Surgical Procedures, Operative Commons^™

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 …

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.

A Rare Intervention: Perimortem Hysterotomy In An Obstetric Emergency In A 32-Year-Old Female, Alec Mirchandani

Rowan-Virtua Research Day

In the realm of obstetric emergencies, perimortem hysterotomy stands as a rare but crucial intervention, employed in dire circumstances to salvage both maternal and fetal lives. This procedure, involving the surgical delivery of a fetus from a mother in cardiac arrest, presents a unique set of challenges and ethical considerations for healthcare providers. This case report delves into the intricate details surrounding a perimortem hysterotomy performed under emergent conditions, exploring the clinical decision-making process, procedural intricacies, and outcomes. Through this narrative, we aim to shed light on the complexities of managing obstetric emergencies, emphasizing the critical role of timely intervention …

Clinical Outcomes For Cardiac Ablation In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

Background

Cardiac ablation is a therapeutic intervention aimed at correcting abnormal heart rhythms by disrupting electrical pathways in the heart, using techniques such as radiofrequency or cryoablation. Despite its effectiveness, there is a scarcity of data regarding the outcomes of cardiac ablation specifically among elderly patients. Previous studies have highlighted the complexities and challenges associated with managing cardiac arrhythmias in the elderly population, emphasizing the need for further investigation into treatment outcomes in this demographic.1,2 Therefore, this study aimed to investigate in-hospital outcomes among elderly patients who underwent cardiac ablation using data from the National Inpatient Sample (NIS) Database.

Methods …

Does Esketamine In Cesarean Delivery Increase Postoperative Adversities And Related Diseases?, Cheryce Daniel, Kylon Coombs

Rowan-Virtua Research Day

Esketamine has emerged as a promising treatment option, particularly noted for its effectiveness in reducing postpartum depression, alleviating pain, and promoting faster recovery. Despite its therapeutic benefits, recent research has raised concerns regarding potential adverse effects associated with high doses of esketamine in patients. Specifically, there is growing interest in understanding the potential risks linked to the administration of esketamine during cesarean delivery, given its increasing use in obstetric anesthesia.

This comprehensive review aims to investigate the potential associations between the use of esketamine during cesarean delivery and the subsequent risk of related diseases or physiological disorders. The goal is …

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

Impact Of Sphenopalatine Ganglion Block On Septoplasty: A Meta-Analysis, Ayman Khatib, Jonathan Elias, Sami Dakhel, Piotr Domaszewski, Andrew Atschinow, Alexander King

Rowan-Virtua Research Day

Objective: This Meta-Analysis aims to explore the impact of sphenopalatine ganglion block on intraoperative blood loss, duration of surgery, and postoperative pain.

Background: Sphenopalatine ganglion block (SPGB) is a form of regional anesthesia that could be coupled with general anesthesia in Septoplasty. Septoplasty is one of the three most common procedures Otolaryngologists perform, which is commonly performed endoscopically. There is lack of research on benefits of Sphenopalatine ganglion block on septoplasty. One of the most common complications of septoplasty is excessive bleeding which may impact endoscopic visualization. Additionally, postoperative pain management is vital to decreasing hospital stay and …

Is There An Association Between Living In A Rural Area And The Incidence Of Postoperative Complications Or Hospital Readmissions Following Left Ventricular Assist Device (Lvad) Implantation, Compared To Urban Lvad Recipients?, Samrat Gollapudi, Abhiram Gollapudi, Srinidhi Banala, Sheraj Singh, Bhaumik Patel

Rowan-Virtua Research Day

Background: Left ventricular assist devices (LVADs) are utilized as a therapeutic option for patients with end-stage heart failure. While LVAD implantation can significantly improve survival rates and quality of life, the procedure is not without risks, and postoperative complications are common. This review aims to investigate whether there is an association between living in a rural area and the incidence of postoperative complications or hospital readmissions following LVAD implantation, compared to urban LVAD recipients.

