Surgery Commons^™

Dexmedetomidine Alters The Inflammatory Profile Of Rat Microglia In Vitro, Michael C Scott, Candice M Haase, Scott D Olson, Charles S Cox

Faculty, Staff and Student Publications

BACKGROUND: Microglia are a primary mediator of the neuroinflammatory response to neurologic injury, such as that in traumatic brain injury. Their response includes changes to their cytokine expression, metabolic profile, and immunophenotype. Dexmedetomidine (DEX) is an α

METHODS: Primary microglia were isolated from Sprague-Dawley rats and cultured. Microglia were activated using multiple mediators: lipopolysaccharide (LPS), polyinosinic-polycytidylic acid (Poly I:C), and traumatic brain injury damage-associated molecular patterns (DAMP) from a rat that sustained a prior controlled cortical impact injury. After activation, cultures were treated with DEX. At the 24-h interval, the cell supernatant and cells were collected for the following studies: …

Impact Of Transfused Citrate On Pathophysiology In Massive Transfusion, Jacob B Schriner, J Michael Van Gent, M Adam Meledeo, Scott D Olson, Bryan A Cotton, Charles S Cox, Brijesh S Gill

Faculty, Staff and Student Publications

This narrative review article seeks to highlight the effects of citrate on physiology during massive transfusion of the bleeding patient.

DATA SOURCES: A limited library of curated articles was created using search terms including "citrate intoxication," "citrate massive transfusion," "citrate pharmacokinetics," "hypocalcemia of trauma," "citrate phosphate dextrose," and "hypocalcemia in massive transfusion." Review articles, as well as prospective and retrospective studies were selected based on their relevance for inclusion in this review.

STUDY SELECTION: Given the limited number of relevant studies, studies were reviewed and included if they were written in English. This is not a systematic review nor a …

Association Between Early Prostacyclin Therapy And Extracorporeal Life Support Use In Patients With Congenital Diaphragmatic Hernia, Akila B Ramaraj, Samuel E Rice-Townsend, Carrie L Foster, Delphine Yung, Emma O Jackson, Ashley H Ebanks, Matthew T Harting, Rebecca A Stark, Congenital Diaphragmatic Hernia Study Group

Faculty, Staff and Student Publications

IMPORTANCE: Prostacyclin (PGI2) is a therapeutic option to treat congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension in neonates. Its use may decrease the need for extracorporeal life support (ECLS).

OBJECTIVE: To evaluate the association of early PGI2 therapy with ECLS use and outcomes among patients with CDH.

DESIGN, SETTING, AND PARTICIPANTS: This was a cohort study from the CDH Study Group (CDHSG) registry of patients born from January 2007 to December 2019. Patients were from 88 different tertiary pediatric referral centers worldwide that contributed data to the CDHSG. Patients were included in the study if they were admitted within the first …

Perception Of Treatment Success And Impact On Function With Antibiotics Or Appendectomy For Appendicitis: A Randomized Clinical Trial With An Observational Cohort, Callie M Thompson, Emily C Voldal, Giana H Davidson, Sabrina E Sanchez, Patricia Ayoung-Chee, Jesse Victory, Mary Guiden, Bonnie Bizzell, Jacob Glaser, Christopher Hults, Thea P Price, Nicole Siparsky, Kristin Ohe, Katherine A Mandell, Daniel A Deugarte, Amy H Kaji, Lisandra Uribe, Lillian S Kao, Krislynn M Mueck, Farhood Farjah, Wesley H Self, Sunday Clark, F Thurston Drake, Katherine Fischkoff, Elizaveta Minko, Joseph Cuschieri, Brett Faine, Dionne A Skeete, Naila Dhanani, Mike K Liang, Anusha Krishnadasan, David A Talan, Erin Fannon, Larry G Kessler, Bryan A Comstock, Patrick J Heagerty, Sarah E Monsell, Sarah O Lawrence, David R Flum, Danielle C Lavallee, Writing Group For The Coda Collaborative

Faculty, Staff and Student Publications

OBJECTIVE: To compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days.

SUMMARY BACKGROUND DATA: The Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status. To address questions about outcomes among participants with lower socioeconomic status, we explored the relationship of sociodemographic and clinical factors and outcomes.

METHODS: We focused on 4 patient reported outcomes at 30 days: high decisional regret, dissatisfaction with treatment, problems performing usual activities, and missing >10 days of work. The randomized …

Use Of Telemedicine For Postdischarge Assessment Of The Surgical Wound: International Cohort Study, And Systematic Review With Meta-Analysis, Nihr Global Health Research Unit On Global Surgery, Globalsurg Collaborative

Faculty, Staff and Student Publications

OBJECTIVE: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardized assessment tools are needed.

