Surgery Commons^™

Readmission For Picc Line Placement In Spine Surgery, Joseph Schaefer, Md, Joshua Heller, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Pseudoarthrosis is failure of adequate bony fusion after a spinal fusion
• Prior literature has implicated occult C. acnes infection in cases of pseudoarthrosis
• Intraoperative cultures are often sent in cases of pseudoarthrosis at Jefferson
• C. acnes cultures often result after discharge requiring readmission

Agenda (Pdf), Department Of Surgery

Surgery Research Symposium

Agenda for the 3rd Annual Surgery Research Symposium held May 15, 2025.

Determining Size In An Era When Size Matters: How Accurate Are Lung Cancer Measurements On Preoperative Computed Tomography?, Katelyn Ward, Ryan Davis, Gayaneh Nazarian, Sayf Al-Katib, Kiran Nandalur, Antonela Muca, Thomas Watson

Conference Presentation Abstracts

No abstract provided.

When Patients Say No - Outcomes Of Opting Against Recommended Treatment After Total Neoadjuvant Therapy For Stage Ii/Iii Rectal Cancer, Danielle Hurst, Scarlett Hao, Jacob Applegarth, Erin Mueller, Harry Wasvary, Matthew Ziegler, Bradley Krasnick

Conference Presentation Abstracts

Introduction: Patients with stage II/III rectal cancer may be recommended total mesorectal excision (TME) or a watch-and-wait (WW) approach depending on clinical response to total neoadjuvant therapy (TNT). In shared decision-making, patients may decide for or against surgery regardless of recommendation. This study aimed to describe the clinical outcomes of patients with locally advanced rectal cancer (LARC) who decide against physician recommendations. Methods: A retrospective cohort study of all patients diagnosed with AJCC clinical stage II/III LARC between 2021-2023 and treated at a single tertiary center with TNT was performed. Patients with IBD, genetic syndromes, synchronous tumors, those who did …

Intraoperative Code Status: Moving From Misinformation To Respect For Patient Autonomy, Jacob Applegarth, Nathan M. Novotny, Ngan Nguyen, Abram Brummett

Conference Presentation Abstracts

No abstract provided.

High Ligation Versus Floor Repair For Adolescent Inguinal Hernias: A Matched Comparison Of Recurrence And Complications, Katelyn Ward, Melanie Ermler, Elizabeth Theirl, Ryan Davis, Huong Tran, Begum Akay, Anthony Stallion, Nathan Novotny, Pavan Brahmamdam

Conference Presentation Abstracts

Background: The optimal surgical approach for inguinal hernias in adolescent patients remains an area of debate. While high ligation (HL) for indirect hernias is standard in younger children, floor repair (FR), usually with mesh, is preferred in adults due to the higher incidence of direct hernias and weakness of the abdominal wall. This study compares recurrence rates and perioperative complications between HL and FR in adolescent patients.

Methods: A retrospective study was performed on 10-17 year old patients who underwent inguinal hernia repair within a single hospital system between 7/2013 and 6/2023. Operations were performed by pediatric surgeons, pediatric urologists, …

Effect Of Clean Closing Tray Use On Surgical Site Infection Following Colorectal Surgeries, Elizabeth Carlson, Nora Laban, Shelli Bergeron, Diana Lee, Donna Kayal, Kristin Lemarbe, Scarlett Hao, Jacob Mesiti, Bradley Krasnick, Harry Wasvary

Conference Presentation Abstracts

Introduction:  Reducing surgical site infections (SSIs) after colorectal surgeries remains a key quality improvement target. The summative effect of multiple pre-, intra-, and postoperative interventions bundled as part of Enhanced Recovery After Surgery (ERAS) programs are shown to effectively reduce SSIs, however the individual impact of each intervention has not been well-studied. This study evaluates the impact of clean closing tray use on the rate of SSIs in colorectal surgeries.  Methods:  A retrospective cohort study was conducted at a single tertiary care center of all intraabdominal colorectal surgeries performed between 2016 and 2021. Patients with documented infection present at the …

Analysis And Monitoring Of A Robotics Curriculum: Are Simnow Modules Valuable?, Ibrahim Baida, Jacob Applegarth, Nathan Novotny, Anthony Iacco, Ngan Nguyen

Conference Presentation Abstracts

No abstract provided.

Screening Mammogram Adherence Before Reduction Mammaplasty And Incidence Of Occult Pathologic Findings In Surgical Specimens, Kristin E. Lemarbe, Carolyn Schnurr, Danielle Hurst, Katelyn Ward, Sayee Kiran

Conference Presentation Abstracts

No abstract provided.

