Surgery Commons^™

Perioperative Team-Based Morbidity And Mortality Conferences: A Systematic Review Of The Literature, Aubrey Samost-Williams, Roni Rosen, Alexander Hannenberg, Melis Lydston, Garrett M Nash, Mary Brindle

Faculty, Staff and Student Publications

OBJECTIVE: This systematic review aimed to identify key elements of perioperative team-based morbidity and mortality conferences (TBMMs) and their impact on patient safety, education, and quality improvement outcomes.

BACKGROUND: Patient safety in the perioperative period is influenced by system, team, and individual behaviors. However, despite this recognition, single-discipline morbidity and mortality conferences remain a mainstay of educational and quality improvement efforts.

METHODS: A structured search was conducted in MEDLINE Complete, Embase, Web of Science, ClinicalTrials.gov, Cochrane CENTRAL, and ProQuest Dissertations and Theses Global in July 2022. Search results were screened, and the articles meeting inclusion criteria were abstracted.

RESULTS: Seven …

Maximizing Wound Coverage In Full-Thickness Skin Defects: A Randomized-Controlled Trial Of Autologous Skin Cell Suspension And Widely Meshed Autograft Versus Standard Autografting, Sharon Henry, Steven Mapula, Mark Grevious, Kevin N. Foster, Herbert Phelan, Jeffrey Shupp, Rodney Chan, David Harrington, Neil Mashruwala, David A. Brown, Haaris Mir, George Singer, Alfredo Cordova, Lisa Rae, Theresa Chin, Lourdes Castanon, Derek Bell, William Hughes, Joseph A. Molnar

Department of Surgery Faculty Papers

BACKGROUND: Traumatic insults, infection, and surgical procedures can leave skin defects that are not amenable to primary closure. Split-thickness skin grafting (STSG) is frequently used to achieve closure of these wounds. Although effective, STSG can be associated with donor site morbidity, compounding the burden of illness in patients undergoing soft tissue reconstruction procedures. With an expansion ratio of 1:80, autologous skin cell suspension (ASCS) has been demonstrated to significantly decrease donor skin requirements compared with traditional STSG in burn injuries. We hypothesized that the clinical performance of ASCS would be similar for soft tissue reconstruction of nonburn wounds.

METHODS: A …

Robot-Assisted Resection Of Tricuspid Valve Papillary Fibroelastoma, Nancy Wang, Zachary Gray, Joseph G Rogers, Kenneth K Liao

Faculty, Staff and Students Publications

We report 3 cases of papillary fibroelastoma of the tricuspid valve. Two of them manifested with atypical symptoms of chest pressure and chest pain. Robot-assisted resection was performed to remove the mass while preserving the native valve. All patients recovered well. The 2 symptomatic patients experienced complete symptom resolution. We demonstrate the safety and feasibility of robotic resection in treating tricuspid valve papillary fibroelastoma.

How Did That Get There? A Case Series Of Adolescent Foreign Bodies, Justin Ian Hanson, Paul Bomar, Sarah Kleist, Denver Rogalla, Lori Crihfield, Scott Gutovitz

HCA Healthcare Journal of Medicine

Introduction

Pediatric foreign bodies (FBs) come in many shapes and sizes, and the method by which they enter the body can greatly impact the level of acuity at presentation. Most FBs in children are found in those younger than 5 years old, but the following 3 cases were found in adolescent patients.

Case Presentation

We report on 3 adolescent patients who presented to a single community-based emergency department with the chief complaint of abdominal pain and were found to have complications of abdominal FBs. If undiagnosed, the initial indolent courses of FBs can lead to serious complications, as shown in …

Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review Of Randomized Controlled Trials, Shin Jeong, Tunmi A. Anwoju, Oscar A. Olavarria, Natalia Cavagnaro, Naila H. Dhanani, Nicole B. Lyons, Zuhair Ali, Mike K. Liang

HCA Healthcare Journal of Medicine

Background

During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.

Methods

PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of …

A Pilot Study Of Inflatable Penile Prosthesis Placement In Transgender Neophallus Using Tutoplast® Pericardium Graft Sock Technique, Justin P Mehr, Kareim Khalaf Alla, Kyle A Blum, Travis P Green, Kailash Panchapakesan, Daniel Freet, Run Wang

Faculty, Staff and Student Publications

Placement of an inflatable penile prosthesis (IPP) in a transgender patient’s neophallus carries unique considerations versus cis-gender IPP placement in mitigating infection, erosion, and overall complication rates. An example of this includes the lack of an anatomical corpus cavernosum and crura for cylinder placement and anchoring. Multiple grafting approaches and materials have been utilized to mitigate possible cylinder instability and improve anchoring. Here we describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with distal and proximal cylinder human cadaver pericardium (Tutoplast®, IOP Ophthalmics, Costa Mesa, CA, USA) grafts. Our goals were to determine postoperative …

