Surgery Commons^™

Metastatic Colon Cancer And Single Agent Neoadjuvant Immunotherapy: A Single Institution Experience, Jacob Applegarth, Scarlett B. Hao, Claire Bova, Harry Wasvary

Conference Presentation Abstracts

Pembrolizumab was granted accelerated FDA approval for the treatment of patients with metastatic MMR deficient solid tumors and has shown significant benefit in the treatment of metastatic colorectal cancer. Recently, the NICHE-2 trial demonstrated that neoadjuvant nivolumab plus ipilimumab led to a significant response in locally advanced MMR deficient colon cancer. This report is a single institution's experience regarding the treatment of metastatic colon cancer with neoadjuvant immunotherapy. Since 2022, our institution has treated two patients with neoadjuvant pembrolizumab for metastatic colon cancer and achieved complete clinical and pathologic responses with no residual evidence of malignancy.

Impact Of Michigan Public Act 246 On Opioid Prescribing After Pediatric Surgery, Madison Saunders, Nathan Novotny, Anthony Stallion, Begum Akay, Pavan Brahmamdam, Ryan T. Davis

Conference Presentation Abstracts

Abstract: Background: In December 2017, Michigan enacted Public Act 246(P246) to address rising opioid misuse. P246 states that, as of June 1, 2018, a prescriber of a controlled substance must discuss the risks of opioid addiction, overdose, and the dangers of taking opioids with benzodiazepine, alcohol or any other nervous system depressant with the minor and the minor’s parent or guardian. This study aims to evaluate the impact of this legislation by comparing opioid morphine milligram equivalents (MME) prescribed to pediatric patients undergoing common general, urological, and ENT surgeries before and after June 1, 2018. Methods: A single-center, retrospective chart …

Intraoperative Code Status: Moving From Misinformation To Respect For Patient Autonomy, Jacob Applegarth, Jacob M. Morton, Nathan M. Novotny, Ngan Nguyen, Abram Brummett

Conference Presentation Abstracts

Introduction: Intraoperative code status represents a complicated topic for patients and providers. Prior studies demonstrated a lack of understanding of intraoperative code status, specifically do not resuscitate (DNR) orders. This misunderstanding appears common despite clear professional recommendations. A recent survey of surgery residents at our institution showed variability in understanding of intraoperative code status policy despite clear institutional guidelines. Few studies utilized simulated education for surgeons and surgical residents to navigate intraoperative DNR status. This project aims to create a simulation-based program for residents to navigate intraoperative DNR status ethically and to assess its impact on learning, practice patterns and …

Epigastric Hernia Containing Incarcerated Gallbladder, Katelyn R. Ward, Melanie Ermler, Kathryn M. Ziegler

Conference Presentation Abstracts

Introduction: Epigastric hernias represent 1.6–3.6% of all abdominal hernias, and usually contain preperitoneal fat and occasionally omentum or small bowel. Rarely, epigastric hernias may contain portions of other organs, such as colon or stomach. We report an unusual case of a patient whose incarcerated epigastric hernia contained her stone-filled gallbladder.over a million performed in the US, and over 20 million worldwide annually. We aim to study and compare interest trends in the US and the World for IHR techniques (open, laparoscopic, robotic) using GT. Methods: The following search topics were analyzed from January 2010 to August 2024 in ‘‘US’’ and …

Left Behind: A Rare Case Of True Gallbladder Sinistroposition And Surgical Implications, Daniel Finn, Jacob Applegarth, Jacob Mesiti, Mario Villalba

Conference Presentation Abstracts

Objectives: Encountering aberrant biliary anatomy is a known risk factor for inadvertent injury while performing biliary surgery. One described anatomic aberrancy, sinistroposition of the gallbladder (also known as ‘‘left sided gallbladder’’), is a rarely seen anatomic abnormality with an incidence of 0.2% to 1.1%. Given the infrequent encounters with this abnormality and its association with other anatomic anomalies, extreme care and caution should be exercised when performing a cholecystectomy in this patient population. Methods: We present the case of a 37-year-old male who presented with abdominal pain and was diagnosed with Tokyo Grade I acute calculous cholecystitis. An ultrasound of …

Examining The Influence Of The General Surgery Resident Colorectal Experience On The Pursuit Of Colorectal Surgery Fellowship, Adam D. Price, Bilal W. Nasim, Frances Hu, Desmond Layne, Robyn Richmond, Zachary E. Hier, Antonela Muca, Alexander R. Cortez, Jonathan Abelson, Jitesh A. Patel