BACKGROUND: Surgical site infection (SSI) is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery.

METHODS: The primary outcome of this study was SSI reported up to 30 days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analyzed primary data from …

Fighting The Obesity Pandemic During The Covid-19 Pandemic, Jordan E Grubbs, Haley J Daigle, Megan Shepherd, Robert E Heidel, Kyle L Kleppe, Matthew L Mancini, Gregory J Mancini

Faculty, Staff and Student Publications

BACKGROUND: The COVID-19 pandemic created delays in surgical care. The population with obesity has a high risk of death from COVID-19. Prior literature shows the most effective way to combat obesity is by weight loss surgery. At different times throughout the COVID-19 pandemic, elective inpatient surgeries have been halted due to bed availability. Recognizing that major complications following bariatric surgery are extremely low (bleeding 0-4%, anastomotic leaks 0.8%), we felt outpatient bariatric surgery would be safe for low-risk patients. Complications such as DVT, PE, infection, and anastomotic leaks typically present after 7 days postoperatively, well outside the usual length of …

Utility And Usability Of Laser Speckle Contrast Imaging (Lsci) For Displaying Real-Time Tissue Perfusion/Blood Flow In Robot-Assisted Surgery (Ras): Comparison To Indocyanine Green (Icg) And Use In Laparoscopic Surgery, Yao Z Liu, Shinil K Shah, Christina M Sanders, Chibueze A Nwaiwu, Alyson F Dechert, Saloni Mehrotra, Steven D Schwaitzberg, Peter C W Kim, Erik B Wilson

Faculty, Staff and Student Publications

BACKGROUND: Utility and usability of laser speckle contrast imaging (LSCI) in detecting real-time tissue perfusion in robot-assisted surgery (RAS) and laparoscopic surgery are not known. LSCI displays a color heatmap of real-time tissue blood flow by capturing the interference of coherent laser light on red blood cells. LSCI has advantages in perfusion visualization over indocyanine green imaging (ICG) including repeat use on demand, no need for dye, and no latency between injection and display. Herein, we report the first-in-human clinical comparison of a novel device combining proprietary LSCI processing and ICG for real-time perfusion assessment during RAS and laparoscopic surgeries. …

Hybrid Repair Strategies For Acute Type B Aortic Dissection Complicating Prior Standard And Complex Endovascular Aortic Repair, Jesse Chait, Bernardo C Mendes, Lily E Johnston, Fahad Shuja, Gustavo S Oderich, Manju Kalra

Faculty, Staff and Student Publications

Type B aortic dissection (TBAD) in the presence of an existing aortic endograft is a rare, but potentially catastrophic, event. False lumen pressurization and propagation leads to several failure modes. Endograft collapse can lead to spinal cord, visceral, or lower extremity ischemia, and rupture of a previously sealed aneurysm sac is often fatal. A successful treatment strategy must incorporate the patient's symptoms, urgency of intervention, extent of dissection, and the location and status of the existing graft. In this series, we present three cases of TBAD complicating prior endovascular aortic repairs-infrarenal, iliac branched, and thoracoabdominal branched endografts-successfully treated with tailored, …

Prospective Assessment Of The Accuracy Of Asge And Esge Guidelines For Choledocholithiasis, Andy Silva-Santisteban, Ishani Shah, Madhuri Chandnani, Vaibhav Wadhwa, Leo Tsai, Abraham F Bezuidenhout, Tyler M Berzin, Douglas Pleskow, Mandeep Sawhney

Faculty, Staff and Student Publications

Background and study aims American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend categorizing patients by risk for choledocholithiasis to determine management. The goal of our study was to compare the accuracy of criteria proposed in these guidelines.

Patients and methods All patients with suspected choledocholithiasis at our institution were prospectively identified. Based upon initial test results, patients were categorized as low, intermediate, and high risk for choledocholithiasis per ASGE 2010 and 2019, and ESGE criteria. Patients were followed until 30 days post-discharge. Results of endoscopic retrograde cholangiography (ERCP), endoscopic ultrasound, and magnetic resonance …

The Risk For Malignancy Using The Milan Salivary Gland Classification Categories: A 5-Year Retrospective Review, Sara Monfared, Joshua J Weis, Shinil K Shah, Daniel J Scott, Melissa M Felinski, Erik B Wilson

Faculty, Staff and Student Publications

BACKGROUND: The field of bariatric surgery has seen peaks and troughs in the types of metabolic procedures performed. Our primary aim was to evaluate bariatric case volumes among fellows enrolled in bariatric Fellowship Council (FC)-accredited programs. Our secondary aim was to assess trends in revisional case volumes.

