Hepatocellular Adenoma Risk Factors of Hemorrhage: Size Is Not the Only Concern!: Single-center Retrospective Experience of 261 Patients
Objective: Our aim was to determine independent risk factors of clinical bleeding of hepatocellular adenoma (HCA) to define a better management strategy. Summary Background Data: HCA is a rare benign liver tumor with severe complications: malignant transformation that is rare (5%–8%) and more often, hemorrhage (20%–27%). To date, only size> 5 cm and histological subtype (possibly sonic hedgehog) are associated with bleeding, but these criteria are not clearly established. Methods: We retrospectively collected data from a cohort of 268 patients with HCA managed in our tertiary center, from...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Long-term Normothermic Machine Preservation of Partial Livers: First Experience With 21 Human Hemi-livers
Conclusion: This pioneering research presents the inaugural evidence for long-term machine perfusion of partial livers and provides a pathway for innovative and relevant clinical applications to increase the availability of organs and provide novel approaches in hepatic oncology. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Partial Versus Total Thyroidectomy: What Influences Most Surgeons’ Decision? Analysis of a Nationwide Cohort of 375,810 Patients Over 10 Years
In this study, 375,810 patients (male: 23%; age = 53 ± 15 years) had a thyroidectomy (partial: 28%) for cancer (17%), hyperthyroidism (16%), nonfunctioning goiter (64%), or other (3%). We noticed a global trend toward more partial thyroidectomy (P (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures
Conclusion: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

FLOT-regimen Chemotherapy and Transthoracic en bloc Resection for Esophageal and Junctional Adenocarcinoma
This study explored operative complications, tolerance, toxicity, physiological impact, and oncologic outcomes. Study design: An observational cohort study on consecutive patients at 3 tertiary centers undergoing FLOT and TTE. Toxicity, operative complications (per ECCG definitions), tumor regression grade (TRG), recurrences and survival were documented, as well as pre and post FLOT assessment of sarcopenia and pulmonary physiology. Results: 175 patients (cT2-4a, Nany) commenced treatment, 84% male, median age 65, 94% cT3/T4a, 73% cN+. 89% completed 4 preoperative cycles, and 35% all cycles. Grade 3/4 toxicit...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Predicting Intraoperative Difficulty of Open Liver Resections: The DIFF-scOR Study, An Analysis of 1393 Consecutive Hepatectomies From a French Multicenter Cohort
Conclusion: The DIFF-scOR accurately predicts open-LR difficulty and may be used for various purposes in clinical practice and research. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable: A French Root Cause Analysis on 5562 Patients
Conclusion: More than half of the postoperative deaths after combined CRS and HIPEC may be preventable, mainly by following guidelines regarding preoperative selection of the patients and adequate intraoperative decisions. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study): A Multicenter Cohort Study
Conclusions: One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Perihilar Cholangiocarcinoma – Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers
Conclusion: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Diverting Enterostomy Improves Overall Survival of Patients With Severe Steroid-refractory Gastrointestinal Acute Graft-Versus-Host Disease
Conclusion: DE should be considered for severe GI-aGVHD as soon as resistance to the corticosteroid is identified. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases
Conclusions: Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Incidence and Risk Factors for Diaphragmatic Herniation Following Esophagectomy for Cancer
Objective: To evaluate the incidence and risk factors of diaphragmatic herniation following esophagectomy for cancer (DHEC), and assess the results of surgical repair. Summary Background data: The current incidence of DHEC is discussed with conflicting data regarding its treatment and natural course. Methods: Monocentric retrospective cohort study (2009–2018). From 902 patients, 719 patients with a complete follow-up of CT scans after transthoracic esophagectomy for cancer were reexamined to identify the occurrence of a DHEC. The incidence of DHEC was estimated using Kalbfleisch and Prentice method ...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Preemptive Endoluminal Vacuum Therapy to Reduce Morbidity After Minimally Invasive Ivor Lewis Esophagectomy: Including a Novel Grading System for Postoperative Endoscopic Assessment of GI-Anastomoses
Conclusions: PEVT is an innovative and safe procedure with a promising potential to reduce postoperative morbidity after minimally invasive Ivor Lewis esophagectomy and may be particularly valuable in highly comorbid cases. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Presentation, Treatment, and Prognosis of Esophageal Carcinoma in a Nationwide Comparison of Sweden and the Netherlands
Objective: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands. Summary of Background data: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement. Methods: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011–...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Improving Outcome of Superior Mediastinal Lymph Node Dissection During Esophagectomy: A Novel Approach Combining Continuous and Intermittent Recurrent Laryngeal Nerve Monitoring
This study aimed at demonstrating the effects and learning curve of utilizing combined intermittent and continuous recurrent laryngeal nerve (RLN) monitoring for lymphadenectomy during esophagectomy. Background: RLN lymphadenectomy is oncologically important but is technically demanding. Vocal cord (VC) palsy as a result from RLN injury, carries significant morbidities. Methods: This is a retrospective study of consecutive esophageal squamous cell carcinoma (ESCC) patients who underwent transthoracic esophagectomy from 2010 to 2020. Combined nerve monitoring (CNM) included: CNM which involved a periodic stimu...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter Propensity Score-matched Analysis
This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection). Background: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking. Methods: Patients with non-progressive LAPC after 4...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis
Objective: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. Summary of Background Data: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients. Methods: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent ...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Neoadjuvant Therapy for Resectable Pancreatic Cancer: A New Standard of Care. Pooled Data From 3 Randomized Controlled Trials
Conclusion: Neoadjuvant therapy can be offered as an acceptable standard of care for patients with purely resectable PDAC. Future research with the advances of precision oncology should now focus on the definition of the optimal regimen. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA PAPERS Source Type: research