Conference Presentation Abstracts

Purpose/Background: Colon and Rectal Surgery (CRS) is a highly sought after and competitive fellowship following General Surgery (GS) residency. However, it has not been studied as to how a resident’s CRS experience during residency impacts their career choice and pursuit of CRS. This study aims to identify individual and program factors associated with matriculation into CRS fellowship. Methods/Interventions: An analysis of case logs and demographic data from graduates of 19 ACGME-accredited GS residency programs between 2010-2020 was completed utilizing the US Resident OPerative Experience (ROPE) Consortium. The demographics and operative experience of residents who pursued CRS fellowship were compared to …

Insights From Targeted Fecal Metabolomic Analysis Reveal Altered Metabolic Pathways In Treatment-Naive Pediatric Subjects With Crohn's Disease, Nadia Ashrafi, Ali Yilmaz, Nicolette Monacelli, Rose E. Callahan, Ilyas Ustun, Nathan M. Novotny, J W. Rattray, Kypros Nicolaides, Stewart Graham

Conference Presentation Abstracts

Crohn’s disease (CD) is a heterogeneous and multifactorial inflammatory bowel disease with a significant global health impact. Genetic and lifestyle factors contribute to its etiology, emphasizing dysregulation of intestinal and dietary habits. Our study aimed to identify fecal metabolites from treatment-naïve, pediatric sufferers of CD, which allowed us to investigate the underlying biochemical perturbations associated with the disease, highlighting potential, translational targets. Using a Waters Acquity UPLC coupled with a Xevo-TQ-S mass spectrometer, we quantified >500 metabolites in fecal samples (n=72) of pediatric CD sufferers. We developed diagnostic tests capable of accurately discriminating between children with CD and healthy individuals …

A Comparison Of Post-Operative Pain Management Following Lumbar Laminectomy Fusions Utilizing Tlip Or Intra-Operative Local Anesthesia Block, Lauren Eberhardt, Philip Zakko, Karen Childers, Daniel Park

Conference Presentation Abstracts

Background/Introduction: Spinal fusion patients suffer significant acute post-operative pain, potentially leading to chronic pain. Opioids are commonly used for peri-operative pain management despite significant side effects. The thoracolumbar interfascial plane (TLIP) and erector spinae plane (ESP) block, alternative analgesic options with rare side effects, have proven to reduce pain and opioid consumption compared to standard non-block care. This study aimed to determine if a significant difference exists between block groups with multi- and single level laminectomy fusions in post-operative and discharge opioid consumption and length of stay. Materials/Methods: A retrospective review was performed via data query for lumbar laminectomy fusion …

Improving Diversity, Equity, And Inclusion In Pediatric Surgery: An Innovative Mentorship Program, Amelia E. Gavulic, Insiyah Campwala, Natalie Moreno, Grace M. Mallampalli, Yousef Ibrahim, Anthony Stallion, Sabina Siddiqui, Marjorie J. Arca, Samir K. Gadepalli, Erika A. Newman

Conference Presentation Abstracts

Abstract: Purpose: Representation among pediatric surgeons does not reflect the pediatric patient population. In line with the Association of Pediatric Surgery Training Program Directors (APSTPD)’s mission to broaden cognitive diversity and representation in the workforce via leadership development and longitudinal mentorship, the Alliance of Pediatric Surgeons Growing and Advancing Representation (APGAR) was created with national collaboration. One year later, we report on the composition of APGAR and the perspectives of its members. Methods: Seventeen mentorship groups (“pods”) were formally established with representatives from each premedical learner level from high school students to pediatric surgery fellows and attendings. Pods were led …

Assessing The Diagnostic Accuracy Of Ti-Rads In Pediatric Thyroid Nodules: A Multi-Instutional Review, Shachi Srivatsa, Ameer Al-Hadidi, Joseph R. Stanek, Kyle Horvath, Lauren N. Parsons, Claudia Martinez-Rios, Amanda Hopp, Samuel Engle, Matthew Plunk, Gail Shapira-Zaltsberg, Sapna Nagar, Sean E. Masters, Sayf Al-Katib, Rennard B. Tucker, Lamya Atwah, Summit Shah, Adam Bobbey, Robert Hoffman, Jennifer H. Aldrink

Conference Presentation Abstracts

Abstract: Purpose: Thyroid nodules are uncommon in children and adolescents but carry an increased risk of malignancy when present. The Thyroid Imaging Reporting and Data System (TI-RADS) is an adult-validated ultrasound-based risk assessment providing a prediction of malignant potential for thyroid nodules, thereby guiding recommendations for fine needle aspiration biopsy (FNAB). Minimal data exist regarding the applicability of TI-RADS to predict malignancy in pediatric thyroid nodules. This study aims to analyze the performance of TI-RADS for children and adolescents with thyroid nodules, hypothesizing that applying TI-RADS criteria would improve accuracy and reduce the number of recommended FNAB compared to American …

