Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis
Optimal postoperative pain therapy for patients undergoing minimally invasive surgery remains controversial. The aim of this meta-analysis was to compare the efficacy and safety of the novel laparoscopic-guided transversus abdominis plane block (L-TAP) to other analgesic alternatives in adults undergoing minimally invasive surgery. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 2, 2020 Category: Surgery Authors: Hytham KS. Hamid, Sameh H. Emile, Alan A. Saber, Jaime Ruiz-Tovar, Vasilis Minas, Thomas E. Cataldo Tags: Collective Review Source Type: research

Ethics in the Time of Coronavirus: Engaging the Conversation
We appreciate the feedback and thoughtful discussion offered by Dr Hai and colleagues. We are pleased our paper is generating meaningful conversations as we all move through this uncharted territory of ethical conundrums created by the COVID-19 pandemic. As Dr Hai and colleagues point out, we are certainly aware of the differences between the HIV/AIDS epidemic of the 1980s/1990s and the current COVID-19 pandemic. The COVID-19 pandemic exceeds what any of us have seen, and therefore requires learning from all similar healthcare crises in history. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 30, 2020 Category: Surgery Authors: Jessica B. Kramer, Douglas E. Brown, Piroska K. Kopar Tags: Letter Source Type: research

Challenges and Ethical Considerations for Trainees and Attending Physicians During the  COVID-19 Pandemic
We read with great interest the article by Kramer and colleagues, “Ethics in the time of Coronavirus: Recommendations in the COVID-19 Pandemic.”1 It is a well-written synopsis of ethical issues from this pandemic. However, we have some concerns. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 30, 2020 Category: Surgery Authors: Shaikh Hai, Adel Elkbuli Tags: Letter Source Type: research

Absence of Evidence Is Not the Evidence of Absence: Clinical Consideration when Interpreting Guidelines for the COVID-19 Pandemic
As the global prevalence of novel coronavirus 2019 (COVID-19) increases, with a death toll exceeding that during wartime, scientists and clinicians alike are racing against time to provide clarity on pathogenesis, mode of transmission, and to research potential treatment and vaccines amid the pandemic. In the meantime, hospital guidance1 is essential to protect health care providers (HCPs) and for disease containment. However, definitive guidelines are often elusive given the rapid emergence of new data and the time constraints for robust evidence. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 29, 2020 Category: Surgery Authors: Vivian Ip, Rakesh Sondekoppam Tags: Letter Source Type: research

Reconceptualizing Ethics through Morbidity and Mortality Rounds
This study implemented and evaluated an innovation meant to prioritize and contextualize ethics in surgical learning and practice. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 28, 2020 Category: Surgery Authors: Ryan Snelgrove, Stella L. Ng, Karen Devon Tags: Original Scientific Article Source Type: research

Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure Prioritization During the COVID-19 Pandemic
The COVID-19 pandemic forced surgeons to reconsider concepts of “elective” surgery. Perceptions regarding the time-sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors such as personal protective equipment conservati on; limiting the risk of exposure to COVID-19 for patients, families, and health care workers; preservation of hospital beds and intensive care unit resources; and minimizing COVID-19 related perioperative risk to patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 26, 2020 Category: Surgery Authors: Mark B. Slidell, Jessica J. Kandel, Vivek Prachand, Fuad M. Baroody, Mohan S. Gundeti, Russell R. Reid, Peter Angelos, Jeffrey B. Matthews, Grace Z. Mak Tags: Original Scientific Article Source Type: research

Enhanced Draping for Airway Procedures During the COVID-19 Pandemic
We read with great interest the article by Foster and colleagues,1 recently published in the Journal of the American College of Surgeons, regarding a draping technique meant to protect healthcare providers (HCP) during tracheostomy. In addition to congratulating the authors, we would like to thank them for this contribution to the safety of the healthcare community. We, too, have developed a similar draping technique for aerosol-generating medical procedures (AGMPs) with a modification that may be of additional benefit. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 26, 2020 Category: Surgery Authors: Nikolaus E. Wolter, Clyde T. Matava, Blake C. Papsin, Alice Oloya, Marie-Eve Mercier, Eloisa Salonga, Evan J. Propst Tags: Letter Source Type: research

