Surgery Commons^™

The Effect Of Celecoxib And Mumab911 On Strain Adaptive Bone Remodeling And Fracture Repair In Female Mice: Implications For Rapidly Progressive Osteoarthritis, Nicholas Ruggiero, Alexandra Ciuciu, Ashkan Sedigh, Ibtesam Rajpar, David Shelton, Patrice Belanger, Kathryn Gropp, John A. Collins, Theresa A. Freeman, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Debilitating pain is the primary clinical feature of osteoarthritis (OA) that drives the enormous healthcare costs. Osteoarthritis-related pain is often treated with non-steroidal anti-inflammatory drugs (NSAIDs), which effectively relieve pain and inflammation by inhibition of prostaglandin synthesis. Antibodies directed against nerve growth factor (NGF) were tested some time ago as an alternative potential analgesic for musculoskeletal pain, including osteoarthritis-related pain. Unfortunately, clinical development of these drugs was put on hold due to adverse outcomes - primarily rapidly progressive osteoarthritis. Both prostaglandin synthesis and NGF have been implicated as critical mediators of strain adaptive bone remodeling, which may play a role …

Renal Denervation Improves Cardiac Function And Exercise Duration In A Miniswine Model Of Heart Failure With Preserved Ejection Fraction, David J. Lefer, Thomas E. Sharp, Amy L. Scarborough, Amelia G. Haydel, Sanjiv J. Shah, Zhen Li, Traci T. Goodchild

School of Medicine Faculty Publications

Aims: Overactivity of the sympathetic nervous system is a common underlying mechanism in development and progression of several heart failure with preserved ejection fraction (HFpEF) comorbidities. Decreasing renal sympathetic nerve activity using catheter-based renal denervation (RDN) systems have shown efficacy in treating resistant hypertension and cardiac dysfunction in heart failure with reduced ejection fraction. The purpose of this study was to determine if modulation of renal sympathetic nerve activity by RDN improves cardiac function and exercise tolerance in a clinically-relevant minipig model of cardiometabolic HFpEF. Methods and results: Multiple HFpEF comorbidities were induced in adult female Göttingen minipigs by mineralocorticoid …

Methylprednisolone After Shoulder Arthroplasty Leads To Decreased Opioid Prescriptions Without An Increased Risk Of Infection: A Matched Cohort Analysis, Tej Joshi, Tuckerman Jones, Akhil Katakam, Daniella Ogilvie, Amanda Azer, Sefy Paulose, Balazs Galdi

Jefferson Hospital Staff Papers and Presentations

Background

Methods

Switching Lanes: Leaving Behind Discharge Antibiotics And Laboratory Testing In Perforated Appendicitis, Seth Saylors, Cory Nonnemacher, Meredith Elman, Pablo Aguayo, Richard Hendrickson, David Juang, Irene Isabel P. Lim, Rebecca Rentea, Charles Snyder, Shawn St. Peter, Tolulope Oyetunji

Research Days

Purpose: Appendicitis is the most common surgical emergency in children with approximately 30% of patients presenting with perforation, defined as a hole in the appendix or a fecalith found in the abdomen, at time of surgery. Our previous protocol at time of discharge, with an 11% intraabdominal abscess (IAA) rate, included checking a white blood cell count (WBC) on day of discharge, with a value ≥10 serving as a trigger for additional outpatient oral antibiotics course. Beginning in May, 2023 we changed our protocol to no longer obtain WBC or prescribe outpatient antibiotics at time of discharge. The purpose of …

Simulation Needs For Mid-Level Skills In General And Cardiothoracic Surgery, Katelyn Ward, M Yassin, J Bui, D Lee, R Reddy

Conference Presentation Abstracts

Objective: As the integrated cardiothoracic (I6) residency reaches maturity, it is important to identify core mid-level surgical skills that are valued within this framework in order to target these skills for development and improve competency and confidence. We aim to understand how I6 skill needs diverge from those traditionally emphasized in general surgery training, enabling a tailored approach to simulation-based education that aligns with evolving educational models. Methods: Surveys were distributed to general surgery (GS) and cardiothoracic (CT) faculty and residents at a single academic center. Respondents reported on current simulation perceptions and ranked open mid-level resident surgical skills that …

Determining Size In An Era When Size Matters: Inter-Radiologist Variability In Lung Cancer Measurement, Katelyn Ward, Gayaneh Nazarian, Ryan Davis, Sayf Al-Katib, Kiran Nandalur, Thomas Watson

Conference Presentation Abstracts

No abstract provided.

