Archives of surgery (Chicago, Ill.: 1960)

Publications in this journal

• Article: Surgeons as Hospital Employees: Good, Bad, or Indifferent? Comment on "The Employed Surgeon"

  Lena M Napolitano
  Archives of surgery (Chicago, Ill.: 1960) 12/2012;
• Article: Show Us the Money: Role of Pancreatectomy and Vascular Reconstruction in Pancreatic Cancer in the Coming Era of Value-Based Payment Comment on "Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease"

  E Christopher Ellison
  Archives of surgery (Chicago, Ill.: 1960) 12/2012;
• Article: Considerations regarding technology and transplant evaluations comment on "evaluation of potential renal transplant recipients with computed tomography angiography".

  Douglas P Slakey
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1122.
• Article: Effects of prior abdominal surgery, obesity, and lumbar spine level on anterior retroperitoneal exposure of the lumbar spine.

  Abid Mogannam, Christian Bianchi, Jason Chiriano, Sheela Patel, Theodore H Teruya, Sharon S Lum, Ahmed M Abou-Zamzam
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE To evaluate the effects of prior abdominal surgery and obesity and the level of spine exposure on the technical aspects and complications of anterior retroperitoneal exposure of the lumbar spine (ARES). DESIGN Retrospective review of prospective database. SETTING Academic vascular surgery practice. PATIENTS Patients undergoing ARES from 2001 to 2011. MAIN OUTCOME MEASURES Influence of prior abdominal surgery, obesity, and level of exposure on time to spine exposure and incidence of vascular and perioperative complications. RESULTS Four hundred seventy-six patients underwent ARES. Mean (SD) age was 47.7 (12.6) years; 46.6% had undergone prior abdominal surgery. Mean (SD) body mass index (BMI) was 28.3 (5.5); 61.6% of procedures included the L4-5 disk. Mean (SD) time to exposure was 70.0 (25.5) minutes. Vascular injury occurred in 23.3% (3.8% major). Perioperative complications occurred in 16.4% of cases. Prior abdominal surgery had no effect on time to exposure, vascular injury, and perioperative complications. A BMI of 30 or more had no effect on time to exposure compared with a lower BMI. A BMI of 30 or more led to higher rates of vascular injury (30.8% vs 19.7%; P = .007) and overall complications (21.4% vs 14.0%; P = .04). Exposures involving L4-5 led to increased time to exposure (77.0 vs 56.2 minutes; P < .001) and higher rates of vascular injury (29.7% vs 13.1%; P < .001) but had no effect on overall complications compared with exposures for other levels. CONCLUSION Prior abdominal surgery should not be considered a contraindication to ARES. Caution is warranted in obese patients and exposures involving L4-5.
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1130-4.
• Article: Integrating human factors research and surgery: a review.

  Daniel Shouhed, Bruce Gewertz, Doug Wiegmann, Ken Catchpole
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE To provide a review of human factors research within the context of surgery. DATA SOURCES We searched PubMed for relevant studies published from the earliest available date through February 29, 2012. STUDY SELECTION The search was performed using the following keywords: human factors, surgery, errors, teamwork, communication, stress, disruptions, interventions, checklists, briefings, and training. Additional articles were identified by a manual search of the references from the key articles. As 2 human factors specialists, a senior clinician, and a junior clinician, we carefully selected the most appropriate exemplars of research findings with specific relevance to surgical error and safety. DATA EXTRACTION Seventy-seven articles of relevance were selected and reviewed in detail. Opinion pieces and editorials were disregarded; the focus was solely on articles based on empirical evidence, with a particular emphasis on prospectively designed studies. DATA SYNTHESIS The themes that emerged related to the development of human factors theories, the application of those theories within surgery, a specific interest in the concept of flow, and the theoretical basis and value of human-related interventions for improving safety and flow in surgery. CONCLUSIONS Despite increased awareness of safety, errors routinely continue to occur in surgical care. Disruptions in the flow of an operation, such as teamwork and communication failures, contribute significantly to such adverse events. While it is apparent that some incidence of human error is unavoidable, there is much evidence in medicine and other fields that systems can be better designed to prevent or detect errors before a patient is harmed. The complexity of factors leading to surgical errors requires collaborations between surgeons and human factors experts to carry out the proper prospective and observational studies. Only when we are guided by this valid and real-world data can useful interventions be identified and implemented.
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1141-6.
• Article: History and heritage of the department of surgery, georgetown university.