Selecting the Optimal Level of Clustering: An Approach to Trial Design Decision Making
Surgical interventions involve complex interactions amongst personnel, equipment, and operating room set-up requirements. Trial implementation at the single clinician level in that environment is not pragmatic, decreases generalizability, and is often unrealistic as such studies may require changes to hospital operating policy. Cluster randomized trials (CRTs) are the preferred method of assessment for systems-based interventions and changes in policy. In CRTs, groups – rather than individuals – are randomized to receive an intervention. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2020 Category: Surgery Authors: Graham R. McClure, Emilie P. Belley-Cote, Jessica Spence, Shun Fu Lee, Richard P. Whitlock Tags: Education Source Type: research

Metabolic (Not Mechanical) Surgery for Metabolic Diseases
The landmark findings of the multicenter, $100 million ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial were recently presented at the meeting of the American Heart Association. The trial demonstrated that although the mechanical surgical procedures of coronary artery stenting or bypass might prevent cardiac damage early in an evolving MI, and provide relief for chronic angina, this therapy will not alter the prognosis for sustaining an MI or prolonging life expectancy. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Henry Buchwald Tags: Special article Source Type: research

Invited Commentary
There has been a rapid and recent surge in literature assessing the risk of venous thromboembolism (VTE) and the prevention of these highly morbid events in our surgical patients. In spite of this trend, data regarding the role of chemoprophylaxis, particularly with an individualized risk assessment in patients undergoing breast surgery, remains limited. Certainly the most commonly cited consensus derives from the American College of Chest Physicians, which provides chemoprevention guidelines in orthopaedic and nonorthopaedic surgical patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Jennifer LaFemina Tags: Invited commentary Source Type: research

Invited Commentary
Surgeons are certainly familiar with the consequences of traumatic injury, a leading cause of death worldwide. Among trauma victims who die despite reaching a hospital, about 20% to 40% of those deaths are due to massive hemorrhage. Control of ongoing bleeding and ideal resuscitation could presumably save many of those lives. And yet the ultimate strategy regarding the ratio of blood components in massive transfusion protocol remains elusive with respect to cost and sequelae of blood products, as well as long-term survival. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: David McAneny Tags: Invited commentary Source Type: research

Invited Commentary
The American College of Surgeons is dedicated to improving the outcomes of surgical patients and, as part of that, seeks better understanding of “the landscape of the quality problem.” Citing this position as a rallying cry, Becher and colleagues1 sought and found significant variation in hospital mortality rates in geriatric emergency general surgery (EGS). Using the California State Inpatient Database from 2010–2011 and hierarchical modelling, they clearly demonstrated that in a cohort of 107 hospitals, the standardized mortality rate (SMR) on a hospital level varied from as high as 230% of expected to ...
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Brent C. White Tags: Invited commentary Source Type: research

Invited Commentary
Typically, patients who suffer from acute pancreatitis will have self-limited disease. However, those who develop pancreatic necrosis will more commonly face a complex and prolonged course, with a mortality that has been reported as high as 30%.1 Over the years, options for management have expanded, with less invasive options increasingly adopted. Open necrosectomy, while once the primary method of intervention, is now reserved for patients with a higher severity or burden of disease that is not amenable to endoscopic, percutaneous, or minimally invasive surgical strategies. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Jennifer LaFemina Tags: Invited commentary Source Type: research

Invited Commentary
It has been demonstrated and known for a while now that discontinuity of (largely elective) surgical care is associated with worse outcomes,1 but only more recently have reports demonstrated an association of discontinuity of care as well as lower hospital quality with worse mortality outcomes in an emergency general surgery (EGS) context.2,3 Havens and colleagues have written a very important article demonstrating yet again that continuity of care should be maintained where possible in the delivery of EGS care. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Brent C. White Tags: Invited commentary Source Type: research