Anterior Cervical Discectomy And Fusion After Presentation To The Acute Care Setting: A Comparison Of Post-Operative Outcomes, Alex Miller, James Whaley, Daniel Park

Conference Presentation Abstracts

Introduction: For patients presenting with cervical radiculopathy or cervical myelopathy, surgical treatment is typically pursued after discussion in the outpatient setting. Yet, there exists a group of patients presenting to the acute care setting with intractable pain or progressive neurologic deficits who are indicated for operative treatment outside of outpatient evaluation. Given the differences in initial management and pre-operative optimization, it is unclear if surgical and post-operative outcomes differ between these populations. Materials and Methods: This was a retrospective cohort study from an academic medical center. Surgical case logs from the institution’s electronic medical record were used to identify patients …

Laparoscopic Repair Of Pediatric Femoral Hernias: A Scoping Review, Alex Chen, Spencer Wilhelm, Michael Sobolic, Begum Akay, Pavan Brahmamdam, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Biportal Endoscopic Spine Surgery For Lumbar Laminectomy And Discectomy: Post-Operative Outcomes And Surgical Learning Curve, Matthew Lipphardt, Philip Zakko, Ali Jawad, Daniel Park, Maximillian Lee

Conference Presentation Abstracts

Background/Introduction

Biportal endoscopic spine surgery (BESS) is a minimally invasive spinal surgery which has gained increased traction for lumbar laminectomy and discectomy. To justify the transition from tubular or open surgery to BESS, BESS outcomes and surgical learning curve should be known. The primary goal of this study is to evaluate rates of complications with BESS as well as how these rates change with increased surgeon experience, especially in the US environment.

Materials/Methods

A United States Fellowship trained orthopaedic surgeon's clinical practice database was interrogated for consecutive patients who underwent BESS at a single institution. Patients aged greater than 18 …

Osteoporosis Is Underdiagnosed And Undertreated In Patients With Fragility Femoral Neck And Vertebral Compression Fractures, Philip Zakko, Lauren Eberhardt, Madeline Declercq, Ahyoung Park, Megan Audet, Daniel Park

Conference Presentation Abstracts

Background/Introduction

Femoral neck (FNF) and vertebral compression fractures (VCF) are common fragility fractures (FF) in the elderly population. Defined as fractures from low-energy trauma, FF are diagnostic of osteoporosis and require treatment. The purpose of this study was to assess whether patients were appropriately diagnosed and treated for osteoporosis following fragility FNF and VCF.

Materials/Methods

A retrospective chart review was performed at a single-institution from 1/1/2017 to 12/31/2020 on consecutive patients who sustained fragility FNF treated with closed reduction percutaneous pinning, hemiarthroplasty, or total hip arthroplasty or VCF treated with kyphoplasty. Patients <50 years of age, who sustained a high-energy or a non-osteoporotic pathologic fracture, were treated non-operatively, or deceased within one-year post-op were excluded. Preoperative demographics, ASA, CCI, smoking, alcohol, and glucocorticoid use were obtained. Diagnosis and treatment of osteoporosis, including dual-energy X-ray absorptiometry (DEXA) scans, calcium, vitamin D, bisphosphonates, denosumab, and alternative treatments (teriparatide, calcitonin, raloxifene, estrogen) were assessed pre-op and within one-year post-op. Subsequent FF were recorded.

Results

Of 593 patients, 276 FNF and 94 …

A Retrospective Evaluation Of External Rotation At 0 Degree And 90 Degrees Of Abduction After Atrhoscopic Latarjet Procedure, Michael E. Bodine, Shariff K. Bishai, Guy Ball, Cameron King, Lydia Wait, Grace Brannan

Conference Presentation Abstracts

BACKGROUND: Several papers have shown that shoulder stabilizing procedures, including the Latarjet procedure, lead to postoperative external rotation (ER) deficits. However, no study on arthroscopic Latarjet procedures has investigated the effect on ER when the arm is abducted at 0° and 90°. This study examined the relationship between the arthroscopic Latarjet procedure and the subsequent effect on external rotation at both 0° and 90° of abduction compared to the contralateral extremity. METHODS: Records of patients who underwent an arthroscopic Latarjet Procedure from December 2015 to April 2021 were retrospectively evaluated for this study. Requirements included both a three- and six-month …

Public Perception Of Robotic-Assisted Total Hip Replacement Surgery, James E. Feng, Marvee Espiritu, Phillip Vartanyan, Drew Moore, Robert Runner, Mark Karadsheh