  Richard W Holt, Stephen R T Evans
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1074-6.
• Article: Exacerbation of symptom severity of pelvic floor disorders in women who report a history of sexual abuse.

  Laurel R Imhoff, Loriel Liwanag, Madhulika Varma
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE To examine the effect of previous sexual abuse or assault (SAA) on symptom severity, quality of life, and physiologic measures in women with fecal incontinence or constipation. DESIGN A cross-sectional study of a prospectively maintained clinical database. SETTING A tertiary referral center for evaluation and physiologic testing for pelvic floor disorders. PATIENTS Women with fecal incontinence or constipation examined during a 6-year period. MAIN OUTCOME MEASURES Symptom severity and quality of life were measured with the Fecal Incontinence Severity Index (FISI), Fecal Incontinence Quality of Life Scale (FIQL), Constipation Severity Instrument (CSI), Constipation-Related Quality of Life measure (CR-QOL), and 12-Item Short Form Health Survey (SF-12). Physiologic variables were ascertained with anorectal manometry, electromyography, and endoanal ultrasonography. RESULTS Of the 1781 women included, 213 (12.0%) reported SAA. These women were more likely to be white, to report a psychiatric illness, and to have a prior hysterectomy or episiotomy. On bivariate analysis, women with prior SAA had increased symptom severity on the FISI (P = .002) and CSI (P < .001) and diminished quality of life on the FIQL (P < .001), CR-QOL (P = .009), and SF-12 (P = .002 to P = .004). Physiologic variables did not differ significantly between patients with and without prior SAA. CONCLUSIONS A history of SAA significantly alters disease perception in fecal incontinence and constipation, but the disorders do not result from increased physiologic alterations. We must elicit a history of SAA in these patients, because the history may play a role in the discrepancy between symptom reporting and objective measurements and may modify treatment recommendations.
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1123-9.
• Article: Cancer surgery in low-income countries: an unmet need.

  David E Gyorki, Arturo Muyco, Adam L Kushner, Murray F Brennan, T Peter Kingham
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES To describe the surgical oncology experience at a major regional hospital in Malawi and to identify barriers to improved outcomes. DESIGN Retrospective review of operating logbooks from a single tertiary referral center. SETTING Major tertiary referral center (Kamuzu Central Hospital) in Lilongwe, Malawi, in sub-Saharan Africa. PATIENTS Patients were identified with a suspected diagnosis of cancer from January 1, 2004, through March 7, 2007. MAIN OUTCOME MEASURES Cancer cases were classified according to patient demographic characteristics, disease location, and therapeutic intent. The Malawi data were compared with US data from the Surveillance Epidemiology and End Results database. RESULTS A malignant diagnosis was suspected in 255 of the 1440 patients undergoing a major resection (17.8%) (mean patient age, 53 years). The most common cancers in males were prostate, esophageal, and gastric. In females, the most common cancers were breast, colon, and esophageal. Many of the procedures were performed with palliative intent. CONCLUSIONS Cancer surgery comprises a significant proportion of the surgical caseload in low-income countries. Patients often present with late-stage, inoperable cancer. The participation of the surgical community is critical for addressing barriers to effective cancer care.
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1135-40.
• Article: Image of the month-quiz case.

  Nsikak J Umoh, Robert E H Khoo
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1149.
• Article: Evaluation of potential renal transplant recipients with computed tomography angiography.

