Surgery Commons^™

Adjunctive Embolization Of Target Vessel Dissections To Improve Suitability For Fenestrated-Branched Endovascular Aortic Repair, Zemia C Ferreira, Hannah V Oden-Brunson, Ying Huang, Steven Maximus, Naveed Saqib, Erin Greenleaf, Thanila A Macedo, Gustavo S Oderich

Faculty, Staff and Students Publications

Suitability of renal-mesenteric target arteries is an essential criterion for fenestrated-branched endovascular aortic repair (FB-EVAR). We describe a staged adjunctive technique of target vessel false lumen (FL) embolization to improve suitability for FB-EVAR in patients with chronic postdissection thoracoabdominal aortic aneurysms (PD-TAAA) and dissection extension into the superior mesenteric artery (SMA). Three patients with SMA dissection and ectasia (diameter > 12-14 mm) underwent staged FL embolization with pre-emptive stent placement to optimize SMA incorporation. Using bilateral transfemoral access with intravascular ultrasound guidance, the proximal SMA true lumen was stented with an 8 L × 39 mm VBX balloon-expandable stent graft (W. …

Considering Access And Methodological Rigor In Framing Results Of The Bergen 4 Day Treatment Program For Obsessive-Compulsive Disorder, Eric A Storch, Benjamin J Chang

Faculty, Staff and Students Publications

No abstract provided.

Social Responsiveness As A Mediator In Adapted Cognitive Behavioral Therapy For Autistic Youth With Maladaptive And Interfering Anxiety, Jeffrey J Wood, Eric A Storch, Katherine Sung, Karen S Wood, Philip C Kendall

Faculty, Staff and Students Publications

Numerous adaptations to interventions have been included in cognitive behavioral therapy (CBT) for autistic youth. This study examines the degree to which CBT adapted to the social needs of autistic youth confers significant benefit by promoting social responsiveness. A secondary analysis was conducted on a multisite randomized clinical trial (Wood et al. in JAMA Psychiatry 77:474-483, 2020) comparing adapted CBT with standard-of-practice CBT and treatment-as-usual (TA). Autistic youth (N = 167; aged 7-13) with maladaptive and interfering anxiety participated. The adapted CBT (BIACA) uses a modular format, with an emphasis on supplementing common CBT practice elements (reframing and graded exposure) …

Reversible Microvascular Ischemia With St-Segment Elevation: An Underrecognized Manifestation Of Antibody-Mediated Rejection In Cardiac Allograft Recipients, Jonathan Ahn, Justin Daneshrad, Liset Stoletniy, Dmitry Abramov

The VAD Journal

Electrocardiographic manifestations of cardiac allograft rejection are often subtle, and stress-induced ST-segment elevation associated with antibody-mediated rejection (AMR) is rarely reported. We describe a 34-year-old heart transplant recipient with progressive exertional angina, nonobstructive coronary disease on angiography, and exercise-induced ST-segment elevation in lead augmented vector right, high-lateral leads I, and augmented voltage left, along with diffuse ST-segment depressions, hypotension, and transient ventricular tachycardia. Concurrent emergence of complement-binding donor-specific antibodies with high mean fluorescence intensity raised concern for AMR, prompting treatment with corticosteroids, plasma exchange, and intravenous immunoglobulin despite the absence of biopsy confirmation. After therapy, symptoms, exercise-induced ischemic electrocardiographic abnormalities, …

Neuroimmune Phenotyping As The Next Frontier In Chronic Pain Medicine For Musculoskeletal Back Pain, Samer G. Salman, Rohan A. Phadke, Adithya Nair, Rahul Kumar, Arbaz Momin, Alireza Tavakkoli, James Rizkalla

Department of Neurosurgery Posters

Background: Chronic low back pain encompasses heterogeneous mechanical, neuropathic, nociplastic, and myofascial presentations that may reflect distinct neuroimmune mechanisms. We synthesized evidence linking these phenotypes to measurable biological features and clinically relevant treatment strategies.

