Surgery Commons^™

Zero Tolerance – Mitigating The Opioid Epidemic Amongst Minimally Invasive Urologic Patients, Daniella Wong, Thenappan Chandrasekar, Md, Costas Lallas, Md

Phase 1

Introduction: Opioids are routinely prescribed following minimally invasive surgery (MIS), yet the majority of medication remains unused. However, the literature is lacking evidence for non-narcotic analgesia in MIS urologic procedures. The purpose of this study is to evaluate the efficacy of a non-narcotic postoperative pain management regimen in reducing opioid use following MIS urologic procedures.

Methods: In this prospective study, 51 MIS urologic patients were recruited over two months. Patients in the first month cohort (P1) were managed with the established pain management standard-of-care, while patients in the second month (P2) followed a non-narcotic postoperative pain management protocol that …

Selective Serotonin Reuptake Inhibitors Are Associated With Increased Bleeding Related Complications Following Primary Total Hip And Total Knee Arthroplasty, Kyle Plusch, John Stammers, Mbbs, Frcs, Alexus M. Cooper, Chi Xu, Md, Paul Kitei, Md, Javad Parvizi, Md, Frcs, Jess H. Lonner, Md

Phase 1

Introduction: Approximately 10-22% of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are diagnosed with depression. Pre-operative depression is associated with poorer patient reported outcomes, costs and increased complications. Selective serotonin-reuptake inhibitors (SSRIs) are first-line treatment for depression due to their efficacy and low side effect profile. There are conflicting studies regarding SSRI-related bleeding complications. This study compares the rate of bleeding-related complications in THA and TKA patients taking SSRI’s to a control group of non-SSRI users.

Methods: A retrospective single institution study of 16,407 primary THA and TKA’s from 2008 to 2018 was performed. Patients with …

Cardiac Risk Factors Predicting 30/90 Day Readmission Rates In Lumbar Decompression Surgeries, Blake Nourie, Kevin Xiao, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Evaluating The Migration Rates In Percutaneous Spinal Cord Stimulation Trials, William Hirsch, Nikolaos Mouchtouris, Md, Ashwini Sharan Md

Phase 1

Introduction: Spinal cord stimulation (SCS) provides symptom reduction in patients with chronic low back pain. The most common complication in SCS is percutaneous lead migration from initial placement site. It is our goal to determine whether using skin anchors during trial implantation reduces SCS trial lead migration rates compared to historical controls.

Methods: 197 patients who underwent SCS trial placement at Thomas Jefferson University Hospital between 2015 and 2018 were considered for this study. Complete data including device impedance measurements and pre and post trial x-rays was collected on 12 historical control patients and 19 patients with leads secured using …

The Effects Of Total Intravenous Versus Inhalational Anesthesia On Fluid Balance For Patients Undergoing Pancreaticoduodenectomy, Jaime Eberle-Singh, David Maguire, Md, Harish Lavu, Md

Phase 1

Introduction: Pancreaticoduodenectomy (PD), the most common surgical treatment for pancreatic cancer, is a complex procedure with a morbidity of 45-60%. Recent studies indicate that intraoperative use of total intravenous anesthesia (TIVA) may reduce post-operative complications for PD patients, when compared to inhalational anesthesia (INHA). We hypothesized that patients who receive TIVA may have a more favorable fluid balance, which is known to reduce postoperative complications in PD patients.

Methods: We carried out a retrospective analysis of patients who underwent PD at Thomas Jefferson University Hospital and were administered TIVA or INHA during surgery between April 2017 and January 2019. …

Mechanical Thrombectomy In Acute Ischemic Stroke Patients Greater Than 90 Years Of Age Experience In 26 Patients In A Large Tertiary Care Center: Outcome Comparison With Younger Patients, Nicholas Elmer, Ahmad Sweid, Md, Joshua H. Weinberg, Vivian Xu, Kavya Shivashankar, Tyler D. Alexander, Ms, Jane Khalife, Md, Michael R. Gooch, Md, Nabeel Herial, Md, Nohra Chalouhi, Md, Pascal Jabbour, Md, Robert H. Rosenwasswer Md, Stavropoula Tjoumakaris, Md

Phase 1

Introduction: Several independent randomized control trials have shown the superior efficacy of mechanical thrombectomy for acute ischemic stroke (AIS). However, the elderly has been underrepresented or excluded in these trials. In this study, we investigated the feasibility and safety of mechanical thrombectomy in patients with AIS aged 90 years or greater.

