Surgery Commons^™

Higher Body Mass Index (Bmi) And Low-Volume Surgeons Confer Increased Operative Complications In Anterior Spinal Exposures, Aisha Shaheen, Md, Mha, Naveed A. Rahman, Abhay Mathur, Bs, Deepika Koganti, Md, Pgy-4, Alec C. Beekley, Md, Facs, John R. Eisenbrey, Phd, Joshua A. Marks, Md, Michael S. Weinstein, Md, Facs, Fccm, Murray J. Cohen, Md, Facs

Department of Surgery Posters

Background

Anterior spinal exposures performed by spine or vascular surgeons have a known complication rate of 2-11%. We present the largest single institution experience of anterior spinal exposures performed by Acute Care Surgeons.

The purpose of this study was to characterize the incidence of vascular and visceral injuries during spinal exposures and to identify risk factors contributing to operative complications during the exposure. We hypothesized that patients with a BMI >30 as well as low-volume surgeons (<20 >operations) would have an increased complication rate.

Poster presented at: American Association for Surgery of Trauma (AAST) in Hawaii

Prevalence And Determinants Of Metabolic Syndrome In Qatar: Results From A National Health Survey, Mohamed Al-Thani, Al Anoud M. Al-Thani, Sohaila Cheema, Javaid Sheikh, Ravinder Mamtani, Albert B. Lowenfels, Walaa F. Al-Chetachi, Badria Almalki, Shamseldin A. Hassan Khalifa, Ahmad O. Haj Bakri, Patrick Maisonneuve

NYMC Faculty Publications

OBJECTIVES: To determine optimum measurements for abdominal obesity and to assess the prevalence and determinants of metabolic syndrome in Qatar.

DESIGN: National health survey.

SETTING: Qatar National STEPwise Survey conducted by the Supreme Council of Health during 2012.

PARTICIPANTS: 2496 Qatari citizens aged 18-64 representative of the general population.

PRIMARY AND SECONDARY OUTCOME MEASURES: Measure of obesity (body mass index, waist circumference or waist-to-height ratio) that best identified the presence of at least 2 other factors of metabolic syndrome; cut-off values of waist circumference; frequency of metabolic syndrome.

RESULTS: Waist circumference ≥102 for men and ≥94 cm for women was …

Department Of Surgery Update, September 2016, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity, and more.

Respiratory Rate Variability In Sleeping Adults Without Obstructive Sleep Apnea, Guillermo Gutierrez, Jeffrey Williams, Ghadah Alrehaili, Anna Mclean, Ramin Pirouz, Richard L. Amdur, Vivek Jain, Jalil Ahari, Amandeep Bawa, Shawn Kimbro

Surgery Faculty Publications

Characterizing respiratory rate variability (RRV) in humans during sleep is challenging, since it requires the analysis of respiratory signals over a period of several hours. These signals are easily distorted by movement and volitional inputs. We applied the method of spectral analysis to the nasal pressure transducer signal in 38 adults with no obstructive sleep apnea, defined by an apnea‐hypopnea index <5, who underwent all‐night polysomnography (PSG). Our aim was to detect and quantitate RRV during the various sleep stages, including wakefulness. The nasal pressure transducer signal was acquired at 100 Hz and consecutive frequency spectra were generated for the length of the PSG with the Fast Fourier Transform. For each spectrum, we computed the amplitude ratio of the first harmonic peak to the zero frequency peak (H1/DC), and defined as RRV as (100 − H1/DC) %. RRV was greater during wakefulness compared to any sleep stage, including rapid‐eye‐movement. Furthermore, RRV correlated with the depth of sleep, being lowest during N3. Patients spent most their sleep time supine, but we found no correlation between RRV and body position. There was a correlation between respiratory rate and sleep stage, being greater in wakefulness than in any sleep stage. We conclude that RRV varies according to sleep stage. Moreover, spectral analysis of nasal pressure signal appears to provide a valid measure of RRV during sleep. It remains to be seen if the method can differentiate normal from pathological sleep patterns.

Spontaneous Hemarthrosis Of The Knee - Late Complication Of Flexible Femur Nailing: A Case Report., Indranil V Kushare, Matthew E. Oetgen, Suzanne J Walters

Orthopaedic Surgery Faculty Publications

We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

Current Practices Of Obesity Pharmacotherapy, Bariatric Surgery Referral And Coding For Counselling By Healthcare Professionals, Christine Petrin, Scott Kahan, Monique Turner, C. Gallagher, William Dietz

Health Policy and Management Faculty Publications

Introduction

Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low.