Methods: A comprehensive review of the literature was conducted, examining studies that compared postoperative outcomes between rural and urban LVAD recipients. Data were extracted on adverse …

Comparing The Effectiveness Of Hyaluronic Acid And Dextrose Prolotherapy Injections In The Treatment Of Lateral Epicondylitis: A Systematic Review And Meta-Analysis, Sara Ragab, Sami Dakhel, Jonathan Elias, Hesham Abdelfattah

Rowan-Virtua Research Day

Background: Lateral epicondylitis (LE), commonly referred to as tennis elbow, is characterized by micro-tears to the tendon origin that attaches to the outer portion of the elbow, with the extensor carpi radialis brevis being the most commonly affected tendon. It presents most often amongst manual workers and athletes that participate in repetitive movements. Patients may experience burning and aching sensations that can potentially radiate down to the wrist. Hyaluronic acid is a primary component of synovial fluid and has anti-inflammatory properties and also provides lubrication to joints. Prolotherapy involves injection of an irritant, most commonly dextrose, into the common extensor …

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 …

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 …

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.

Case Report: Pneumoperitoneum In The Setting Of Altered Mental Status, Aloysius C. Ibe, Neelesh Parikh, Robin Lahr

Rowan-Virtua Research Day

We report a case of an 80-year-old female who presented to the emergency department as altered mental status and diagnosed with pneumoperitoneum requiring immediate surgical intervention. The differential for altered mental status is vast but for a patient who was initially hypoglycemic on ED arrival, suspected drug overdose was at the forefront until the patient was intubated for airway protection and chest radiograph for confirmatory endotracheal tube placement showed pneumoperitoneum.

Integrated Transcriptomics And Histopathology Approach Identifies A Subset Of Rejected Donor Livers With Potential Suitability For Transplantation, Ankita Srivastava, Alexandra Manchel, John Waters, Manju Ambelil, Benjamin K. Barnhart, Jan B. Hoek, Ashesh P. Shah, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Liver transplantation is an effective treatment for liver failure. There is a large unmet demand, even as not all donated livers are transplanted. The clinical selection criteria for donor livers based on histopathological evaluation and liver function tests are variable. We integrated transcriptomics and histopathology to characterize donor liver biopsies obtained at the time of organ recovery. We performed RNA sequencing as well as manual and artificial intelligence-based histopathology (10 accepted and 21 rejected for transplantation).

RESULTS: We identified two transcriptomically distinct rejected subsets (termed rejected-1 and rejected-2), where rejected-2 exhibited a near-complete transcriptomic overlap with the accepted livers, …

Qualitative Vs. Quantitative Train Of Four, Caleb Culbreath

Doctor of Nursing Practice Projects

The growing body of evidence linking residual neuromuscular blockade (NMB) to postoperative complications has underscored the need to integrate quantitative neuromuscular monitoring techniques into anesthesia practice. This study, conducted at a tertiary care center in southern Illinois, investigates the gap between current clinical practices and the latest evidence advocating for objective monitoring. The study utilized a non-experimental pretest-posttest design to evaluate an educational intervention's effectiveness in increasing anesthesia providers' knowledge of quantitative neuromuscular monitoring techniques and enhancing their awareness of the incidence and clinical implications of postoperative residual neuromuscular blockade. Analysis of the pretest and post-test responses revealed significant improvements …

Outcomes Of Drug-Eluting Stents In Comparison To Bare Metal Stents In Cancer Patients With Percutaneous Coronary Intervention: A Systematic Review And Meta-Analysis, Muhammad Siddiqui, Eric Warner, Joey Junarta, Parker O’Neill, David Signarovitz, Eyad Kanawati, Mohammed Murtaza, David Fischman

Division of Cardiology Faculty Papers

Background: Studies have demonstrated poor prognosis in cancer patients who undergo percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Cancer patients receiving PCI are at increased risk of in-stent thrombosis, bleeding, hospital readmissions, and cardiovascular and noncardiovascular mortality when compared to patients without cancer. It is unclear if the poor outcomes in cancer patients are related to the stent type utilized for PCI. This meta-analysis attempts to identify differences in efficacy and safety outcomes when comparing drug-eluting stents (DESs) with bare metal stents (BMSs) in cancer patients.