Methods: A retrospective review of patients age 90 years or older presenting with AIS who underwent mechanical thrombectomy between 2010 and 2018.

Results: Of total 453 patients with AIS, 5.74 % (26) were aged 90 or older, and 69.32 % (314) ranged from 60-89 years of age. Of …

Comparison Of Home Therapy Vs Formal Outpatient Physical Therapy In Post-Operative Management Of Two-Incision Distal Bicep Tendon Repair, Joseph Botros, John Horneff Iii, Md, Thomas Harper, Brent Page

Phase 1

Background: Distal bicep tendon tears are a relatively uncommon injury, affecting 1.2/ 100,000 persons per year; they can also cause substantial loss in supination and flexion strength. The most common treatment is a double incision distal bicep tendon repair, which involves surgical reinsertion of the bicep tendon onto the radial tuberosity. Following surgery, physicians have traditionally recommended the patient undergo 5-12 weeks of formal outpatient physical therapy. This can be a significant cost and time burden to the patient. Therefore, some physicians have instead opted for home physical therapy, in which the patient is given instructions on exercises to complete …

Blood Transfusion Requirements For Patients On Extracorporeal Membrane Oxygenation, Min Choi, Hitoshi Hirose, Md, Phd

Phase 1

No abstract provided.

Evaluation Of Rotator Cuff Repair With Concomitant Biceps Tenodesis, Matthew Beucherie, Daniel Nemirov, Sommer Hammoud, Md, Meghan Bishop, Md, Brandon Erickson, Md

Phase 1

Introduction: Surgical rotator cuff repair (RCR) has proven to be an effective treatment for rotator cuff tears. Commonly, rotator cuff tears are associated with concomitant biceps pathology, which are often treated by biceps tenodesis (BT). We hypothesize that patient outcomes will be similar in those that have undergone RCR with concomitant BT and isolated RCR.

Methods: This is a retrospective cohort study comparing patients who underwent arthroscopic RCR with arthroscopic or open BT to patients who underwent isolated RCR at a multisurgeon orthopaedic practice during the time period of November 2016 to December 2016. The outcome for comparison is …

Commentary On: Cosmeceuticals: The Principles And Practice Of Skin Rejuvenation Of Nonprescription Topical Therapy, Clifford P. Clark, Ashley Goldston

Surgery Faculty Publications

No abstract provided.

Free Abdominal Tissue Transfer And Utilization Of The Umbilical Stalk For “Tubular” Reconstruction In Ear, Nose, And Throat Defects, Jake Laun, Julian Pribaz

Surgery Faculty Publications

Large head and neck burns and cancer-related defects pose many challenges to the reconstructive surgeon with the ultimate goals being aesthetic, as well as functional restoration, or as the renowned Italian plastic surgeon Gaspare Tagliacozzi espoused to “restore, rebuild, and make whole those parts which nature hath given but which fortune has taken away.” The face, in particular, has inherent structures that are vital to interpersonal relationships, as well as everyday function. Large head and neck burns or cancer defects may require a tracheostomy and stoma creation or reconstruction of the external auditory meatus both posing a significant reconstructive challenge. …

A Policy Analysis Of The 2017 Fasting Guidelines Among Gi Surgical Patients, Toney Banks

Doctor of Nursing Practice Projects

The objective of the fasting guidelines is to improve the quality and efficacy of anesthesia care. It is based on two main researched principles: The ingested material must be clear without particulates, and it must not be within two hours of the procedure. The purpose of this project is to equip the medical community with the latest guidelines on NPO (fasting), ensuring that patients are seen on time without delays or cancellations of surgery and with improved patient comfort. A retrospective chart review of 500 randomly chosen charts from patients seen at an Endoscopy Center. Pearson’s Chi-square value and the …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Breast Cancer Recurrence Rate In Patients Treated For Early Breast Cancer, Cecilia Munguti

