Surgery Commons^™

Intraoperative Acoustics: Auditory Cues In Hip Reconstructive Surgery, Jeffrey M. Henstenburg, Walaa Abdelfadeel, Anthony J. Boniello, Joseph Schmitz, Jeffrey J. Vakil, Andrew M. Star

Rothman Institute Papers

Background: Orthopaedic surgeons rely on visual and tactile cues to guide performance in the operating room (OR). However, there is very little data on how sound changes during orthopaedic procedures and how surgeons incorporate audio feedback to guide performance. This study attempts to define meaningful
changes in sound during vital aspects of total hip arthroplasty (THA) within the spectrum of human hearing.

Methods: 84 audio recordings were obtained during primary elective THA procedures during sawing of the femoral neck, reaming of the acetabulum, acetabular cup impaction, polyethylene liner impaction, femoral broaching, planning of the femoral calcar and press-fit of a …

Candida Pericarditis Presenting With Cardiac Tamponade And Multiple Organ Failure After Combined Damage Control Thoracotomy And Laparotomy With Splenectomy In A Trauma Patient: Case Report And Review Of Literature, R. A. Siller, Jeffrey Skubic, J. L. Almeda, Adolfo E. Kaplan

School of Medicine Publications

Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and …

Thyroidectomy In Mechanical Circulatory Support - A Salvage Treatment For Thyrotoxicosis-Induced Cardiogenic Shock: Case Series, Rody G. Bou Chaaya, Lauren M. Saint, Onyedika J. Ilonze Md, Mph

The VAD Journal

Amiodarone is frequently used to treat arrhythmias in patients supported with left ventricular assist devices. Long term amiodarone use can cause hyperthyroidism ultimately leading to cardiomyopathy and sometimes thyrotoxicosis-induced cardiogenic shock (CS). We describe two cases of thyrotoxicosis-induced CS rescued by successful thyroidectomy under mechanical circulatory support (MCS) – one with a Heartmate III (Abbott Laboratories) and another supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO). In refractory CS, the initiation of V-A ECMO as a bridge to recovery is critical. In thyrotoxicosis-induced CS that is refractory to medical therapy requiring MCS, thyroidectomy is feasible, and a growing body of …

Decreasing Pre-Procedural Fasting Times: A Benchmark Study, Sheila Gasparek

MSN Capstone Projects

On a busy Surgical Trauma unit, scheduled procedures and operations are often delayed for priority emergent cases. Patients admitted to the unit with delayed procedures often endure extended fasting times beyond the six-hour intention of standard nothing by mouth (NPO) after midnight fasting order. With prolonged fasting times, patients inquire about pending surgery times and dietary options. Some providers may allow ice chips, but most doctors prefer patients to remain NPO in case Operating Room availability opens for surgery, leaving already anxious and uncomfortable patients more frustrated as prolonged fasting affects patients’ physical and psychological well-being (Anderson & Comrie, 2009). …

Reduced Risk Of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From A United States Claims Database, Chengyuan Wu, Sean J Nagel, Rahul Agarwal, Monika Pötter-Nerger, Wolfgang Hamel, Ashwini Sharan, Allison T Connolly, Binith Cheeran, Paul S Larson

Department of Neurosurgery Faculty Papers

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.

Design: Retrospective, contemporaneous cohort study.

Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.

Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, …

Genetic Susceptibility To Hepatocellular Carcinoma In Chromosome 22q13.31, Findings Of A Genome-Wide Association Study., Zhanwei Wang, Anuradha S Budhu, Yi Shen, Linda Lou Wong, Brenda Y Hernandez, Maarit Tiirikainen, Xiaomei Ma, Melinda L Irwin, Lingeng Lu, Hongyu Zhao, Joseph K Lim, Tamar Taddei, Lopa Mishra, Karen Pawlish, Antoinette Stroup, Robert Brown, Mindie H Nguyen, Jill Koshiol, Maria O Hernandez, Marshonna Forgues, Hwai-I Yang, Mei-Hsuan Lee, Yu-Han Huang, Motoki Iwasaki, Atsushi Goto, Shiori Suzuki, Koichi Matsuda, Chizu Tanikawa, Yoichiro Kamatani, Dean Mann, Maria Guarnera, Kirti Shetty, Claire E Thomas, Jian-Min Yuan, Chiea Chuen Khor, Woon-Puay Koh, Harvey Risch, Xin Wei Wang, Herbert Yu

