Surgery Commons^™

Impact Of Fellow/Resident Involvement During Colonoscopy In A High-Volume Colorectal Surgical Practice, Zachary Chomitzky, William Sangster

Research Scholars

No abstract provided.

Treatment And Outcomes Of Soft Tissue Sarcoma Of Groin, Hip And Thigh: A Retrospective Review From A Tertiary Care Hospital, Masood Umer, Javeria Saeed, Zaid Ahmed Shamsi, Muhammad Usman Tariq

Section of Orthopaedic Surgery

Objective: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi.
Methodology: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included.
Results: Total 119 cases of soft tissue tumours (STS) …

The Effect Of Patient Age In Progression To A Hemorrhoidectomy, Justin Yoon, William Sangster

Research Scholars

No abstract provided.

Angiovac Outcome Analysis In Tricuspid Valve Endocarditis, Maya Parekh, James K. Wu Md

Research Scholars

No abstract provided.

Is There A Difference Between Burn Patients Treated With Topical Mafenide Acetate Before And During Covid-19?, Morgan Anderson, Sigrid A. Blome-Eberwein Md

Research Scholars

No abstract provided.

Evaluating Patient Outcomes Following Redo Sternotomies In Cardiac Surgery, Sajan Patel, James K. Wu Md

Research Scholars

No abstract provided.

Prevention Of Falls In Hospital: Audit Report From A Tertiary Care Hospital Of Pakistan, Anum Sadruddin Pidani, Tashfeen Ahmad, Nasreen Panjwani, Shahryar Noordin

Department of Surgery Docs

Objective: The study aims to assess the fall incidents in past 5 years and fall assessment practices at the Aga Khan University Hospital, Karachi.
Methods: We performed a single-center retrospective audit at Aga Khan University Hospital from October 2019 to December 2019. A list of all patients admitted to Aga Khan University Hospital under the Musculoskeletal and Sports Medicine Service Line was obtained using the Hospital Information Management System (HIMS) from Jan 2017 to June 2018. Data including fall assessment scores was collected retrospectively from medical record files.
Results: A total of 1499 patients were admitted during this time period, …

Institutional Factors In General Surgery Resident Wellness And Burnout: Identification Via A Modified Delphi Technique, Darci C. Foote, Gurjit Sandhu, Kathryn Ziegler, James Lau

Conference Presentation Abstracts

Background: While there has been significant focus on individual and programmatic factors impacting general surgical residents wellbeing and burnout, the effect of the greater institutional macrocosm has not been well studied. Our work seeks to identify organizational factors that may be implicated in resident wellness. Summary of Work: Using a modified Delphi technique, a survey structured around six domains of the Maslach Burnout Theory (workload, control, reward, community, fairness, values) was distributed to wellness stakeholders at two institutions. Participants identified factors that may be implicated in resident wellness and burnout. Two subsequent multiple-choice survey iterations were distributed to stakeholders who …

Abdominal Vascular Injuries- What General/ Trauma Surgeons Should Know?, Zia Ur Rehman

Department of Surgery Docs

Abdominal vascular injuries are the common cause of death post-trauma. These are challenging injuries to manage due to severe haemodynamic instability, other associated injuries and difficulty in accessing and controlling these deep-seated vessels. Early control of bleeding can decrease mortality in these patients. Abdominal vasculature is divided into three zones, each requiring different operative strategy for exposure. Standard vascular surgery principles of achieving proximal and distal control before exploring any haematoma are followed when managing these injuries. Resuscitative endovascular balloon occlusion of aorta is a minimally invasive method of achieving proximal aortic occlusion. This also acts as bridge for definitive …

Comparison Of Brachiobasilic Transposition Arteriovenous Fistula Outcomes Among Diabetic And Non-Diabetic Patients: A Case Controlled Study, Zia Ur Rehman, Waryam Muhammad Saleh, Anum Sadruddin Pidani

Department of Surgery Docs

Diabetes is considered a risk factor for arteriovenous fistula failure and increased perioperative complications; but this view is not proven for patients undergoing brachiobasilic transposition arteriovenous fistula (BBT-AVF). Fifty-one (68.9%) diabetic and 23 (31.08%) non-diabetic patients undergoing single-stage BBT-AVF were compared in terms of perioperative complications, access maturation and patency rates at The Aga Khan University Hospital from between January 2016 to December 2017. Diabetics were elder and more obese. The perioperative complications 19 (37.2%) vs. 8 (34.7%), and access maturation rates were compared (93.2% vs. 95.5%) between the two groups. At 6 months, access patency in diabetics was lower …

