Surgery Commons^™

Optimizing Costs In Plastic Surgery: A Systematic Review Of Time-Driven Activity-Based Costing Applications, Emily L. Isch, Gabrielle Kozlowski, D. Mitchell Self, Theodore E. Habarth-Morales, Sydney Somers, Ahilan Sivaganesan, David Kim, Heather A. Mcmahon, Andrew Newsman, Matthew Jenkins

Department of Surgery Faculty Papers

BACKGROUND: The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.

METHODS: A systematic review was conducted …

Detecting Early Changes In Cartilage Collagen And Proteoglycans Distribution Gradients In Mice Harboring The R992c Collagen Ii Mutant Using 2d Correlation Infrared Spectroscopy, Jolanta Fertala, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Collagen II is a vital structural component in developing bones and mature cartilage. Muta- tions in this protein cause spondyloepiphyseal dysplasia, a disease characterized primarily by altered skeletal growth and manifesting with a range of phenotypes, from lethal to mild. This study examined transgenic mice harboring the R992C (p.R1124C) substitution in colla- gen II. Previous research demonstrated significant growth abnormalities and disorganized growth plate structure in these mice, and histological signs of osteoarthritic changes in the knee joints of 9-month-old mice with the R992C mutation. Our study focuses on detecting early structural changes in the articular cartilage that occur before …

Epidemiological Trends Of Facial Fractures In The United States, Gabriel I. Onor, Ugochi T. Aguwa, Nicholas Barksdale, Isaiah X. Hughes, Molly Milano, Camila Cordero, Uche Nwagu, Oluwatomi Akingbola, Chibuzo J. Aguwa, Michael C. Okoronkwo

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Sustaining facial fractures may pose significant challenges to patients' health and quality of life. In the United States (U.S.), facial fractures account for 20 % of all sports-related injuries in pediatrics and many of these injuries are associated with traumatic brain injury. The objective of this study was to identify overall and sports-related incidence rates of facial fractures presenting to U.S. hospital emergency departments from 2014 to 2023 and define demographic risk factors for these injuries.

METHODS: The National Electronic Injury Surveillance System was queried to identify facial fractures from 2014 to 2023 as well as associated demographic data. …

Early Recurrent Midgut Volvulus Post Ladd's Procedure In A Newborn: A Case Report, Nicole Clarke, Joanna Sajdlowska, John Paul Bustamante, Nishith Bhattacharyya

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Ladd's procedure is the standard surgical intervention for intestinal malrotation. Although generally curative, rare cases of early postoperative complications, including adhesions or recurrent volvulus, can necessitate reoperation. We present the case of a full-term newborn girl who underwent emergent Ladd's procedure on Day 3 of life for malrotation with volvulus. She was discharged on postoperative Day 17 but returned the following day with recurrent bilious emesis. Imaging suggested partial obstruction. Exploratory laparotomy revealed recurrent volvulus with two twists at the duodenojejunal junction, which was successfully reduced. The patient recovered well and was discharged on postoperative Day 8. This case underscores …

Attitudes Toward Pig Islet Xenotransplantation For Type 1 Diabetes: A Scoping Review, Daniel J Hurst, Daniel Rodger, Luz A Padilla, Fernando Ovalle

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Over 8 million people globally have type 1 diabetes. Islet allotransplantation offers an alternative to insulin therapy but is constrained by donor availability. Genetically modified pig islet transplantation presents a potential solution, yet understanding stakeholder attitudes is crucial before clinical adoption.

METHODS: This scoping review followed Joanna Briggs Institute methodology and PRISMA guidelines. CINAHL, EMBASE, PubMed, PsychINFO, and SCOPUS were searched for studies examining attitudes toward pig islet xenotransplantation among patients, healthcare workers, and other stakeholders.

RESULTS: From 199 sources, 16 met eligibility criteria, spanning ten countries from 2003 to 2023. The 23,780 participants included 1,535 (6.5%) patients/family members, …

Large Right Subclavian Artery True Aneurysm Treated With Hybrid Surgery, Melissa Xu, Ioannis Tsouknidas, Alec Krosser, Gaurang Joshi, Babak Abai, Michael Nooromid, Paul Dimuzio, Dawn M. Salvatore

Student Papers, Posters & Projects

Introduction

Subclavian artery (SCA) aneurysms are exceedingly rare (~0.13% of peripheral aneurysms).

There are no criteria regarding size cut off for repair.

Surgery is indicated given risk of complications (thrombosis, embolization leading to CVA or UE ischemia, compression of adjacent structures).