METHODS: We reviewed de-identified FC case logs for all bariatric surgery-accredited programs from 2010 through 2019. The number of primary sleeve gastrectomy, gastric band, gastric bypass, biliopancreatic diversion, and major revisional bariatric surgical procedures (defined as a revision with creation of a new anastomosis) were graphed for each academic year. Fellows were stratified …

A Primer For The Student Joining The Adult Cardiac Surgery Service Tomorrow: Primer 1 Of 7, Rohun Bhagat, Mary A Siki, Nicholas Anderson, Lena Trager, Edgar Aranda-Michel, Daniel Ziazadeh, Ashley Choi, John A Treffalls, Valentino Bianco, Clauden Louis, David Blitzer, Marc R Moon

Faculty, Staff and Students Publications

No abstract provided.

Distinguishing Renal Cell Carcinoma From Normal Kidney Tissue Using Mass Spectrometry Imaging Combined With Machine Learning, Vishnu Shankar, Kanchustambham Vijayalakshmi, Rosalie Nolley, Geoffrey A Sonn, Chia-Sui Kao, Hongjuan Zhao, Ru Wen, Livia S Eberlin, Robert Tibshirani, Richard N Zare, James D Brooks

Faculty, Staff and Students Publications

PURPOSE: Accurately distinguishing renal cell carcinoma (RCC) from normal kidney tissue is critical for identifying positive surgical margins (PSMs) during partial and radical nephrectomy, which remains the primary intervention for localized RCC. Techniques that detect PSM with higher accuracy and faster turnaround time than intraoperative frozen section (IFS) analysis can help decrease reoperation rates, relieve patient anxiety and costs, and potentially improve patient outcomes.

MATERIALS AND METHODS: Here, we extended our combined desorption electrospray ionization mass spectrometry imaging (DESI-MSI) and machine learning methodology to identify metabolite and lipid species from tissue surfaces that can distinguish normal tissues from clear cell …

Safety And Efficacy Of A Kaolin-Impregnated Hemostatic Gauze In Cardiac Surgery: A Randomized Trial, Mubashir Mumtaz, Richard B Thompson, Marc R Moon, Ibrahim Sultan, T Brett Reece, William B Keeling, Jacob Delarosa

Faculty, Staff and Students Publications

OBJECTIVE: A kaolin-based nonresorbable hemostatic gauze, QuikClot Control+, has demonstrated effective hemostasis and safety when used for severe/life-threatening (grade 3/4) internal organ space bleeding. We evaluated the efficacy and safety of this gauze for mild to moderate (grade 1-2) bleeding in cardiac surgery compared with control gauze.

METHODS: This was a randomized, controlled, single-blinded study of patients who underwent cardiac surgery between June 2020 and September 2021 across 7 sites with 231 subjects randomized 2:1 to QuikClot Control+ or control. The primary efficacy end point was hemostasis rate (ie, subjects achieving grade 0 bleed) through up to 10 minutes of …

Highlights Of The 2022 Brano Heart Failure Forum: Part One, Ugo Livi, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The 2022 BHHF forum was held on the 6^th thru 8^th of September 2022 in Trieste, Italy. It was attended by over 94 faculty from 14 countries. In addition, participation through online streaming was available. Throughout the forum, 17 sessions focused on challenges and solutions …

Race-Free Estimated Glomerular Filtration Rate Equation In Kidney Transplant Recipients: Development And Validation Study, Marc Raynaud, Solaf Al-Awadhi, Ivana Juric, Gillian Divard, Yannis Lombardi, Nikolina Basic-Jukic, Olivier Aubert, Laurence Dubourg, Ingrid Masson, Christophe Mariat, Dominique Prié, Vincent Pernin, Moglie Le Quintrec, Timothy S Larson, Mark D Stegall, Boris Bikbov, Piero Ruggenenti, Laurent Mesnard, Hassan N Ibrahim, Marie Bodilsen Nielsen, Arthur J Matas, Brian J Nankivell, Stan Benjamens, Robert A Pol, Stephan J L Bakker, Xavier Jouven, Christophe Legendre, Nassim Kamar, Byron H Smith, Hani M Wadei, Antoine Durrbach, Flavio Vincenti, Giuseppe Remuzzi, Carmen Lefaucheur, Andrew J Bentall, Alexandre Loupy

Faculty, Staff and Student Publications

OBJECTIVE: To compare the performance of a newly developed race-free kidney recipient specific glomerular filtration rate (GFR) equation with the three current main equations for measuring GFR in kidney transplant recipients.

DESIGN: Development and validation study SETTING: 17 cohorts in Europe, the United States, and Australia (14 transplant centres, three clinical trials).

