Surgery Commons^™

Analyzing The Effects Of Body Mass Index In Total Hip Arthroplasty Cases. Does It Influence Patient Characteristics, Operative Planning, And Postoperative Outcomes?, Cesar A. Sevilla Jr, Vanessa Elena Lopez, Mauricio Burbano, Michael Sander

MEDI 9331 Scholarly Activities Clinical Years

Background: Total hip arthroplasty (THA) is one of the most performed orthopaedic procedures commonly used for the treatment of osteoarthritis (OA). There are several underlying factors that lead to the formation of this condition. Not only is obesity one of the main contributors, but it is also a modifiable risk factor and one of the leading causes of end-stage arthrosis of the hip. Though there have been advancements in agricultural and health technologies, rates of obesity continue to rise causing similar increases in the demands for hip replacement surgeries. Therefore, we sought to investigate the effects of BMI on …

The Value Of Right Heart Catheterization: Case Series Showing Benefits In A Variety Of Diagnoses, Max Ruge, David Fischman, Indranee Rajapreyar, Yevgeniy Brailovsky

Division of Cardiology Faculty Papers

Although the right heart catheterization (RHC) was first introduced in 1945, its use in the quantitative hemodynamic assessment of patients has remained of questionable benefit. With recent advances in pharmacotherapies and mechanical support devices, RHC has been increasingly used to assess and help tailor the management of more complex patient scenarios. We present a case series in which the use of the RHC was helpful in making complex medical decisions.

State Of The Art Bowel Management For Pediatric Colorectal Problems: Hirschsprung Disease., Elizaveta Bokova, Ninad Prasade, Sanjana Janumpally, John Rosen, Irene Isabel P. Lim, Marc A. Levitt, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with …

The Safety Of Robotic Pneumonectomy, Shale J. Mack, Micaela L. Collins, Brian M. Till, Greg L. Whitehorn, Jonathan Martin, Hamza Rshaidat, Tyler Grenda, Nathaniel R. Evans, Olugbenga T. Okusanya

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Pneumonectomy remains among the most morbid procedures in thoracic surgery. Increasingly, robotic approaches are being adopted for a range of thoracoscopic procedures. The safety profile of robot-assisted thoracoscopic pneumonectomy remains poorly described, as do outcomes compared with traditional approaches.

METHODS: The National Cancer Database was used for a retrospective cohort analysis for patients with non-small cell lung cancer undergoing pneumonectomy from 2014 to 2018. Robotic approach was compared with open and thoracoscopic pneumonectomy. Descriptive and outcomes analyses, and 5-year overall survival were assessed.

RESULTS: Robot-assisted approach was completed in 269 (5.56%) cases, 3671 (75.88%) by open resection, and 898 …

Systematic Review Of Needlestick Injuries In The Operating Room: A Case For Surgical Glove Redesigning, Shalmali Mirajkar, Zachary Bauman, Bethany Lowndes

EMET Projects

Background: Sharps or needlestick injuries (NSI) occur in roughly 15% of surgeries and are largely preventable. With such injuries, healthcare workers have a high risk of exposure to blood borne pathogens. Despite the implementation of several prevention measures such as double gloving and using blunt suture needles, there is still a high prevalence of NSIs. The aim of the current study is to conduct a systematic review to identify the most vulnerable parts of the hand for needlestick injuries, the most common tasks during which injuries occurred, and the most common instrument associated with the injury.

Methods: A …

Successful Return To Sport And Daily Activities After Suture Augmentation Of Both The Anterior Talofibular Ligament And Calcaneofibular Ligament, S Ali Ghasemi, Jetha Tallapaneni, Benjamin C Murray, Clark Yin, James Raphael, Zachary Vaupel, Allan Grant, Paul Fortin

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To evaluate the return to sport and daily activities in addition to clinical outcomes after modification of the Brostöm repair, specifically using suture augmentation for concomitant fixation of both the anterior talofibular ligament and calcaneofibular ligament.