Methods: We conducted a structured literature search of MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published from January 2005 through January 2025. Systematic reviews, randomized controlled trials, and mechanistic studies addressing neuroinflammation, glial activation, central sensitization, biomarkers, or imaging were organized according to four clinically relevant pain phenotypes and translational readiness.

Results: Neuroimmune findings differed across axial mechanical, …

A Worldwide Cross-Sectional Survey Seeks The Current Global Practice Patterns On Perioperative Management In Elective Shoulder Replacement Surgery, Maciej Simon, Farhad Moola, Jennifer Coghlan, Osvandre Lech, Carlos Ramos, Njalalle Baraza, Hadrian Platzer, Simone Gantz, Andreas Seekamp, Babak Moradi

General Surgery, East Africa

Background Perioperative management in elective shoulder arthroplasty varies widely, with no universal consensus on best practices. This study aimed to characterize current global standards of perioperative care, including pre-operative, intraoperative, and post-operative management, among orthopedic surgeons performing elective shoulder replacement surgery, with the aim of contributing to a global standard of care.

Methods A comprehensive online questionnaire was designed and anonymously distributed to orthopedic societies on each continent. Participants were cross-sectionally surveyed with the goal of identifying current global pre-operative, intraoperative, and post-operative practices in patient care and discharge management.

Results Eighteen societies from 5 continents participated in the survey. …

Neuromotor Compromise As A Presenting Symptom In Advanced Lower Extremity Soft Tissue Sarcoma: A Case Series, Adam Maestas, Parsa Charkhchi, Farbod Malek

HCA Healthcare Journal of Medicine

Background

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, representing less than 1% of adult cancers. Approximately half arise in the extremities, most often presenting as a painless, enlarging mass. Symptoms are often misattributed to benign neuropathic or musculoskeletal causes, leading to delayed diagnosis and treatment. Neurological deficits such as foot drop or distal weakness are exceptionally uncommon presenting signs and generally indicate advanced local invasion or compression of major peripheral nerves. Recognizing acute neuromotor compromise as a potential manifestation of soft tissue malignancy is crucial for timely oncologic evaluation and limb-sparing management.

Case Presentation

This series …

Comparing The Expression Of Estrogen Receptors, Progesterone Receptors, And Human Epidermal Growth Factor Receptor 2 Between Initial Biopsy And Excision Specimens In Invasive Breast Carcinoma Cases. Is There A Need For Universal Repeat Testing? Experience From A Community Hospital, Astrid M. Sacasa, Gul Emek Wymer, Susana Ferra

HCA Healthcare Journal of Medicine

Background

The current national recommendation is that breast biomarkers estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) testing should be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors. Repeat testing on a subsequent excision specimen is not indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need for adopting universal reflex re-testing of breast biomarkers in excision specimens in our institution.

Methods

The study population included 70 sequential invasive breast cancer patients where the results of ER, PR, and …

Psychological Adaptation In Colorectal Cancer Survivors: Pilot Study Findings, Anuja L. Sarode, Emily M. Su, Amber Kerstetter-Fogle, Steve Paciorek, Erica L. Laipply

HCA Healthcare Journal of Medicine

Background

In this pilot study, we examined psychological impacts of colorectal cancer (CRC), focusing on cancer-related posttraumatic stress disorder (CR-PTSD) symptoms, posttraumatic growth (PTG), and their relationship with coping strategies in surgically treated CRC patients.