Invited Commentary
Donor scarcity, the principal challenge of kidney allocation today, is a result of the success of our field. Over recent decades, we have accomplished dramatic improvements in immunosuppression, perioperative care, and approaches to patient selection. As a result, successful kidney transplantation is all but taken for granted. Consequently, the demand for kidneys continues to far outpace the supply of donated organs. One strategy has been to re-examine how best to use organ categories that were previously thought to be marginal or unusable, such as those from donors infected with hepatitis C virus (HCV). (Source: Journal o...
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Jonathan Merola, Peter S. Yoo Tags: Invited commentary Source Type: research

Invited Commentary
Decreasing or eliminating time on dialysis and expediting kidney transplant are prime objectives when caring for chronic kidney disease sufferers,1 particularly since longer wait times on dialysis are associated with higher mortality rates. While influence of online patient portal (OPP) participation has been studied in other patient populations,2,3 and other tools of patient engagement have been evaluated in transplant candidates on the waitlist,4 this is the first study focused on OPP in waitlist kidney candidates and its effect on kidney transplantation wait time. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Nahel Elias Tags: Invited commentary Source Type: research

Invited Commentary
Ketorolac is an NSAID that has assumed a prominent place in the management of acute postoperative pain over the past 10 years because it can be administered intravenously to patients who are npo as a means to decrease both opioid exposure and opioid side effects such as ileus. It is an effective analgesic with antipyretic and anti-inflammatory properties, which are presumably related to it being a nonselective inhibitor of cyclooxygenase (COX) enzymes. Although ketorolac is considered to have more side effects than many other NSAIDs –hence the recommendation to use for no more than 5 days–its toxicity profile i...
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Giles F. Whalen Tags: Invited commentary Source Type: research

The Warfighters' Surgeon: Past and Present
“He who wishes to become a surgeon should go to war.” Hippocrates (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: M Margaret Knudson Tags: Invited commentary Source Type: research

Invited Commentary
Li and colleagues address the important and timely topic of patient completion of multimodality therapy for advanced gastric cancer.1 Although there has been an improvement in survival in patients with gastric cancer over the past few decades, the 5-year overall survival remains low, at 31.5%.2 Surgical resection with lymph node dissection is the mainstay of potential curative treatment for early-stage disease, while multimodality therapy (MMT) has been shown to increase survival in patients with locoregional or advanced gastric cancer, as addressed in this study. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Christina V. Angeles Tags: Invited commentary Source Type: research

Invited Commentary
This case series of 66 patients with 96 paired studies presents compelling evidence that abdominal ultrasound (US), in the right hands, provides more information about the intestinal and liver health of a neonate than plain abdominal film in the evaluation of necrotizing enterocolitis (NEC).1 Ultrasound seems to better detect pneumatosis intestinalis (PI), free air (FA), and portal venous gas (PVG). Additional information about bowel wall thickness, motility, perfusion, and the presence of extra-intestinal fluid collection (not evident on plain film) is captured. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Baird Mallory Tags: Invited commentary Source Type: research

Invited Commentary
As quoted by El Hechi and colleagues1 in this timely and important manuscript: “the pain can be close to debilitating” when surgeons are involved in adverse outcomes. The patient is the first victim; but the provider is the second. Medical providers involved in near misses, unintentional medical errors, or devastating patient outcomes may suffer predictably and silently as the second victim of the event. This syndrome is prevalent across health care providers and can cause significant physical (fatigue, tachycardia, sleeping issues) and psychological (depression, suicidal ideation) impact. (Source: Journal of t...
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Kari M. Rosenkranz Tags: Invited commentary Source Type: research