Surgery Faculty Publications

Background and Aim: Chronic hepatitis C virus (HCV) infection, long-term alcohol use, cigarette smoking, and obesity are the major risk factors for hepatocellular carcinoma (HCC) in the United States, but the disease risk varies substantially among individuals with these factors, suggesting host susceptibility to and gene-environment interactions in HCC. To address genetic susceptibility to HCC, we conducted a genome-wide association study (GWAS).

Methods: Two case-control studies on HCC were conducted in the United States. DNA samples were genotyped using the Illumian microarray chip with over 710 000 single nucleotide polymorphisms (SNPs). We compared these SNPs between 705 HCC cases and …

Increased Use Of Opioids Perioperatively Leads To Unmanaged Postoperative Pain, Halida Sehic

Nursing | Senior Theses

Background: Total knee and total hip joint arthroplasty are two frequently preformed surgeries, with 5.2 million total knee arthroplasties performed the United States between the year 2000 and 2010 (Williams et al., 2015). Opioids are widely used to manage pain for patients undergoing total joint arthroplasty. However, use of opioids is associated with undesirable adverse effects, such as nausea and respiratory depression, (Johnson et al., 2011). In postoperative patients following total joint replacement, 75 % of the patients complain of inadequately controlled moderate to severe pain (De Luca et al., 2018). Increased use and overprescribing increase tolerance to opioids …

Impact Of The Who Surgical Safety Checklist Relative To Its Design And Intended Use: A Systematic Review And Meta-Meta-Analysis, Kenji T. Sotto, Barbara K. Burian, Mary E. Brindle

Faculty Research, Scholarly, and Creative Activity

Background
The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use.
Study Design
We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Results
Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of …

The Effect Of Saline Flush After Rocuronium Bolus On Intubating Conditions In Adult Patients Undergoing Elective Surgery: A Randomized Controlled Trial, Ian Odari, Vitalis Mung’Ayi, Rajpreet Bal, David Odaba

Anaesthesiology, East Africa

Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time to avoid hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time. All these methods have positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, we investigated the effects of a 20 ml saline bolus following intravenous rocuronium at 0.6 mg/kg on the proportions of patients with excellent intubating conditions …

Characterization Of Anti-Ana O 3 Monoclonal Antibodies And Their Application In Comparing Brazilian Cashew Cultivars, Christopher P. Mattison, Barry Vant-Hull, Ana Cecilia Ribeiro De Castro, Heidi J. Chial, Yvette Bren-Mattison, Peter J. Bechtel, Edy Sousa De Brito

School of Medicine Faculty Publications

Ana o 3 is an immuno-dominant cashew nut allergen. Four monoclonal antibodies to Ana o 3 (2H5, 6B9C1, 19C9A2, and 5B7F8) were characterized by ELISA and in silico modeling. The 2H5 antibody was the only antibody specific for cashew nut extract. In addition to cashew nut extract, the 6B9C1 and 19C9A2 antibodies recognized pistachio extract, and the 5B7F8 recognized pecan extract. All four antibodies recognized both recombinant Ana o 3.0101 and native Ana o 3. ELISA assays following treatment of purified Ana o 3 with a reducing agent indicated that the 6B9C1 and 19C9A2 antibodies likely recognize conformational epitopes, while …

Cdk5 Drives Formation Of Heterogeneous Pancreatic Neuroendocrine Tumors, Angela M. Carter, Nilesh Kumar, Brendon Herring, Chunfeng Tan, Rachael Guenter, Rahul Telange, Wayne Howse, Fabrice Viol, Tyler R. Mccaw, Hayden H. Bickerton, Priyanka Gupta, Frank Gillardon, Eugene A. Woltering, Deepti Dhall, John Totenhagen, Ronadip R. Banerjee, Elizabeth M. Kurian, Sushanth Reddy, Herbert Chen, Joerg Schrader