Master of Medicine in General Surgery

Background: Breast cancer, the leading cause of cancer in Kenya among women, has a prevalence of 57.1 per 100,000 women and an annual mortality of 3.7 per 100,000. Early breast cancer is curable, but has a residual risk of recurrence of 10.4% in the first 5 years. Fifty percent of the recurrences occur after the first 5 years after diagnosis. Recurrent breast cancer is associated with poorer prognosis and higher mortality rates. Objectives: The primary objective was to determine the breast cancer recurrence rates for women managed for DCIS and early breast cancer at Aga Khan University Hospital. Secondary objectives …

The Quality Of Life Of Patients With Early Breast Cancer And Their Partners One Year After Breast Conserving Surgery Versus Modified Radical Mastectomy: A Single Centre Five Year Review, Senoga Andrew

Master of Medicine in General Surgery

Background: Breast cancer accounts for the highest incidence rate (40.3/100000) and fourth highest mortality rate (17.8/100000) among cancers in Kenya. Forty percent of breast cancer cases in Kenya are early breast cancer and this is will increase with scaled up awareness campaigns and screening. Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the commonest forms of surgical techniques utilized in treatment of early breast cancer with similar overall survival and recurrence rates. These treatments impact variably on the quality of life of the patients and their spouses who are their immediate emotional and social …

Prevalence And Factors Associated To Incidental Prostate Carcinoma Among Patients Undergoing Turp For Benign Prostatic Enlargement., Isaac Herman Mawalla

Master of Medicine in General Surgery

Background: Prostate carcinoma carries higher morbidity and mortality when diagnosed late. Prostate cancer screening is paramount, however, there are no specific clinical signs for early-stage prostate cancer. As an independent variable, prostate-specific antigen is an established predictor of cancer. Incidental prostate cancer is detected by histological examination of resected biopsy tissue that had been previously diagnosed as benign. In the current PSA-use era the prevalence of incidental prostate cancer ranges from 1.4 to 13%. The prevalence in Tanzania as published by Gunda et al was 21.71%. This is alarmingly high. However, in his study, patients with high prostate-specific antigens were …

Perceptions Of Surgeons On Surgical Antibiotic Prophylaxis Use At Aga Khan Hospital, Dar Es Salaam., Elizabeth Elibariki Mmari

Master of Medicine in General Surgery

Introduction: Surgical site infections are a major cause of morbidity and mortality among operated patients. The use of antibiotic prophylaxis in prevention and reduction of incidence of surgical site infection is widespread. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medications for a single patient. Few studies have shown qualitatively factors influencing this, and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania. Objective: To describe the perceptions of surgeons …

Referral Patterns Affecting Age At Orchidopexy For Undescended Testis At A Tertiary Hospital In Nairobi., Muthua Ken Njoroge

Master of Medicine in General Surgery

BACKGROUND: Undescended Testis is the most common urological congenital anomaly with significant burden of disease especially in our local context. Management relies on early diagnosis, in the perinatal period, and prompt referral to an appropriate surgical unit. Spontaneous descent, while possible, doesn’t occur beyond 6 months and thus surveillance should not proceed beyond this age. Current guidelines recommend surveillance up to 6 months, referral by 9 months and, most importantly, orchidopexy by 1 year of age. Despite these clear guidelines, achieving them has proven difficult globally with low rates of orchidopexy by 1 year. The most common cited cause has …

Gynecologic Large Cell Neuroendocrine Carcinoma: A Review, Grant Burkeen, Aman Chauhan, Rohitashva Agrawal, Riva Raiker, Jill M. Kolesar, Lowell B. Anthony, B. Mark Evers, Susanne Arnold