Invited Commentary
Program directors and faculty teaching residents across virtually all specialties have long suspected that residents neglect their own healthcare needs, and those opinions and concerns are likely highly informed by physicians ’ personal experiences as trainees. Dr Rangel and colleagues take the opportunity to more thoroughly evaluate this issue in an objective and informative manner that provides tangible data and numerous opportunities for intervention. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Anne Campbell Larkin Tags: Invited commentary Source Type: research

Mechanical Surgery Eases the Burden of Metabolic Disease
Ischemic heart disease continues to be the leading cause of death worldwide.1 In many countries, the mortality from complications of coronary artery disease has continued to decline. Risk factor modification, medical management, percutaneous catheter intervention (PCI), and surgical revascularization can all appropriately be credited with increasing survival and improving quality of life in patients with ischemic heart disease. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Thomas E. MacGillivray Tags: Invited commentary Source Type: research

Importance of the Circumferential Resection Margin
It is difficult to overstate the importance of the circumferential resection margin (CRM) in surgery for locally advanced rectal cancer (LARC). From the first description of the “holy plane” by Professor Heald,1 the importance of respecting proper anatomic planes during rectal cancer resection has been clear. Maintaining the integrity of the fascia propria of the rectum in order to encompass the entire node-bearing mesorectum as an intact unit is essential to precise to tal mesorectal excision (TME), both in achieving negative circumferential resection margins and in avoiding autonomic nerve injury and minimizi...
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Harvey G. Moore Tags: Invited commentary Source Type: research

Eliminating Opioids from Breast Conserving Surgery: Perioperative Pain Management Pathway
Opioid prescribing guidelines for partial mastectomy (PM) and PM with sentinel lymph node biopsy (PM-SLNB) recommend prescribing anywhere from 0 to 15 oxycodone pills for postoperative pain. We sought to eliminate opioids after breast-conserving surgery. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Ravinder Kang, Jackson T. Read, Adam C. Glaser, Richard J. Barth Tags: New England surgical society article Source Type: research

Invited Commentary
Surgeons have been scrutinized for years about contributing to the opioid epidemic. Although certain operative procedures are more likely to require postoperative narcotic analgesia, others can be managed with strategies for intraoperative local anesthesia and anti-inflammatory medication after discharge. Several studies have demonstrated that patients undergoing breast operation are commonly prescribed opioids, but it is believed that perception is perhaps excessive. Efforts have been made to eliminate postoperative opioids in many surgical procedures, including in the breast surgery setting. (Source: Journal of the Ameri...
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Walter E. Longo Tags: Invited commentary Source Type: research

How SURPAS May Improve the Surgical Informed Consent Process
Obtaining informed consent from patients before they have surgery is one of the cornerstones of the ethical practice of surgery. Despite the ubiquitous requirement to inform patients about their disease process in order to make informed consent ethically valid, there remain few studies to identify methods of improving the informed consent process. Wiesen and colleagues1 have provided evidence that the Surgical Risk Preoperative Assessment System (SURPAS) is a useful method for improving the informed consent process in surgery. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Peter Angelos Tags: Invited commentary Source Type: research

Remembering Priceless, Soulful Moments as a Student
When I was a third-year medical student at Rush Medical School in 1978, I did my surgery rotation first in order to get it out of the way. My plan was to become a pediatrician because that really was the only doctor I had ever known when as I was growing up in a small town in Illinois. The rumors on how tough the rotation on surgery was were so vibrant that I gathered up my energy and grit and started my rotation, first on orthopaedics and then on general surgery. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Julie Ann Freischlag Tags: Invited commentary Source Type: research

Contents
(Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Source Type: research

Editorial Board
(Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Source Type: research

Virtual Colorectal Cancer Surveillance: Bringing Scope Rate to Target
While endoscopy is recommended at one year after colorectal cancer (CRC) resection to detect locally recurrent CRC, prior work at our Veterans Affairs (VA) facility demonstrated that 35% of patients achieve this metric. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 22, 2020 Category: Surgery Authors: Gretchen C. Edwards, Kristy K. Broman, Richard L. Martin, Walter E. Smalley, LeaAnne Smith, Rebecca A. Snyder, Carmen C. Sol órzano, Robert S. Dittus, Christianne L. Roumie Tags: Original Scientific Article Source Type: research