Methods

This prospective pre- and postoperative pilot study assessed CRC patients at 2 time points, pre- and postoperative. Psychological symptoms were evaluated using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the PTG Inventory Short Form (PTGI-SF). Coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (COPE) instrument. Changes in CR-PTSD, PTG, and coping …

Coping Beyond Cancer: Exploring Fear Of Recurrence In Colorectal Cancer Survivors—A Pilot Investigation, Emily M. Su, Steve Paciorek, Erica L. Laipply, Anuja L. Sarode

HCA Healthcare Journal of Medicine

Background

Evidence is limited on the fear of cancer recurrence (FCR) among colorectal cancer (CRC) survivors in the US, especially regarding patterns and trends of post-recovery coping mechanisms. This pilot mixed-methods study quantified FCR, examined its associations with Brief COPE domains, and contextualized coping through qualitative analysis.

Methods

Twenty-three patients who successfully underwent CRC surgery were included in this pilot study. Fear of cancer recurrence was measured using the FCR Inventory (FCRI) Short Form, and coping strategies were assessed with the Brief Coping Orientation to Problems Experienced (COPE) survey. Descriptive statistics summarized participant characteristics, FCR, and COPE scores. Spearman correlation …

Retrieval Strategies For Embolized Left Atrial Appendage Closure Devices, Usama Sadiq, Muneeba Ali, Stacey Damito, Maxwell Ambrosino, Muhammad Sabri, Muhammad Ahmad Sadiq, Muhammad Hamza Sadiq, Richard Kovach, Sheena Rastogi, Muhammad Raza

Abington Jefferson Health Papers

BACKGROUND: Device embolization (DE) is a rare but potentially life-threatening complication of left atrial appendage occlusion (LAAO). As landmark trials broaden the eligible population for LAAO, operator preparedness for DE management becomes increasingly critical.

CASE SUMMARY: We present 4 cases of LAAO DE managed with distinct retrieval strategies: 1) open surgical retrieval with concurrent AtriClip ligation for an endothelialized left atrial device; 2) sequential transseptal then retrograde arterial snaring for intraprocedural migration to the abdominal aorta; 3) transseptal retrieval using a dedicated ONO system with cerebral embolic protection for partial left atrial dislodgment; and 4) retrograde large-bore arterial retrieval for …

Mechanism Of Injury And Fracture Status Influence Outcomes After Central Cord Injury, Karlo M. Pedro, Mohammed Ali Alvi, Kathleen Zang, Christopher Lozano, Jetan H. Badhiwala, Jefferson R. Wilson, James Harrop, James D. Guest, Bizhan Aarabi, Christopher I. Shaffrey, Michael G. Fehlings

Department of Neurosurgery Faculty Papers

Central cord syndrome (CCS) is the most common form of incomplete cervical spinal cord injury (SCI), yet its optimal management remains controversial. We examined whether stratifying CCS by injury stability improves treatment assessment. CCS was defined as an American Spinal Injury Association Impairment Scale (AIS) C/D cervical SCI with a ≥5-point lower-upper extremity motor score difference and classified as CCS-stable (CCS-S) or -unstable (CCS-U) based on the absence or presence of fracture/dislocation. Functional recovery at 1 year was assessed using the functional independence measure (FIM) motor score. Among 291 patients, 131 (45%) had CCS-S. These patients were older and more …

Improved Foraminal Expansion And Pain Scores Following Placement Of Novel Expandable Interlaminar Stabilization Device For Lumbar Spinal Stenosis, Robert P. Norton, Ian Koch, Kendra Primavera, Roy Y. Miloh, Alex R. Vaccaro, Mitchell K. Ng

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To evaluate radiographic durability and clinical outcomes following placement of a novel expandable interlaminar stabilization device for single-level lumbar spinal stenosis. Specifically, we aimed to: 1) quantify immediate postoperative posterior column distraction; 2) determine whether foraminal expansion is improved postoperatively without radiographic subsidence; and (3) assess potential improvements in patient-reported pain/clinical outcomes.

