Surgery Commons^™

Preserving Pediatric Wellness: Enhanced Recovery After Surgery Protocols And Pain Management In Pediatric Surgery, Kimberly Kim

Theses and Graduate Projects

Background: Enhanced recovery after Surgery (ERAS) protocols and multimodal pain management strategies have revolutionized perioperative care in adult surgical practice by leading to improved postoperative outcomes and better pain management. However, the adoption of these protocols to pediatric surgical care remains underexplored.

Purpose: This systematic review aims to examine recent randomized clinical trials on the implementation of ERAS protocols and multimodal pain management strategies in pediatric surgical patients.

Methods: A computer-based literature search of databases through Google Scholar and PubMed with manual reference searches was used to identify eligible studies. The review includes randomized controlled trials focusing on multimodal pain …

Left Atrial Venoarterial Extracorporeal Membrane Oxygenation Strategy In Postcardiotomy Cardiogenic Shock: A Case Series, Daniel Manzur-Sandoval Md, Gian Manuel Jiménez-Rodríguez Md, José Luis Elizalde-Silva Md, Meredith Fernanda Sánchez-Torres Md, Uriel Encarnación-Martínez Md, Cristhian Josué Gaytán-García Md, José Octavio Salazar-Delgado Md, Guadalupe Lisseth Hernández-González Md, Gustavo Rojas-Velasco Md

The VAD Journal

Postcardiotomy cardiogenic shock is a rare complication with high mortality. When patients do not respond to the placement of an intra-aortic balloon pump or pharmacological treatment, therapy with peripheral venoarterial extracorporeal membrane is a viable option that allows active resuscitation. The adjunct use of Impella® (Abiomed, Danvers, MA, USA) allows active unloading of the dysfunctional left ventricle. However, left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) is an appealing and effective strategy in cases of aortic dissection, aortic valve replacement, or bioprosthesis of the aorta. Insertion of an extraction cannula that can discharge both atria or only the left atrium allows …

Changing Landscape Of Liver Transplant In The United States—Time For A New Innovative Way To Define And Utilize The “Non-Standard Liver Allograft”—A Proposal, Rashmi Seth, Kenneth Andreoni

Department of Surgery Faculty Papers

Since the first liver transplant was performed over six decades ago, the landscape of liver transplantation in the US has seen dramatic evolution. Numerous advancements in perioperative and operative techniques have resulted in major improvements in graft and patient survival rates. Despite the increase in transplants performed over the years, the waitlist mortality rate continues to remain high. The obesity epidemic and the resultant metabolic sequelae continue to result in more marginal donors and challenging recipients. In this review, we aim to highlight the changing characteristics of liver transplant recipients and liver allograft donors. We focus on issues relevant in …

High-Grade Liver Injuries With Contrast Extravasation Managed Initially With Interventional Radiology Versus Observation: A Secondary Analysis Of A Wta Multicenter Study, Negaar Aryan, Areg Grigorian, Erika Tay-Lasso, Michael Cripps, Heather Carmichael, Robert Mcintyre, Shane Urban, Catherine Velopulos, Clay Cothren Burlew, Shana Ballow, Rachel C. Dirks, Aimee Lariccia, Michael S. Farrell, Deborah M. Stein, Michael S. Truitt, Heather M. Grossman Verner, Caleb J. Mentzer, T. J. Mack, Chad G. Ball, Kaushik Mukherjee, Georgi Mladenov, Daniel J. Haase, Hossam Abdou, Thomas J. Schroeppel, Jennifer Rodriquez, Miklosh Bala, Natasha Keric, Morgan Crigger, Navpreet K. Dhillon, Eric J. Ley, Tanya Egodage, John Williamson, Tatiana Cp Cardenas, Vadine Eugene, Kumash Patel, Kristen Costello, Stephanie Bonne, Fatima S. Elgammal, Warren Dorlac, Claire Pederson, Nicole L. Werner, James M. Haan, Kelly Lightwine, Gregory Semon, Kristen Spoor, Laura A. Harmon, Jason M. Samuels, M. C. Spalding, Jeffry Nahmias

Department of Surgery Faculty Publications

Background: High-grade liver injuries with extravasation (HGLI + Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI + Extrav. Therefore, we evaluated the management of HGLI + Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. Methods: HGLI + Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. Results: From 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) …

Chronic Recurrent Shoulder Instability Treated With A Hemiarthroplasty, Glenojet Allograft Glenoid Reconstruction, And Anterior Capsular Reconstruction: A Case Report., Matthew Glazier, Morgan Turnow, Peter Spencer, Vishvam Metha, Hunter Pharis, Nathaniel Long, Stephen Wiseman

Surgery Articles

No abstract provided.

