Surgery Commons^™

Variability In The Orthopaedic Residency Trainee Trauma Surgical Experience, Todd Phillips, Benjamin Fiedler, Joshua T Morrow, Zbigniew Gugala, Melvyn Harrington, Douglas R Dirschl

Faculty, Staff and Students Publications

Background: The aim of this study was to analyze fracture fixation case logs from residents training at a level 1 trauma center to assess variability across residents' surgical experiences within a single residency program. The authors hypothesize that notable variability exists between residents' surgical experiences in fracture care.

Methods: A retrospective case series was conducted at a single, urban residency program with a level 1 trauma center. Completed case logs were collected from program graduates from 2022 to 2024. All surgical cases involving fracture fixation at the level 1 trauma center were included for analysis. The anatomic region of the …

Utility Of Diagnostic Arthroscopy Before Medial Patellofemoral Ligament Reconstruction In Pediatric And Adolescent Patients Without Articular Findings On Magnetic Resonance Imaging, Holden Archer, Kaleb Patterson, Jonathan D Schwartzman, Scott D Mckay, Indranil Kushare

Faculty, Staff and Students Publications

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is frequently used to manage recurrent patellar instability. Diagnostic arthroscopy is commonly performed before MPFL reconstruction to identify, confirm, and address intra-articular pathology. However, when preoperative magnetic resonance imaging (MRI) does not demonstrate intra-articular lesions, it is unclear how often diagnostic arthroscopy in pediatric patients alters surgical management.

PURPOSE: To determine the utility of diagnostic arthroscopy in young patients undergoing MPFL reconstruction who had no intra-articular chondral or osteochondral pathology, meniscal tears, or loose bodies identified on preoperative MRI, and to characterize intra-articular pathology detected on arthroscopy but not identified on MRI.

STUDY DESIGN: …

Trends In Meningioma-Related Mortality Among U.S. Adults: A Cdc Wonder Analysis From 2000 To 2023, Tirath Patel, Rai Muhammad Umar Khan, Fatima Hussain, Meer Murtaza, Muhammad Shayan Tariq, Abuzar Khan, Sara Aleem, Maryam Athar, Sharoz Shahid, Nikhilesh Anand

School of Medicine Publications

Background: Meningiomas are the most common primary intracranial tumors in the United States, comprising nearly 41% of central nervous system tumors. While the majority are benign, atypical (World Health Organization Grade II) and malignant (Grade III) subtypes are clinically significant due to their aggressive biology, higher recurrence, and increased mortality risk. Despite their burden, national mortality trends and demographic disparities in meningioma-related deaths remain underexplored.

Methods: We conducted a population-based analysis of meningioma-related mortality among U.S. adults aged ≥65 years from 1999 to 2023 using the centers for disease control and prevention (CDC) wide-ranging online data for epidemiologic research (WONDER) …

Single-Center Experience Using Endologix Anatomically Fixated Endograft Device For Treatment Of Aortoiliac Occlusive Disease, Isabella Muti, Gaurang Joshi, Dawn M. Salvatore, Michael J. Nooromid, Paul J. Dimuzio, Babak Abai

Department of Surgery Faculty Papers

OBJECTIVE: The covered endovascular reconstruction of the aortic bifurcation (CERAB) technique was developed in recent years as a novel surgical intervention for aortoiliac occlusive disease (AIOD). One tool frequently used in such procedures is the anatomically fixated endograft (AFX), manufactured by Endologix. The present study aimed to review the outcomes of patients with AIOD after CERAB procedure using the Endologix AFX device.

METHODS: This is an institutional review board-approved retrospective study investigating the experience of a single center in using Endologix's AFX device as CERAB for AIOD from September 2018 to June 2024. Data were obtained from the medical records …

Initial Site Of Metastasis Influences Prognosis In Pancreatic Ductal Adenocarcinoma, Eleanor Mancheski, David Baek, Wilbur Bowne, Harish Lavu, Charles Yeo, Avinoam Nevler

Department of Surgery Faculty Papers

INTRODUCTION: Metastatic pancreatic ductal adenocarcinoma (mPDAC) is a highly aggressive malignancy. Prior studies suggest that the initial site of metastasis may impact prognosis. This study investigates whether overall survival in mPDAC patients differs between patients first presenting with lung metastases versus those presenting with liver metastases.

