Medicine and Health Sciences Commons^™

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Stage Of Disease And Likelihood Of Surgical Intervention In Colon Cancer Patients: An Exploratory Analysis Of The Seer Database, R. Denneny, D. Delgado, V. Nguyen, J. Subramoney, B. George, E. Mitchell, Md

Phase 1

Introduction/Objectives: Colorectal cancer (CRC) remains as the third-leading cause of cancer-related deaths amongst both men and women in the United States. However, the mortality rate from CRC continues to drop, which has been attributed to increased surgical polyp removal. This study explored the association between disease stage and the likelihood of surgical intervention as primary treatment for the disease.

Methods: Retrospective cohort study analysis using de-identified patient data from the NCI’s Surveillance, Epidemiology, and End Results (SEER) database from 1998-2015. Inclusion criteria included patients with colon cancer, over 18 years of age, with known disease in either the proximal or …

Are We Doing It For The Money? A Salary Survey Of The United States Surgical Program Directors, Alexander Hoey, Ba, Brian Hoey, Md, Stanislaw Stawicki, Md

Phase 1

Compensation packages and job responsibilities for United States surgical program directors (PD) vary considerably from one institution to the next. With limited compensation data available for PD’s, this survey reassesses and compares the salaries, benefits, duties, and contract arrangements of all allopathic U.S. surgical PDs. Questionnaires regarding these areas of interest were mailed out electronically to all of the PDs and data was compared between the individuals’ responses using Chi-Squared and Fischer Exact Tests. Fifty-five percent of the PDs responded, revealing significant variation in total compensation packages, size of the dedicated stipend for the role, and time spent on clinical …

Assessing The Operative Log Data Of Traditional (5+2) Vs. Integrated (0+5) Vascular Training Programs, Ernest Gillan, Bs, Anthony Feghali, Md, Tuong Nguyen, Md, Dawn Salvatore, Md, Paul Dimuzio, Md, Babak Abai, Md

Phase 1

Introduction: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5 year vascular surgery residency program. Operative experience can be used as a surrogate marker for success in the evolving field of vascular surgery training.

Objective: The purpose of this study is to compare the operative experience of those graduating from the traditional (5+2) vascular training program with the integrated (0+5) program.

Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2018. Mean case numbers were compared between integrated vascular residents and traditional …

Minimally Invasive Surgery In Neonates With Congenital Anomalies: Experience From The Nsqip-P, Emily Sagalow, Katerina Dukleska, Md, Courtney Devin, Md, Erin Teeple, Md, Scott W. Cowan, Md, Charles D. Vincour, Md, Loren Berman, Md

Phase 1

Background: Congenital diaphragmatic hernias (CDH) and tracheoesophageal fistulas (TEF) are managed with minimally invasive surgery (MIS) or open surgery. Little is known about the patient populations and outcomes for those treated by each approach. Hypothesis/Specific Aims: We expect that there will be fewer complications, better outcomes, and longer operative times for the MIS group versus the open group.

Methods: National Surgical Quality Improvement Program-Pediatric Participant Use Files (NSQIP-P PUFs) from 2012-2015 were used to identify neonates (up to 30 days old) who underwent CDH and TEF repair. The patient characteristics, post-operative complications, and 30-day mortality were analyzed using multivariable logistic …

Retrospective Chart Review Assessing Factors That Contribute To Network Leakage In Postoperative Pancreatic Cancer Patients, Nazanin Sarpoulaki, Christian Fernandez, Md, Mark Hurwitz, Md

Phase 1

Introduction: Standard of care for resectable pancreatic cancer includes surgery, chemotherapy, with consideration of radiotherapy. Thomas Jefferson University Hospital (TJUH) is a large volume institution for pancreatectomy. Rate of subsequent in-network adjuvant treatment are far less which may impact outcomes. We will elucidate variables that influence coordinated patient care.

Objective: To evaluate variables that correlate with follow up and adjuvant treatment of pancreatic cancer patients at TJUH.