Methods: This meta-analysis is reported according to the Preferred Reporting Items for …

Five-Year Mortality Rates Following Elective Shoulder Arthroplasty And Shoulder Arthroplasty For Fracture In Patients Over Age 65., Adam Khan, Xiaoran Zhang, Erlyn Macarayan, Matthew Best, Catherine Fedorka, Derek Haas, April Armstrong, Andrew Jawa, Evan O'Donnell, Jason Simon, Eric Wagner, Momin Malik, Michael Gottschalk, Gary Updegrove, Jon Warner, Uma Srikumaran, Joseph Abboud

Rothman Institute Papers

BACKGROUND: To effectively counsel patients prior to shoulder arthroplasty, surgeons should understand the overall life trajectory and life expectancy of patients in the context of the patient's shoulder pathology and medical comorbidities. Such an understanding can influence both operative and nonoperative decision-making and implant choices. This study evaluated 5-year mortality following shoulder arthroplasty in patients ≥65 years old and identified associated risk factors.

METHODS: We utilized Centers for Medicare & Medicaid Services Fee-for-Service inpatient and outpatient claims data to investigate the 5-year mortality rate following shoulder arthroplasty procedures performed from 2014 to 2016. The impact of patient demographics, including fracture …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Modified Frailty Index Associates With Transoral Robotic Surgery Complications And Survival: A National Database Study, Amiti Jain, Zachary N. Goldberg, Erin Briggs, Dev R. Amin, Zachary D. Urdang, Richard A. Goldman, David M. Cognetti, Joseph M. Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population.

METHODS: Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic …

Treatment Of Warthin’S Tumors Of The Parotid Gland With Radiofrequency Ablation: A Systematic Review Of The Current Literature, Kenny Do, Eric Kawana, Sisi Tian, Jo-Lawrence Bigcas

School of Medicine Faculty Research

Objective: Warthin’s tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on Warthin’s tumors of the parotid gland can be complicated in patients who wish to avoid risks of surgery and general anesthesia. This systematic review explores the potential of radiofrequency ablation (RFA) as a minimally invasive alternative. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model was used to collect 3 relevant studies that focused on RFA treatment for Warthin’s tumors. The cumulative averages for tumor size and cosmetic scores were then quantified for …

Biocomposite Anchors Have Greater Yield Load And Energy Compared With All-Suture Anchors In An In Vitro Ovine Infraspinatus Tendon Repair Model, Robert A. Walton, Lindsey Liuzza, Catherine Takawira, Claudia Leonardi, Mandi J. Lopez

School of Public Health Faculty Publications

Purpose: To compare tensile fatigue and strength measures of biocomposite and all-suture anchors in an ovine humerus-infraspinatus tendon model of rotator cuff repair. Methods: Infraspinatus tendons on adult ovine humeri were sharply transected at the insertion. One of each pair was assigned randomly for fixation with 2 biocomposite or all-suture anchors. Constructs were tested with 200 cycles of 20 to 70 N tensile load, and gap formation was measured at the incised tendon end every 50 cycles. They were subsequently tested to failure. Outcome measures including fatigue stiffness, hysteresis, creep, and gap formation and tensile stiffness, and yield and failure …

Primary Anastomosis With Diverting Loop Ileostomy Vs. Hartmann's Procedure For Acute Diverticulitis: What Happens After Discharge? Results Of A Nationwide Analysis, Arturo J. Rios Diaz, Lisa A. Bevilacqua, Theodore E. Habarth-Morales, Alicja Zalewski, David Metcalfe, Caitlyn Costanzo, Charles J. Yeo, Francesco Palazzo

Department of Surgery Faculty Papers

BACKGROUND: Current guidelines recommend resection with primary anastomosis with diverting loop ileostomy over Hartmann's procedure if deemed safe for acute diverticulitis. The primary objective of the current study was to compare the utilization of these strategies and describe nationwide ostomy closure patterns and readmission outcomes within 1 year of discharge.

METHODS: This was a retrospective, population-based, cohort study of United States Hospitals reporting to the Nationwide Readmissions Database from January 2011 to December 2019. There were 35,774 patients identified undergoing non-elective primary anastomosis with diverting loop ileostomy or Hartmann's procedure for acute diverticulitis. Rates of ostomy closure, unplanned readmissions, and …

Comparison Of Prehospital Finger Thoracostomy And Needle Thoracostomy Performed By Ground Emergency Medical Services, Angelo Ciaraglia, Alison Smith, Benjamin Axtman, Brian Eastridge, Ronald Stewart, Susannah Nicholson, Donald Jenkins