Internal Medicine Faculty Publications

Large cell neuroendocrine carcinomas (LCNEC) are rare, aggressive high-grade neuroendocrine neoplasms within the neuroendocrine cell lineage spectrum. This manuscript provides a detailed review of published literature on LCNEC of gynecological origin. We performed a PubMed search for material available on gynecologic LCNEC. We analyzed 104 unique cases of gynecologic LCNECs, of which 45 were cervical primary, 45 were ovarian, 13 were uterine, and 1 was vaginal. A total of 45 cases of cervical LCNEC were identified with a median age of 36 years. Median overall survival was 16 months. We identified 45 ovarian LCNEC cases in the published literature with …

Cyto-Histological Correlation Of Thyroid Cytology And Associated Adverse Surgical Outcomes At Aga Khan University Hospital, Nairobi., Moses Barasa

Master of Medicine in General Surgery

Background: Solitary thyroid nodules are commonly encountered endocrine disorders in surgical practice. Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, accurate and cost-effective diagnostic tool that provides basis for surgical decisions-making in thyroid lesions management. Thus, it’s imperative that such a test should have high diagnostic accuracy in order to avoid under or over-treatment arising from false negative or positive results respectively. Studies from the African region, compared to the developed world have reported higher thyroid cyto-histologic discrepancy. Objective: To determine the diagnostic accuracy and adverse surgical outcome of discrepant thyroid cytology. Methods: Retrospective cross-sectional analytical study conducted at …

Local Anaesthetic Wound Infusion Versus Thoracic Epidural Analgesia For Post-Operative Pain Control Following Elective Laparotomy: A Randomised Controlled Trial, Daniel Gathege Mwangi

Master of Medicine in General Surgery

Background: Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients Objective: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients. Design: A randomised, single-blind, controlled clinical trial. Setting: Aga Khan University Hospital, Nairobi, Kenya. Population: Patients undergoing elective laparotomy. Methods: Thirty eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous local anaesthetic wound infusion or …

Ageism In Consent? In A Decision-Making Capable Geriatric Orthopaedic Trauma Patient Population, Does Increased Age Impact Who Physicians Consent For Surgical Fixation?, Madeline M. Mcgovern, Michael F. Mctague, Mph, Marilyn Heng, Md, Mph, Frcsc

Phase 1

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Our study examines the consenting process in an orthogeriatric trauma patient population to determine if there is a relationship between increased age at presentation and utilization of health care proxies (HCPs) for surgical procedure consent.

Methods: We retrospectively reviewed medical records of patients aged 65 and older admitted for an operative fracture between 2013 and 2016. Patients were considered decision-making capable if there was absence of history of cognitive impairment prior to surgical consent and if the patients screened negative in …

Renewing Hearts: Catholic Perspectives In Valve Replacement Surgery For Those Who Use Intravenous Drugs, Kimberly Feeney, Robert Perkel, Md

Phase 1

Introduction: The incidence of infectious endocarditis has been increasing, particularly among those with a history of intravenous drug use (IVDU). Although current bioethics literature supports valve surgery as treatment for this patient population, clinical guidelines and literature continues to provide unclear recommendations for physicians. Catholic bioethics may provide a different perspective to re-contextualize the recommendations of secular ethics.

Methods: A PubMed search was used to gain background information regarding the incidence of infectious endocarditis and current treatment guidelines, as well as historical and current ethical considerations. Search terms included: “infectious endocarditis,” “IE,” “intravenous drug use,” “IVDU,” “ethics.” Related citations were …

Prospective Molecular Profiling Of Circulating Tumor Cells From Patients With Melanoma Receiving Combinatorial Immunotherapy., Selena Y Lin, Shu-Ching Chang, Stella Lam, Romela Irene Ramos, Kevin Tran, Shuichi Ohe, Matthew P Salomon, Ali Asgar S Bhagat, Chwee Teck Lim, Trevan D Fischer, Leland J Foshag, Christine L Boley, Steven J O'Day, Dave Hoon

Articles, Abstracts, and Reports

BACKGROUND: Blood molecular profiling of circulating tumor cells (CTCs) can enable monitoring of patients with metastatic melanoma during checkpoint inhibitor immunotherapy (CII) and in combination with targeted therapies. We developed a microfluidics-based CTC platform to explore CTC profiling utility in CII-treated patients with melanoma using a melanoma messenger RNA (mRNA)/DNA biomarker panel.