Objectives

The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management.

Methods

Primary care physicians (PCPs), OB‐GYN physicians and nurse practitioners (NPs) responded to a web‐based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice.

Results

Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB‐GYNs and NPs …

Management And Outcomes Of Intramedullary Spinal Cord Tumors: A Single Center Experience From A Developing Country, Dr Saqib Kamran Bakhshi, Muhammad Waqas, Baila Shakaib, Ather Enam

Section of Neurosurgery

Background: Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery.
Methods: This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified …

Predictive Model For Blood Product Use In Coronary Artery Bypass Grafting, Hasanat Sharif, Hamza Zaheer Ansari, Awais Ashfaq, Wasiq Faraz Rawasia, Gulshan Bano, Shiraz Hashmi

Section of Cardiothoracic Surgery

Objective: To build a clinical predictive model to determine the need for transfusing blood and its products in coronary artery bypass grafting (CABG) procedures in South East Asian population.STUDY Design: Analytical study.PLACE AND DURATION OF STUDY: Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from January 2006 to October 2014.METHODOLOGY: Information on pre-, intra- and postoperative variables were collected for all adult patients who underwent on-pump CABG. The patients grouped into those who received blood and its components, and those who did not. Aunivariate as well as multivariate logistic model was built to determine the predictors of transfusion.Results: A …

Microdose Fluorescence Imaging Of Aby-029 On An Operating Microscope Adapted By Custom Illumination And Imaging Modules, Jonathan T. Elliott, Alisha V. Dsouza, Kayla Marra, Brian W. Pogue, David Roberts, Keith Paulsen

Dartmouth Scholarship

Fluorescence guided surgery has the potential to positively impact surgical oncology; current operating microscopes and stand-alone imaging systems are too insensitive or too cumbersome to maximally take advantage of new tumor-specific agents developed through the microdose pathway. To this end, a custom-built illumination and imaging module enabling picomolar-sensitive near-infrared fluorescence imaging on a commercial operating microscope is described. The limits of detection and system specifications are characterized, and in vivo efficacy of the system in detecting ABY-029 is evaluated in a rat orthotopic glioma model following microdose injections, showing the suitability of the device for microdose phase 0 clinical trials.

The Duration Of Pubertal Growth Peak Among Three Skeletal Classes, Waqar Jeelani, Mubassar Fida, Attiya Shaikh

Department of Surgery Docs

ABSTRACT

Introduction:

Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability.

Objective:

The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes.

Methods:

A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. …

Morbidity Of Colostomy Reversal, Salma Khan, Abdul Rehman Alvi, , Zara Awan, Naveed Haroon Rashid

Department of Surgery Docs

Abstract

OBJECTIVE:

To determine morbidity after colostomy reversal at a tertiary care hospital.

METHODS:

The retrospective case series was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients aged 15 years or more who underwent colostomy reversal from January 2003 to December 2011. Data was collected regarding demographics, procedure dates, indication, as well as type and location of colostomy. Details of colostomy reversal, including pre-operative, intra-operative and post-operative variables were recorded.

RESULTS:

The mean age of the 96 patients was 40±16 years; 72(75%) of them being males. The most frequent indications for fashioning of colostomy were …

Reliability Of Overbite Depth Indicator (Odi) And Anteroposterior Dysplasia Indicator (Apdi) In The Assessment Of Different Vertical And Sagittal Dental Malocclusions: A Receiver Operating Characteristic (Roc) Analysis, Farheen Fatima, Mubassar Fida, Attiya Shaikh

Department of Surgery Docs

Abstract

INTRODUCTION::

Differential diagnosis of skeletal and dental relationships is crucial for planning orthodontic treatment. Overbite depth indicator (ODI) and anteroposterior dysplasia indicator (APDI) had been introduced in the past for assessment of vertical and sagittal jaw relationships, respectively.

OBJECTIVE: :

The objectives of this study were to evaluate the reliability of ODI and APDI in overbite and Angle malocclusions, as well as assess their diagnostic reliability among males and females of different age groups.

MATERIAL AND METHODS: :

This study was conducted using pretreatment dental casts and lateral cephalograms of 90 subjects. For ODI, subjects were divided into three …

Recurrent Violent Injury: Magnitude, Risk Factors, And Opportunities For Intervention From A Statewide Analysis., Elinore Kaufman, Kristin L. Rising, Md, Ms, Douglas J. Wiebe, David J. Ebler, Marie L. Crandall, M. Kit Delgado

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established.