METHODS: Patients who had grade III ankle sprains and lateral ankle instability, all of whom failed supervised conservative management, were included. Patients underwent a modified Broström procedure consisting of suture augmentation for both the anterior talofibular ligament and calcaneofibular ligament. For clinical outcome evaluation, Foot and Ankle Ability Measure (FAAM) and Karlsson-Peterson Scoring System for Ankle Function questionnaires coupled with questions regarding time …

Tav-In-Tav And Beyond: How Far Can We Go?, Taramasso Maurizio, Ana Paula Tagliari, David L. Fischman

Division of Cardiology Faculty Papers

No abstract provided.

Deep Brain Stimulation For Substance Use Disorder: A Systematic Review And Meta-Analysis, Nour Shaheen, Ahmed Shaheen, Can Sarica, Arun Singh, Mario Zanaty, Karim Johari, Andrew Yang, Theresa Zesiewicz, Brian Dalm, Yarema Bezchlibnyk, Andres M Lozano, Oliver Flouty

Department of Neurosurgery Faculty Papers

OBJECTIVE: Substance use disorder (SUD) is a significant public health issue with a high mortality rate. Deep brain stimulation (DBS) has shown promising results in treating SUD in certain cases. In this study, we conducted a meta-analysis to evaluate the efficacy of DBS in the treatment of SUD and reduction of relapse rates.

METHODS: We performed a thorough and methodical search of the existing scientific literature, adhering to the PRISMA guidelines, to identify 16 original studies that fulfilled our inclusion criteria. We used the evidence levels recommended by the Oxford Centre for Evidence-Based Medicine to assess bias. The R version …

A Hypothetical New Challenging Use For Indocyanine Green Fluorescence During Laparoscopic Appendectomy: A Mini-Series Of Our Experience And Literary Review, Noemi Zorzetti, Augusto Lauro, Manuela Cuoghi, Marco La Gatta, Ignazio R. Marino, Salvatore Sorrenti, Vito D'Andrea, Andrea Mingoli, Giuseppe Giovanni Navarra

Department of Surgery Faculty Papers

Laparoscopic appendectomy (LA) is a well-standardized surgical procedure, but there are still controversies about the different devices to be used for the appendiceal stump closure and the related postoperative complications. Indocyanine green (ICG) fluorescence angiography (FA) has already been shown to be helpful in elective and emergency surgery, providing intraoperative information on tissue and organ perfusion, thus guiding the surgical decisions and the technical strategies. According to these two aspects, we report a mini-series of the first five patients affected by gangrenous and flegmonous acute appendicitis intraoperatively evaluated with ICG-FA during LA. The patients were admitted to the Emergency Department …

Seeing Into The Future: Heartmate 3 To The Systemic Right Ventricle In A Completely Blind Patient With Congenitally-Corrected Transposition Of The Great Arteries, Juhi Ramchandani, Chirag Dipak Shah, Kashif Saleem, Maya Guglin, Roopa Rao

The VAD Journal

A 24-year-old, blind male with congenitally-corrected transposition of the great arteries and systemic right ventricular failure presented with New York Heart Association class IV heart failure despite home inotropic therapy. He was not a transplant candidate due to psychosocial issues. He underwent a successful HeartMate 3 (Abbott Laboratories) placement with the implementation of techniques to guide home ventricular assist device care despite blindness.

Characteristics And Outcomes Of Patients Who Underwent Coronary Atherectomy In Centers With And Without On-Site Cardiac Surgery, Mohamed Dafaalla, Muhammad Rashid, Saadiq Moledina, Tim Kinnaird, Peter Ludman, Nick Curzen, Sarah Zaman, James Nolan, Mamas A. Mamas

Department of Medicine Faculty Papers

We aimed to describe the clinical characteristics and outcomes of patients who underwent atherectomy at the time of percutaneous coronary intervention in centers with on-site surgical centers (SCs) versus nonsurgical centers (NSCs). Patients treated with coronary atherectomy between January 1, 2006, to December 31, 2019, from the British Cardiovascular Society Intervention (BCIS) registry were included. Primary outcomes were in-hospital all-cause mortality and major adverse cardiovascular and cerebrovascular events. A total of 20,833 patients were treated with coronary atherectomy, of which 7,983 (38%) were performed at NSC. The proportion of coronary atherectomies performed in NSC increased from 12.5% in 2006 to …