Tacrolimus Dosing In Liver Transplant Recipients Using Phenotypic Personalized Medicine: A Phase 2 Randomized Clinical Trial, Jeffrey Khong, Megan Lee, Curtis Warren, Un Kim, Sergio Duarte, Kenneth Andreoni, Sunaina Shrestha, Mark Johnson, Narendra Battula, Danielle Mckimmy, Thiago Beduschi, Ji-Hyun Lee, Derek Li, Chih-Ming Ho, Ali Zarrinpar

Department of Surgery Faculty Papers

Tacrolimus is the most commonly used immunosuppression drug after solid organ transplantation; however, its dosing is challenging due to substantial inter-individual variability, often resulting in blood levels that deviate from the target therapeutic range. We explored whether a dynamically customized, phenotypic-outcome-guided drug dosing method could improve maintenance of drug trough levels within pre-determined target ranges, focusing on tacrolimus immediately after liver transplantation. This single-center, partially blinded, completed clinical trial involved 62 adults undergoing liver transplantation, block randomized into parallel groups: standard-of-care (SOC) clinician-determined or Phenotypic Personalized Medicine (PPM)-guided tacrolimus dosing. The primary outcome was percentage of post-transplant days with large …

Robotic-Assisted Excision Of Choledochal Cyst With Hepaticoduodenostomy And Intraoperative Identification Of Gallbladder Agenesis, Luke Man, Melanie Ermler, Ryan Davis, Pavan Brahmamdam

Conference Presentation Abstracts

No abstract provided.

Implementation Of A Clinical Pathway For Complicated Appendicitis In Children, Kristin E. Lemarbe, Andrew Glaza, Alexander L. Chen, Diane Studzinski, Amanda Henderson, Anthony Stallion, Nathan Novotny, Begum Akay, Pavan Brahmamdam

Conference Presentation Abstracts

No abstract provided.

When The Right Ventricle Fails After Left Ventricular Assist Device Implantation: Prediction Tools, Recognition Strategies, And Support Options, Juan Jose Rodriguez Arias, James Schurr, Phyllis Billia, Joyce W. Wald

Journal of Shock and Hemodynamics

The incidence of right heart failure (RHF) during durable left ventricular assist device (LVAD) surgery ranges from 9% to 42%, depending on the definition. RHF can be divided into three peri-implantation categories: early acute, early, and late. Despite many available risk models, predicting RHF before durable LVAD implantation has been difficult. Preemptive right-sided temporary mechanical circulatory support can improve outcomes; however, if intraoperative RHF is not suspected, early recognition and appropriate intervention after surgery are important.

Epigastric Hernia With Unusual Contents, Katelyn Ward, Melanie Ermler, Alexis Lonjin, Kathryn Ziegler

Conference Presentation Abstracts

No abstract provided.

Postoperative Calcium Supplementation Adherence In Total Thyroidectomy And Parathyroidectomy Patients - Risk Factors And Outcomes, Katelyn Ward, Cydney Mcchesney, John Nida, Negin Mohtashemian, Jacob Mesiti, Emmanuel Nageeb, Diane Studzinski, Rose Callahan, Peter Czako, Sapna Nagar

Conference Presentation Abstracts

No abstract provided.

Surgical Site Infection Bundle For Babies - Preliminary Data, Cullen Woodley, Katelyn Ward, John Nida, Alexis Lonjin, Diane Studzinski, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Conference Presentation Abstracts

No abstract provided.

The Impact Of Cultures On Treating Abscesses Associated With Appendicitis, Cory Nonnemacher, Seth Saylors, Meredith Elman, Tolulope A. Oyetunji Md Mph, Shawn D. St Peter

Research Days

Background/Purpose

Perforated appendicitis is associated with elevated risk of post-operative intra-abdominal abscess (PIAA) formation. Small PIAAs can be successfully treated without drainage, while larger ones warrant Interventional Radiology drainage. Routine culture of drained abscesses occurs at most institutions, with some prior studies showing resistance rates of 40-50%, prompting change of post-drainage antibiotics. The purpose of our study is to evaluate if culture results impact the antimicrobial therapy chosen for patients with PIAA, with our hypothesis being that routine culture does not have a significant impact on patient outcomes.

Methods

Patients < 18 years of age who were treated for perforated appendicitis at a standalone tertiary children’s hospital from 2011 to 2024 were retrospectively evaluated for abscess formation and extracted those who underwent drainage procedures with abscess cultures to assess the need for antibiotic adjustments from the standard of care based on culture results.