Hypothermic Oxygenated Machine Perfusion Reduces Early Allograft Injury and Improves Post-transplant Outcomes in Extended Criteria Donation Liver Transplantation From Donation After Brain Death: Results From a Multicenter Randomized Controlled Trial (HOPE ECD-DBD)
Conclusion: This multicenter RCT demonstrates that HOPE, in comparison to SCS, significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation. (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA-RANDOMIZED CONTROLLED TRIALS Source Type: research

Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial
Conclusion: Both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1-year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation. Trial Registration: ISRCTN18591339 (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA-RANDOMIZED CONTROLLED TRIALS Source Type: research

Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions: First Results of a Randomized Controlled Trial
Objective: To compare the early results of mass and layered closure of upper abdominal transverse incisions. Summary of Background Data: Contrary to midline incisions, data on closure of transverse abdominal incisions are lacking. Methods: This is the first analysis of a randomized controlled trial primarily designed to compare mass with layered closure of transverse incisions with respect to incisional hernias. Patients undergoing laparotomy through upper abdominal transverse incisions were randomized to either mass or layered closure with continuous sutures. Incisional surgical site infection (incisiona...
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA-RANDOMIZED CONTROLLED TRIALS Source Type: research

Discovery and Innovation in Surgery: Chance and Necessity
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: ESA HONORARY MEMBER LECTURE Source Type: research

Patient, Surgeon, and Health Care Worker Safety during the COVID-19 Pandemic
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - October 12, 2021 Category: Surgery Tags: PRESIDENTIAL ADDRESS Source Type: research

Initial Laparotomy Versus Peritoneal Drainage in Extremely Low Birthweight Infants With Surgical Necrotizing Enterocolitis or Isolated Intestinal Perforation: A Multicenter Randomized Clinical Trial
Objective: The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP). Summary Background Data: The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown. Methods: We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of deat...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: RANDOMIZED CONTROLLED TRIAL Source Type: research