School of Medicine Faculty Publications

Pancreatic neuroendocrine tumors (PanNETs) are a heterogeneous population of neoplasms that arise from hormone-secreting islet cells of the pancreas and have increased markedly in incidence over the past four decades. Non-functional PanNETs, which occur more frequently than hormone-secreting tumors, are often not diagnosed until later stages of tumor development and have poorer prognoses. Development of successful therapeutics for PanNETs has been slow, partially due to a lack of diverse animal models for pre-clinical testing. Here, we report development of an inducible, conditional mouse model of PanNETs by using a bi-transgenic system for regulated expression of the aberrant activator of Cdk5, …

Clinical Applications Of Magnetic Resonance Imaging Based Functional And Structural Connectivity, Chengyuan Wu, Francisca Ferreira, Michael Fox, Noam Harel, Jona Hattangadi-Gluth, Andreas Horn, Saad Jbabdi, Joshua Kahan, Ashwini Oswal, Sameer A Sheth, Yanmei Tie, Vejay Vakharia, Ludvic Zrinzo, Harith Akram

Department of Neurosurgery Faculty Papers

Advances in computational neuroimaging techniques have expanded the armamentarium of imaging tools available for clinical applications in clinical neuroscience. Non-invasive, in vivo brain MRI structural and functional network mapping has been used to identify therapeutic targets, define eloquent brain regions to preserve, and gain insight into pathological processes and treatments as well as prognostic biomarkers. These tools have the real potential to inform patient-specific treatment strategies. Nevertheless, a realistic appraisal of clinical utility is needed that balances the growing excitement and interest in the field with important limitations associated with these techniques. Quality of the raw data, minutiae of the …

Effects Of Il-10 On Local Cell Populations And Functional Recovery Following Vml Injury, Zain Blackwell

Biomedical Engineering Undergraduate Honors Theses

Volumetric muscle loss (VML) injuries are prevalent in both military personnel suffering from battlefield related incidents, and civilians following severe motor accidents. Despite its prevalence, VML has no pro-regenerative clinical treatments in place to recover some of the functional capabilities of the damaged muscle. Free flap grafting, debridement of damaged tissue, and physical therapy are the only clinical standards available that offer little functional recovery benefits, even after years of consistent treatment. In this study, anti-inflammatory cytokine interleukin-10 in conjunction with autologous minced muscle was assessed as a possible treatment for VML injuries and its influences on cellular behavior within …

Outcomes Of Mechanical Thrombectomy For Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score In The Early And Extended Window, Eyad Almallouhi, Sami Al Kasab, Zachary Hubbard, Eric C Bass, Guilherme Porto, Ali Alawieh, Reda Chalhoub, Pascal Jabbour, Robert M Starke, Stacey Q Wolfe, Adam S Arthur, Edgar Samaniego, Ilko Maier, Brian M Howard, Ansaar Rai, Min S Park, Justin Mascitelli, Marios Psychogios, Reade De Leacy, Travis Dumont, Michael R Levitt, Adam Polifka, Joshua Osbun, Roberto Crosa, Joon-Tae Kim, Walter Casagrande, Shinichi Yoshimura, Charles Matouk, Peter T Kan, Richard W Williamson, Benjamin Gory, Maxim Mokin, Isabel Fragata, Osama Zaidat, Albert J Yoo, Alejandro M Spiotta

Department of Neurosurgery Faculty Papers

Importance: Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct.

Objective: To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5.

Design, setting, and participants: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid …

Laparoscopic Assisted Robotic Radical Prostatectomy With Pelvic Lymph Node Dissection Using Viable Cryopreserved Umbilical Tissue To Improve Cavernosal Nerve Function., Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason Hafron

Conference Presentation Abstracts

Radical prostatectomy is the preferred treatment for patients with clinically localized prostate cancer and is typically performed using a robotic approach. Surgical techniques that preserve the neurovascular bundle minimize the risk of incontinence and erectile dysfunction post-operatively. Umbilical cord tissue is a relatively new technique, which has been shown to reduce inflammation and promote regenerative healing. In this video we show a robotic radical prostatectomy with bilateral nerve sparing technique utilizing a cryopreserved umbilical cord allograft nerve wrap.