Postural Ergonomics and Micro-Neurosurgery: Microscope Has an Edge Over Loupes
We read with interest the work by Yang and colleagues1 highlighting the importance of postural ergonomics and the commonality of this occupational risk to surgeons in several specialties. Alarmingly, they showed that in procedures with loupes, there were significantly more extreme neck angles, increased awkward neck postures, and a significant impact on both subjective and objective workloads. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 21, 2020 Category: Surgery Authors: Andreas K. Demetriades, Torstein R. Meling, Florian A. Ringel, Karl Schaller Tags: Letter Source Type: research

Assessing Incidence and Risk Factors of Delirium after Emergency General Surgery in Geriatric Patients
In the recent article by Saljuqi and colleagues1 assessing the incidence and risk factors of postoperative delirium (POD) in geriatric patients undergoing emergency general surgery, we noted several issues that needed attention. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 20, 2020 Category: Surgery Authors: Yi Cheng, Fu-Shan Xue, Shao-Hua Liu Tags: Letter Source Type: research

Delirium in Geriatric Patients Undergoing Emergency General Surgery: A Call to Action
We would like to thank the editor for the opportunity to reply to the thoughtful comments raised by Cheng and colleagues. It is evident that delirium remains a significant burden on the health care system and is associated with adverse postoperative outcomes, including delayed recovery,1 functional decline, and increased risk of institutionalization. The pathogenesis of delirium, especially when occurring within a background of biologic vulnerability, is complex and multifactorial, and shares multiple mechanistic pathways with frailty. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 19, 2020 Category: Surgery Authors: Kamil Hanna, Abdul Tawab Saljuqi, Bellal Joseph Tags: Letter Source Type: research

Pandemic and the Role of the Program Director as Gatekeeper
GatekeeperNounPronunciation: / ˈɡātˌkēpər// ˈɡertˌkipər/1: An attendant at a gate who is employed to control who goes through it.1.1 A person or thing that controls access to something.1 (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 18, 2020 Category: Surgery Authors: John R. Potts Tags: Special article Source Type: research

The Pandemic and the Role of the Program Director as Gatekeeper
Short Summary: Graduation decisions are weighty and sometimes difficult, even under normal circumstances. The novel coronavirus (COVID-19) pandemic has imposed highly abnormal circumstances, leaving the program director with less than the usual amount of data to inform 2020 graduation decisions. Nevertheless, the program director is obligated to the program, the sponsoring institution, the residents/fellows and, most importantly, to the public to graduate only those residents/fellows who are truly prepared to safely and independently practice their specialty. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 18, 2020 Category: Surgery Authors: John R. Potts Tags: Special Article Source Type: research

Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources
Physicians must satisfy two competing expectations: advocate for patients and serve as stewards of resources. No guidelines exist for surgeons on resolving this conflict. We surveyed surgeons ’ perceptions regarding these dual obligations. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 16, 2020 Category: Surgery Authors: Piroska K. Kopar, Felix Y. Lui Tags: Original Scientific Article Source Type: research

En Bloc Celiac Axis Resection for Pancreatic Cancer: Classification of Anatomical Variants Based on Tumor Extent
En bloc celiac axis resection (CAR) for pancreatic cancer (PC) is increasingly considered after modern neoadjuvant chemotherapy (NAC). “Appleby” and “DP-CAR” are anatomically inaccurate terms as tumors can extend beyond celiac axis proper requiring concurrent resection of the proper hepatic artery and/or superior mesenteric artery. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 14, 2020 Category: Surgery Authors: Mark J. Truty, Jill J. Colglazier, Bernardo C. Mendes, David. M. Nagorney, Thomas C. Bower, Rory L. Smoot, Randall R. DeMartino, Sean P. Cleary, Gustavo S. Oderich, Michael L. Kendrick Tags: Western Surgical Association Article Source Type: research