Conference Presentation Abstracts

PURPOSE: Computer-assisted and robotic (CA/R) total hip arthroplasty (THA) has gained considerable attention due to its superior accuracy and precision. However, few studies have evaluated the public’s understanding and appraisal of this technology. Here, we evaluate the public’s initial perception of technology-assisted compared to traditional THA, and if interactive education may alter an individual’s preferences. MATERIALS & METHODS: A prospective cohort study was developed utilizing a 48-question, paid survey distributed via a clinically validated, public, online marketplace in April 2022. After collecting baseline demographics and knowledge regarding THA, participants were queried whether they would prefer a CA/R THA or traditional …

Eliminating Barriers To Prosthetic Use Following Lower Extremity Amputation, Matthew Laskovy, Graham Long, Samuel Osei, Jonathon Murdock, Diane Studzinski, Rose E. Callahan, Otto W. Brown

Conference Presentation Abstracts

OBJECTIVES: Approximately 60,000 lower extremity amputations (LEA) are performed annually in the United States and 38%-55% of those individuals are fitted for a prosthesis. The average price of a lower extremity prosthetic device alone is $10,000, not including the associated costs of physical therapy and prosthetic fitting and maintenance. The most important factor influencing quality of life for individuals who have undergone LEA is the ability to ambulate with a prosthesis. The goal of our study was to investigate characteristics of individuals who abandon use of their prosthesis following LEA and identify any modifiable factors that may increase long-term successful …

Assessing General Vs. Spinal Anesthesia As A Risk Factor For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: As bundle payment care initiatives become ever prevalent in total knee arthroplasty (TKA), institutions have increasingly focused on cost-saving measures which maintain or improve upon the standard of care. One area of interest is identifying potential modifiable and non-modifiable risk factors. Here we evaluate the correlations of general versus spinal anesthesia in TKAs in perioperative outcomes. METHODS: All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data includes baseline demographics, select medical comorbidities, intraoperative variables and postoperative course/complications. Patients were separated into two …

Pedicle Screw-Associated Violation Of The Adjacent Unfused Facet Joint: Clinical Outcomes And Fusion Rates, Nathan J. Sinz, David Hanwuk Kim, Raymond W. Hwang, Gyu-Ho Lee, Kevin Charles Baker, Rick C. Sasso, Daniel K. Park, Jeffrey S. Fischgrund, Ruijia Niu

Conference Presentation Abstracts

INTRODUCTION: Lumbar spine pedicle screws are the most commonly utilized implants for providing immediate spinal stability during fusion surgery. Ideal pedicle screw positioning includes avoiding violation of any adjacent unfused facet joints. Nevertheless, inadvertent screw malposition and screw-associated violation of adjacent facet joints (FJV) remains a potential complication of the procedure regardless of whether surgery is performed in open fashion or with minimally invasive techniques and despite the use of intraoperative imaging or surgical navigation. Given the proximity of the lumbar vertebral pedicle to the proximal facet joint, FJV occurs almost exclusively at the level of the proximal as opposed …

Analysis Of The Effects Of Intraoperative Neurophysiological Monitoring On Anterior Cervical Surgery: A Michigan Spine Surgery Improvement Collaborative (Mssic) Study, Conner D. Ahlgren, Philip Zakko, Andrew Zachary Blankenship, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: The utility of intraoperative neurophysiological monitoring (IOM) for anterior cervical surgery remains controversial. Despite insufficient evidence demonstrating a clear benefit, IOM continues to be utilized and in some areas is considered standard of care. The aim of this study was to evaluate the effects of IOM on anterior cervical surgery outcomes by utilizing data from the Michigan Spine Surgery Improvement collaborative. METHODS: Anterior cervical surgeries from February 2014 to November 2019 were included for analysis. IOM (EMG, MMG, SSEPs, or MEP) was the primary variable examined. Primary outcome measures were: new weakness after surgery, new radicular symptoms, return to …

Shorter Length Of Stay And Increased Return To Work With Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy And Fusion, Philip Zakko, Alex Miller, Daniel K. Park, Jad Khalil

Conference Presentation Abstracts

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are established surgical options for the treatment of cervical radiculopathy, myelopathy, and cervical degenerative disc disease. However, current literature does not demonstrate a clear benefit between ACDF or CDA. The primary objective of this study is to compare the outcomes of ACDF and CDA for patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. Secondary objectives include assessment of early complications, procedural/perioperative outcomes, and patient-reported outcome measures after both ACDF and CDA. METHODS: Patients undergoing 1 or 2 level ACDF or CDA surgery were included. A …