• Open surgery (via median sternotomy, hemisternotomy, lateral thoracotomy, supraclavicular or axillary incision),
• Endovascular (stent graft, aneurysm sac coiling, kissing stents or combination)
• Hybrid (endovascular + extra-anatomic bypass).

Quality Over Quantity-Current Challenges Of Robotic Surgery In Poland, Marcin Kubiak, Jacek Doniec, S Vincent Grasso, Andrew Gumbs, Amir Nour Mohammadi, Katarzyna Sędłak, Zuzanna Pelc, Stanisław Góźdź, Wojciech Załuska, Artur Bachta, Paweł Rybojad, Kamil Torres, Timothy M Pawlik, Marek Zawadzki, Andrzej Budzyński, Karol Rawicz-Pruszyński

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Since its introduction in 2010, a dynamic growth of robotic-assisted surgery (RAS) has been observed in Poland. The number of healthcare institutions implementing RAS has tripled in the last 36 months, with 80 surgical robots currently utilized on a national scale. While urological procedures dominate RAS utilization (73%), adoption in gynecology (12.2%) and gastrointestinal surgery (8.5%) is rising, driven by recent National Health Fund reimbursement policies. However, significant fragmentation and alarmingly low numbers of individual RAS procedures were identified: 47.7% of surgeons perform less than 40 cases annually. Parallel to expanding the robotic surgery reimbursement program, several standardized actions are …

Comparison Of Open And Laparo-Endoscopic Repair Techniques For Patients With Bilateral Inguinal Hernias, Divyansh Agarwal, Tina Bharani, Nora Fullington, Lauren Ott, Kortney Hodgson, Daelyn Mcclain, Kaela Blake, Michael Reinhorn

Department of Surgery Faculty Papers

INTRODUCTION: For primary bilateral inguinal hernias, international guidelines favor a laparoscopic posterior mesh repair due to relatively lower risk of acute and chronic pain, faster recovery, and favorable biomechanical properties compared to open anterior approaches (Lichtenstein, plug and patch, etc.). However, studies comparing open mesh-based bilateral inguinal hernia repairs to bilateral laparoscopic and robotic mesh-based approaches are limited. The Abdominal Core Health Quality Collaborative (ACHQC) registry includes longitudinal data on bilateral inguinal hernia repairs performed via open as well as laparo-endoscopic approaches. We hypothesize that outcomes for bilateral inguinal hernia repair are similar between open and laparo-endoscopic approaches in the …

Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery, Jacinta Smith, Mary Jo Kelly

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Incidental Finding Of An Infarcted Epiploic Appendage Attached To The Sigmoid Colon, Ifeanyi K. Uche, Alec A. Hirsch

School of Medicine Faculty Publications

Background: Epiploic appendagitis is a condition usually caused by infarction of the epiploic appendages, small outpouchings of adipose tissue found on the serosal surface of the colon. Epiploic appendagitis is a rare cause of acute lower abdominal pain, but the condition does not have any specific presenting clinical features and is often misdiagnosed as acute diverticulitis, appendicitis, or other gastrointestinal disorder. Case Report: A 53-year-old female presented with abnormal uterine bleeding and pelvic pain and was seeking definitive surgical management. During the patient’s total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, an infarcted epiploic appendage attached to the sigmoid colon was found. …

Histologic- And Genomic-Directed Adjuvant Therapy For Ampullary Adenocarcinoma: A Hidden Genome-Derived Analysis, Brett L Ecker, Kenneth Seier, Ankur Choubey, Austin M Eckhoff, Gabriella N Tortorello, Vinod P Balachandran, Nicola Blackburn, Michael I D'Angelica, Ronald P Dematteo, Daniel G Blazer, Jeffrey A Drebin, William E Fisher, Anthony J Gill, Marie-Claude Gingras, T Peter Kingham, Major K Lee, Michael E Lidsky, Daniel P Nussbaum, Michael J Overman, Jaswinder S Samra, Ronglai Shen, Carlie S Sigel, Charles M Vollmer, Alice C Wei, Sabino Zani, Australian Pancreatic Genome Initiative, Robert E Roses, Mithat Gonen, William R Jarnagin

Faculty, Staff and Students Publications

Background: The benefit of adjuvant chemotherapy (AC) for ampullary adenocarcinoma is unclear. The Hidden Genome model classifies prognostic subtypes with greater accuracy than standard histologic classification (intestinal [INT] vs pancreatobiliary [PB]), but its predictive capacity to guide the use of AC remains unstudied.

Methods: We applied the Hidden Genome model to an international cohort of 183 patients with resected ampullary adenocarcinoma who underwent genomic sequencing. The model quantified the predicted cell of origin (colorectal vs pancreas/distal bile duct) in all specimens. Overall survival (OS) was compared using Kaplan-Meier estimates, stratified by AC use versus surgery alone (SA).