METHODS: Blood samples (n = 213) were collected prospectively from 75 American Joint Committee on Cancer-staged III/IV melanoma patients during CII treatment and those enriched for CTCs. CTC profiling was performed using 5 known melanoma mRNA biomarkers and BRAF V600E DNA mutation. CTC biomarker status associations with clinical …

Empathy In Clinical Practice: A Qualitative Study Of Early Medical Practitioners And Educators, Sonia Ijaz Haider, Qamar Riaz, Roger Christopher Gill

Department for Educational Development

Objective: To explore the reasons for decline in empathy among physicians and to identify strategiesfor fostering empathetic clinical practice.
Methods: The qualitative study was conducted at the Aga Khan University Hospital, Karachi, from February to June 2017, and comprised focus group discussions involving separate sessions with medical students, residents and clinical teachers. Content analysis was used to analyse the verbatim transcripts for identification of codes which led to derivation of themes from the data. Consolidated criteria for reporting qualitative research was used to assess the quality of the study.
Results: Of the 109 subjects, 57(52.3%) were medical students, 30(27.5%) residents …

In Adult Patients 60+ Y.O. With Aaa, Would (F)Evar Lead To Least Amount Of Post-Operative Complications Than Traditional Osr?, Sandra Yoo

Capstone Showcase

INTRODUCTION: An abdominal aortic aneurysm (AAA) is a permanent ballooning of the abdominal aorta greater than 3cm in diameter. A small AAA is often asymptomatic. However, as time passes the risk of rupture increases as the diameter of the aneurysm widens. This can ultimately lead to massive internal bleeding and fatality. Surgery is the most common course of treatment for AAA. Most patients will undergo traditional open surgery, but this is often associated with prolonged in-hospital recovery and is contraindicated in an aging population that have a higher prevalence of comorbidities. With this in thought, some clinicians have been turning …

The Efficacy Of Thoratec Implantable Ventricular Assist Devices Compared To Syncardia Total Artificial Hearts As Bridge-To-Transplantation Therapy In Adults With Biventricular Heart Failure, Alexandria Davenport

Capstone Showcase

Abstract

Introduction: Systolic heart failure is a chronic condition in which there is a decrease in the heart’s ability to pump blood to the body. While there are several treatments for the symptoms of heart failure, the only curative treatment for most causes of chronic heart failure is a heart transplant. Due to the limited number of heart donors, 72.2% of patients in need of a heart transplant in 2017 spent up to 2 years waiting for a transplant. Mechanical circulatory support has been used to increase patient survival to transplantation. In the past, these machines were external devices that …

The Efficacy Of Acute Normovolemic Hemodilution Compared To Cell Salvage As A Blood Transfusion Alternative, Julia Yu

Capstone Showcase

Blood transfusions are currently the treatment of choice for significant blood loss. However, there are a variety of reasons for which they cannot be utilized. Current alternatives are acute normovolemic hemodilution (ANH) and cell 1 This study analyzes whether ANH or cell salvage is more effective in minimizing blood loss in perioperative or trauma patients. Multiple different studies involving either ANH or cell salvage were compared to each other. However, due to the lack of research conducted in either method, results obtained were largely inconclusive.

Comparative And Cost Benefit Analysis: Vancomycin Versus Ancef In Total Knee Arthroplasties, Zelda Epperson

Doctor of Nursing Practice Projects

Total knee arthroplasty (TKA) is the definitive treatment for degenerative joint disease of the knee. Total joint infections, although low, are a complication that can be a massive expenditure on health care systems and patients. Economic costs have the potential of being high for this procedure. It is estimated to treat these TKA infections, primarily methicillin-resistant Staphylococcus aureus (MRSA) to be between $68,000 and $107,000. The purpose of this retrospective study is to determine whether vancomycin has greater cost benefits and efficacy in reducing post-operative infection rate of total knee arthroplasties than does cefazolin.

Lateral Sub-Cutaneous Route For Anterior Tibial Artery Revascularisation, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.