Reevaluation of Hepatic Angioembolization for Trauma in Stable Patients: Weighing the Risk
Angioembolization (AE) is recommended for extravasation from liver injuries on CT. Data supporting AE are limited to retrospective series that have found low mortality but high morbidity. These studies did not focus on stable patients. We hypothesize that AE is associated with increased complications without improving mortality in stable patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 14, 2020 Category: Surgery Authors: Jason M. Samuels, Heather Carmichael, Alexandra Kovar, Shane Urban, Stephanie Vega, Catherine Velopulos, Robert C. McIntyre Tags: Western Surgical Association Article Source Type: research

Fibrinolysis Shutdown Correlates to Thromboembolic Events in Severe COVID-19 Infection
COVID-19 ICU patients are hypercoagulable. Fibrinolysis shutdown as demonstrated by complete lack of clot lysis at 30 minutes on thromboelastography combined with elevated D-Dimer levels predicts thromboembolic complications and new onset kidney failure. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 14, 2020 Category: Surgery Authors: Franklin L. Wright, Thomas O. Vogler, Ernest E. Moore, Hunter B. Moore, Max V. Wohlauer, Shane Urban, Trevor L. Nydam, Peter K. Moore, Robert C. McIntyre Tags: Original Scientific Article Source Type: research

Delirium in Geriatric Patients Undergoing Emergency General Surgery: A Call to Action
We would like to thank the editor for the opportunity to reply to the comments raised in the letter to the editor. Despite all unified efforts to streamline multidisciplinary care, delirium remains a prevalent postoperative complication in the older adult surgical population. Our understanding of the natural history of this complication continues to evolve. Frailty and delirium may be manifestations of a shared vulnerability to illness and reduced physiologic reserve in older adults.1 It is evident that the occurrence of delirium is dependent on a complex interaction between predisposing patient-related factors and precipi...
Source: Journal of the American College of Surgeons - May 14, 2020 Category: Surgery Authors: Abdul Tawab Saljuqi, Samer Asmar, Bellal Joseph Tags: Letter Source Type: research

Minimizing Healthcare Worker Contamination Risk During Tracheostomy
We read the article, “Novel approach to reduce transmission of COVID-19 during tracheostomy,” by Foster and colleagues.1 We appreciate the authors’ protocol to reduce the risk of healthcare worker (HCW) infection during most of the surgical procedure; however, based on our experience with Coronavirus disease (COVI D-19) pneumonia patients in one of Italy’s national “hot spots” (Pesaro Civil Hospital, Marche Region), we believe the most dangerous phase for HCW contamination in tracheostomy is the interval between deflation of the endotracheal tube (EET) cuff and the patient’s reconn...
Source: Journal of the American College of Surgeons - May 14, 2020 Category: Surgery Authors: Luca D'Ascanio, Manlio Pandolfini, Maria Capalbo, Michele Tempesta Tags: Letter Source Type: research

Need for Accurate Assessment of Volume Status and Fluid Responsiveness in Critically Ill Trauma Patients
Thank you to Drs Xue, Dong, and Liu for their letter to the editor with thoughtful comments on our recent manuscript evaluating the relationship between 48-hour fluid balance and acute kidney injury (AKI) in severely injured trauma patients.1 (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 12, 2020 Category: Surgery Authors: Gabrielle E. Hatton, John A. Harvin, Charles E. Wade, Lillian S. Kao Tags: Letter Source Type: research

Postoperative Delirium in Geriatric Patients after Emergency General Surgery
Postoperative delirium (POD) is associated with severe obstacles related to increased lengths of hospital stay, costs, morbidity, and mortality in elderly patients.1 The most important management of POD is based primarily on prevention and early recognition.2 Therefore, a more complete understanding of potential risk factors for POD in elderly patients undergoing surgery is needed. However, there has been little research aimed at finding the risk factors for POD. I have carefully read the article published in the Journal of the American College of Surgeons by Saljuqi and colleagues,3 and his findings and conclusions are in...
Source: Journal of the American College of Surgeons - May 12, 2020 Category: Surgery Authors: Yu Seob Shin Tags: Letter Source Type: research