A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms
Objective: To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. Summary and Background Data: Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. Methods: We conducted a secondary analysis of a pragmatic 25-trauma center rando...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Optimal Pancreatic Surgery: Are We Making Progress in North America?
Objective: Our aims were to assess North American trends in the management of patients undergoing pancreatoduodenectomy (PD) and distal pancreatectomy (DP), and to quantify the delivery of optimal pancreatic surgery. Background: Morbidity after pancreatectomy remains unacceptably high. Recent literature suggests that composite measures may more accurately define surgical quality. Methods: The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried to identify patients undergoing PD (N = 16,222) and DP (N = 7946). Patient, process, procedur...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Incidence and Risk Factors of Postoperative Mortality and Morbidity After Elective Versus Emergent Abdominal Surgery in a National Sample of 8193 Patients With Cirrhosis
Conclusions: Accurate preoperative risk assessments in patients with cirrhosis should account for cirrhosis severity, comorbidities, type of procedure, and whether the procedure is emergent versus elective. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Hospital and Surgeon Selection for Medicare Beneficiaries With Stage II/III Rectal Cancer: The Role of Rurality, Distance to Care, and Colonoscopy Provider
Objective: To determine factors associated with rectal cancer surgery performed at high-volume hospitals (HVHs) and by high-volume surgeons (HVSs), including the roles of rurality and diagnostic colonoscopy provider characteristics. Summary of Background Data: Although higher-volume hospitals/surgeons often achieve superior surgical outcomes, many rectal cancer resections are performed by lower-volume hospitals/surgeons, especially among rural populations. Methods: Patients age 66+ diagnosed from 2007 to 2011 with stage II/III primary rectal adenocarcinoma were selected from surveillance, epidemiology, an...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Perioperative Risks of Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass Among Patients With Chronic Kidney Disease: A Review of the MBSAQIP Database
Conclusions: Among well-matched cohorts of RYGB and sleeve gastrectomy patients, incidence of primary outcomes were similar. Among secondary outcomes, only acute kidney injury was statistically-significantly higher among RYGB patients; however, the E-value for this difference was small and relatively weak confounder(s) could abrogate the statistical difference. The perception that RYGB has prohibitively-high perioperative risks among CKD patients is disputable and operative selection should be weighed on patient candidacy and anticipated long-term benefit. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Value of Lymphadenectomy in Patients Receiving Neoadjuvant Therapy for Esophageal Adenocarcinoma
Conclusions: Worldwide data for adenocarcinoma of the esophagus and esophagogastric junction demonstrate that lymphadenectomy during esophagectomy is a valuable component of neoadjuvant therapy. Survival is maximized when an optimum range of nodes is resected. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Medicare Advantage Networks and Access to High-volume Cancer Surgery Hospitals
Conclusions: The study identifies lack of high-volume hospital coverage in MA health plans as a major detriment in regionalization of cancer surgery impacting at least a third of older Americans. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Timing of Preoperative Antibiotic Prophylaxis and Surgical Site Infection: TAPAS, An Observational Cohort Study
Conclusions: For SAP with short infusion time no clear superior timing interval within the 60-minute interval before incision could be identified in this cohort. We were unable to reproduce differences in SSI risk found in earlier studies. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Changes in Hospital-acquired Conditions and Mortality Associated With the Hospital-acquired Condition Reduction Program
Conclusions and Relevance: Although hospital-acquired conditions targeted under the HACRP declined at a greater rate after the program was announced, 30-day mortality was unchanged. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Outcomes of Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation for Tertiary Hyperparathyroidism: Multi-institutional Study
Conclusions: To our knowledge, this is the largest multi-center study that compared different approaches for managing tertiary HPT. Showing that STPX is the better modality in patients diagnosed with tertiary HPT and had kidney transplants avoiding the risk of hypoparathyroidism. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Biomarker Evidence of the Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) in Chronic Critical Illness (CCI) After Surgical Sepsis
Conclusions: Persistent elevations of PICS biomarkers in the CCI and Zubrod 4/5 cohorts and their improved prediction of Zubrod 4/5 validate that PICS plays a role in CCI pathobiology. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