Methods: Retrospective medical chart reviews will be performed with data from patients with pancreatic cancer who have undergone resection at TJUH from April 2017 to March 2018. Patient demographics, clinical, and pathologic information …

Selection Criteria For Posterior Circulation Stroke And Functional Outcome Following Mechanical Thrombectomy, Vivian Xu, Ahmad Sweid, Md, Stavropoula Tjoumakaris, Md, Kavya Shivashankar, Ba, Karim Hafazalla, Bs, Michael R. Gooch, Md, Nabeel Herial, Md, Robert H. Rosenwasswer Md, Pascal Jabbour, Md

Phase 1

Objective: 20% of all acute ischemic strokes (AIS) are caused by posterior circulation strokes, which carry an intensified mortality touching 95%. Early recanalization improves outcome as shown by several reports; however, safety, patient selection, and prognostic factors remain lacking. An investigation of the safety and prognostic factors for posterior circulation mechanical thrombectomy (MT) was performed.

Methods: A retrospective review of patients presenting with posterior circulation AIS, who underwent MT between 2010 and 2018.

Results: Of 443 patients who underwent MT for AIS, 83 patients had posterior circulation strokes. 95% of procedures were conducted under general anesthesia. The median NIHSS upon …

Opioid Consumption After Orthopedic Surgery: Prospective Randomized Trial On The Effects Of Preoperative Counseling, Sage Vincent, Taylor Paskey, Elizabeth Critchlow, Erica Mann, Talia Chapman, Md, Kristin Sandrowski, Md, Asif Ilyas, Md

Phase 1

Introduction: Recently, there have been increases in morbidity and mortality associated with opioid medications. Physician overprescribing, particularly within orthopedics, contributes to large quantities of leftover opioids, leading to an increased risk of non-medical opioid use and abuse.

Objective: To understand the role of preoperative patient counseling on postoperative opioid consumption, a prospective randomized study was done, with the idea that patients receiving counseling would take fewer opioids than their control counterparts.

Methods: Patients undergoing elective outpatient orthopedic surgery at Jefferson affiliate hospitals were enrolled over a 3-month period. Patients were randomized to a control group or to receive preoperative counseling …

Post-Operative Outcomes Of Surgical Treatment For Trigeminal Neuralgia, Daniel Tzou

Phase 1

Introduction: Trigeminal Neuralgia causes severe paroxysmal facial pain that leads to debilitating quality of life. Pharmacologic management often becomes insufficient, and the microvascular decompression (MVD) procedure is the mainstay surgical intervention. Internal neurolysis (IN) is a novel addition to the MVD procedure to treat trigeminal neuralgia, and its efficacy has not been well tested.

Objective: The objectives of the study are to understand appropriate surgical treatments for trigeminal neuralgia and to determine the efficacy of the additional IN compared to MVD.

Methods: A retrospective cohort study on patients undergoing surgical intervention for trigeminal neuralgia at TJUH was conducted. Surgical treatment …

The Pathway To Low Outlier Status In Venous Thromboembolism Events: An Analysis Of Pancreatic Surgery In Acs Nsqip, Samantha L. Savitch, Tyler M. Bauer, Nikosi H. Alvarez, Adam P. Johnson, Theresa P. Yeo, Harish Lavu, Charles J. Yeo, Jordan M. Winter, Geno J. Merli, Scott W. Cowan

Phase 1

Introduction: Our institution’s hepatopancreaticobiliary service (HPBS) is a high-volume pancreatic surgery service, which has demonstrated consistently low rates of symptomatic venous thromboembolism (VTE) compared to similar institutions as reported by NSQIP. We sought to determine if the HPBS’s regimented multimodal VTE prophylaxis pathway plays a role in achieving consistently low VTE rates.

