Medical Specialties Commons^™

High Flow Nasal Cannula In The Surgical Patient, Morta Lapkus, Paras Khandhar

Articles

No matter how much they want it, airway management and the decision to place a surgical patient on a ventilator should not just be for the PICU physicians to decide. The type of ventilation a patient receives can affect the surgical patient both positively and negatively. Could High Flow Nasal Cannula in the surgical patient be beneficial? Imagine a patient with an esophageal anastomosis that is extubated to CPAP. Now imagine the tears that would flow from the surgeon when they discover bilateral pneumothoraces and a blown-out anastomosis. Tragic. Therefore, we must weigh the risks and benefits of intubation versus …

Post-Op Day 1 Fever Is Never Atelectasis, Elizabeth Boudiab, Paras Khandhar

Articles

Postop day 1 fever is never atelectasis. It has been blamed for decades while even the latest editions of surgical textbooks disseminate this myth1. Whilst both fever and atelectasis are extraordinarily common after surgery – occurring in up to 40% and 90% of patients, respectively2 this is NOT the cause on Day 1. It is time that we exonerate this myth.

Postop day 1 fever is never atelectasis, it is due to inflammation and trauma of surgery. The concept that atelectasis was causing fever was derived principally from a study showing that alveolar macrophages sampled from an atelectatic rat lung …

Trends, Survival Outcomes, And Predictors Of Non-Adherence To Mastectomy Guidelines For Non-Metastatic Inflammatory Breast Cancer: Stage-Stratified Propensity Scoring Analysis Of Ncdb, Mohamad Sebai, Patrick Karabon, David Lee, Sayee Kiran, Nayana Dekhne

Articles

Background/Objective: Current National Comprehensive Cancer Network (NCCN) guidelines recommend modified radical mastectomy (MRM) as the surgical treatment of choice for nonmetastatic inflammatory breast cancer (IBC). Using data from the National Cancer Database (NCDB), our study compared the national trends and outcomes of breast-conserving surgery (BCS) vs. MRM for the treatment of IBC. Methods: NCDB data from 2004 to 2014 were retrospectively analyzed. Patients’ demographics, tumor characteristics, and overall mortality (OM) trends were compared between BCS and MRM cases of IBC. Univariate, multivariate, and propensity score weighted analyses were done to compare study groups and build a predictive model for undergoing …

National Trends For Intra-Operative Radiation Therapy In Favorable, Early-Stage Breast Cancer: A Propensity Scoring Analysis Of The National Cancer Database, Mohamad Sebai, Muayad F. Almahariq, Joshua Dilworth, Patrick Karabon, Rachel Kalthoff, Sayee Kiran, Jayant Vaidya, Kyle J Feldmann, Nayan Dekhne

Articles

No abstract provided.

Gender Differences And Survival Outcomes In Breast Cancer Patients: Stage Stratified Propensity Scoring Analysis Of The National Cancer Database, M Sebai, Pe Karabon, T Luan, S Kiran, N Dekhne

Articles

Background: There is limited research examining breast cancer gender differences. This study compares the trends and survival outcomes over the years between male (MBC) and female (FBC) breast cancer patients using the National Cancer Database (NCDB). Methods: We retrospectively analyzed the NCDB registry for MBC and FBC cases diagnosed between 2004 and 2014. Patient demographics, tumor characteristics, overall mortality (OM), and trends were compared between MBC and FBC Patients. Univariate, multivariate, and propensity score weighted analyses were done to compare MBC and FBC. Results: 19,488 MBC patients (0.9%) and 2,138,730 FBC patients (99.1%) were identified. Median follow-up was 59.63 months. …

High Lymph Node Positive To Sampled Ratio As A Potential Indication For Postoperative Radiation Therapy In Patients With Pn2 Non-Small-Cell Lung Cancer, Nikhil P Mankuzhy, Muayad F Almahariq, Craig W Stevens, Thomas J Quinn

Articles

Background: The role for postoperative radiation therapy (PORT) for patients with non–small-cell lung cancer (NSCLC) with mediastinal lymph node (LN) involvement (pN2 disease) is controversial. We performed a SEER analysis comparing surgery alone with PORT among patients with pN2 NSCLC. As we await the final results of the LUNG ART trial, a subset of patients with a high LN positive to sampled (LPR) ratio may benefit from PORT. Patients/methods: Patients with pN2 NSCLC, ranging from 1989-2016, were assessed from the Surveillance, Epidemiology and End Results (SEER) database. A propensity score (PS)-matched, inverse probability of treatment weighting (IPTW) analysis was conducted …

Aortic Valve Calcium Score Indexed To Transaortic Valve Gradient: A Novel Hemodynamic And Anatomic Index For Patients With Low Gradient Aortic Stenosis., Ramy Mando, George S Hanzel, Francis Shannon, Ashish Chaddha, Craig Tucker, Michael Gallagher, Robert D Safian, Amr E Abbas

Conference Presentation Abstracts

Background Aortic valve calcium score (AVCS) is a marker for aortic stenosis (AS) severity. We sought to evaluate the effect of aortic valve (AV) variables of flow defined by stroke volume index (SVI), area (AVA), and gradient (MG) on AVCS and study the role of AVCS/MG ratio in patients with low gradient AS.

Methods We retrospectively studied patients undergoing transcatheter aortic valve replacement (TAVR) for severe AS (defined by Echo, Cath, and multimodality team consensus) at our institution from January 1, 2014 through September 1, 2018. AVCS was compared among patient groups defined by their MG (low < or high ≥40 mmHg), echocardiographic SVI (low < or normal ≥35 mL/m2), and AVA (< 0.8 or ≥0.8 cm2) using a three-way factorial ANOVA. The AVCS/MG ratio was developed and compared to AVCS and AVCS/cm2 (annular area) to identify severe AS in patients with low gradient. AVCS/MG was developed based on AVSC (AU) 2000 in males, and 1600 in females/ 40 mmHg (50 and 30, retrospectively)

Results Our analysis …

A265 Lymphocytic Esophagitis: A Single Tertiary Center’S Experience With This Emerging Clinical Entity., C Shams, M Co, M Cappell

Conference Presentation Abstracts

Background: Various disorders can produce esophagitis. Lymphocytic esophagitis (LE) has emerged as another clinical entity responsible for esophagitis symptoms. Although increasingly reported pathologically, the clinical characteristics of LE have not been well characterized. Aims: The present study extends the clinicopathologic characterization of LE by comprehensive analysis of 30 affected patients and identifies specific clinical presentations significantly associated with LE. Methods: Thirty patients were identified from January 2000-December 2016 that satisfied diagnostic criteria for LE by lower esophageal biopsy; (1) high concentration of intraepithelial lymphocytes and (2) few granulocytes (ratio of lymphocytes:granulocytes >50:1). Controls, selected from patients undergoing esophagogastroduodenoscopy (EGD) during …

Caring For The Care‐Giver: Debriefing Following Intra‐Operative Death, Roy Soto, Julie Kado, Bryan Kerner, Paul O’Leary, Gerald Rosen

Articles

Introduction: Intraoperative death affects a team of individuals, each with different levels of training and experience. Although briefings, time-outs, and debriefings have been well described, it is unclear how often they occur following intraoperative catastrophic events. We utilized an electronic survey to assess the frequency and potential utility of a formal debriefing process following the intraoperative death of a patient, and discuss our findings in light of the mental well-being of perioperative medical personnel. Methods:A 19 question electronic survey was distributed to primary operating room staff in two hospital systems. The survey was designed to identify which OR staff members …