De-escalation of Endocrine Therapy in Early Hormone Receptor-positive Breast Cancer: When Is Local Treatment Enough?
Objective: To identify subgroups of hormone receptor-positive (HR+) breast cancer patients that might not benefit from adding endocrine therapy (ET) to their local treatment. Background: De-escalation in breast cancer treatment has included surgery, radiation, and chemotherapy and has often focused on older patient populations. Systemic ET has yet to be de-escalated, though it carries serious side-effects, decreasing quality of life over 5 to 10 years. We hypothesize the 21-gene recurrence score (RS) could identify subgroups of younger patients whose long-term survival is unaffected by adjuvant ET. Methods:...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Gastroesophageal Reflux Disease Outcomes After Vertical Sleeve Gastrectomy and Gastric Bypass
The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients undergoing Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, supported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG. Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with ≥2 years enrollment were identified and matched by follow-up time. GERD [re...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

The Correlation Between Case Total Work Relative Value Unit, Operative Stress, and Patient Frailty: Retrospective Cohort Study
Conclusions: Surgeon reimbursement correlates with operative stress but not patient frailty. The total wRVU does not adequately reflect patient-specific factors that increase the physician workload required to render optimal care to complex patients. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Interleukin-10 Producing T Lymphocytes Attenuate Dermal Scarring
Conclusions: IL-10 producing T-lymphocytes, specifically Tr1, regulate inflammatory cell cytokine expression to promote HA-rich ECM deposition and attenuate fibrosis. Promoting IL-10 producing lymphocytes in wounds may be a therapeutic target to promote regenerative wound healing. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients
Conclusions: Amputation rate among Medicare CLI patients is inversely correlated with US BEST-CLI site distribution. Higher participation in clinical research, especially within large RCTs, may be a marker of optimal PAD management. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Optimal Timing of Administration of Direct-acting Antivirals for Patients With Hepatitis C-associated Hepatocellular Carcinoma Undergoing Liver Transplantation
Objective: To investigate the optimal timing of direct acting antiviral (DAA) administration in patients with hepatitis C-associated hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). Summary of Background Data: In patients with hepatitis C (HCV) associated HCC undergoing LT, the optimal timing of direct-acting antivirals (DAA) administration to achieve sustained virologic response (SVR) and improved oncologic outcomes remains a topic of much debate. Methods: The United States HCC LT Consortium (2015–2019) was reviewed for patients with primary HCV-associated HCC who underwent LT ...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Successful Implementation of Enhanced Recovery in Elective Colorectal Surgery is Variable and Dependent on the Local Environment
Objective: To evaluate local hospital success with enhanced recovery implementation as measured by colorectal surgery process measure (PM) compliance and characterize local environment factors associated with success within a contemporary quality improvement collaborative. Summary Background Data: Enhanced recovery programs (ERP) have proven an effective perioperative quality improvement strategy, but local variation in implementation can hinder patient outcome improvement. Methods: Individual hospitals participating in a national colorectal ERP quality improvement program were evaluated with quantitative...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Racial and Ethnic Bias Impact Perceptions of Surgeon Communication
Objective: To evaluate patient satisfaction scores as a function of physician and patient race and sex. Background: Patient satisfaction is increasingly used as a surrogate for physician performance. How patient and surgeon race and ethnicity affect perceptions of surgeon communication and care is not widely explored. Methods: Press Ganey patient satisfaction surveys collected from January 2019 to September 2020 were studied. Multivariate logistic regressions were used to identify factors associated with favorable surgeon performance as a function of patient and surgeon demographics. Results: A tot...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Five Hundred Patients With Gut Malrotation: Thirty Years of Experience With the Introduction of a New Surgical Procedure
Objectives: Define clinical spectrum and long-term outcomes of gut malrotation. With new insights, an innovative procedure was introduced and predictive models were established. Methods: Over 30-years, 500 patients were managed at 2 institutions. Of these, 274 (55%) were children at time of diagnosis. At referral, 204 (41%) patients suffered midgut-loss and the remaining 296 (59%) had intact gut with a wide range of digestive symptoms. With midgut-loss, 189 (93%) patients underwent surgery with gut transplantation in 174 (92%) including 16 of 31 (16%) who had autologous gut reconstruction. Ladd's procedure was d...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Value Analysis of Methods of Inguinal Hernia Repair
Conclusions: Use of higher cost technology to repair inguinal hernias reduces value. Incremental health benefits must be realized to justify increased costs. We expect payors and patients will incorporate value into payment decisions. (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Age-related Opioid Exposure in Trauma: A Secondary Analysis of the Multimodal Analgesia Strategies for Trauma (MAST) Randomized Trial
Objective: Evaluate the effect of age on opioid consumption after traumatic injury. Summary Background Data: Older trauma patients receive fewer opioids due to decreased metabolism and increased complications, but adequacy of pain control is unknown. We hypothesized that older trauma patients require fewer opioids to achieve adequate pain control. Methods: A secondary analysis of the multimodal analgesia strategies for trauma Trial evaluating the effectiveness of 2 multimodal pain regimens in 1561 trauma patients aged 16 to 96 was performed. Older patients (≥55 years) were compared to younger patient...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Expanding the Donor Pool: First Use of Hepatitis B Virus Nat Positive Solid Organ Allografts Into Seronegative Recipients
Objectives: The aim of this study was to assess the 1-year safety and effectiveness of HBV Nucleic Acid Test positive (HBV NAT+) allografts in seronegative kidney transplant (KT) and liver transplant (LT) recipients. Summary Background Data: Despite an ongoing organ shortage, the utilization of HBV NAT+ allografts into seronegative recipients has not been investigated. Methods: From January 2017 to October 2020, a prospective cohort study was conducted among consecutive KT and LT recipients at a single institution. Primary endpoints were post-transplant HBV viremia, graft and patient survival. Results:...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

