Financial Toxicity and Unemployment in Patients with Major Lower Limb Amputation are High.

Background: Major limb amputation can place a significant financial burden on patients and their families because of costs of care and loss of income, encapsulated by the concept of financial toxicity. We sought to measure and understand factors associated with financial toxicity among patients undergoing major lower limb amputation for diabetic foot ulcers or peripheral arterial disease.

Methods: We identified patients in an institutional database who received lower limb amputations and excluded patients who underwent amputation due to known trauma or cancer.

Cognitive Impairment is Common and Unrecognized in Vascular Surgery Patients.

Background: Patients' capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States.

Risk-Specific Training Cohorts to Address Class Imbalance in Surgical Risk Prediction.

Importance: Machine learning tools are increasingly deployed for risk prediction and clinical decision support in surgery. Class imbalance adversely impacts predictive performance, especially for low-incidence complications.

Objective: To evaluate risk-prediction model performance when trained on risk-specific cohorts.

Resolvin D2/GPR18 signaling enhances monocytic myeloid-derived suppressor cell function to mitigate abdominal aortic aneurysm formation.

Abdominal aortic aneurysm (AAA) formation is a chronic vascular pathology characterized by inflammation, leukocyte infiltration, and vascular remodeling. The aim of this study was to delineate the protective role of Resolvin D2 (RvD2), a bioactive isoform of specialized pro-resolving lipid mediators, via G-protein-coupled receptor 18 (GPR18) receptor signaling in attenuating AAAs. Importantly, RvD2 and GPR18 levels were significantly decreased in aortic tissue of AAA patients compared with controls.

Community-engaged artificial intelligence research: A scoping review.

The degree to which artificial intelligence healthcare research is informed by data and stakeholders from community settings has not been previously described. As communities are the principal location of healthcare delivery, engaging them could represent an important opportunity to improve scientific quality. This scoping review systematically maps what is known and unknown about community-engaged artificial intelligence research and identifies opportunities to optimize the generalizability of these applications through involvement of community stakeholders and data throughout model development, validation, and implementation.

MerTK-dependent efferocytosis by monocytic-MDSCs mediates resolution of ischemia/reperfusion injury after lung transplant.

Lung transplantation (LTx) outcomes are impeded by ischemia/reperfusion injury (IRI) and subsequent chronic lung allograft dysfunction (CLAD). We examined the undefined role of receptor Mer tyrosine kinase (MerTK) on monocytic myeloid-derived suppressor cells (M-MDSCs) in efferocytosis to facilitate resolution of lung IRI. Single-cell RNA sequencing of lung tissue and bronchoalveolar lavage (BAL) from patients after LTx were analyzed.

Use of an electronic documentation module to improve surgical debriefing effectiveness.

Background: Effective communication in the operating room is crucial for patient safety and optimal outcomes. Structured debriefing communication tools can improve team coordination and address recurring safety concerns. During the unique circumstances of the COVID-19 pandemic, this study evaluated an approach to documentation and loop closure that functioned under constrained hospital resources, a loss of capacity for face-to-face provider training and loop closure, and periods of performing only urgent and emergent surgery for which some debriefing elements, like patient disposition and equipment needs, are more dynamic.

Association of Surgeon Self-Reported Gender and Surgical Outcomes in Current US Practice.

Objective: This study aimed to evaluate the association of surgeon self-reported gender on clinical outcomes in contemporary US surgical practice.

Background: Previous research has suggested that there are potentially improved surgical outcomes for female surgeons, yet the underlying causal path for this association remains unclear.

Methods: Using the Vizient Clinical Database(2016-2021), 39 operations categorized by the CDC's National Healthcare Safety Network were analyzed.

Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery.

Objective: To determine whether certain patients are vulnerable to errant triage decisions immediately after major surgery and whether there are unique sociodemographic phenotypes within overtriaged and undertriaged cohorts.

Background: In a fair system, overtriage of low-acuity patients to intensive care units (ICUs) and undertriage of high-acuity patients to general wards would affect all sociodemographic subgroups equally.