  Daniel Smith, Avni Chudgar, Barry Daly, Matthew Cooper
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES To determine the safety, clinical yield, and cost of computed tomography angiography (CTA) use in the workup of potential renal transplant recipients. DESIGN Single-site, retrospective review of medical, surgical, and radiologic records. SETTING Large university tertiary care center. PATIENTS Potential recipients of transplants from living donors. INTERVENTIONS Computed tomography with and without 100 mL of iodixanol intravenous contrast enhancement as part of the preoperative workup. MAIN OUTCOME MEASURES Mean pre- and post-CTA estimated glomerular filtration rate and number of patients requiring emergent dialysis after CTA, number of patients who had their treatment changed by CTA findings, patient predictors of significant CTAs, and cost per significant CTA. RESULTS From July 20, 2006, through December 10, 2010, a total of 179 transplant candidates underwent CTA. Forty-two patients were predialysis at the time of CTA. Mean (SD) serum creatinine levels in this group were unchanged after CTA (5.06 [2.13] mg/dL vs 5.00 [2.28] mg/dL [to convert to micromoles per liter, multiply by 88.4], P = .49), and no patients required subsequent emergent dialysis. Forty-one patients (22.9%) had their treatment changed by CTA findings. Multivariate logistic regression analysis revealed 3 patient history and physical criteria that predicted significant CTA findings: chronic infection (odds ratio, 10.91; 95% CI, 2.72-43.69; P < .001), patient weight less than 69 kg (3.11; 1.49-6.51; P < .001), and ventral torso surgical scarring (4.13; 1.57-10.84; P < .001). Diagnostic cost per significant CTA study was $2660, with an estimated reduced cost of $1480 per significant study with screening using 1 of the 3 predictors. CONCLUSION Diagnostic CTA is a safe and cost-effective procedure for both operative planning and screening for potentially prohibitive abdominal disease.
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1114-22.
• Article: Image of the month-quiz case.

  Kensuke Adachi, Tomohito Minami
  Archives of surgery (Chicago, Ill.: 1960) 12/2012; 147(12):1147.
• Article: No-Scar Transanal Total Mesorectal Excision: The Last Step to Pure NOTES for Colorectal Surgery.

  Joël Leroy, Brian Donncha Barry, Armando Melani, Didier Mutter, Jacques Marescaux
  [show abstract] [hide abstract]
  ABSTRACT: HYPOTHESIS Because of the concerns over the operative platform, accidental organ injury, and viscerotomy closure, natural orifice transluminal endoscopic surgery (NOTES) currently remains an experimental technique. Transanal NOTES for colorectal surgery overcomes all of these issues; however, all of the reports to date have used hybrid laparoscopic techniques. We demonstrate herein the first case, to our knowledge, of pure transanal NOTES colorectal surgery. DESIGN Case report. SETTING University hospital. PATIENT The patient was a 56-year-old woman with a midrectal neoplasia. INTERVENTION Pure transanal NOTES total mesorectal excision with a coloanal anastomosis and without a diverting stoma. Using a transanal endoscopic operation device as a surgical platform, we created a viscerotomy distal to an endoluminal purse-string suture. We performed a total mesorectal excision using a "bottom-up" approach. The sigmoid colon was mobilized by a posterior, retroperitoneal approach and the colon was divided intraperitoneally. A hand-sewn, side-to-end, coloanal anastomosis was performed. Because the viscerotomy was incorporated into the anastomosis, the concerns of both accidental organ damage and viscerotomy closure were abrogated. RESULTS The procedure was completed entirely by a transanal fashion. We successfully mobilized the rectum, mesorectum, and sigmoid colon. The specimen length was more than 20 cm. The patient required minimal analgesia and her pain was nonabdominal. CONCLUSIONS To our knowledge, the first pure transanal NOTES total mesorectal excision with retroperitoneal sigmoid mobilization and coloanal, side-to-end anastomosis was successfully performed using what we called a Peri-Rectal Oncologic Gateway for Retroperitoneal Endoscopic Single Site Surgery (PROGRESSS). This monumental case could pave the way for a new era in pure transanal NOTES for colorectal surgery.
  Archives of surgery (Chicago, Ill.: 1960) 11/2012;
• Article: Laparoscopic Spleen-Preserving Distal Pancreatectomy: Splenic Vessel Preservation Compared With the Warshaw Technique.

  Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent, Denis Collet, Bernard Masson, Laureano Fernández-Cruz, Antonio Sa-Cunha
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE To compare preservation with the division of the splenic vessels in the surgical management of laparoscopic spleen-preserving distal pancreatectomy. DESIGN Bicentric retrospective study. SETTING Prospectively maintained databases. PATIENTS Between January 1997 and January 2011, 140 patients who underwent laparoscopic spleen-preserving distal pancreatectomy for benign or low-grade malignant tumors in the body/tail of the pancreas were included. Patients treated with the attempted splenic vessel preservation were compared with patients treated with the attempted division of the splenic vessels (Warshaw technique). MAIN OUTCOME MEASURES Operative outcomes and postoperative morbidity were evaluated. RESULTS The outcomes of 55 patients in the splenic vessel preservation group were compared with those of 85 patients in the Warshaw technique group. The clinical characteristics were similar in both groups, except for tumor size, which was significantly greater in the Warshaw technique group (33.6 vs 42.5 mm; P < .001). The mean operative time, mean blood loss, and rate of conversion to the open procedure did not differ between the 2 groups. The rate of successful spleen preservation was significantly improved following the splenic vessel preservation technique (96.4% vs 84.7%; P = .03). Complications related to the spleen only occurred in the Warshaw technique group (0% vs 10.5%; P = .03), requiring a splenectomy in 4 patients (4.7%). The mean length of stay was shorter in the splenic vessel preservation group (8.2 vs 10.5 days; P = .01). CONCLUSIONS The short-term benefits associated with the preservation of the splenic vessels should lead to an increased preference for this technique in selected patients undergoing laparoscopic spleen-preserving distal pancreatectomy for benign or low-grade malignant tumors in the body/tail of the pancreas.
  Archives of surgery (Chicago, Ill.: 1960) 11/2012;
• Article: Venous thromboembolism prophylaxis: one size does not fit all: comment on "comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery".

  M Margaret Knudson
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):998-9.
• Article: Association of postdischarge complications with reoperation and mortality in general surgery.

  Hadiza S Kazaure, Sanziana A Roman, Julie A Sosa
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures. DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files. PATIENTS A total of 551 510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting. MAIN OUTCOME MEASURES Postdischarge complications, reoperation, and mortality. RESULTS Of 551 510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use. CONCLUSIONS The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):1000-7.
• Article: Effective perioperative management of multiple endocrine neoplasia type 1-associated insulinomas.

  Kazuhiro Hanazaki, Akihiro Sakurai, Masaya Munekage, Takehiro Okabayashi, Masayuki Imamura
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):991-2.
• Article: Another club in the bag : comment on "irreversible electroporation for the ablation of liver tumors".

  Steven D Colquhoun
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):1061.
• Article: Postoperative mortality after surgery for brain tumors by patient insurance status in the United States.

  Eric N Momin, Hadie Adams, Russell T Shinohara, Constantine Frangakis, Henry Brem, Alfredo Quiñones-Hinojosa
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE To examine whether being uninsured is associated with higher in-hospital postoperative mortality when undergoing surgery in the United States for a brain tumor. DESIGN Retrospective cohort study using the Nationwide Inpatient Sample, January 1, 1999, through December 31, 2008. SETTING The Nationwide Inpatient Sample contains all inpatient records from a stratified sample of 20% of hospitals in 37 states. PATIENTS A total of 28 581 patients, aged 18 to 65 years, who underwent craniotomy for a brain tumor. Three groups were studied: Medicaid recipients and privately insured and uninsured patients. MAIN OUTCOME MEASURE The main outcome measure was in-hospital postoperative death. Associations between this outcome and insurance status were examined within the full cohort and within the subset of patients with no comorbidity using Cox proportional hazards models. These models were stratified by hospital to control for any clustering effects that could arise from differing access to care. RESULTS In the unadjusted analysis, the mortality rate for privately insured patients was 1.3% (95% CI, 1.1%-1.4%) compared with 2.6% for uninsured patients (95% CI, 1.9%-3.3%; P < .001) and 2.3% for Medicaid recipients (95% CI, 1.8%-2.8%; P < .001). After adjusting for patient characteristics and stratifying by hospital in patients with no comorbidity, uninsured patients still had a higher risk of experiencing in-hospital death (hazard ratio, 2.62; 95% CI, 1.11-6.14; P = .03) compared with privately insured patients. In this adjusted analysis, the disparity was not conclusively present in Medicaid recipients (hazard ratio, 2.03; 95% CI, 0.97-4.23; P = .06). CONCLUSIONS Uninsured patients who underwent craniotomy for a brain tumor experienced the highest in-hospital mortality. Differences in overall health do not fully account for this disparity.
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):1017-24.
• Article: Image of the month-quiz case.

  Antonio Pio Tortorelli, Sergio Alfieri, Alejandro Martin Sanchez, Fausto Rosa, Giovanni Battista Doglietto
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):1063.
• Article: Image of the month-quiz case.

  Emmanouil P Pappou, Catherine Velopulos, Elliot K Fishman, Elliott R Haut
  Archives of surgery (Chicago, Ill.: 1960) 11/2012; 147(11):1065.