Surgery Commons^™

Association Between Multimorbidity And Postoperative Mortality In Patients Undergoing Major Surgery: A Prospective Study In 29 Countries Across Europe, Starsurg Collaborative, Eurosurg Collaborative

Department of Surgery Faculty Publications

Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. Methods This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery. Results Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more …

High-Grade Liver Injuries With Contrast Extravasation Managed Initially With Interventional Radiology Versus Observation: A Secondary Analysis Of A Wta Multicenter Study, Negaar Aryan, Areg Grigorian, Erika Tay-Lasso, Michael Cripps, Heather Carmichael, Robert Mcintyre, Shane Urban, Catherine Velopulos, Clay Cothren Burlew, Shana Ballow, Rachel C. Dirks, Aimee Lariccia, Michael S. Farrell, Deborah M. Stein, Michael S. Truitt, Heather M. Grossman Verner, Caleb J. Mentzer, T. J. Mack, Chad G. Ball, Kaushik Mukherjee, Georgi Mladenov, Daniel J. Haase, Hossam Abdou, Thomas J. Schroeppel, Jennifer Rodriquez, Miklosh Bala, Natasha Keric, Morgan Crigger, Navpreet K. Dhillon, Eric J. Ley, Tanya Egodage, John Williamson, Tatiana Cp Cardenas, Vadine Eugene, Kumash Patel, Kristen Costello, Stephanie Bonne, Fatima S. Elgammal, Warren Dorlac, Claire Pederson, Nicole L. Werner, James M. Haan, Kelly Lightwine, Gregory Semon, Kristen Spoor, Laura A. Harmon, Jason M. Samuels, M. C. Spalding, Jeffry Nahmias

Department of Surgery Faculty Publications

Background: High-grade liver injuries with extravasation (HGLI + Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI + Extrav. Therefore, we evaluated the management of HGLI + Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. Methods: HGLI + Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. Results: From 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) …

In-Hospital Risk Factors For Reintervention And Amputation In Brachial Arterial Trauma, Aast Proovit Study Group, Justin M. Robbins, Corinna Crayton, Isaac Koloditch, Casey Walk, Limayre Gramajo, Samantha Shugar, Peter Ekeh, Joseph Dubose, Yee Wong, Cathline Layba

Department of Surgery Faculty Publications

Introduction: Brachial artery trauma is a rare but potentially devastating injury. There is little data regarding risk factors for reintervention and amputation prevention in this population, as well as anticoagulant (AC) and antiplatelet (AP) regimens and outcomes after discharge in trauma patients with vascular injuries requiring repair. This study aims to identify in-hospital risk factors for reintervention and amputation and stratify outcomes of follow-up by discharge AC or AP regimen. Methods: The AAST Prospective Observational Vascular Injury Trial database was queried for all patients who underwent traumatic brachial arterial repair from 2013 to 2022. Patients were evaluated by need for …

A Prognostic Model For Use Before Elective Surgery To Estimate The Risk Of Postoperative Pulmonary Complications (Gsu-Pulmonary Score), Nihr Global Health Research Unit On Global Surgery, Starsurg Collaborative

Department of Surgery Faculty Publications

Background: Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery. Methods: Data from an international, prospective cohort study were used to develop a novel prognostic risk model for pulmonary complications after elective surgery in adult patients (aged ≥18 years) across all operation and disease types. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery, which was a …

Resident Perspectives On The Value Of Rural General Surgery Rotations: It's Not Just About The Cases, Dorothy Hughes, Rebekah Wood, Randy Woods, Michael Sarap

Department of Surgery Faculty Publications

Purpose: Understand the scope of cases that residents participate in during rural general surgery rotations and the value residents and program directors find in such rotations. In turn, our goal is to add to the ongoing conversation the value exposure to rural surgery brings to surgery training. Methods: Qualitative study analyzed reviews of residents' self-reported case lists and field notes from exit interviews with the site director. Results: Trainees participated in an average of 105 cases during the rotation, including basic and advanced endoscopy along with exposure to a wide array of surgical cases. Residents had exposure to the rural …

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 …

The Impact Of Surgical Delay On Resectability Of Colorectal Cancer: An International Prospective Cohort Study, Covidsurg Collaborative

Department of Surgery Faculty Publications

Aim: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in …

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.

Effect Of Covid-19 Pandemic Lockdowns On Planned Cancer Surgery For 15 Tumour Types In 61 Countries: An International Prospective, Cohort Study, Covidsurg Collaborative

Department of Surgery Faculty Publications

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national …

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 …

Holding Traction During Ct: Simple Tricks To Maintain Reduction In The Lower Extremity, Garrhett G. Via, David A. Brueggeman, Alexander Chase, Jennifer L. Jerele, Kyle S. Mobley

Medical Student Research Symposium Abstracts and Posters

Traction is one of the pillars of orthopaedic injury management, as it can provide both temporizing and definitive treatment for anatomic malalignment associated with joint dislocations and fractures. In the realm of modern orthopaedic care, post-traction imaging provides the surgeon with information about resting fracture position and the overall effects of traction that are critical to preoperative planning. However, there are often circumstances in which an orthopaedic surgery provider is faced with the discrepancy between the proper sequence of orthopaedic care and the need for emergent, advanced imaging to evaluate other organ systems. In other words, they are often forced …

The Role Of Implantable Cardioverter Defibrillators For The Prevention Of Ventricular Arrhythmia In Left Ventricular Assist Device Recipients, Nikhil Reddy, Cristina Ortiz, Toshimasa Okabe, Muhammad Afzal, Mohamed H. Derbala, Asvin Ganapathi, Sakima Smith