A Biologic-Device Combination Product Delivering Tumor-Derived Antigens Elicits Immunogenic Cell Death-Associated Immune Responses Against Glioblastoma, Christopher Cultrara, Christopher Uhl, Kenneth Kirby, Essam Abed Elrazaq, Amelia Zellander, David W. Andrews, Charles B. Scott, Lorenzo Galluzzi, Mark A. Exley, Jenny Zilberberg

Department of Neurosurgery Faculty Papers

Background IGV-001 is a personalized, autologous cancer cell-based immunotherapy conceived to deliver a tumor-derived antigenic payload in the context of immunostimulatory signals to patients with glioblastoma (GBM). IGV-001 consists of patient-derived GBM cells treated with an antisense oligodeoxynucleotide against insulin-like growth factor 1 receptor (IGF1R) and placed in proprietary biodiffusion chambers (BDCs). The BDCs are then exposed to 5–6 Gy radiation and implanted at abdominal sites for ~48 hours. IGV-001 has previously been shown to be generally safe with promising clinical activity in newly diagnosed GBM patients.

Methods Mouse (m) or human (h) variants of IGV-001 …

Transmission Of Yellow Fever Vaccine Virus Through Blood Transfusion And Organ Transplantation In The Usa In 2021: Report Of An Investigation, Carolyn V. Gould, Rebecca J. Free, Julu Bhatnagar, Raymond A. Soto, Tricia L. Royer, Warren R. Maley, Sean Moss, Matthew A. Berk, Rebecca Craig-Shapiro, Rosy Priya L. Kodiyanplakkal, Lars F. Westblade, Thangamani Muthukumar, Yoram A. Puius, Amresh Raina, Azam Hadi, Kymberly A. Gyure, Danielle Trief, Marcus Pereira, Matthew J. Kuehnert, Vennus Ballen, Debra A. Kessler, Kimberly Dailey, Charles Omura, Thuy Doan, Steve Miller, Michael R. Wilson, Jennifer A. Lehman, Jana M. Ritter, Elizabeth Lee, Luciana Silva-Flannery, Sarah Reagan-Steiner, Jason O. Velez, Janeen J. Laven, Kelly A. Fitzpatrick, Amanda Panella, Emily H. Davis, Holly R. Hughes, Aaron C. Brault, Kirsten St George, Amy B. Dean, Joel Ackelsberg, Sridhar V. Basavaraju, Charles Y. Chiu, J. Erin Staples

Department of Medicine Faculty Papers

BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients.

METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by …

Penumbra Aspiration Thrombectomy Of The Superior Mesenteric Artery For Mesenteric Ischemia, Brandon A. Creisher, Prashanth Palvannan, Dawn Salvatore, Paul J. Dimuzio, Babak Abai, Michael Nooromid

Department of Surgery Faculty Papers

Acute mesenteric ischemia from thromboembolic occlusion is a life-threatening emergency associated with a high mortality rate. Prompt diagnosis and intervention are vital to preserve viable bowel and prevent mortality. In the past decade, a shift has occurred toward minimally invasive alternatives such as endovascular therapies. We present a case of acute mesenteric ischemia from superior mesenteric artery thrombosis treated promptly with the Penumbra suction thrombectomy device (Penumbra Inc).

Effects Of Preoperative Chlorhexidine Gluconate (Chg) Cloths Educational Intervention For Preoperative Staff On Chg Knowledge And Surgical Site Infection Rates: A Quality Improvement Initiative., Deven Leffler

Doctor of Nursing Practice Papers

Abstract

Background: Surgical site infections (SSIs) are the most common cause of a surgical complication and account for 38% of all hospital acquired infections (HAI). The cost of caring for SSIs in the United States can range from $3.5-$10 billion annually.

Purpose: The purpose of this DNP Quality Improvement (QI) initiative was to improve preoperative staff’s knowledge and application of the Food and Drug Administration (FDA) approved 3-minute application scrub time for the 2% CHG cloths and reduce SSIs for an acute care hospital located in Louisville, Kentucky.