PARTICIPANTS: 15 489 adults (3622 in development cohort (Necker, Saint Louis, and Toulouse hospitals, France), 11 867 in multiple external validation cohorts) who received kidney transplants between 1 January 2000 and 1 January 2021.

MAIN OUTCOME MEASURE: The main outcome measure was GFR, measured according to local practice. …

Comparison Of Satisfaction With Penile Prosthesis Implantation In Patients With Prostate Cancer Radiation Therapy Versus Radical Prostatectomy, Justin P Mehr, Kyle A Blum, Travis Green, Skyler Howell, Stephen Palasi, Andrew T Sullivan, Benjamin Kim, Christopher Kannady, Run Wang

Faculty, Staff and Student Publications

Background: Penile prosthesis surgery (PPS) is a commonly used treatment for erectile dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with a urologic malignancy such as prostate cancer, surgical interventions like radical prostatectomy (RP) as well as non-surgical treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. Our aim was to compare sexual satisfaction in patients with prosthesis implantation for ED following RP versus ED following radiation therapy for prostate cancer.

Methods: A retrospective chart review from our …

A Clinical Practice Review Of Percutaneous Ethanol Injection For Thyroid Nodules: State Of The Art For Benign, Cystic Lesions, Robert D.E. Clark, Xinyi Luo, Peter P. Issa, Ralph P. Tufano, Emad Kandil

School of Medicine Faculty Publications

Percutaneous ethanol injection (PEI) is a widely used treatment option for cystic and predominantly cystic thyroid nodules. It has several advantages over other treatment modalities. Compared to surgery, PEI is less painful, can be performed in the outpatient setting, and carries less risk of transient or permanent side effects. Compared to other minimally invasive techniques such as radiofrequency ablation (RFA), PEI is less expensive and does not require specialized equipment. PEI performs well in the context of cystic nodules. PEI does not perform as well as other techniques in solid nodules, so its use as a primary treatment is limited …

Artificial Intelligence And Machine Learning In The Diagnosis And Management Of Stroke: A Narrative Review Of United States Food And Drug Administration-Approved Technologies, Anirudha S. Chandrabhatla, Elyse A. Kuo, Jennifer D. Sokolowski, Ryan T. Kellogg, Min Park, Panagiotis Mastorakos

Department of Neurosurgery Faculty Papers

Stroke is an emergency in which delays in treatment can lead to significant loss of neurological function and be fatal. Technologies that increase the speed and accuracy of stroke diagnosis or assist in post-stroke rehabilitation can improve patient outcomes. No resource exists that comprehensively assesses artificial intelligence/machine learning (AI/ML)-enabled technologies indicated for the management of ischemic and hemorrhagic stroke. We queried a United States Food and Drug Administration (FDA) database, along with PubMed and private company websites, to identify the recent literature assessing the clinical performance of FDA-approved AI/ML-enabled technologies. The FDA has approved 22 AI/ML-enabled technologies that triage brain …

A Comparison Of Radiographic Alignment Between Bilateral And Unilateral Interbody Cages In Patients Undergoing Transforaminal Lumbar Interbody Fusion, Mark J. Lambrechts, Jeremy Heard, Nicholas D. D'Antonio, John Bodnar, Gregory Schroeder, Evan Bloom, Jose Canseco, Barrett Woods, Ian David Kaye, Mark Kurd, Jeffrey Rihn, Alan Hilibrand, Gregory D. Schroeder, Alex R. Vaccaro, Christopher Kepler

Rothman Institute Papers

Study Design

Purpose:

Overview of Literature

Methods:

Incidence, Risk Factors, And Outcomes Of Incidental Durotomy During Lumbar Spine Decompression With Or Without Fusion, Gregory Toci, Mark James Lambrechts, Tariq Issa, Brian A. Karamian, Nicholas Siegel, Nicholas D'Antonio, Jose Canseco, Mark Kurd, Barrett Woods, Ian D. Kaye, Alan Hilibrand, Christopher K. Kepler, Alexander Vaccaro, Gregory Schroeder

Rothman Institute Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: The primary objective of this study was to determine the incidence and risk factors for incidental durotomies during lumbar decompression surgeries. In addition, we aimed to determine the changes in patient-reported outcome measures (PROMs) based on incidental durotomy status.

OVERVIEW OF LITERATURE: There is limited literature investigating the affect of incidental durotomy on patient reported outcome measures. While the majority of research does not suggest differences in complications, readmission, or revision rates, many studies rely on public databases, and their sensitivity and specificity for identifying incidental durotomies is unknown.

METHODS: Patients undergoing lumbar decompression …