Concurrent Primary Cardiac Tumors In A High-Risk Patient Presenting With Tamponade., Jay V Gopal, Lauren Crowley, Shawn M Quinn, Timothy S Misselbeck, Joseph B Zackary

Department of Emergency Medicine

Primary cardiac tumors are rare, particularly in the elderly population. The patient described in this report presented with symptoms of dyspnea on exertion, leg swelling, and weight gain and was found to have two histologically distinct cardiac masses: atrial myxoma with concurrent aortic fibroelastoma. Given her history of cirrhosis and end-stage renal disease, the patient was a poor surgical candidate but opted for excision of both masses. The patient eventually succumbed to her cirrhosis six weeks after presentation. In this report, we advocate for further research into medical management for the unique presentation of concurrent primary cardiac tumors in high-operative-risk …

Long-Term Clinical And Functional Outcomes Of Distally Based Sural Artery Flap: A Retrospective Case Series, Pervaiz Hashmi, Abeer Musaddiq, Muhammad Ali, Alizah Hashmi, Marij Zahid, Zohaib Nawaz

Section of Orthopaedic Surgery

Background: Reconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome.
Methods: A retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect …

Towards Laparoscopic Visual Ai: Development Of A Visual Guidance System For Laparoscopic Surgical Palpation, Kerwin G. Caballas, Harold Jay M. Bolingot, Nathaniel Joseph C. Libatique, Gregory L. Tangonan

Electronics, Computer, and Communications Engineering Faculty Publications

Currently, there are numerous obstacles to performing palpation during laparoscopic surgery. The laparoscopic interface does not allow access into a patient's body anything other than the tools that are inserted through the trocars. Palpation is usually done with the surgeon's hands to detect lumps and certain anomalies underneath the skin, muscle, or tissues. It can be useful technique for augmenting surgical decision-making during laparoscopic surgery, especially when discerning operations involving cancerous tumors. Previous research demonstrated the use of tactile sensors and mechanical sensors placed at the end-effectors for palpating laparoscopically. In this study, a visual guidance system is proposed for …

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.

Designing A Virtual Reality Experience To Reduce Anxiety Of Children With Chd During The Perioperative Period, Yang Zhang

Theses - ALL

Children with congenital heart disease (CHD) often need to bear great anxiety related to various invasive surgeries and medical procedures. In a study of virtual reality technology in the medical industry, I found that it has great development potential in reducing children's anxiety. Therefore, the goals of this thesis project were to use virtual reality technology to reduce anxiety for children with CHD. Using previous research of anxiety in children with CHD and the solutions to children's anxiety in various hospitals, this thesis summarizes the design directions. Then, through interviews with pediatric cardiologists, child development experts, and children with coronary …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

Impact Of Duration Of Antibiotic Prophylaxis On Rates Of Surgical Site Infection (Ssi) In Patients Undergoing Mastectomy Without Immediate Reconstruction, Comparing A Single Prophylactic Dose Versus Continued Antibiotic Prophylaxis Postoperatively: A Multicentre, Double-Blinded Randomised Control Trial Protocol, Abida K. Sattar, Nida Zahid, Hania Shahzad, Rufina Soomro, Omema Saleem, Syed Faisal Mahmood

Department of Surgery Docs

Introduction: In breast surgeries, prophylactic antibiotics given before the surgical incision as per Joint Commission Surgical Care Improvement Project guidelines have been shown to decrease the rate of postoperative infections. There is, however, no clear consensus on postoperative antibiotic prophylaxis in patients undergoing mastectomy with indwelling drains. This trial protocol proposes to study the difference in rates of surgical site infection (SSI) with or without continuation of postoperative antibiotics in patients undergoing mastectomy without immediate reconstruction and with indwelling drains.
Methods and analysis: In this multicentre, double-blinded clinical trial, all patients undergoing mastectomy (without immediate reconstruction) will receive a single …