Robotic Spleen Preserving Distal Pancreatectomy (Warshaw Techniqe) In A 12-Year-Old Female., Rachel Harvey, Begum Akay, Pavan Brahmamdam

Conference Presentation Abstracts

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare entity seen in young females. Complete surgical resection is often curative. This video shows a robotic spleen preserving distal pancreatectomy for a SPN in a 12-year-old female using the Warshaw technique. This technique preserves the short gastric and left gastroepiploic vessels allowing for splenic survival after ligation of the splenic vessels. This video demonstrates the feasibility of using the robot to perform this procedure in a pediatric patient. MRI at 18 months follow up showed that the spleen was completely perfused, with no evidence of recurrence or metastasis.

Strocss 2021: Strengthening The Reporting Of Cohort, Cross-Sectional And Case-Control Studies In Surgery, Ginimol Mathew, Riaz Agha, Strocss Group, Joerg Albrecht, Prabudh Goel, Indraneil Mukherjee, Prathamesh Pai, Anil K. D'Cruz, Ather Enam, Hammad Ather

Section of Neurosurgery

Introduction: Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) guidelines were developed in 2017 in order to improve the reporting quality of observational studies in surgery and updated in 2019. In order to maintain relevance and continue upholding good reporting quality among observational studies in surgery, we aimed to update STROCSS 2019 guidelines.
Methods: A STROCSS 2021 steering group was formed to come up with proposals to update STROCSS 2019 guidelines. An expert panel of researchers assessed these proposals and judged whether they should become part of STROCSS 2021 guidelines or not, through a Delphi consensus exercise.
Results: 42 …

Defining The Epidemiology Of Safety Risks In Neonatal Intensive Care Unit Patients Requiring Surgery, Daniel J France, Jason Slagle, Emma Schremp, Sarah Moroz, L Dupree Hatch, Peter Grubb, Timothy J Vogus, Matthew S Shotwell, Amanda Lorinc, Christoph U Lehmann, Jamie Robinson, Marlee Crankshaw, Maria Sullivan, Timothy A Newman, Tamara Wallace, Matthew B Weinger, Martin L Blakely

Faculty, Staff and Student Publications

OBJECTIVE: The aim of the study was to determine the incidence, type, severity, preventability, and contributing factors of nonroutine events (NREs)-events perceived by care providers or skilled observers as a deviations from optimal care based on the clinical situation-in the perioperative (i.e., preoperative, operative, and postoperative) care of surgical neonates in the neonatal intensive care unit and operating room.

METHODS: A prospective observational study of noncardiac surgical neonates, who received preoperative and postoperative neonatal intensive care unit care, was conducted at an urban academic children's hospital between November 1, 2016, and March 31, 2018. One hundred twenty-nine surgical cases in …

A Novel Simulation-Based Multidisciplinary Verbal De-Escalation Training., Gary Duncan, Megan Schabbing, Brad D Gable

Trauma and Acute Care Articles

Background Agitated or aggressive patients pose a high risk of emotional and physical harm to hospital staff. Healthcare associates have the highest rate of workplace violence among studied fields. Learning to effectively de-escalate a patient who is a danger to self or others is key to reducing these incidents. This course was designed to improve education and communication among staff on a hospital surgical floor when verbal de-escalation is needed. Methods A ninety-minute simulation-based multidisciplinary curriculum was developed. This included a 30-minute didactic discussion, 10-minute simulation, and 50-minute debrief. Learners included nurses, patient service associates, and protective services officers from …

Surgical Management Of Subclavian And Proximal Axillary Artery Injuries, Zia Ur Rehman, Suleman Yousaf, Tehmeed Ahmad

Department of Surgery Docs

Subclavian and proximal axillary arterial injuries are rare and difficult to manage. Eight patients were managed from January 2008 to December 2018 at The Aga Khan University Hospital, Karachi, Pakistan with mean age of 36.13 ± 14.48 years. All patients had penetrating injuries, from gunshot in 5 (62.5%), bomb blast in 2 (25%), and stab wound in 1 (12.5%) case. Six (75%) patients presented in haemodynamically stable condition. The mean time between the injury and patient presentation was 28 ± 8.39 hours. The injuries were approached via supraclavicular incision in 3 (37.5%) patients, infraclavicular incisions in 2 (25%) patients and …