METHODS: This retrospective analysis utilized the multi-institutional TriNetX database, identifying patients with histologically diagnosed PDAC who initially presented with either liver or lung metastases. Demographic, histologic, and outcome data were collected and analyzed. Patients were matched 1:1 using a nearest neighbor propensity score (PS) algorithm, and Kaplan-Meier survival analyses were performed. Cox regression was …

Clinical Characteristics Of Cystic Biliary Atresia, Kanokrat Thaiwatcharamas, Sinobol Chusilp, Katawaetee Decharun, Pachareeporn Tanming, Nimmita Srisan, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Background & Objective: Cystic biliary atresia (BA) is a unique form of BA. Our objective was to review the clinical characteristics of cystic BA in order to better understand its nature.

Methods: We retrospectively reviewed all infants diagnosed with cystic BA during January 2005 to December 2019. The diagnosis of BA was confirmed in all cases by laparotomy. Clinical data, pre-operative laboratory and imaging, intraoperative findings, and post-operative outcome were recorded. Data were expressed as mean and SD.

Results: There were 14 cystic BA patients out of the 227 BA patients (6.2%) during the studied period. The mean pre-operative ultrasound …

Superior Mediastinal Cut-Off Measurements In Chest Radiographs For Screening Of Silent Thoracic Aortic Diseases, Kantheera Leesmidt, Boonyarit Sintuvikaiwong, Apichaya Sripariwuth

Chulalongkorn Medical Journal

Objective: To determine cut-off values for superior mediastinal width and the mediastinal width-to-thoracic cage ratio from chest radiographs for the early detection of unrecognized thoracic aortic diseases. Additionally, this study aims to enhance diagnostic strategies for identifying aortic abnormalities.

Materials and Methods: This retrospective analysis included 152 subjects who underwent both computed tomography angiography (CTA) of the thoracic aorta and chest radiograph between April 2007 and January 2021. Superior mediastinal width was measured at 3 levels on chest radiographs. Thoracic CTA findings were categorized into normal and abnormal groups, the latter comprising aortic dissection, intramural hematoma, penetrating atherosclerotic …

Free Versus In Situ Right Internal Mammary Artery As A Conduit In Coronary Artery Bypass Surgery: A Meta-Analysis, Yuta Kikuchi, Tomoki Sakata, Tomonari Shimoda, Shinichi Fukuhara, Junichi Shimamura, Makoto Hibino, Tsuyoshi Kaneko, Hiroo Takayama, Hisato Takagi, Michel Pompeu Sa, Toshiki Kuno

Department of Medicine Faculty Papers

OBJECTIVES: There is debate regarding the optimal choice for a second conduit in coronary artery bypass grafting. The right internal mammary artery (RIMA) is commonly employed as a second conduit; however, it is unclear whether the free (fRIMA) or in situ (isRIMA) configuration yields superior outcomes. We performed a systematic review and meta-analysis to compare clinical outcomes between fRIMA and isRIMA as the second conduit.

METHODS: A comprehensive search of PubMed (MEDLINE), EMBASE, and CENTRAL was performed through May 2025 to identify studies comparing outcomes in patients undergoing coronary artery bypass grafting with either fRIMA or isRIMA as a second …

Incidence Of Carpal Tunnel Syndrome After The Diagnosis Of Ulnar Neuropathy, Harrison S. Fellheimer, Eric Didomenico, Mahaa Ayub, Magnolia Livingston, William L. Justice, Gabriel I. Onor, Eric Tecce, Pedro K. Beredjiklian

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: The purpose of this study is to determine whether patients diagnosed with ulnar nerve lesions (UNLs) have an increased risk of developing carpal tunnel syndrome (CTS).

METHODS: A retrospective cohort study was conducted using the TriNetX database, which contains data of >100 million patients. We identified 360,021 patients with UNLs and matched them 1:1 with controls. The incidence of CTS was assessed at 1, 2, 3, 4, and 5 years following the diagnosis of UNL. Statistical analyses were used to evaluate the development of CTS in the UNL cohort compared with controls.