Assessing Public Reported Perceptions Of Hand Surgery Provided In The Office Vs. An Ambulatory Surgery Center, Trevor Tooley, James Feng, Jannat Khan, Paul Scott Shapiro

Conference Presentation Abstracts

INTRODUCTION: There is a growing body of literature supporting the efficacy, safety, and benefits of wide awake office-based low risk hand surgery. Procedures such as a carpal tunnel release are now, under the right clinical circumstances, being performed in the office-setting as opposed to a traditional operating room. While there is growing evidence supporting technique, procedure room setup, and cost analyses of office-based surgery, there is little investigation into the public perceptions of having surgery done in the office. Here we sought to evaluate public perceptions of undergoing low risk hand surgery in the office setting. METHODS: A prospective survey …

Assessing Risk Factors For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, Phil Vartanyan, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: With the increasing adoption of value-based healthcare initiatives in total knee arthroplasty (TKA), a greater emphasis has been placed on implementing cost-saving measures while maintaining or improving quality of care. One area of interest has been postoperative ED visits. Here we evaluate potential risk factors for 90-day ED visits. METHODS: This is a case control study from a large, tertiary, private, academic institution. All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. All patient charts were subsequently verified and reviewed for all-cause 90-day ED …

Responsive Neurostimulation (Rns) Of The Centromedian Nucleus Of The Thalamus For The Treatment Of Drug Resistant Idiopathic Generalized Epilepsy, Angelique Manasseh, Hannah Guider, Brooklynn Bondy, Ayman Haykal, Nour Baki, Ashleigh Terrell, Michael Staudt, Christopher Parres, Andrew Zillgitt

Conference Presentation Abstracts

Rationale: Idiopathic generalized epilepsy (IGE) accounts for approximately one-third of all epilepsies. The majority of people with IGE achieve seizure-freedom from treatment with anti-seizure medications (ASM). However, up to 25% of people with IGE continue to experience seizures despite adequate ASM trials. In patients with drug resistant IGE, neuromodulation with responsive neurostimulation (RNS) in the bilateral centromedian nucleus (CMN) of the thalamus may be an effective treatment option. Methods: Five patients with drug resistant IGE were evaluated through the Beaumont Adult Comprehensive Epilepsy Center and underwent an epilepsy presurgical evaluation including video-EEG monitoring in the epilepsy monitoring unit, brain MRI, …

Obstetric Complications And Wellbeing Among Us Surgical Residents, Ruojia Li, Joshua Eng, Darci C. Foote, Christine Wu, Julie Johnson, Sarah Easter, Karl Bilimoria, Yue-Yung Hu, Erika Rangel

Conference Presentation Abstracts

No abstract provided.

The Competitive Edge: Improving Absite Scores Through A Team-Based Approach, Sean Masters, Kathryn Howard, Darci Foote, Diane Studzinski, Rose E. Callahan, Felicia Ivascu, Begum Akay

Conference Presentation Abstracts

Introduction: A competitive team-based approach to encourage self-studying and didactic participation is a novel method of American Board of Surgery In-Training Examination (ABSITE) preparation. We aimed to determine if this method significantly improves residents’ percentile performances on the ABSITE. Methods: We reviewed ABSITE performance and preparation from general surgery residents for the last ten years. Percentile scores were compared before and after implementation of a purchased online question bank (TrueLearn LLC, Mooresville, NC), a team-based competition, and a virtual format of the team-based competition. Statistical analysis was performed with ANOVA Kruskal-Wallis and Mann Whitney tests where appropriate. Results: 378 ABSITE …

Let Them Play: A Prospective Study Of Postoperative Activity Restrictions In Children, Rachel Harvey, Diane Studzinsk, Angela England, Robert Morden, Nathan M. Novotny, Anthony Stallion, Begum Akay

Conference Presentation Abstracts

No abstract provided.

How Program Directors Understand General Surgery Resident Wellness, Darci C. Foote, Julie Evans, Tedi Engler, Alisha Lussiez

Conference Presentation Abstracts

No abstract provided.

Resident Labor Unions: A Mechanism For Agency Or Conflict, Darci C. Foote, Daniela Amórtegui, Carlos Diaz, Brian Brajcich, Karl Y. Bilimoria, Yue-Yung Hu, Julie K. Johnson

Conference Presentation Abstracts

No abstract provided.

The Impact Of Contact Sports: A Marker Of Grit Among General Surgery Residents, Darci C. Foote, John N. Donkersloot, Bridger Rodoni, Samantha Baker, Niki Matusko, Quintin Solano

Conference Presentation Abstracts

No abstract provided.