Laparoscopic Stapled Anastomosis For Congenital Duodenal Obstruction: Superior Outcomes And Efficiency Compared To Hand-Sewn Techniques, Ryan Davis, Ibrahim Baida, Katelyn Ward, Pavan Brahmamdam, Begum Akay, Anthony Stallion, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Delaying Infant Inguinal Hernia Repair Does Not Increase Incarceration Rate, Seth Saylors, Cory Nonnemacher, Charles Snyder, Pablo Aguayo, Richard Hendrickson, Bhargava Mullapudi, Irene Lim-Beutel, Rebecca Rentea, Shawn St. Peter, David Juang, Tolulope Oyetunji

Research Days

Introduction: Inguinal hernia repair is one of the most common pediatric surgical procedures performed with an estimated incidence of 1-5% in children. Patients can present with or without symptoms, with symptomatic hernias (incarcerated or strangulated) that may require emergent or urgent operative intervention. During the Covid-19 pandemic, restrictions, and shutdowns of elective surgeries at our institution resulted in delaying elective inguinal hernia repair unless presenting with more emergent symptoms, with no apparent increase in complication. In our institution, this practice was continued even after COVID restrictions were lifted, with elective repairs delayed until patients were older before completing elective inguinal …

Single-Incision Laparoscopic Ileocecectomy In Pediatric Crohn’S Disease: A 15-Year Experience, Seth Saylors, Cory Nonnemacher, Meredith Elman, Shawn St. Peter

Research Days

Purpose: In refractory Crohn’s disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single institutional experience with SILS ileocecectomy and evaluate the impact of experience.

Methods: We completed a retrospective review of patients who underwent single-incision laparoscopic (SILS) ileocecectomy for Crohn’s disease from 1/1/2009-3/31/2024 at a single institution by a single surgeon. Operative and inpatient characteristics were collected to determine …

Implementation Of An Enhanced Recovery After Surgery Pathway In Adolescent Patients Undergoing Laparoscopic Evaluation Of Endometriosis, Lauren Roth Md, Madeline Ross Md, Todd Glenski Md, Emily Weisberg Md, Ashli Lawson

Research Days

This study evaluates the implementation of an Enhanced Recovery After Surgery (ERAS) pathway for adolescent patients undergoing diagnostic laparoscopy for endometriosis at a tertiary children's hospital. The retrospective reviewed included 53 patients (20 pre-ERAS, 33 post-ERAS) aged 12-20 years old, comparing preoperative compliance, intraoperative adherence, and postoperative outcomes. Findings showed 81% compliance with preoperative medication, 76% received appropriate preoperative medications, and 39% had recommended carbohydrate loading. Intraoperative compliance was 87%, with 61% adherence to postoperative medications. Post-anesthesia care unit (PACU) stay time increased (44 vs 53 minutes, p=0.21), but pain scores, postoperative prescriptions, and hospital readmissions remained unchanged. This study …

Bivalirudin Versus Heparin In Patients With Congenital Diaphragmatic Hernias Requiring Extracorporeal Life Support, Cory Nonnemacher, Seth Saylors, Vatche Melkonian, Richard Hendrickson, Inna Lobeck

Research Days

Introduction

Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly. The pulmonary hypoplasia, pulmonary hypertension and altered cardiac function associated with CDH may result in early cardiorespiratory failure requiring life-saving extracorporeal life support (ECLS). Early repair of CDH on ECLS has shown to improve survival, but poses an increased bleeding risk due to anticoagulation. Heparin has traditionally been the anticoagulant of choice for ECLS. Recent data has suggested that the use of bivalirudin may result in lower bleeding rates and transfusion requirements. This study aims to stratify complications for patients with CDH repaired on heparin versus bivalirudin, hypothesizing that complications …

Same Day Discharge Following Minimally Invasive Repair Of Pectus Excavatum Following An Eras Protocol, Cory Nonnemacher, Seth Saylors, Meredith Elman, Pablo Aguayo, Charles Snyder, David Juang, Beth A. Orrick, Amy L. Pierce, Shawn St. Peter, Tolulope Oyetunji

Research Days

Background/Purpose

Corrective surgery for Pectus Excavatum comes primarily via the Nuss procedure. Pain control contributes significantly to the postoperative length of stay (LOS). Optimization of pain control can be achieved in multiple ways in the form of an Enhanced Recovery After Surgery (ERAS) protocol. The purpose of our study is to assess the success of same-day discharge with a ERAS protocol for same-day discharge (SDD) of patients undergoing Pectus Excavatum repair.