Methods: We queried the ACS NSQIP Participant User File and our institution’s data from 2011-2016 for major pancreatic operations. We used Chi-squared analysis to compare the HPBS and national patient populations, and created a matched dataset based on preoperative patient factors. Univariate and multivariate analyses were performed on …

Repeat Neuro-Imaging In Patients Presenting With Traumatic Extra-Axial Intracranial Hemorrhage, Austin Saline, Anthony Stefanelli, Md, Omaditya Khanna, Md, Sol Feuerwerker, Somnath Das, Evan Selzer

Phase 1

Introduction: The management of extra-axial intracranial hemorrhage patients is complicated and lacks a systemic algorithm to determine the timing and necessity of head computed tomography (HCT). However, repeat HCTs weakly predict the need for an intervention after mild traumatic brain injury (TBI).

Objective: This study focused on assessing the safety, efficacy, and necessity of obtaining serial HCTs in patients presenting with subdural hemorrhages.

Methods: A retrospective chart review was conducted of patients with subdural hemorrhages and a GCS between 13-15 on admission (n=116). The total number of HCTs, time between repeat HCTs, duration of hospital stay, and factors necessitating surgery …

Direct Anterior Approach Utilizing A Bikini Incision Has Less Wound Related Complications In Patients With High Bmi, Taylor Paskey, Bs, Jorge Manrique, Md, Majd Tarabichi, Md, Camilo Restrepo, Md, Carol Foltz, Phd, William J. Hozack, Md

Phase 1

Introduction: Direct anterior approach (DAA) total hip arthroplasty (THA) can be performed through a traditional vertical skin incision, situating the proximal incision at the hip flexion crease, or a horizontal (bikini) skin incision, situating the incision slightly distal and parallel to the hip flexion crease. The dissection beyond the subcutaneous layer is identical for both methods.

Objective: The purpose of this study was to compare these approaches, performed by an experienced single surgeon, in terms of overall wound complications and patient-reported esthetics 6-months post-operatively. It was hypothesized that the bikini incision would result in less wound complications and …

Is Excision Of Radial Scars Identified On Cnb Necessary?, K. Nimtz, K. Hookim, Md, A. Sevrukov, Md, T. Tsangaris, Md, A. Willis, Md, A. Berger, Md, M. Lazar, Md

Phase 1

Introduction: Quantifying the risk of upgrade to malignancy with radial scars has been an ongoing challenge, as the published upgrade rate varies widely from 0-40%, making management strategy controversial. The lack of consensus on optimal management highlights the need for further analysis. We sought to identify our institutional upgrade rate of radial scar identified on core needle biopsy (CNB).

Methods: A retrospective review of pathology and radiology databases was performed to identify radial scars found on CNB. We excluded patients with malignancy associated with radial scar and those who did not undergo surgical excision. The upgrade rates to …

Sensory Outcomes In Digital Nerve Repair Techniques: An Updated Meta-Analysis And Systematic Review, Zachary J. Herman, Bs, Asif M. Ilyas, Md

Phase 1

Introduction: Injuries to the digital nerves are common with trauma to the hand; surgery is often required to repair injured nerves. Surgical management of digital nerve injuries includes neurorrhaphy or use of allograft, autografts, and conduits.

Objective: In light of the increasing availability and utilization of digital nerve repair constructs, an updated meta-analysis was undertaken in order to comparatively review the available evidence to determine differences in outcomes.

Methods: We reviewed the most current literature on sensory outcomes of various digital nerve repair techniques using static two-point discrimination (S2PD), moving two-point discrimination (M2PD), Semmes Weinstein–Monofilament testing (SWMF) and complication rates …

3d Printed Biliary Anatomy For Surgical Planning, Jason Core, Erik Massenzio, Tamar Wasserman, Kevin Xie

Phase 1

Background: Studies demonstrated that 3D-printed livers from CT or MRI data can be accurate models of actual patient anatomy. However, it has yet to be established if 3D printing offers improvements to clinical outcomes in surgery. This project seeks to optimize these applications for use at Jefferson by producing 3D-printed models from patient CT scans to guide liver resection surgeries.

Methods: A liver transplant attending was interviewed about challenges encountered during hepatectomies. A publicly available abdominal computed tomography scan was used to render a liver and its vasculature in 3DSlicer. The liver surface was cut into two halves in MeshMixer …