Methods: Quality improvement was initiated using the Plan, Do, Study, Act (PDSA) …

Two Thymomas Of Different Histological Subtypes Arising In A Giant Thymolipoma: Case Report And Review Of The Literature., Vincent C Daniel, Konstantin Shilo

Surgery Articles

Thymolipoma is a rare benign tumor of the anterior mediastinum. Only a few reports describing thymoma arising within a thymolipoma have been documented in the literature. We report herein a detailed description of thymolipoma giving rise to 2 thymomas of different histological subtypes. A 74-year-old male with history of metastatic papillary thyroid carcinoma gradually developed 2 soft tissue nodules within a large right hemithorax fatty mass that was present for the past 20 years. Computed tomography (CT)-guided needle biopsy revealed one of the soft tissue nodules to be a thymoma, and the entire mass was surgically resected. Final pathological examination …

Current Relevance Of Biomarkers In Diagnosis Of Periprosthetic Joint Infection: An Update., Saksham Tripathi, Saad Tarabichi, Javad Parvizi, Ashok Rajgopal

Rothman Institute Papers

With a significant rise in the number of arthroplasty procedures performed worldwide, the increasing revision burden posed by periprosthetic joint infection (PJI) is a matter of growing concern. In spite of various attempts to diagnose PJI, there are no defined tests that can be called a gold standard. Given the importance of early diagnosis in PJI, newer tests and biomarkers have been introduced to improve cumulative diagnostic accuracy. Novel biomarkers like calprotectin, lipocalcin, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet-to-mean platelet volume ratio have demonstrated a potential as diagnostic biomarkers for PJI. This article discusses the relevance of available …

Whole Blood Resuscitation And Association With Survival In Injured Patients With An Elevated Probability Of Mortality, Jason L Sperry, Bryan A Cotton, James F Luther, Jeremy W Cannon, Martin A Schreiber, Ernest E Moore, Nicholas Namias, Joseph P Minei, Stephen R Wisniewski, Frank X Guyette, Shock, Whole Blood, And Assessment Of Traumatic Brain Injury (Swat) Study Group

Faculty, Staff and Student Publications

BACKGROUND: Low-titer group O whole blood (LTOWB) resuscitation is becoming common in both military and civilian settings and may represent the ideal resuscitation intervention. We sought to characterize the safety and efficacy of LTOWB resuscitation relative to blood component resuscitation.

STUDY DESIGN: A prospective, multicenter, observational cohort study was performed using 7 trauma centers. Injured patients at risk of massive transfusion who required both blood transfusion and hemorrhage control procedures were enrolled. The primary outcome was 4-hour mortality. Secondary outcomes included 24-hour and 28-day mortality, achievement of hemostasis, death from exsanguination, and the incidence of unexpected survivors.

RESULTS: A total …

Hernia Prevention Using Biologic Mesh And/Or Small Bites: A Multispecialty 2 × 2 Factorial Randomized Controlled Trial, Rainna Coelho, Naila H Dhanani, Nicole B Lyons, Karla Bernardi, Erik P Askenasy, Stefanos Millas, Julie L Holihan, Zuhair Ali, Mike K Liang

Faculty, Staff and Student Publications

BACKGROUND: Ventral incisional hernias are the most common complication after abdominal operation. Randomized trials have shown efficacy of prophylactic synthetic mesh and small bites. Adoption of these practices has been limited due to concerns with placement of synthetic mesh in contaminated cases and small bites in an overweight population. We sought to assess the efficacy of prophylactic biologic mesh and small bites to prevent postoperative major complications: ventral incisional hernias, surgical site infection, reoperation, and death.

STUDY DESIGN: High-risk patients (overweight/obese, current smoker) undergoing abdominal operation with a midline incision (5 cm or greater) were randomized (2 × 2 factorial …

Biologic Versus Synthetic Mesh In Ventral Hernia Repair: Participant-Level Analysis Of Two Randomized Controlled Trials At Twenty-Four To Thirty-Six Months, Naila H Dhanani, Kyung Hyun Lee, Oscar A Olavarria, Charlotte Young, Frank Primus, Julie L Holihan, Mike K Liang, Hobart W Harris

Faculty, Staff and Student Publications

Background: Biologic mesh has been used increasingly in complex ventral hernia repair despite limited evidence at low risk of bias supporting its use. Patients and

Methods: We performed a participant-level analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh with complex ventral hernia repair at 24 to 36 months. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at 24 to 36 months post-operative. Secondary outcomes included length of index hospital stay, surgical site occurrence, surgical site infection, and death. Outcomes were assessed using both frequentist and Bayesian generalized linear regression models.

Results: …