METHODS: We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and …

Geographic And Age-Based Variations In Medicare Reimbursement Among Assh Members., Michael P. Gaspar, Patrick M. Kane, Grace B. Honik, Eon K. Shin, Sidney M. Jacoby, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus …

Bilateral Triad Of Persistent Median Artery, A Bifid Median Nerve And High Origin Of Its Palmar Cutaneous Branch. A Case Report And Clinical Implications, Olutayo Ariyo, John Shea

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

We report the association of a persistent median artery, a bifid median nerve with a rare very high origin palmar cutaneous branch, presenting bilaterally in the upper limb of a 75-year-old female cadaver. The persistent median nerve with a bifid median nerve has been reported in patients presenting with carpal tunnel syndrome. Reports of this neurovascular anomaly occurring in association with a high origin palmar cutaneous branch however, are few. This subset of patients is at risk of inadvertent nerve transection during forearm and wrist surgery. Pre-operative magnetic resonance imaging (MRI) and high resolution sonography (HRS) can be used to …

Systemic Inflammatory Response Syndrome (Sirs) After Extracorporeal Membrane Oxygenation (Ecmo): Incidence, Risks And Survivals., Karthik Thangappan, Nicholas C. Cavarocchi, Michael Baram, Brandi Thoma, Hitoshi Hirose

Department of Surgery Faculty Papers

INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is frequently observed after extracorporeal membrane oxygenation (ECMO) decannulation; however, these issues have not been investigated well in the past.

METHODS: Retrospective chart review was performed to identify post-ECMO SIRS phenomenon, defined by exhibiting 2/3 of the following criteria: fever, leukocytosis, and escalation of vasopressors. The patients were divided into 2 groups: patients with documented infections (Group I) and patients with true SIRS (Group TS) without any evidence of infection. Survival and pre-, intra- and post-ECMO risk factors were analyzed.

RESULTS: Among 62 ECMO survivors, 37 (60%) patients developed the post-ECMO SIRS phenomenon, including …

Non-Psychotropic Cannabinoid Based Therapy Modulates Nociceptive Signaling Molecules, Microglia, And Pain Behavior In A Model Of Post-Concussion Headache, Jarred M. Stratton, Lan Cheng, Ashley L. Tyburski, Jessica Perino, Melanie B. Elliott

Department of Neurosurgery Posters

Background & Objectives

Headache is a common symptom of post-concussion syndrome which may persist in a substantial portion of patients contributing to a poor quality of life and disability. There is a pressing need to develop novel treatments for post-traumatic headache as current treatments have a number of side effects, are contraindicated or lack efficacy. The Elliott laboratory first established models of post-traumatic headache demonstrating sensitization of trigeminal neurons in rodent models of post-traumatic headache using well-known nociceptive and behavioral markers in the pain and migraine fields^1-3. Traumatic brain injury in mice increases expression of calcitonin gene related …

Early Detection Of Idiopathic Scoliosis In Adolescents, M. Timothry Hresko, Vishwas Talwalkar, Richard Schwend

Orthopaedic Surgery and Sports Medicine Faculty Publications

The early detection of idiopathic scoliosis has been advocated since the 1950s and ’60s, concurrent with the development in the modern era of ambulatory spinal orthoses to treat scoliosis in adolescents. This led to the development of screening programs for specific populations, as evidenced by school screening programs in the United States and public health systems in Europe and Asia. Over time, the value of population screening in terms of optimal health care and economics has been debated in the popular press, by the U.S. Preventive Services Task Force, and by professional societies. Recent studies on the effectiveness of bracing …

First-Case Operating Room Delays: Patterns Across Urban Hospitals Of A Single Health Care System, Callie M. Cox Bauer, Danielle M. Greer, Kiley B. Vander Wyst, Scott A. Kamelle

Journal of Patient-Centered Research and Reviews

Purpose

Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs.

Methods

We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of …

Metastatic Pancreatic Adenocarcinoma During Pregnancy., Jessica Davis, Showkat Bashir, Helmae Wubneh, Marie L. Borum

Surgery Faculty Publications

We present a rare case of metastatic pancreatic adenocarcinoma diagnosed antepartum. A high index of suspicion must be maintained to diagnose pancreatic cancer during pregnancy. We recommend a thorough history and physical and aggressive pursuit of sensitive imaging in patients with persistent symptoms. If pancreatic adenocarcinoma is diagnosed, a multidisciplinary approach that focuses on patient goals should be undertaken. The effect of pregnancy on tumor growth rates is unknown.