School of Medicine Faculty Publications

Introduction: Tension pneumothorax related to chest trauma is a rapidly lethal condition that requires immediate treatment, often prior to arrival at definitive ca.re. Recent concerns regarding the safety and efficacy of needle thoracostomy (NT) have led to alternatives. Finger thoracostomy (FT) is a potential life-sav­ing treatment performed by prehospital providers as an alternative to NT. We hypothesize that FT has improved rates of prehospital thoracic decompression and is a safe alternative to NT. Materials and Methods: Retrospective cohort study of consecutive adult trauma patients presenting to a Level 1 trauma center who sustained chest trauma. A matched cohort of patients …

A Comparison Of Health Outcomes In Bare-Metal Stenting Versus Drug-Eluting Stenting, Ryan Hill

Senior Theses

Coronary artery disease (CAD) is an epidemic in the United States and around the world, with millions falling victim to CAD and other forms of heart disease annually. There are both many causes and many treatments to these aforementioned heart diseases. Some of these causes and comorbidities include the usual suspects: obesity, diabetes and smoking. However, the component I am more interested in is the multitude of different procedures and technologies that can serve to treat cases of CAD.

The inspiration for choosing the topic of CAD treatment for my senior thesis derives from my interest in the field of …

Decoding Implant-Related Sickness: Unraveling The Complexities Of Breast Implant Illness, Madison M. Stewart

Senior Theses

This thesis investigates the phenomenon of breast implant illness (BII), examining its potential correlation with individual factors such as obesity and poor lifestyle habits. BII, characterized by nonspecific symptoms, is often self-diagnosed by patients influenced by social media and internet sources, leading to requests for implant removal. Conducting a comprehensive meta-analysis, the study scrutinizes existing literature to evaluate the association between BII, obesity, and lifestyle choices. Employing inclusion criteria, peer-reviewed publications are analyzed through systematic review methodology to offer insights into the interplay between BII and adiposity, exploring inflammatory mechanisms and patient behaviors like exercise and smoking. The research aims …

The Association Between Robotic Lung Cancer Resection And Esophagectomy Outcomes: A Facility-Level Analysis, Micaela L. Collins, Gregory L. Whitehorn, Shale J. Mack, Brian M. Till, Hamza Rshaidat, Tyler Grenda, Nathaniel R. Evans Iii, Karen A. Chojnacki, Olugbenga T. Okusanya

Department of Neurosurgery Faculty Papers

Background: Within the field of robotic thoracic surgery, the association between facility surgical volume, conversion rates, and patient outcomes across multiple procedures has not been explored. This study aims to examine the potential association between robotic lung cancer resection surgical volume and conversion rates for robotic-assisted minimally invasive esophagectomy (RAMIE). Methods: A retrospective analysis of the National Cancer Database, between the years 2010–2018 was conducted. Facility-years were categorized into one of four groups based on a combination of robotic lung cancer resection surgical volume and RAMIE volumes. Cutoffs were based on previously identified surgical volume thresholds. Results: A total of …

Close Contacts Of Xenograft Recipients: Ethical Considerations Due To Risk Of Xenozoonosis, Daniel J Hurst, Luz Padilla, Daniel Rodger, Tamar Schiff, David K C Cooper

Rowan-Virtua School of Osteopathic Medicine Departmental Research

With decades of pre-clinical studies culminating in the recent clinical application of xenotransplantation, it would appear timely to provide recommendations for operationalizing oversight of xenotransplantation clinical trials. Ethical issues with clinical xenotransplantation have been described for decades, largely centering on animal welfare, the risks posed to the recipient, and public health risks posed by potential spread of xenozoonosis. Much less attention has been given to considerations relating to potentially elevated risks faced by those who may care for or otherwise have close contact with xenograft recipients. This paper examines the ethical and logistical issues raised by the potential exposure to …

Rebound Intracranial Hypertension, Simy K. Parikh

Department of Jefferson Headache Center Papers and Presentations

PURPOSE OF REVIEW: Rebound intracranial hypertension (RIH) is a post-procedural treatment complication in patients with spontaneous intracranial hypotension (SIH) characterized by transient high-pressure headache symptoms. This article reviews the epidemiology, clinical features, risk factors, and treatment options for RIH.

RECENT FINDINGS: This article discusses how changes in underlying venous pressure and craniospinal elastance can explain symptoms of RIH, idiopathic intracranial hypertension (IIH), and SIH.

SUMMARY: The pathophysiology of RIH provides a clue for how high and low intracranial pressure disorders, such as IIH and SIH, are connected on a shared spectrum.