Surgery Commons^™

Pediatric Appendicitis Or Not? A Retrospective Cohort Study From A Single Institution - Our Management And Factors Determining The Disease, Nimmita Srisan, Teerasak Phewplung, Katawaetee Decharun, Prapapan Rajatapiti, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Purpose: The aims were to assess our treatment guidelines and to determine factors in differentiating children with acute appendicitis from other diseases.

Methods: Pediatric surgery consultations for suspected appendicitis from October 2019 to October 2021 was retrospectively studied. The treatment guidelines of children with suspected appendicitis were elucidated. Moreover, factors identifying the diagnosis of appendicitis were analyzed using multi-variate logistic regression.

Results: Ninety-one children were consulted for suspected appendicitis. Forty-one children (45.1%) were promptly successfully treated without observation or ultrasonography, except one negative appendectomy (2.4%). The other 50 children (54.9%), showed equivocal clinical symptoms and signs, requiring further management either …

Increased Hif-2Α Activity In The Nucleus Pulposus Causes Intervertebral Disc Degeneration In The Aging Mouse Spine, Shira N Johnston, Maria Tsingas, Rahatul Ain, Ruteja A Barve, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Hypoxia-inducible factors (HIFs) are essential to the homeostasis of hypoxic tissues. Although HIF-2α, is expressed in nucleus pulposus (NP) cells, consequences of elevated HIF-2 activity on disc health remains unknown. We expressed HIF-2α with proline to alanine substitutions (P405A; P531A) in the Oxygen-dependent degradation domain (HIF-2αdPA) in the NP tissue using an inducible, nucleus pulposus-specific K19^CreERT allele to study HIF-2α function in the adult intervertebral disc. Expression of HIF-2α in NP impacted disc morphology, as evident from small but significantly higher scores of degeneration in NP of 24-month-old K19^CreERT; HIF-2α^dPA (K19-dPA) mice. Noteworthy, comparisons of grades …

Surgery Of The Palatomaxillary Structure, Jessica R Burgess, Kathleen C Heneghan, Tarra G Barot, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care.

METHODS: This study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association's electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons' management of perioperative pain in patients with opioid use …

Endoscopic Management Of Boerhaave Syndrome: Are Outcomes Better Than Surgery? A Case Report And Review Of Literature, Ammar Qureshi, Uvesh Mansuri, Mona Roknsharifi, Youssef Ghobrial, Artin Asgeri, Mehrdad Asgeri

Journal of Community Hospital Internal Medicine Perspectives

Boerhaave syndrome (BS) is a rare clinical diagnosis associated with a high morbidity and mortality rate. Diagnosis of this condition is usually delayed which can lead to a very poor outcome. The timing of presentation and time to management plays a very important role in the prognosis and selection of the management method. With the advances seen in therapeutic endoscopy, many authors have been exploring the possibility of shifting the focus of management from surgery to interventional endoscopy. We present a case report of a patient presenting with BS that was successfully managed endoscopically. We also reviewed the literature on …

Rapid (Reducing The Anxiety Of Patients In Interventional And Diagnostic) Radiologic Procedures: A Review Of The Literature, Unie Háng, Nathan Sim, Harika K. Bollineni, Arif Musa Md, Foaz Kayali Md, Roger Kakos Md, Monte Harvill Md, Ali Harb Md

Medical Student Research Symposium

Abstract Title: RAPID (Reducing the Anxiety of Patients in Interventional and Diagnostic) Radiologic Procedures: A Review of the Literature

Background: Pre-procedural anxiety is a prevalent concern that can be associated with negative effects for patients including perceived pain. Most interventional radiologic procedures are performed under local anesthesia with minimal sedation if any, which may not be sufficient in relaxing the patient. Effective patient education with appropriate pain management and anxiety control can improve comfort and can yield optimal post-procedural outcomes.

Methods: A search was done with the PubMed database for studies concerning patient anxiety in radiologic procedures. Search terms included, …

The Long-Term Economic Implications Of Burn Injury For Burn Survivors, Jacob M. Dougherty Bs, Hannan A. Maqsood Mbbs, Zhaohui Fan Md Mph, Stewart C. Wang Md Phd, Mark R. Hemmila Md, Naveen F. Sangji Md Mph

Medical Student Research Symposium

Introduction: The long-term economic implications of burn injury on patients and payors has not been well described. Burn injury can be costly due to prolonged intensive care, wound care, rehabilitation, psychological care, and reconstructive surgery that may be required well after the initial injury. We investigated index and post-acute payor and out-of-pocket (OOP) costs related to burn injury for in-patient care at 30 days, and up to 36 months post-discharge to understand the long-term economic implications for burn survivors.

