Personal Protective Equipment and COVID-19: A Review for Surgeons
There is a long history of personal protective equipment (PPE) used by the surgeon to minimize the transmission of various pathogens. In the context of the present coronavirus disease 2019 pandemic there is significant controversy as to what forms of PPE are appropriate or adequate. This review aims to describe the pathogenic mechanism and route of spread of the causative virus, severe acute respiratory syndrome coronavirus, as it pertains to accumulated published data from experienced centers globally. The various forms of PPE that are both available and appropriate are addressed. There are options in the form of eyewear,...
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

A Practical Decontamination Framework for COVID-19 Front-line Workers Returning Home
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery
Conclusions: The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention. (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Current Evidence for Minimally Invasive Surgery During the COVID-19 Pandemic and Risk Mitigation Strategies: A Narrative Review
Conclusion: While it is currently assumed that open surgery minimizes operating room staff exposure to the virus, our findings reveal that this may not be the case. A well-informed, evidence-based opinion is critical when making decisions regarding which operative approach to pursue, for the safety and well-being of the patient, the operating room staff, and the healthcare system at large. Minimally invasive surgical approaches offer significant advantages with respect to both patient care, and the mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present. (...
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

A Snapshot of Elective Oncological Surgery in Italy During COVID-19 Emergency: Pearls, Pitfalls, and Perspectives
Objective: To analyze the impact of COVID-19 emergency on elective oncological surgical activity in Italy. Summary of Background Data: COVID-19 emergency shocked national health systems, subtracting resources from treatment of other diseases. Its impact on surgical oncology is still to elucidate. Methods: A 56-question survey regarding the oncological surgical activity in Italy during the COVID-19 emergency was sent to referral centers for hepato-bilio-pancreatic, colorectal, esophago-gastric, and sarcoma/soft-tissue tumors. The survey portrays the situation 5 weeks after the first case of secondary transmission in...
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience
Conclusions: Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase. (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic
Conclusions: The COVID-19 pandemic has stressed already limited health care resources and forced rationing, triage, and prioritization of care in general, specifically of surgical interventions. Established guidelines allow for modifications of optimal timing and type of surgery for colorectal cancer during an unrelated pandemic. (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Taking a Second Look at Neoadjuvant Endocrine Therapy for the Treatment of Early Stage Estrogen Receptor Positive Breast Cancer During the COVID-19 Outbreak
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Cancer Surgery During COVID-19: How We Move Forward
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Global Survey on Pancreatic Surgery During the COVID-19 Pandemic
Objective: The aim of this study was to clarify the role of pancreatic surgery during the COVID-19 pandemic to optimize patients’ and clinicians’ safety and safeguard health care capacity. Summary Background Data: The COVID-19 pandemic heavily impacts health care systems worldwide. Cancer patients appear to have an increased risk for adverse events when infected by COVID-19, but the inability to receive oncological care seems may be an even larger threat, particularly in case of pancreatic cancer. Methods: An online survey was submitted to all members of seven international pancreatic associations and s...
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

A Combined Approach to Priorities of Surgical Oncology During the COVID-19 Epidemic
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Prehabilitation Telemedicine in Neoadjuvant Surgical Oncology Patients During the Novel COVID-19 Coronavirus Pandemic
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

The Consequences of Delaying Elective Surgery: Surgical Perspective
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America
Conclusions: This is 1 the first case series describing VV ECMO outcomes in COVID-19 patients. Our initial data suggest that VV ECMO can be successfully utilized in appropriately selected COVID-19 patients with advanced respiratory failure. (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Coronavirus Threatens Blood Supply: Patient Blood Management Now!
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Design and Impact of a COVID-19 Multidisciplinary Bundled Procedure Team
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Acute Care Surgeons’ Response to the COVID-19 Pandemic: Observations and Strategies From the Epicenter of the American Crisis
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting
Conclusion: Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent. (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Gastrointestinal Complications in Critically Ill Patients With COVID-19
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Maintaining Trauma Care Access During the COVID-19 Pandemic: An Urban, Level-1 Trauma Center's Experience
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Domestic Violence and Safe Storage of Firearms in the COVID-19 Era
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Trauma Does not Quarantine: Violence During the COVID-19 Pandemic
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Apples to Oranges: Ethical Considerations in COVID-19 Surgical Recovery
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

To a New Normal: Surgery and COVID-19 During the Transition Phase
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