RESULTS:  Patients with UNL demonstrated a significantly …

Influenza Infection Has Higher Risk Of Postoperative Complications Than Covid-19 In Shoulder Arthroplasty Patients, Jad J Lawand, Umar Ghilzai, Caleb Witsken, Dion Birhiray, Abdullah Ghali, Youssef M Khalafallah, Rohan G Reddy, Sameer R Khawaja, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

INTRODUCTION: The COVID-19 pandemic has captured the attention of healthcare systems worldwide, and testing remains a mainstay of preoperative testing before all surgical procedures, including shoulder arthroplasty. Other viral illnesses, specifically influenza, while still having severe complications, are either overshadowed by testing for COVID-19 or not tested at all.

METHODS: A multi-institutional cohort study using the TriNetX network examined patients undergoing total or hemi shoulder arthroplasty from January 2020 to March 2024. Matched cohorts were created: one with influenza and one with COVID-19 infection, 14 days before surgery.

RESULTS: A total of 3233 and 18,209 patients were included in the …

Increasing Utilization Trends Of Robotic Assistance In Orthopaedic Surgery, Anish K. Ponna, Alec Giakas, Anthony A. Khoudary, Spencer N. Uggla, Sina Ramtin, Yousef A. Soliman, Asif M. Ilyas

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: Robotic-assisted surgeries in orthopaedics have increased, particularly in hip and knee arthroplasty and spine surgeries. This study evaluates national utilization trends of robotic-assisted orthopaedic surgeries and demographic and geographic distribution of patients undergoing these surgeries.

METHODS: A retrospective cohort study was conducted on patients who underwent total hip arthroplasty, total and partial knee arthroplasty, or spine arthrodesis from 2017 to 2023 using the TriNetX database. Relevant International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes identified patients who underwent a primary surgery with a corresponding robot-assisted code on the same day. Temporal trends in procedural volume were …

Predicting Trauma Admission In Anticoagulated Geriatric Patients Presenting With A Ground Level Fall, Y-Nhi H. Bui Ms, Trevor Glad Bmus, Dylan Jack Bs, Michael Martyak

Knowledge and Creativity Expo

Our study undertook a rigorous investigation into an expanding trauma patient population, tackling some of the significant challenges with this patient population in trauma triage. Our research has not only addressed key questions, but has also paved the way for future inquiries by offering innovative perspectives. This presentation is particularly important given the current advancements and interests in geriatric trauma. We hope that our findings will influence ongoing projects and spark collaborations among diverse research communities.

Practice Patterns And Inpatient Outcomes In Lung Abscess: A Cross Sectional Study, Saikou Saidy, Ali Iqbal, Saqib H. Baig

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Background: Lung abscess is typically managed with antibiotics, but drainage procedures are sometimes performed when there is inadequate clinical response or when source control is needed. Real-world inpatient practice patterns remain incompletely described in contemporary U.S. data. Our aim was to evaluate national inpatient practice patterns, predictors of procedural intervention, and associated in-hospital outcomes and resource utilization among patients hospitalized with lung abscess managed conservatively, with bronchoscopic drainage, or with percutaneous drainage.

Methods: Using the National Inpatient Sample (NIS) (2016–2018), we identified adult (18 years and older) hospitalizations with a principal diagnosis of lung abscess [International Classification of Diseases, 10th …

Concomitant Subacromial Decompression Remains Commonly Performed During Rotator Cuff Repair: A Trinetx Study, Madison Baldauf, Zachary Krumm, Savannah Ward, Katherine Worcester, Kevin Bonner Md

Knowledge and Creativity Expo

Introduction:

Arthroscopic rotator cuff repair (RCR) is among the most frequently performed shoulder procedures in the US and is often accompanied by concomitant subacromial decompression (SAD). In recent years some studies have called into question the benefit of SAD in this setting. The topic is controversial as many surgeons still feel SAD is indicated. This study aims to characterize the changes in proportion of SAD performed concomitantly with RCR over recent years using TriNetX.

Methods:

The TriNetX database was queried for all patients undergoing arthroscopic rotator cuff repair from 2013 to 2025. Cohorts were established using the Current Procedural Terminology …

Extracorporeal Membrane Oxygenation In Trauma Before And After Covid-19: Associations Of Utilization, Timing, And Outcomes, Ryan Mancoll, William Rice, Theodore Chin, Grayson Mast M.D, Samantha Olafson M.D.