In-Hospital Risk Factors For Reintervention And Amputation In Brachial Arterial Trauma, Aast Proovit Study Group, Justin M. Robbins, Corinna Crayton, Isaac Koloditch, Casey Walk, Limayre Gramajo, Samantha Shugar, Peter Ekeh, Joseph Dubose, Yee Wong, Cathline Layba

Department of Surgery Faculty Publications

Introduction: Brachial artery trauma is a rare but potentially devastating injury. There is little data regarding risk factors for reintervention and amputation prevention in this population, as well as anticoagulant (AC) and antiplatelet (AP) regimens and outcomes after discharge in trauma patients with vascular injuries requiring repair. This study aims to identify in-hospital risk factors for reintervention and amputation and stratify outcomes of follow-up by discharge AC or AP regimen. Methods: The AAST Prospective Observational Vascular Injury Trial database was queried for all patients who underwent traumatic brachial arterial repair from 2013 to 2022. Patients were evaluated by need for …

Acute Changes In Inflammatory Biomarkers Expression Following Cosmetic Surgery With Use Of Compression Garment, Michael James Sanchez

Open Access Theses & Dissertations

BACKGROUND: Inflammation is an acute phase response to physiological conditions such as infection, tissue injury, and tissue stress and malfunction (Medzhitov, 2008). Inflammation caused by surgical trauma (tissue injury) elicits a myriad of responses by the patient that is experienced far past the operation. It is estimated that American individuals will undergo nine surgeries throughout an 85 year lifespan (Lee & Gawande, 2008). Focus on surgical recovery modalities has grown over the past few decades. The use of compression garments (CG+) following surgery has been shown to be successful in preventing deep vein thrombosis, pulmonary embolisms, as well as aiding …

Advanced Visualization In Minimally Invasive Spine Surgery: The Ergonomics, Economics, And Evolution Of Camera-Based Tubes And Retractors, Advith Sarikonda, Ahilan Sivaganesan, Sheeraz Qureshi

SKMC Student Presentations and Publications

BACKGROUND: Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.

OBJECTIVE: To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).

METHODS: This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular …

Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial, Jason L Sperry, Francis X Guyette, Bedda L Rosario-Rivera, Matthew E Kutcher, Lucy Z Kornblith, Bryan A Cotton, Chad T Wilson, Kenji Inaba, Eva V Zadorozny, Laura E Vincent, Ashley M Harner, Emily T Love, Joseph E Doherty, Joseph Cuschieri, Aaron E Kornblith, Erin E Fox, Yu Bai, Marcus K Hoffman, Catherine P Seger, Jay Hudgins, Sheila Mallett-Smith, Matthew D Neal, Christine M Leeper, Philip C Spinella, Mark H Yazer, Stephen R Wisniewski, Cold Stored Platelet For Hemorrhagic Shock (Crisp-Hs) Study Group

Faculty, Staff and Student Publications

OBJECTIVE: To determine the feasibility, efficacy, and safety of early cold stored platelet transfusion compared with standard care resuscitation in patients with hemorrhagic shock.

BACKGROUND: Data demonstrating the safety and efficacy of early cold stored platelet transfusion are lacking following severe injury.

METHODS: A phase 2, multicenter, randomized, open label, clinical trial was performed at 5 US trauma centers. Injured patients at risk of large volume blood transfusion and the need for hemorrhage control procedures were enrolled and randomized. The intervention was the early transfusion of a single apheresis cold stored platelet unit, stored for up to 14 days versus …

Assessing The State Of Obesity Care: Quality, Access, Guidelines, And Standards, Lee M Kaplan, Caroline M Apovian, Jamy D Ard, David B Allison, Louis J Aronne, Rachel L Batterham, Luca Busetto, Dror Dicker, Deborah B Horn, Aaron S Kelly, Jeffrey I Mechanick, Jonathan Q Purnell, Ximena Ramos-Salas, Assessing The State Of Obesity Care Writing Group

Faculty, Staff and Student Publications

BACKGROUND: An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence.

AIMS: The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity.

METHODS: The panel was held in Leesburg, Virginia in September 2019.

RESULTS: The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice …

Where Do Plastic Surgery Leaders Come From? A Cross-Sectional Analysis Of Research Productivity, Megan M Rodriguez, Kylie R Swiekatowski, Robert C Tung, Matthew R Greives, David W Mathes, Phuong D Nguyen

Faculty, Staff and Student Publications

Background: It is increasingly apparent that plastic surgery residency applications with lengthy research publications are the new standard in applicant competitiveness. This study aims to evaluate the research history of plastic surgery program faculty leadership to understand the trends and evolution of research expectations.

