that drive interruptions to eventually aid in intervention design and implementation.

Application Of Medical Student Research Objectives In An International Medical Elective: Voluntary Medical Male Circumcision In Swaziland, Alison M. Bales, David J. Dennis, Robert C. Siska, Michael A. Schneider, Echo Vanderwal, Harry Vanderwal, Mary C. Mccarthy

Department of Surgery Faculty Publications

No abstract provided.

A Randomized 2x2 Factorial Clinical Trial Of Renal Transplantation: Steroid-Free Maintenance Immunosuppression With Calcineurin Inhibitor Withdrawal After Six Months Associates With Improved Renal Function And Reduced Chronic Histopathology, R. Brian Stevens, Kirk W. Foster, Clifford D. Miles, Andre C. Kalil, Diana F. Florescu, John P. Sandoz, Theodore H. Rigley, Tamer Malik, Lucile E. Wrenshall

Department of Surgery Faculty Publications

Introduction

The two most significant impediments to renal allograft survival are rejection and the direct nephrotoxicity of the immunosuppressant drugs required to prevent it. Calcineurin inhibitors (CNI), a mainstay of most immunosuppression regimens, are particularly nephrotoxic. Until less toxic antirejection agents become available, the only option is to optimize our use of those at hand.

Aim

To determine whether intensive rabbit anti-thymocyte globulin (rATG) induction followed by CNI withdrawal would individually or combined improve graft function and reduce graft chronic histopathology–surrogates for graft and, therefore, patient survival. As previously reported, a single large rATG dose over 24 hours was well-tolerated …

Irreversible Electroporation Of Malignant Lesions: An Institution Experience, Benjamin Bates, Minia Hellan, Shannon Kauffman, James R. Ouellette

Department of Surgery Faculty Publications

Background: Irreversible electroporation (IRE) is a tumor ablation technique where short, high-voltage pulses are applied to tumors to permeabilize the cell membranes. Since no thermal energy is created, it can be used near vital structures. We report our experience in a wide array of anatomic locations and on diverse oncologic processes.

Methods: We performed a retrospective review of all IRE cases performed at our institution from September 2010 to September 2013. Patients were evaluated for peri-operative morbidity, mortality, and oncologic outcome.

Results: Twenty-seven patients underwent IRE during 16 laparotomies and 12 CT guided percutaneous procedures. Anatomic locations: 9 liver, 7 …

A Novel Approach Using Liquid Embolic Agent For The Treatment Of Pancreatic-Cutaneous Fistulas: Report Of A Case, Amye M. Farag, Priti Parikh, Tamer Malik, Shannon L. Kauffman

Department of Surgery Faculty Publications

Pancreatic fistula formation remains one of the most dreadful complications after pancreaticoduodenectomies, resulting in extended hospital stays, increased healthcare costs, along with significantly increased morbidity and mortality. Little is mentioned in the literature about the use of percutaneous techniques to resolve this complication when conservative treatments fail. Thus, we developed a novel technique for treating pancreatic-cutaneous fistulas that develop post-pancreaticoduodenectomy. This work describes a novel approach of using a liquid embolic agent to treat a high-output pancreatic-cutaneous fistula after a Whipple procedure, which to the best of our knowledge after extensive literature searches, has not been performed before.

Management Of Siewert's Type Iii Gastroesophageal Junction Adenocarcinoma In A 52 Year Old Female, Adam Bourgon, Minia Hellan, Rebecca N. Tuttle

Department of Surgery Faculty Publications

A 52 year old female presented with a Siewert's type III gastroesophageal junction (GEJ) adenocarcinoma treated with neoadjuvant chemotherapy, laparoscopic-robotic total gastrectomy, and adjuvant chemoradiation.

The Geriatric Trauma Team: A Novel Approach To Caring For Elderly Trauma Patients, Mary F. Stuever, Kimberly M. Hendershot, Priti Parikh, A. Russeau, Mary C. Mccarthy, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

No abstract provided.

Identification Of A Cytotoxic Form Of Dimeric Interleukin-2 In Murine Tissues, Lucile E. Wrenshall, Suzanne E. Clabaugh, David R. Cool, Prakash Arumugam, William C. Grunwald Jr., Deandra R. Smith, Gino C. Liu, John D. Miller

Department of Surgery Faculty Publications

Interleukin-2 (IL-2) is a multi-faceted cytokine, known for promoting proliferation, survival, and cell death depending on the cell type and state. For example, IL-2 facilitates cell death only in activated T cells when antigen and IL-2 are abundant. The availability of IL-2 clearly impacts this process. Our laboratory recently demonstrated that IL-2 is retained in blood vessels by heparan sulfate, and that biologically active IL-2 is released from vessel tissue by heparanase. We now demonstrate that heparanase digestion also releases a dimeric form of IL-2 that is highly cytotoxic to cells expressing the IL-2 receptor. These cells include “traditional” IL-2 …