National Institutes of Health Career Development (K) Awards to Young Surgeons: An Academic Milestone or One-hit Wonder?
Objective: To assess contemporary trends in the National Institutes of Health (NIH) Career Development (K) Awards within the Departments of Surgery and its impact on the likelihood of achieving independent R01 grants. Background: The NIH provides K-type Career Development Awards to nurture young clinicians toward a productive academic career, thereby maintaining a pipeline of physician-scientists. However, the impact of K awards on career trajectory of surgeons remains unclear. Methods: The NIH grant data was queried for all new K08/K23 grants awarded to Departments of Surgery (1999–2019). Principal...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

Chemotherapy Versus Chemotherapy Plus Chemoradiation as Neoadjuvant Therapy for Resectable Gastric Adenocarcinoma: A Multi-institutional Analysis
Objective: We compare neoadjuvant chemotherapy (CT) to neoadjuvant chemotherapy plus chemoradiation (CRT) for patients with gastric adenocarcinoma (GA). Summary of Background Data: The optimal neoadjuvant therapy regimen for resectable GA is not defined. Methods: Utilizing data from 2 high-volume cancer centers, we analyzed patients who underwent surgery for localized GA from 1/1/2000-12/31/2017. Standard CT regimens were used according to treatment period. We compared propensity matched cohorts based on age, sex, race, histology, and clinical stage. Results: Four-hundred five patients (age 62 &plu...
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PAPERS OF THE 141ST ASA ANNUAL MEETING Source Type: research

A Public Health Approach to Prevent Firearm Related Injuries and Deaths
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - September 14, 2021 Category: Surgery Tags: PRESIDENTIAL FORUM Source Type: research