Methods: The curriculum vitaes of faculty involved in residency admissions among all US Accreditation Council for Graduate Medical Education-accredited integrated and independent plastic surgery programs were reviewed. Doximity, program websites, and Scopus were used to gather information. H-index and publication count at the time of medical school and residency graduations were collected. Student t test and …

Can Anorectal Stenosis Be Managed With Dilations Alone? A Pcplc Review., Zoe M. Saenz, Kelly Austin, Jeffrey R. Avansino, Andrea Badillo, Casey M. Calkins, Megan M. Durham, Megan K. Fuller, Ankur Rana, Ron W. Reeder, Rebecca M. Rentea, Michael D. Rollins, K Elizabeth Speck, Richard J. Wood, Jamie C. Harris, Jamie Anderson, Maheen Hassan, Payam Saadai, Pediatric Colorectal And Pelvic Learning Consortium (Pcplc)

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Congenital anorectal stenosis is managed by dilations or operative repair. Recent studies now propose use of dilations as the primary treatment modality to potentially defer or eliminate the need for surgical repair. We aim to characterize the management and outcomes of these patients via a multi-institutional review using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry.

METHODS: A retrospective database review was performed using the PCPLC registry. The patients were evaluated for demographics, co-morbidities, diagnostic work-up, surgical intervention, current bowel management, and complications.

RESULTS: 64 patients with anal or rectal stenosis were identified (57 anal, 7 rectal) from …

Technical Considerations In Robotic Aberrant Right Subclavian Artery Resection For Dysphagia Lusoria, Luke Meredith, Emily Isch, Mohammed Ali, Michael Nooromid, Olugbenga Okusanya

Department of Surgery Faculty Papers

Dysphagia lusoria occurs due to compression of the esophagus as an aberrant right subclavian artery (ARSA) crosses the mediastinum. Surgical management includes open, hybrid, and endovascular techniques, with no consensus gold standard. There are few reports of robotic-assisted ARSA resection. We describe the innovative technique and outcomes for two patients who successfully underwent robotic-assisted transthoracic resection of an ARSA after right carotid–subclavian bypass for dysphagia lusoria. Both patients experienced improvement or resolution of their dysphagia and no major complications. In select patients with a noncalcified origin of the ARSA without aneurysmal degeneration, the robotic-assisted approach represents a viable option.

Staged Endovascular And Open Surgical Approach For Treatment Of A Giant Left Upper Back Arteriovenous Malformation, Nitya Venkat, Avinash Saraiya, M. Irfan Ali, Matthew Jenkins, Stavropoula Tjoumakaris, Babak Abai

Department of Surgery Faculty Papers

We present a case of a symptomatic, giant, left upper back arteriovenous malformation that was treated through a staged endovascular and open approach. Through a series of embolizations, followed by resection, we were able to preserve the limb and upper back neurovascular supply, demonstrating an approach to preserve sensation and function and improving quality of life.

The Effect Of Blood Flow Restriction Training On Quadriceps Activity After Anterior Cruciate Ligament Reconstruction: A Preliminary Randomized Controlled Trial, Florian Forelli, Camille Nguyen, Jean Mazeas, Georgios Kakavas, Timothy E. Hewett, Andreas Bjerregaard, Vasileios Korakakis, Alexandre Jm Rambaud

Marshall Journal of Medicine

Background

After anterior cruciate ligament reconstruction, a crucial priority is restoring knee muscle strength, especially the quadriceps, to reach the pre-injury strength levels as fast as possible. A feasible alternative to heavy loading might be blood flow restriction training that may elicit quadriceps muscle strength adaptations using low external loads. This study assessed whether quadriceps strengthening using low load blood flow restriction (LL-BFR) would enhance electromyographic (EMG) activity of the vastus medialis (VMO), vastus lateralis (VLO), and rectus femoris (RF) similar to quadriceps strengthening using heavy loads resistance training (HLRT). The secondary objective was to assess intra-quadriceps regional EMG differences …

Alpha Angle And Anterior Femoral Neck Offset Identify Different Cohorts Of Cam Morphology: An Osteologic Study, Grigory A. Manyak