The Compounding Access Problem for Surgical Care: Innovations in the Post-COVID Era
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

COVID-19 – Implications on and of Surgical Practices: Where Do We Draw the Line?
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Charting a Roadmap for Value-based Surgery in the Post-pandemic Era
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

Approaching Surgical Triage During the COVID-19 Pandemic
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: COVID PAPERS Source Type: research

The Electronic Medical Record Has Ruined It All, Including the Physician-patient Relationship
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: EMR DEBATE Source Type: research

The Electronic Health Record Will Be What We Make It
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: EMR DEBATE Source Type: research

Using Surgical Video to Classify Intraoperative Events
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: FEATURES Source Type: research

Development and Evaluation of a Novel Instrument to Measure Severity of Intraoperative Events Using Video Data
Conclusion: The SEVERE index may prove to be a useful instrument in identifying patients with high risk of developing postoperative complications. (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: FEATURES Source Type: research

Surgical Prophylaxis of Crohn Disease Recurrence: “Light at the End of The Tunnel”
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: FEATURES Source Type: research

Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: The SuPREMe-CD Study - A Randomized Clinical Trial
Objective: This trial aimed to provide randomized controlled data comparing Kono-S anastomosis and stapled ileocolic side-to-side anastomosis. Background: Recently, a new antimesenteric, functional, end-to-end, hand-sewn ileocolic anastomosis (Kono-S) has shown a significant reduction in endoscopic recurrence score and surgical recurrence rate in Crohn disease (CD). Methods: Randomized controlled trial (RCT) at a tertiary referral institution. Primary endpoint: endoscopic recurrence (ER) (Rutgeerts score ≥i2) after 6 months. Secondary endpoints: clinical recurrence (CR) after 12 and 24 months, ER after 18 months...
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: FEATURES Source Type: research

Hepatic Vein Embolization for Safer Liver Surgery: Insignificant Novelty or a Breakthrough?
No abstract available (Source: Annals of Surgery)
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: FEATURES Source Type: research

Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization
Objective: The aim of this retrospective study was to compare portal vein embolization (PVE) and radiologica simultaneous portohepatic vein embolization (RASPE) for future liver remnant (FLR) growth in terms of feasibility, safety, and efficacy. Summary of Background Data: After portal vein embolization (PVE), 15% of patients remain ineligible for hepatic resection due to insufficient hypertrophy of the FLR. RASPE has been proposed to induce FLR growth. Materials and Methods: Between 2016 and 2018, 73 patients were included in the study. RASPE was proposed for patients with a ratio of FLR to total liver volume (FLR...
Source: Annals of Surgery - July 30, 2020 Category: Surgery Tags: FEATURES Source Type: research

The American College of Surgeons Entering Resident Readiness Assessment Program: Development and National Pilot Testing Results
Conclusions: Results can be used to identify strengths and weaknesses in residents’ decision-making skills and yield valuable information to create individualized learning plans. The data can also support efforts directed at the transition into residency training and inform discussions about levels of supervision. In addition, surgery program directors can use the aggregate test results to make curricular changes. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Doxycycline Reduces Scar Thickness and Improves Collagen Architecture
Objective: To investigate the effects of local doxycycline administration on skin scarring. Background: Skin scarring represents a major source of morbidity for surgical patients. Doxycycline, a tetracycline antibiotic with off-target effects on the extracellular matrix, has demonstrated antifibrotic effects in multiple organs. However, doxycycline's potential effects on skin scarring have not been explored in vivo. Methods: Female C57BL/6J mice underwent dorsal wounding following an established splinted excisional skin wounding model. Doxycycline was administered by local injection into the wound base following in...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Comparison of Outcomes After Partial Versus Complete Mesh Excision
Conclusions: With over 350,000 VHR performed annually and increasing mesh use, guidelines for management of mesh during reexploration are needed. This analysis of a multicenter hernia database demonstrates significantly increased postoperative complications in PME patients with clean-contaminated wounds and mesh infections/fistulas, however showed similar outcomes in those with clean wounds. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Association of Primary Ventral Hernia and Pregnancy
Conclusion: To reduce the risk of hernia recurrence, the optimal timing of elective repair is after the last pregnancy. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Clinical Factors Associated With Practice Variation in Discharge Opioid Prescriptions After Pancreatectomy
Objective: To characterize opioid discharge prescriptions for pancreatectomy patients. Background: Wide variation in and over-prescription of opioids after surgery contribute to the United States opioid epidemic through persistent use past the postoperative period. Objective strategies guiding discharge opioid prescriptions for oncologic surgery are lacking, and factors driving prescription amount are not fully delineated. Methods: Characteristics of pancreatectomy patients (March 2016–August 2017) were retrospectively abstracted from a prospective database. Discharge opioids prescriptions were converted to o...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