Methods: An observational cohort study was conducted using a commercial claims database from IBM Watson Health® Marketscan. Patients age ≤ …

Exploring The Effects Of Amniotic Bladder Therapy On Female Sexual Dysfunction In Interstitial Cystitis/Bladder Pain Syndrome Patients, Jonathan D. Lutchka, Jack Vercnocke Md, David Pearlman Md, Aron Liaw Md, Nivedita Dhar Md

Medical Student Research Symposium

Introduction and Objectives: Female sexual dysfunction (FSD) is commonly associated with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). FSD manifests as abnormalities in sexual desire, arousal, orgasm, pain, distress, and satisfaction. Our primary objective was to assess the impact of micronized amniotic membrane injections (AM) on FSD and lower urinary tract symptoms using comprehensive measures, including the multi-domain Female Sexual Function Index (FSFI), the Pain Visual Analog Scale (VAS), and the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI).

Methods: Study participants included patients diagnosed with IC/BPS and FSD refractory to traditional therapies. Under general anesthesia, these …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Midterm Outcomes Of Suture Anchor Fixation For Displaced Olecranon Fractures, Michael Gutman, Jacob Kirsch, Jonathan Koa, Mohamad Fares, Joseph Abboud

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures.

METHODS: A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed.

RESULTS: Suture anchor fixation was performed on 17 patients with …

Venovenous Extracorporeal Membrane Oxygenation Usage Following Bullet Embolism To The Pulmonary Artery, Jonathan E. Schoen, Brian Carr, Murtuza Ali, Brett Chapman, Alan Marr, Lance Stuke, Patrick Greiffenstein, John P. Hunt, Paige Deville, Alison Smith

School of Medicine Faculty Publications

Background: Pulmonary artery embolus is a rare complication following gunshot wounds that creates a unique and serious challenge for trauma surgeons. While the majority of bullets that embolize through the vascular system end in the peripheral circulation, approximately one-third enter the central venous circulation. Case Report: We present the case of a bullet embolus to the left pulmonary artery following gunshot wounds to the right chest and the abdomen, with the abdominal ballistic traversing the liver before entering the vena cava and embolizing. The patient’s course was complicated by the development of severe acute respiratory distress syndrome that was successfully …

Surgical Site Infections Post Cesarean Section And Associated Risk Factors: A Retrospective Case-Control Study At A Tertiary Hospital In Kenya., David Odada, Jasmit Shah, Annastacia Mbithi, Reena Shah

School of Nursing & Midwifery, East Africa

Background: Surgical site infection is a common healthcare-associated infection that affects maternal health, yet it can be prevented or controlled. Caesarian sections are most likely to develop surgical site infections. The rates of delivery by caesarian section in reported to be higher that the acceptable rates in some healthcare facilities. Risk factors for surgical site infections can be identified and modified to reduce the occurrence of surgical site infections. This study aims to determine the risk factors that contribute to surgical site infections post caesarian section in a tertiary teaching hospital in Kenya.

Methods: This was a retrospective case-control (1:2 …

Language Matters: Effective Communication And Connections For Firearm Injury Prevention, Sandra Mckay, Mary E Aitken

Faculty, Staff and Student Publications

No abstract provided.

Multidisciplinary Approach To The Management Of Renal Angiomyolipoma With Inferior Vena Cava Thrombus And Pulmonary Embolism: A Case Report., Jordyn Perdue, Alexandra Wells, Krishna Patel, Wihan Du Plessis, Jaya Varre, Patrick Salibi

Surgery Articles

Renal angiomyolipoma (AML) is a benign tumor with rare venous extension. We present a case of a patient with renal AML with inferior vena cava (IVC) tumor thrombus and acute pulmonary embolism (PE). A 34-year-old female presented with chest pain. Imaging revealed a 5 cm right renal AML, with tumor thrombus into the renal vein and IVC, and acute left lower lobe PE. Right radical nephrectomy and caval thrombectomy were performed using intraoperative ultrasound. Rarely, these benign tumors generate thrombus with caval extension. The location of IVC thrombus guides surgical planning, which may involve suprahepatic IVC control or cardiopulmonary bypass. …

Demographics And Paindetect As Predictors Of 24-Month Outcomes For 10 Khz Scs In Nonsurgical Refractory Back Pain, Leonardo Kapural, Chengyuan Wu, Aaron Calodney, Julie Pilitsis, Markus Bendel, Erika Petersen, Dawood Sayed, Colleen Kelly, Rose Province-Azalde, Naresh P. Patel

Department of Neurosurgery Faculty Papers

BACKGROUND: Nonsurgical refractory back pain (NSRBP) is broadly defined as chronic refractory back pain in patients who have not had previous spine surgery and, because they are deemed inappropriate candidates for surgery, are reliant on conventional medical management (CMM), which often provides poor long-term outcomes. High-frequency spinal cord stimulation (10kHz SCS) has demonstrated high rates of pain relief and improvements in functioning in patients with NSRBP. However, despite the use of temporary trial stimulation to select patients who will respond to therapy, some patients fail to achieve long-term therapy response with permanent implants. Prediction analysis founded on patients' baseline characteristics …

Case Sampling For Evaluating Hospital Postoperative Morbidity In Us Surgical Quality Improvement Programs, Vivi W Chen, Tracey Rosen, Yongquan Dong, Peter A Richardson, Jennifer R Kramer, Laura A Petersen, Nader N Massarweh

Center for Medical Ethics and Health Policy Staff Publications

Importance: US surgical quality improvement (QI) programs use data from a systematic sample of surgical cases, rather than universal review of all cases, to assess and compare risk-adjusted hospital postoperative complication rates. Given decreasing postoperative complication rates over time and the types of cases eligible for abstraction, it is unclear whether case sampling is robust for identifying hospitals with higher than expected complications.