Knowledge and Creativity Expo

Objectives:

The COVID-19 pandemic expanded and altered general ECMO utilization and provider experience; however, any impact on trauma-specific ECMO practice following this shift remains unclear. We hypothesize that trauma ECMO utilization patterns, timing of initiation, and outcomes have differed following COVID-19.

Methods:

We conducted a retrospective cohort study of trauma patients receiving ECMO (2017-2024) using the American College of Surgeons Trauma Quality Improvement Program (TQIP) Participant Use Files. The primary exposure was the COVID era (2017-2019 vs. 2021-2024). Primary outcomes included ECMO utilization, time to initiation, and in-hospital mortality; secondary outcomes included discharge disposition, major complications, and length of stay …

External Fixation Assisted Intramedullary Total Femur Arthroplasty: A Case Report, Matthew Hnatow, Blake Martin, Emma Herrera

School of Medicine Publications

Introduction:Total femur replacement (TFR) is a salvage procedure for patients with multiple failed hip and knee arthroplasties and is associated with high complication rates. Intramedullary TFR has emerged as a technique to preserve critical soft tissue attachments; however, maintaining limb length, alignment, and rotation remains challenging.

Case Presentation: We describe a novel case of intramedullary TFR utilizing external fixation to address these technical challenges. A 64-year-old male with subsidence of a hinged knee tumor prosthesis to the level of the greater trochanter underwent intramedullary TFR. External fixation was applied to the residual femoral and tibial bones to maintain …

Impact Of Depression And Anxiety On Outcomes Following Muscle-Preserving Transforaminal Lumbar Interbody And Fusion., Sahil Garg, Sean M Muir, Kyle Jamar, Alexa Dietrich, Patrick Young, Sonny Gill

Surgery Articles

Background: The impact of concurrent diagnoses of anxiety and depression has not been extensively studied in spine surgery. We hypothesize that a muscle-sparing technique may be associated with decreased postoperative pain and improved strength postoperatively compared to open techniques, decreasing the stress of the postoperative recovery process. Therefore, this study aims to assess the benefits that a modified muscle-preserving lumbar fusion technique (Wiltse transforaminal lumbar interbody and fusion (W-TLIF)) would have on this subset of patients.

Methods: One hundred twenty subjects who underwent a single-level W-TLIF were identified with a recorded diagnosis status associated with mental health. The subjects underwent …

The Prospects Of Car T-Cell Therapies In Changing The Therapeutic Algorithm Of Neurologic Autoimmunities, Marinos C. Dalakas

Department of Neurosurgery Faculty Papers

T cells, genetically modified to express chimeric antigen receptors (CAR T), successfully used in hemato-oncologic malignancies, are showing promising and sustained benefits in refractory autoimmune neurological diseases, including Myasthenia Gravis, stiff-person syndrome, neuromyelitis optica, myositis, autoimmune neuropathies, and multiple sclerosis. Several reported patients with a steadily progressive disease and evolving disability unresponsive to available therapies, including rituximab and new biologics, after 2-3 months of treatment with CARs targeting CD19-positive, antibody-secreting, long-lived plasma cells, and plasmablasts exhibit impressive, long-lasting, and drug-free clinical improvements with the potential for immune reset shifting immunity to a healthy state without the need for continuing more …

Incidence Of Venous Thromboembolism In Women Receiving Transdermal Oestradiol/Testosterone With Micronised Progesterone In Accordance With Nice Guidelines, Amy Neville, Dan Reisel, John Benton, Mohit Khera, Louise Newson

Faculty, Staff and Students Publications

Background: Despite growing evidence supporting the long-term safety of hormone replacement therapy (HRT), concerns persist about certain adverse health outcomes, including venous thromboembolism (VTE). The aim of the study is to evaluate the risk of VTE in peri- and postmenopausal women treated with transdermal 17β-oestradiol with micronised progesterone or intrauterine progesterone (levonorgestrel) via the Mirena coil, in a real-world clinical setting.

Methods: The study included peri- and postmenopausal women attending a private menopause clinic between January 1, 2023, and December 31, 2023. Patients were actively undergoing treatment with transdermal oestradiol and progesterone in the form of micronised oral progesterone or …

2. Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery, Jacinta Smith

Providence Nursing Research Conference 2023 – Present

No abstract provided.