Medical Student Research Symposium Abstracts and Posters

Advanced heart failure represents a significant strain on our health care system and is associated with increased morbidity and mortality. New device therapies, including left ventricular assist device (LVAD) implantation, have transformed management as both a destination therapy and as a bridge to transplantation. Although LVADs have improved patient outcomes, arrhythmias represent a significant and costly complication of this therapy. In recent years, implantable cardioverter-defibrillators (ICDs) have been developed to reduce the incidence of lethal arrhythmia. However, a gap in the literature exists for both guidelines in prevention of early ventricular arrhythmia (VA) in LVAD recipients and the effectiveness of …

Is Microscopic Colitis Associated With Increased Risk For Other Gastrointestinal Diseases?, Tanner Graves, Paul Koles

Medical Student Research Symposium Abstracts and Posters

Microscopic colitis is clinically suspected in patients with recurrent watery diarrhea and the absence of gross pathologic changes in the colon by endoscopic examination. The diagnosis is established only by microscopic evaluation of colonic biopsies. Microscopic colitis is currently classified into three subgroups: collagenous colitis (CC), lymphocytic colitis (LC), and combined CC and LC. The incidence rates are 4.14 per 100,000 person-years and 4.85 per 100,000 person-years for CC and LC, respectfully.

Diagnosis is typically made without measuring the exact thickness of the subepithelial collagen band or by counting the number of lymphocytes in the epithelium. There is little research …

Fluorescence-Guided Surgical Debridement Of Chronic Osteomyelitis Utilizing Doxycycline Bone Labeling: A Technical Trick Revived, Garrhett G. Via, David A. Brueggeman, Grant M. Slack, James M. Danias, Jennifer L. Jerele

Medical Student Research Symposium Abstracts and Posters

The present manuscript discusses the concept of fluorescence-guided surgical debridement of chronic osteomyelitis in the orthopaedic patient based upon a two-fold mechanism, natural fluorescence of healthy bone combined with bone labeling by tetracyclines. The senior author prefers preoperative administration of oral doxycycline 100 mg twice daily for at least 1 month. The excitation source of choice is an ordinary blacklight, as this is both cost-effective and readily attainable. Intraoperatively, viable bone is noted to fluoresce a greenish hue which is then used to guide the debridement. Previous studies have demonstrated that bleeding bone is not a reliable indicator of a …

Local Wound Infiltration With Liposomal Bupivacaine Decreases Post-Cesarean Pain Scores, Avni Gupta, Justin Williams, Rose A. Maxwell, Marilyn Kindig

Medical Student Research Symposium Abstracts and Posters

Surgical patients are routinely prescribed opioid analgesics that are strongly associated with drug overdose deaths. Liposomal bupivacaine is a long-acting local anesthetic that received FDA approval in 2011 for local surgical site infiltration to promote post-operative analgesia. This anesthetic has demonstrated an improvement in post-operative pain control in various surgical realms, indicating a decreased need for opiates and subsequently decreased risks. However, few studies have investigated its use at the time of cesarean delivery.

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, …

Publication Status Of Unpublished Research Manuscripts On Orthopaedic Surgery Residency Applications After 30 Months, J. T. Barnes

Scholarship in Medicine - All Papers

Objectives: The orthopaedic surgery residency applicant class of 2016 had a nationwide match rate of 67.8%. This institution received 573 applications for four residency spots. As orthopaedic surgery residency becomes more competitive, so does the drive among applicants to improve their residency applications. Research experience, in particular, is becoming an increasingly common component of applications. Previous research has demonstrated that the requirement for a PubMed Identification number on all published citations on residency applications since 2014 has led to a drastic decrease in misrepresentation of published research. While publication is the ultimate goal of most research projects, not all manuscripts …

Outcomes And Complications Of Scfe Surgery, Tyler Sanda

Scholarship in Medicine - All Papers

Objective: Slipped capital femoral epiphysis (SCFE) is a common hip disorder affecting children and adolescents. There is much debate concerning best treatment with regards to adverse outcomes, specifically avascular necrosis (AVN). This study analyzed the rates of adverse outcomes after the surgical treatment of SCFEs. It examined risk factors which may lead to the development adverse outcomes. This research will aid clinical decision-making, helping determine optimal surgical treatment of SCFEs and adding to external datasets of SCFE treatment.

Methods: This was a retrospective review of patient health records at a level 2 pediatric trauma hospital. The study included all SCFE …

Determining The Appropriate Technique For Appendix Stump Closure, Cynthia White

Scholarship in Medicine - All Papers

Background In a laparoscopic appendectomy, closure of the appendeceal stump can be done using an endostapler or endoloop. We compared outcome data of the two techniques in patients who underwent laparoscopic appendectomy.

Method We included all patient > 18 years who underwent laparoscopic appendectomy for acute appendicitis at a single institution over a 4-year period. Demographic and outcome data were compared between both groups. Results 501 patients, with no significant differences in age, gender or BMI, were identified for the study. No differences were noted in procedure length, readmission rates, complication rates (including intra-abdominal abscess) or hospital charges. There was a …

Outcomes And Management Approaches Of Resuscitative Endovascular Balloon Occlusion Of The Aorta Based On The Income Of Countries, Ramiro Manzano-Nunez, David Mcgreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Aast-Aorta Investigators And The Abotrauma Registry Group

Department of Surgery Faculty Publications

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and …

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 …

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 …

Department Of Surgery Update, August 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Department Of Surgery Update, March 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Department Of Surgery Update, March 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Department Of Surgery Update, February 2018, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.

Department Of Surgery Update, October 2017, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.