Faculty Scholarship

Purpose: To explore differences in cam morphology defined by alpha angle (AA) and anterior femoral neck offset (AFNO) in the context of other anthropometric parameters in an osteologic collection to further elucidate whether each measurement tool is identifying the same underlying pathology. Methods: Anthropometric measurements of 992 cadaveric hips from the Hamann-Todd Osteological Collection were analyzed. Femurs with cam morphology were identified by AA >55° or AFNO <7 mm. Anthropometric parameters stratified by cam morphology were assessed with Wilcoxon rank-sum and Pearson χ2 tests. Multivariate logistic regressions were performed on significant variables in univariate analysis to examine the predictive ability of anthropometric variables to cam morphology. Results: Cam morphology was identified in 242 hips via AA, 344 hips via AFNO, and 123 hips via both measures. Multivariate logarithmic regression analysis demonstrated that sex negatively predicted AA (females with less pathology, β = –0.14, P = .04), race negatively predicted AA (Blacks with less pathology, β = –0.21, P < .01), and proximal femoral osteoarthritis was positively associated with AA (β = 0.16, P = .02), while none of these were associated with AFNO. On the other hand, right-side specimens were associated with AA (β = 0.15, P = .02) and AFNO (β = 0.25, P < .01), whereas the combined version was unassociated with both measures. Conclusions: In conclusion, cam morphology was identified in a modest percentage of osteologic specimens by both AA and AFNO in our study. Further, associations of multiple demographic, anthropometric, and anatomical parameters to AA and AFNO suggest they may identify different subsets of cam morphology. Clinical Relevance: Cam morphology identified by AA versus AFNO may represent 2 different pathologic entities. Future studies should assess differences between these measures in a clinical cohort and determine whether these 2 definitions of cam morphology identify different clinical populations.

Aso Author Reflections: The Association Between Sentinel Lymph Node Biopsy And Melanoma-Specific Survival In The Elderly, Luke D. Rothermel

Faculty Scholarship

No abstract provided.

The Utility Of Sentinel Lymph Node Biopsy In Elderly Patients With Melanoma, Carmen A. Jung, Kathleen M. Mulligan, Iris Sheng, John B. Ammori, Ankit Mangla, Richard S. Hoehn, Luke D. Rothermel

Faculty Scholarship

Background: Sentinel lymph node biopsy (SLNB) is performed less often for older patients with melanoma. We investigated the association of SLNB and melanoma-specific survival (MSS) in the elderly. Methods: We retrospectively reviewed the Surveillance, Epidemiology, and End Results (SEER: 2010–2019) for patients ≥ 70 years with cT2-4N0M0 melanoma. We used multivariable Cox proportional hazard models to evaluate the impact of SLNB performance and SLN status on MSS at increasing age cutoffs. In addition, we evaluated the association of different factors with SLNB performance using multivariable logistic regression. Results: We identified 11,548 patients. Sentinel lymph node biopsy occurred in 6754 (58.5%) …

National Estimates For The Percentage Of All Readmissions With Demographic Features, Morbidity, Overall And Gender-Specific Mortality Of Transcutaneous Versus Open Surgical Tricuspid Valve Replacement/Repair, Muhammad Shayan Khan, Abdul Baqi, Ayesha Tahir, Ghulam Mujtaba Ghumman, Waqas Ullah, Jay Shah, Yasar Sattar, Tanveer Mir, Zain Sheikh, Fnu Salman, Moaaz Baghal, Kritika Luthra, Vinod Khatri, Zainulabedin Waqar, Malik Waleed Zeb Khan, Mohammed Taleb, Syed Sohail Ali

Abington Jefferson Health Papers

BACKGROUND: The aim of the study was to determine national estimates for the percentage of all readmissions with demographic features, length of stay (LOS), cost analysis, comorbidities, complications, overall and gender-specific mortality and complications of transcutaneous tricuspid valve replacement/repair (TTVR) vs. open surgical tricuspid valve replacement/repair (open TVR).

METHODS: Data were extrapolated from the Nationwide Readmissions Database (NRD) 2015-19. Of the 75,266,750 (unweighted) cases recorded in the 2015 - 2019 dataset, 429 had one or more of the percutaneous approach codes as per the ICD-10 dataset, and 10,077 had one or more of the open approach codes.

RESULTS: Overall, the …

Find Your Perfect Match For Surgical Residency: Six Steps To Building Your Brandd From The Collaboration Of Surgical Education Fellows, John M. Woodward, Sarah Lund, Riley Brian, Ananya Anand, Rebecca Moreci, Sergio M. Navarro, Jorge Zarate Rodriguez, Ariana Naaseh, Katrina Tate, Joshua Roshal, Caitlin Silvestri, Connie Y. Gan, Tejas Sathe, Steven W. Thornton, Madeline Cloonan, Lauren Weaver, Mary H. Oh, Frederick Godley, Joseph C. L'Huillier

School of Medicine Faculty Publications

No abstract provided.