Effect of Establishing a Teaching Assistant Case Minimum on General Surgery Residents: 18-Year Comparison of a Single Institution to National Data
The 2014 minimum Teaching Assistant (TA) case requirement for graduating general surgery residents has led to a significantly increased number of logged TA cases, thereby hopefully fostering increased autonomy and increasing resident comfort and capability. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 10, 2020 Category: Surgery Authors: Prakash Jayanthi, Mitesh Bharat Patel, Vijay Mittal Tags: Western Surgical Association Article Source Type: research

Beware of Time Delay and Differential Diagnosis when Screening for Symptoms of COVID-19 in Surgical Cancer Patients
We read with interest the original paper by Forrester and colleagues1 and would like to congratulate the authors on producing an operational algorithm for operating room team members' protection. At the National Institute of Oncology of Rabat, we share the same guiding principles for team safety. However, we would like to draw attention to time-delay risk on screening symptoms for novel coronavirus (COVID-19), especially in cancer patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 7, 2020 Category: Surgery Authors: Abdelilah Ghannam, Amine Souadka Tags: Letter Source Type: research

Vanishing Calot Syndrome: Common Face of Many Problems
Misidentification remains the most common mechanism involved in post-cholecystectomy bile duct injury (BDI). Risk of misidentification increases when pathologic factors alter local anatomy. The critical view of safety approach helps in minimizing such injuries, even in difficult cases.1 However, it might not be possible to achieve critical view of safety if the hepatocystic triangle (HCT) is obliterated. An attempt to continue dissection in the HCT in such a situation is fraught with danger of biliary or vasculobiliary injury. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 7, 2020 Category: Surgery Authors: Vishal Gupta Tags: Letter Source Type: research

The Ever-Elusive Quest for Operating Room Efficiency
We congratulate Chapman and colleagues for bringing out the importance of last case on time end and its causal relationship with first case on time start (FCOTS). Unfortunately,> 90% of cases recorded in the article were day-case operations (outpatient or same-day operation). These results are not generalizable to exclusive inpatient theater lists. The authors themselves reported poor FCOTS in this group (adjusted odds ratio 0.25; 95% CI, 0.19 to 0.35) and higher overtime minutes if they had more than 1 “inpatient” on the list. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 7, 2020 Category: Surgery Authors: Raghvinder Pal Singh Gambhir, Elizabeth Faulkner, Laura Leeves, Joseph Jankinson, Lilly Liu Tags: Letter Source Type: research

Robotic Approach to Outpatient Inguinal Hernia Repair
Robotics offers improved ergonomics, visualization, instrument articulation, and tremor filtration. Disadvantages include startup cost and system breakdown. Surgeon education notwithstanding, we hypothesize that robotic inguinal hernia repair carries minimal advantages over the laparoscopic or open approach. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 4, 2020 Category: Surgery Authors: Haroon Janjua, Evelena Cousin-Peterson, Tara M. Barry, Marissa C. Kuo, Marshall S. Baker, Paul C. Kuo Tags: Western Surgical Association Article Source Type: research

Determining Association of Fluid Balance with Acute Kidney Injury in Trauma Patients Admitted to the ICU
We read with great interest the recent article by Hatton and colleagues.1 They showed that a positive fluid balance at 48 hours after ICU admission was independently and incrementally associated with the development of acute kidney injury (AKI) in trauma patients. Their findings have potential implications, but we noted several issues in this study that were not well addressed. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 3, 2020 Category: Surgery Authors: Fu-Shan Xue, Peng Dong, Shao-Hua Liu Tags: Letter Source Type: research