Management Of The Left Subclavian Artery During Aortic Arch Replacement Using A Frozen Elephant Trunk Approach: A Review, Vicente Orozco-Sevilla, Joseph S Coselli

Faculty, Staff and Students Publications

The frozen elephant trunk (FET) technique for total aortic arch replacement extends repair into the proximal portion of the descending thoracic aorta. Several techniques and modifications of total arch replacement have been described in the literature, and many of these iterations are related to facilitating the distal anastomosis while preserving flow to the left subclavian artery (LSCA), as well as maintaining posterior circulation of the brain via the vertebral artery, by reducing the circulatory arrest time during reconstruction. Because of the LSCA's posterior and deep anatomic location in the chest, particularly in obese patients, this revascularization is often challenging; additional …

Atmospheric Pressure Plasma Treatment Of Skin: Penetration Into Hair Follicles, Kseniia Konina, Theresa A. Freeman, Mark J. Kushner

Department of Orthopaedic Surgery Faculty Papers

Sterilization of skin prior to surgery is challenged by the reservoir of bacteria that resides in hair follicles. Atmospheric pressure plasma jets (APPJs) have been proposed as a method to treat and deactivate these bacteria as atmospheric plasmas are able to penetrate into structures and crevices with dimensions similar to those found in hair follicles. In this paper, we discuss results from a computational investigation of an APPJ sustained in helium flowing into ambient air, and incident onto a layered dielectric similar to human skin in which there are idealized hair follicles. We found that, depending on the location of …

Corneal Wound Healing In The Presence Of Antifibrotic Antibody Targeting Collagen Fibrillogenesis: A Pilot Study, Zeba A. Syed, Tatyana Milman, Jolanta Fertala, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Highly organized collagen fibrils interlacing with proteoglycans form the crucial architecture of the cornea and facilitate its transparency. Corneal scarring from accidental injury, surgery, or infection alters this highly organized tissue, causing severe consequences, including blindness. There are no pharmacological or surgical methods to effectively and safely treat excessive corneal scarring. Thus, we tested the anticorneal scarring utility of a rationally designed anticollagen antibody (ACA) whose antifibrotic effects have already been demonstrated in nonocular models. Utilizing a rabbit model with an incisional corneal wound, we analyzed ACA’s effects on forming collagen and proteoglycan-rich extracellular matrices in scar neotissue. We used …

Pulmonary Outcomes Of Congenital Diaphragmatic Hernia Patients Based On Defect Size (Cdh Study Group Stage), Hina Emanuel, Hannah V Breitschopf, Matthew T Harting, Diana J Martinez Castillo, Aravind Yadav, Katrina Mcbeth, S Syed Hashmi, Ashley H Ebanks, Tomika S Harris, Kevin P Lally, Cindy K Jon, James M Stark, Ricardo A Mosquera

Faculty, Staff and Student Publications

BACKGROUND: Congenital diaphragmatic hernia (CDH) is associated with significant pulmonary morbidity. Previous investigation has shown that postnatal inpatient morbidity is linked to diaphragmatic defect size. The objective of this study was to evaluate long-term pulmonary outcomes by CDH study group defect size.

METHODS: A retrospective analysis was conducted for CDH patients (n=133) managed in a neonatal intensive care unit (NICU) at a single children's hospital within an adult hospital system and subsequently followed up at a comprehensive multidisciplinary CDH clinic (n=102) from January 2012 to April 2022. CDH patients were stratified according to Congenital Diaphragmatic Hernia Study Group (CDHSG) Stage, …

Aggregated Molecular Phenotype Scores: Enhancing Assessment And Visualization Of Mass Spectrometry Imaging Data For Tissue-Based Diagnostics, Jessie R Chappel, Mary E King, Jonathon Fleming, Livia S Eberlin, David M Reif, Erin S Baker

Faculty, Staff and Students Publications

Mass spectrometry imaging (MSI) has gained increasing popularity for tissue-based diagnostics due to its ability to identify and visualize molecular characteristics unique to different phenotypes within heterogeneous samples. Data from MSI experiments are often assessed and visualized using various supervised and unsupervised statistical approaches. However, these approaches tend to fall short in identifying and concisely visualizing subtle, phenotype-relevant molecular changes. To address these shortcomings, we developed aggregated molecular phenotype (AMP) scores. AMP scores are generated using an ensemble machine learning approach to first select features differentiating phenotypes, weight the features using logistic regression, and combine the weights and feature abundances. …

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 …