Methods

A retrospective review of patients from August 2022 to August 2024 at a stand-alone tertiary care children’s hospital who underwent minimally invasive repair of Pectus Excavatum was performed. …

Navigating The Fallout: How Pediatric Spine Surgeons Cope, Recover, And Persevere After Major Surgical Complications, Sandeep Yanamala, Richard M. Schwend, Hannah Geoffroy, Gary Sutkin

Research Days

Hypothesis: We hypothesized that surgeons who continue practicing after a major complication are more likely to have strong institutional and peer support, a growth mindset, and access to coping mechanisms that mitigate distress and legal pressures. Study Design:
Qualitative study using Constructivist Grounded Theory (CGT) based on semi-structured interviews with pediatric spine surgeons who have experienced major surgical complications.
Introduction:
Complications in pediatric spine surgery have significant emotional, ethical, and legal
consequences. However, little is known about the factors that differentiate surgeons who continue performing spine surgery from those who transition away.
Methods:
33 pediatric spine surgeons were interviewed (28 …

Treatment Outcomes Following Tme For Biologically Unfavorable Locally Advanced Rectal Cancer, Maryam Aleissa, Amr Aref, Hussein Gharib, Ernesto R. Drelichman, Amer Zeni, Amer Alame, Jasneet S. Bhullar

Conference Presentation Abstracts

Purpose/Background: Many centers now offer organ preservation for selected patients with locally advanced rectal cancer. Our group initiated three Phase II trials to assess the safety of this approach in various clinical scenarios. Nonoperative management was recommended only for patients achieving complete clinical response CCR)after total neoadjuvant therapy TNT. Total mesorectal excision TME was advised when CCR was not achieved (primary TME), following residual cancer after Limited Local Excision LLE (completion TME), or after tumor recurrence/regrowth post-LLE or watchful waiting WW (salvage TME). This study examines treatment outcomes following primary or salvage TME in these biologically unfavorable cases.

Methods/Interventions: Each …

Comparison Of Magnetic Resonance Imaging (Mri) And Endoluminal Endoscopic Ultrasound (Eus) For Restaging Rectal Cancer After Neoadjuvant Chemotherapy, Judy Sheffeh, Amr Aref, Mohammed Barawi, Amer Alame, Amer Zeni, Ernesto R. Drelichman, Jasneet S. Bhullar

Conference Presentation Abstracts

Purpose/Background: Given the high incidence and mortality of rectal cancer, accurate staging and restaging are crucial for guiding optimal interventions. However, no consensus exists on the best imaging modality for restaging after neoadjuvant chemoradiotherapy. This study aims to compare MRI and EUS in the restaging of rectal cancer following neoadjuvant chemoradiotherapy.

Methods/Interventions: We conducted a prospective observational study and enrolled patients with rectal cancer. EUS and MRI were performed at diagnosis for initial staging and repeated after neoadjuvant chemotherapy and chemoradiotherapy for restaging. A total of 43 patients were enrolled, with 25 patients (10 males, 15 females) with rectal cancer …

Distinguishing Chronic Sigmoid Volvulus From Ogilvie Syndrome: A Case Report, Amanda Paulus, Arpit Aggarwal, Sara Glendinning

Conference Presentation Abstracts

Purpose/Background: Benign etiologies of large bowel obstructions are categorized by mechanical or functional. Mechanical obstructions include volvulus, hernia, adhesions, and stricture. Sigmoid volvulus is the most common benign cause of large bowel obstruction. Functional disorders include colonic pseudo obstruction, paralytic ileus, and chronic constipation. Colonic pseudo obstruction (also known as Ogilvie’s Syndrome) is a functional disorder that causes a large bowel obstruction that can be acute or chronic in nature.

Methods/Interventions: A 62-year-old male with chronic constipation and multiple comorbidities presented with abdominal distention and dyspnea. He was previously treated for Ogilvie's pseudo obstruction through conservative measures. On exam, his …

Improved Survival With Improved Naprc Compliance: Our Single Institution Experience, Jacob Applegarth, Claire Bova, Scarlett B. Hao, Harry Wasvary

Conference Presentation Abstracts

The National Accreditation Program for Rectal Cancer (NAPRC) was developed in 2017 in an effort to better standardize rectal cancer care in the United States. This study investigates short-term outcomes of rectal cancer patients relative to compliance with NAPRC standards at an NAPRC accredited institution.