METHODS: A retrospective review was performed of adult patients undergoing single-level decompression supplemented by an interlaminar device for symptomatic lumbar spinal stenosis by a single surgeon from 2024 to 2025. Radiographic parameters included anterior, middle, and posterior disc height, foraminal height, and …

Surgical Outcomes Of Hidradenitis Suppurativa Excision: Factors Impacting Wound Healing Time, Christina Huang, Scott H. Koeneman, Sherry Yang, Sami Tannour

Department of Surgery Faculty Papers

Hidradenitis suppurativa (HS) can be treated surgically to excise recurrent and recalcitrant regions of disease activity. However, surgical outcomes are highly variable depending on closure method, concomitant medical management and area of excision. In this study, we aim to characterise the healing courses from HS excision in a case series. To reduce operator variability, we opted to conduct a case series from a single surgeon. Surgeries conducted from June 2024-December 2025 by surgeon S.T. were included, and the postoperative course was followed until February 2026. Surgical details and postoperative course for 34 sites of HS across 20 patients were analysed. …

High-Flow Nasal Cannula Oxygen Therapy Versus Standard Oxygen Therapy On Perioperative Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement, Kirsten B. Whiteside, Jacqueline M. Case

Graduate Theses, Dissertations, and Capstones

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion …

Decreased Frequency Of Splenectomy For High-Grade Splenic Injuries Following The Implementation Of An Interventional Radiology Alert Protocol., Maura Kopchak, John Bach, William B Devoe, Brian Dusseau, Katherine A Graham, John Dillis, Thomas Glusich, Jeff Hubartt

OhioHealth Research Institute Articles

Background A vascular interventional radiology (VIR) protocol was initiated at a mature level 2 trauma center on 3/1/2023 to reduce time to vessel puncture to < 60 minutes as per American College of Surgeons (ACS) guidelines. The average time to vessel puncture in the two years prior to protocol initiation was 102 minutes. Following initiation, time to vessel puncture was reduced to 48.2 minutes (p < 0.001). A statistically significant increase in the number of splenic embolizations was noted in the post-protocol group. The primary outcome of the current study was to evaluate if the initiation of a VIR protocol correlated with a statistically significant decrease in splenectomies for high-grade splenic injuries (American Association for the Surgery of Trauma (AAST) grade 3 or higher) in favor of splenic embolization. The secondary outcomes of the study were to assess whether the initiation of the VIR alert protocol improved our rate of splenic salvage, defined as preserved splenic immune function, and if there was a decreased rate of splenectomies across all injury grades. Methods The trauma registry database was queried for all splenic injuries from 1/1/2021 to 9/1/2024. Admission CT scans were used to grade injuries using the AAST Organ Injury Scale. Demographic and clinical characteristics, including severity of illness (ISS), admission INR, age, blood product required pre- and post-intervention, mortality, sex, length of stay, anticoagulant (AC)/antiplatelet (AP) use, mechanism of injury, and need for REBOA (resuscitative endovascular balloon occlusion of the aorta) placement, were collected for all patients. Patients were further broken down into those requiring splenectomy, embolization, or no intervention. Data were analyzed using chi-square and Mann-Whitney U with Jamovi Version 2.3.26.0 (The Jamovi Project, 2023). Results No statistically significant difference was found for clinical or demographic characteristics between groups. Fewer splenectomies and more splenic embolizations were performed in the post-protocol group for high-grade splenic injuries (grade 3), which was statistically significant (p< 0.001). This was also true when all grade splenic injuries were compared (p< 0.001). Conclusion Following the establishment of an institutional VIR alert protocol for active hemorrhage control in trauma patients, more frequent utilization of angioembolization for high-grade splenic injuries was found with a subsequent decrease in splenectomy rate. Implementation of the VIR alert protocol directly correlated with a shift in practice pattern reflecting attempts at splenic salvage for all injury grades.