New Model for Predicting Malignancy in Patients With Intraductal Papillary Mucinous Neoplasm
Conclusion: This predictive model provides important information for physicians and patients in assessing an individual's risk for malignancy and may help to identify patients who need surgery. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Liver Resection for Multiple Hepatocellular Carcinomas: A Japanese Nationwide Survey
Objective: The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs). Background: Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial. Methods: Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, tr...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation: Recurrence Risk Over Time
Conclusions: Conditional survival suggests that patients have significantly lower risks (≤10%) of developing recurrences after 2 years of achieving cCR following nCRT. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Long-term Results of the Side-to-side Isoperistaltic Strictureplasty in Crohn Disease: 25-year Follow-up and Outcomes
Conclusions: SSIS is a safe, effective, and durable strictureplasty in patients with extensive fibrostenosing CD of the small bowel. Half the surgical recurrences on SSIS can be managed by subsequent revision or strictureplasty. The majority of patients maintain the original SSIS after a median follow-up of 11 years. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Pregnancy As a Risk Factor for Small Bowel Obstruction After Laparoscopic Gastric Bypass Surgery
Objective: To evaluate whether pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery. Background: Small bowel obstruction is a common and feared long-term complication to laparoscopic gastric bypass surgery that may be more common during pregnancy. It is unclear if the risk truly increases during pregnancy. Methods: Women, 18 to 55 years, operated with a primary laparoscopic gastric bypass procedure from 2010 until 2015 were identified through the Scandinavian Obesity Surgery Registry (n = 25,853). Through record-linkage to the Medical Birth Registry, the ...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Can Minimally Invasive Esophagectomy Replace Open Esophagectomy for Esophageal Cancer? Latest Analysis of 24,233 Esophagectomies From the Japanese National Clinical Database
This study included 24,233 esophagectomies for esophageal cancer conducted between 2012 and 2016. Esophagectomy for clinical T4 and M1 stages, urgent esophagectomy, 2-stage esophagectomy, and R2 resection were excluded. The effects of preoperative treatment and surgery on short-term outcomes were analyzed using generalized estimating equations logistic regression analysis. Results: MIE was superior or equivalent to OE in terms of the incidence of most postoperative morbidities and surgery-related mortality, regardless of the type of preoperative treatment. Notably, MIE performed with no preoperative treatment was associ...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Unique Considerations for Females Undergoing Esophagectomy
Objective: To improve understanding of sex differences in clinicopathologic characteristics, treatment and outcomes between male and female patients undergoing esophagectomy for esophageal cancer. Summary Background Data: Esophageal cancer is a male predominant disease, and sex has not been considered in previous studies as an important factor in diagnosis or management. Sex differences in demographics, clinicopathologic characteristics, and postoperative outcomes remain largely undefined. Methods: Retrospective review of 1958 patients (21% female) with esophageal cancer who underwent esophagectomy at a single inst...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Hospital Length of Stay Reduction Over Time and Patient Readmission for Severe Adverse Events Following Surgery
Conclusions: Patients who underwent surgical procedures in hospitals experiencing major decreases in LOS were demonstrated worse postoperative outcomes after urgent hip fracture repair and not after elective colectomy. Development of care bundles to enhance recovery after emergency surgeries may allow better control of LOS reduction and patient outcomes. (Source: Annals of Surgery)
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Health Care Spending and New Persistent Opioid Use After Surgery
We examined insurance claims among 133,439 opioid-naive adults undergoing surgery. Outcomes included 6-month postoperative health care spending; proportion of spending attributable to admission, readmission, ambulatory or emergency care; monthly spending 6 months before and following surgery. We defined persistent opioid use as continued opioid fills beyond 3 months postoperatively. We used linear regression to estimate outcomes adjusting for clinical covariates. Results: In this cohort, 8103 patients developed persistent opioid use. For patients who underwent inpatient procedures, new persistent opioid use was associat...
Source: Annals of Surgery - June 20, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research