Results

A total of 1736 patients treated for perforated appendicitis …

Post-Operative Management Of Chronic Subdural Hematomas, Steven R. Glener, Md

Health Equity and Quality Improvement (HEQI) Summit

Primary Objective & Outcome Measures

Objective: Identify standard of care for post-operative subacute to chronic subdural hematomas (cSDH) that undergo burr hole evacuation

Primary outcomes:

• Rate of SDH recurrence requiring re-evacuation or MMA embolization

Secondary outcomes:

• LOS
• Readmission for a medical problem related to chronic subdural evacuation

Future Of Transplant Centers: Leveraging Integration Of Transplant Institutes To Mitigate The Impact Of Transplant Professional Shortages And Enhance Patient Outcomes, Kiran Goli, Prashamsa Shenoy, Paula Martinez-Cantarin, Maitreyee Gupta, Rakesh Gulati, Pooja Singh

Health Equity and Quality Improvement (HEQI) Summit

Background

The Increasing Organ Transplant Access (IOTA) Model introduced by the Centers for Medicare & Medicaid Services (CMS) emphasizes increasing transplant volumes, reducing disparities, and enhancing care efficiency. Transplant centers face unique challenges, including workforce shortages, growing demand for organ transplants, care delivery inefficiencies, and the need to align with the achievement, efficiency, and quality domains of the IOTA model while fostering health equity. Integration, whether through mergers, acquisitions, or strategic alliances, offers transplant centers a competitive advantage in optimizing resources, expanding access, and meeting CMS metrics.

Improving Deep Vein Thrombosis Rates In Spine Surgery Patients, Arbaz A. Momin, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- DVT/PEs are sources of morbidity and mortality in hospitalized patients
- Spine surgery patients are immobile postop and tend to be obese
- For spine surgery patients DVT rates reported to range from 0.3% to 15.5%
- DVT propagation to PE can lead to significant mortality

• 30-day case fatality rate of PE is 3.9%

- Quality metric that hospitals are evaluated

• Patient safety indicator (PSI)

Optimizing Intraoperative Parathyroid Hormone Testing Protocols To Improve Efficiency And Outcomes In Parathyroid Surgeries, Andrew Neeson, Bs, Hani Samarah, Bs, Bryan Renslo, Md, Eric Fei, Ba, Kalena Liu, Bs, Harleen K. Sethi, Do, Elizabeth E. Cottrill, Md

Health Equity and Quality Improvement (HEQI) Summit

Background:

• Intraoperative PTH (ioPTH) helps confirm the removal of hyperfunctioning glands by leveraging its short half-life (~3-5 minutes).
• Timely results are critical for minimizing unnecessary bilateral neck exploration and operative time.
• Delays in ioPTH processing can increase anesthesia time, OR costs, and patient risk.
• Anecdotal reports have suggested variation in ioPTH processing speeds across Jefferson Health surgical sites.

Problem Statement: Significant delays in ioPTH turnaround time at one surgical site may prolong operative and anesthesia times, compromising patient safety.

Project Aim: To identify and compare ioPTH processing times across three surgical sites to pinpoint workflow inefficiencies and propose future improvements.

The Need For Innovative Changes In The Jackson-Pratt (Jp) Drain, Elizabeth Goldstein, Bs, Spencer Haber, Krishna Koka, Bs, Devin Williams, Bs, Andrew Newman, Md

Health Equity and Quality Improvement (HEQI) Summit

Purpose

The JP drain is a closed suction drain used in surgeries throughout the body. This design, introduced by Dr. Frederick Jackson and Dr. Richard Pratt in 1971, prevents seroma formation through continual negative pressure drainage while resisting drain collapse and obstruction. Through a focused literature review, we summarized findings on JP drain-related complications in breast reconstruction and mastectomy. Though the JP drain effectively reduces seroma formation, there has been a profound lack of innovation in how its design addresses Surgical Site Infection (SSI), Surgical Site Pain (SSP), and Quality of Life (QOL). In addition, there is no standardized, evidence-based …

Resumption Of Anti-Platelet/Anticoagulation Therapy Following Lumbar Spine Surgery, Stephanie Serva, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem: There is data on AC/AP use in perioperative period for patients undergoing spine surgery and no formal established guidelines on when to resume AC/AP medications after surgery
• Aim: To determine standardized protocol for resuming antiplatelet/anticoagulation therapy following lumbar surgery and to reduce combined post-operative cardiac/cerebrovascular/thrombotic events, and post- operative hematomas by 10% in 5 years
• Population: Patients undergoing elective lumbar spine surgery who take AC/AP at home