Objective: To compare the assessment of hospital 30-day complication rates derived from sampling strategy used by some US surgical QI programs relative to universal review of all cases.

Design, setting, and participants: This US hospital-level analysis took …

Decoding Surgical Skill: An Objective And Efficient Algorithm For Surgical Skill Classification Based On Surgical Gesture Features -Experimental Studies, Zixin Chen, Dewei Yang, Ang Li, Louzong Sun, Jifan Zhao, Jie Liu, Linxun Liu, Xiaobo Zhou, Yonghua Chen, Yunqiang Cai, Zhong Wu, Ke Cheng, He Cai, Ming Tang, Bing Peng, Xin Wang

Faculty, Staff and Student Publications

BACKGROUND: Various surgical skills lead to differences in patient outcomes and identifying poorly skilled surgeons with constructive feedback contributes to surgical quality improvement. The aim of the study was to develop an algorithm for evaluating surgical skills in laparoscopic cholecystectomy based on the features of elementary functional surgical gestures (Surgestures).

MATERIALS AND METHODS: Seventy-five laparoscopic cholecystectomy videos were collected from 33 surgeons in five hospitals. The phase of mobilization hepatocystic triangle and gallbladder dissection from the liver bed of each video were annotated with 14 Surgestures. The videos were grouped into competent and incompetent based on the quantiles of modified …

Structured Textbook Review And Individualized Learning Plans Successfully Remediate Underperforming Residents And Improve General Surgery Program Performance On The Absite, Aaron Pinnola, Christoph Kaufmann

HCA Healthcare Journal of Medicine

Background

We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance.

Methods

This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. …

Use Of Technology In Training Periop 101 Students, John Carroll, Bsn, Rn. Cnor. Tcrn, Rnfa, Annamarie R. Vrobel, Bsn, Rv, Cpt, Sarah Germanovich, Msn, Rn, Cnor, Tcrn

Jefferson Hospital Staff Papers and Presentations

Presented at the 2024 Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo.

Contemporary Report Of Surgical Outcomes After Single-Stage Total Pancreatectomy: A 10-Year Experience, Nitzan Zohar, Luke Kowal, David Moskal, Francesca Ponzini, George Sun, Ryan J. Lamm, John Williamson, Avinoam Nevler, Harish Lavu, Warren R. Maley, Charles J. Yeo, Wilbur B. Bowne

Department of Surgery Faculty Papers

BACKGROUND: Surgeons rarely perform elective total pancreatectomy (TP). Our study seeks to report surgical outcomes in a contemporary series of single-stage (SS) TP patients.

METHODS: Between the years 2013 to 2023 we conducted a retrospective review of 60 consecutive patients who underwent SSTP. Demographics, pathology, treatment-related variables, and survival were recorded and analyzed.

RESULTS: SSTP consisted of 3% (60/1859) of elective pancreas resections conducted. Patient median age was 68 years. Ninety percent of these patients (n = 54) underwent SSTP for pancreatic ductal adenocarcinoma (PDAC). Conversion from a planned partial pancreatectomy to TP occurred intraoperatively in 31 (52%) patients. Fifty-nine …

Exploring The Mechanical Strength, Antimicrobial Performance, And Bioactivity Of 3d-Printed Silicon Nitride-Peek Composites In Cervical Spinal Cages, Cemile Basgul, Paul Desantis, Tabitha Derr, Noreen J. Hickok, Ryan M. Bock, Steven M. Kurtz

Department of Orthopaedic Surgery Faculty Papers

In this study, our goal was to assess the suitability of a polyether-ether-ketone (PEEK) and silicon nitride (Si3N4) polymer composite for antimicrobial three-dimensional (3D)-printed cervical cages. Generic cage designs (PEEK and 15 vol.% Si3N4-PEEK) were 3D-printed, including solid and porous cage designs. Cages were tested in static compression, compression shear, and torsion per ASTM F2077. For antibacterial testing, virgin and composite filament samples were inoculated with Staphylococcus epidermidis and Escherichia coli. In vitro cell testing was conducted using MC3T3-E1 mouse preosteoblasts, where cell proliferation, cumulative mineralization, and osteogenic activity were measured. The 3D-printed PEEK and Si3N4-PEEK cages exhibited adequate mechanical …