Endoscopic Versus Catheter-Based Minimally Invasive Evacuation Of Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review And Meta-Analysis, Shaan Patel, Shiva A Nischal, Kush M Kale, Angelette Mendonca, Keenan Piper, Pious D. Patel, Michael R. Gooch, Stavropoula Tjoumakaris, Pascal M. Jabbour

Department of Neurosurgery Faculty Papers

Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral hemorrhage (sICH) includes endoscopic evacuation and catheter-based evacuation (aspiration or drainage ± thrombolysis), but comparative performance remains uncertain. We performed a systematic review and meta-analysis comparing MIS approaches. PubMed, Embase, and CENTRAL were searched (December 2025) for studies in adults undergoing endoscopic or catheter-based MIS for supratentorial sICH. Random-effects meta-analysis was conducted. Prespecified subgroup analyses stratified catheter-based techniques by thrombolysis use. Risk of bias and certainty of evidence was assessed. Twenty-nine studies (8221 patients; 5041 endoscopic; 3180 catheter-based) were included. Endoscopic evacuation was associated with lower mortality (RR 0.64; 95% CI: 0.47–0.87; …

Advancing Health Equity In Global Oncology: A Collaborative Academic-Cancer Society-Industry Program To Address Health Disparities In Sub-Saharan Africa, Kenneth Merrell, Ben Kamdem-Talom, Hannah Anie, Christine Wekesa, Nomsa Tsikai, Miriam Mutebi, Rakiya Saidu, Nwamaka Lasebikan, Adamu Bojude, Randiak Alaro

General Surgery, East Africa

Purpose Cancer care capacity in sub-Saharan Africa (SSA) is constrained by late diagnosis and limited treatment access. Few funding mechanisms support innovative, locally led programs to address these challenges. A collaborative initiative was developed to strengthen oncology care through quality improvement (QI) projects.

Materials and Methods The program was developed by Global Bridges Oncology (GBO) at Mayo Clinic, Pfizer Global Medical Grants, and the African Organisation for Research and Training in Cancer. A committee composed primarily of African oncology experts guided the process. An RFP was disseminated across SSA in English, French, and Portuguese, inviting applications to improve diagnostic and …

Expanding Cleft Surgical Workforce Capacity In Low- And Middle-Income Countries Through Competency-Based Training, Daniel Bradley, Jonathan Diaz, Emily Jones, Kealani Unkel, Atenas Bustamante, Zenebe Gebremariyam, Daniel Abate, Mamy Andriamanarivo, Mekonen Abebe, Armando Siu

General Surgery, East Africa

Objective To evaluate a competency-based cleft surgery training pathway designed to expand local surgical capacity in low- and middle-income countries (LMICs).

Design Prospective observational study of cleft surgery training outcomes between July 2022 and September 2024.

Setting Operation Smile cleft surgery programs and partner hospitals in LMICs, with integrated virtual education.

Patients/Participants Twenty trainee cleft surgeons from 11 countries.

Interventions A competency-based training pathway combining virtual education and mentored operative experience, with assessment using a validated surgical competency tool.

Main Outcome Measures Changes in self-reported surgical confidence and educator-rated surgical competency

Results Trainee cleft surgeons participated in 1168 cleft lip …

Defining The Value Of Elective Lumbar Fusion: A Systematic Review Of Existing Methodologies And Framework For The Operative Value Index, Advith Sarikonda, Anthony Chen, Theo S. Biddle, Danyal A. Quraishi, Preston Carey, Arbaz A. Momin, Matthews Lan, Dwight Mitchell Self, Ashmal S. Kabani, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

BACKGROUND: Despite wide variation in the outcomes and costs of lumbar fusion, few studies have integrated these domains together within a single metric to assess "value" (outcomes achieved per dollar spent). In this review, we sought to 1) characterize existing metrics of cost-effectiveness for lumbar fusion, 2) evaluate all applications of time-driven activity-based costing (TDABC) in spine surgery, and 3) outline the conceptual foundation for a standardized Operative Value Index (OVI).

METHODS: Two PRISMA-concordant systematic reviews were performed on PubMed and Scopus databases. The first review examined all studies which reported a cost-effectiveness metric for lumbar fusion. The second review …