Results: Most patients …

"Touch&Play" Wood Typification By The Masspec Pen, Adriano Reis, Caroline Pais Carvalho, Iasmim Lopes De Lima, Felipe R P Mansoldo, Alane Beatriz Vermelho, Rosineide Costa Simas, Livia S Eberlin, Marcos N Eberlin

Faculty, Staff and Students Publications

We have investigated the ability of a MasSpec Pen (MSPen) "three-in-one" (extraction, transfer, and ionization) device coupled to a mass spectrometer to provide instantaneous chemical profiles that could promptly characterize wood samples from the mahogany (Meliaceae) family. For that, we selected a set of five representative wood species, that is, Brazilian mahogany (Swietenia macrophylla, also known as Honduran mahogany), two African mahoganies (Khaya ivorensis and Khaya senegalensis), and two "nongenuine" ("fake") mahogany woods: cedar (Cedrela odorata) and andiroba (Carapa guianensis). By simply touching the superficially polished wood surface and after 3 s of automatic extraction, profiles of highly characteristic markers …

New Frontiers: The Intern Experience In A Newly Established Integrated Plastic Surgery Program, Hendrik Lintel, Imran Rizvi, Michael Haydon, Erik S Marques, Matthew R Greives, Mohin A Bhadkamkar

Faculty, Staff and Student Publications

The plastic surgery residency pathway has undergone many changes since its inception. The advent of integrated training has largely taken over as the predominant residency model with the addition of a few new programs every year. There is currently a paucity of literature describing the experiences of first-year interns in a new integrated residency program transitioning from the independent model. In this article, we seek to elucidate some of the advantages and difficulties encountered by the initial residents of a newly established integrated program and the steps taken to pave the way for future matched integrated trainees.

Time To Weight Plateau With Tirzepatide Treatment In The Surmount-1 And Surmount-4 Clinical Trials, Deborah B Horn, Scott Kahan, Rachel L Batterham, Dachuang Cao, Clare J Lee, Madhumita Murphy, Sylvia Gonsahn-Bollie, Farai Chigutsa, Adam Stefanski, Julia P Dunn

Faculty, Staff and Student Publications

The rate of weight reduction during obesity treatment declines over time and eventually reaches a weight plateau. We investigated factors associated with time to weight plateau (TTWP) in tirzepatide-treated participants with obesity or overweight in a post-hoc analysis of SURMOUNT-1 and SURMOUNT-4 trials. Participants adherent to tirzepatide treatment and achieving ≥5% weight loss by primary endpoint (week 72 SURMOUNT-1; week 88 SURMOUNT-4) were included. Weight plateau was defined as a weight change < 5% over a 12-week interval and all subsequent 12-week intervals. TTWP was time from randomization to the start of the first 12-week interval. Association between baseline characteristics and TTWP was assessed. Overall, 1438 participants in SURMOUNT-1 and 259 in SURMOUNT-4 were included. Across BMI categories (overweight, class I, II, and III), median TTWP in SURMOUNT-1 was 24.3, 26.0, 36.1, and 36.1 weeks, respectively (p < .05, class II and III vs. overweight). By week 72, 90.2%, 88.9%, 87.6%, and 87.8% of participants in SURMOUNT-1 had reached a weight plateau across respective BMI categories [Correction added on 22 January 2025, after first online publication: The "72%" has been changed to "72" in this version.]. Higher doses of tirzepatide (10/15 mg), younger age, and female sex were more likely to reach a weight plateau later. Results in SURMOUNT-4 were similar. In this post-hoc analysis, most participants reached a weight plateau by week 72. Higher doses of tirzepatide, younger age, and female sex were associated with a longer TTWP. Further research into modifiers of weight reduction phases with tirzepatide may inform treatment decisions for its use in chronic weight management. Clinical Trial Registration: ClinicalTrials.gov, identifiers NCT04184622 (SURMOUNT-1) and NCT04660643 (SURMOUNT-4), available at http://www.clinicaltrials.gov/.

Association Between Timing Of Angiotensin Ii Administration And Outcomes In Vasoplegia After Cardiac Surgery, Travis J Miles, Michael T Guinn, Orlando R Suero, Todd K Rosengart, Marc R Moon, Joseph S Coselli, Ravi K Ghanta, Subhasis Chatterjee

Faculty, Staff and Students Publications

Objective: Vasoplegic shock after cardiopulmonary bypass (CPB) is a highly morbid condition. The novel vasopressor angiotensin II is increasingly being used for catecholamine-resistant vasoplegia. Although early intervention with adjunctive therapies such as methylene blue can improve outcomes of vasoplegia, the optimal timing for escalation with angiotensin II is unknown.

Methods: Pharmacologic data were extracted from electronic health records for patients who underwent surgery with CPB during 2017-2022. Patients were identified who received angiotensin II intraoperatively or postoperatively (ie, early or late). Multivariable logistic regression was used to determine the risk-adjusted effects of earlier angiotensin II administration on postoperative major adverse …

Can Tanzanian Neurosurgeons Access Tanzanian Neurosurgical Literature? A Systematic Review And Survey Of Neurosurgical Publications, Sabas Romani R, Woodfield Julie, Ikwuegbuenyi Chibuikem Anthony, Cadieux Magalie, Shayo Consolata, Shabhay Zarina, Rabiel Happiness, Beverly Cheserem, Bwemelo Joel, Wright Drew N

General Surgery, East Africa

BACKGROUND AND OBJECTIVES: Free and open access to research data and findings promotes equity in access to healthcare knowledge and equity in patient care and treatment. To benefit the health care of the population studied, research findings must be accessible to clinicians, academics, and policymakers serving those populations. The aim of this study was to assess the extent of published Tanzanian neurosurgical data and its accessibility to those practicing within the country.

METHODS: A systematic review of all published neurosurgical studies from Tanzania was conducted. Authorship, funding, and open-access status were recorded. Tanzanian neurosurgeons were surveyed by telephone …

From Rags To Riches: Ai-Powered Retrieval Augmented Generation (Rag) For Just-In-Time Learning And Accelerated Onboarding In High Turnover Icus, Celestino Castanon Md, Alison A. Smith Md, Phd, Patrick Greiffenstein Md, Jennifer M. Brewer Md, Roslyn Alexander Md

Quality Improvement & Patient Safety Forum

No abstract provided.

Socioeconomic Disparities In Breast Cancer Survival: Examining Potential Mediator Role Of Oncotype Dx(Odx) Test And Stage At Diagnosis Among Hr+/Her2- Breast Cancer Women, Pratibha Shrestha, Qingzhao Yu, Edward S. Peters, Edward Trapido, Mei Chin Hsieh, Tekeda Ferguson, Quyen D. Chu, Xiao Cheng Wu

School of Public Health Faculty Publications

Background: Women with a lower socioeconomic status (SES) have an increased risk of dying from breast cancer (BC) than those with a higher SES. The association of SES with BC survival may be partially mediated by factors such as Oncotype DX (ODX) testing and stage at diagnosis. This study aims to examine SES disparities in survival among HR+/HER2- BC women and to quantify the mediating effects of the ODX test and stage. Methods: We used data from the Louisiana Tumor Registry to identify women aged 20–90 years diagnosed with stage I–II in 2011–2014 and stage I–III in 2015–2017 HR+/HER2- BC …

A Novel Arthroscopic-Assisted Fibular-Based Dual Reconstruction With Popliteus Repair Technique For Posterolateral Corner Injury: A Cadaveric And Functional Anatomic Study, S. Ali Ghasemi, Ahmad Naja, Benjamin C. Murray, Arthur Bartolozzi, Gene Shaffer, James Raphael

Einstein Health Papers

The structures of the posterolateral corner (PLC) work together as a single unit to provide both static and dynamic functions to the knee. Multiple techniques have been described for PLC reconstruction, however most of these techniques re-establish the static function of the PLC without addressing dynamic components. The popliteus muscle serves an important role in providing dynamic stability to the PLC, but this function is often not restored in reconstruction techniques. We describe a novel technique for PLC reconstruction that includes popliteus repair, and review the functional anatomy and biomechanics of the PLC. We also confirm the dynamic stabilizing role …

Revisiting Traumatic Intracerebral Hemorrhage In The Context Of Enrich: Illustrative Cases, Erik Werheim, Brendan Mcshane, Zachary Sokol, Theodore Hannah, Robert Ziechmann, Phillip Villaneuva

Department of Surgery Faculty Papers

BACKGROUND: Traumatic intracerebral hemorrhage (tICH) is a common form of intracranial hemorrhage after traumatic brain injury (TBI). The role of surgical intervention in tICH remains a subject of discussion. Recent trials, such as Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH), have shown the efficacy of minimally invasive clot evacuation for non-tICH for hemorrhages with volumes of 30-80 mL. The generalizability of ENRICH to tICH remains unclear; however, it demonstrates the need for rigorous studies evaluating the efficacy of surgical intervention in tICH versus medical management.

OBSERVATIONS: Here the authors present 2 cases of tICH, both in the dominant temporal …