Methods: This multicenter, longitudinal cohort study of hospital admissions immediately after major surgery compared hospital mortality and value of care (risk-adjusted mortality/total costs) across 4 cohorts: overtriage (N = 660), risk-matched overtriage controls admitted to general wards (N = 3077), undertriage (N = 2335), and risk-matched undertriage controls admitted to ICUs (N = 4774).

Volumetric analysis of acute uncomplicated type B aortic dissection using an automated deep learning aortic zone segmentation model.

Background: Machine learning techniques have shown excellent performance in three-dimensional medical image analysis, but have not been applied to acute uncomplicated type B aortic dissection (auTBAD) using Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS)-defined aortic zones. The purpose of this study was to establish a trained, automatic machine learning aortic zone segmentation model to facilitate performance of an aortic zone volumetric comparison between patients with auTBAD based on the rate of aortic growth.

Methods: Patients with auTBAD and serial imaging were identified.

TRANSCRIPTOMIC DIFFERENCES IN PERIPHERAL MONOCYTE POPULATIONS IN SEPTIC PATIENTS BASED ON OUTCOME.

Postsepsis early mortality is being replaced by survivors who experience either a rapid recovery and favorable hospital discharge or the development of chronic critical illness with suboptimal outcomes. The underlying immunological response that determines these clinical trajectories remains poorly defined at the transcriptomic level. As classical and nonclassical monocytes are key leukocytes in both the innate and adaptive immune systems, we sought to delineate the transcriptomic response of these cell types.

Outcomes of Patients with Acute Type B Aortic Dissection and High-Risk Features.

Background: Recently the Society for Vascular Surgery (SVS) and Society for Thoracic Surgeons (STS) published contemporary guidelines clearly defining complicated versus uncomplicated acute type B aortic dissections (TBADs) with an additional high-risk grouping. Few studies have evaluated outcomes associated with "high-risk" TBADs. The objective of this study was to assess differences in demographics, clinical presentation, symptom onset, and outcomes in high-risk patients that underwent either thoracic endovascular aortic repair (TEVAR) or best medical management for acute TBAD compared to those with complicated and uncomplicated acute TBAD.

Limited health literacy is common among vascular surgery patients.

Background: Health literacy is a crucial aspect of informed decision-making, and limited health literacy has been associated with worse health care outcomes. To date, health literacy has not been examined in vascular surgery patients. Therefore, we conducted a prospective observational study to determine the prevalence and factors associated with poor health literacy in vascular surgery patients.

Operating Room Supply Cost and Value of Care after Implementing a Sustainable Quality Intervention.

Background: Variability in operating room supply cost is a modifiable cause of suboptimal resource use and low value of care (outcomes vs cost). This study describes implementation of a quality improvement intervention to decrease operating room supply costs.

Study Design: An automated electronic health record data pipeline harmonized operating room supply cost data with patient and case characteristics and outcomes.

Perioperative Cerebrospinal Fluid Drain Placement Does Not Increase Venous Thromboembolism Risk After Thoracic and Fenestrated Endovascular Aortic Repair.

Background: Venous thromboembolism (VTE) incidence after thoracic and fenestrated endovascular aortic repair (TEVAR/FEVAR) is high (up to 6-7%) relative to other vascular procedures; however, the etiology for this discrepancy remains unknown. Notably, patients undergoing TEVAR/FEVAR commonly receive cerebrospinal fluid drains (CSFDs) for neuroprotection, requiring interruption of perioperative anticoagulation and prolonged immobility. We hypothesized that CSFDs are a risk factor for VTE after TEVAR/FEVAR.

Surgical leadership: Ensuring financial stability through growth.

Maintaining financial stability is important for leaders in surgery because it (1) allows consistent, fair (market value) reimbursement for employees, which conveys that they are valued; (2) enables strategic investment in new programs that may not generate direct financial gains but are required; and (3) builds trust with stakeholders outside the department while strengthening the department's position in negotiations. Key strategies that we have used to increase revenue (income) over the past 6 years have been hiring more faculty, advocating for greater operating room and staffing capacity, staffing surgeons at other institutions using affiliation agreements, attempting to shift grant-funded efforts to non-clinical (research) faculty to mitigate National Institutes of Health salary cap penalties, and increasing efforts to identify external funding for educational and administrative tasks performed by surgeons (eg, increasing contact hours with medical students to secure a greater proportion of state general revenue). Using these strategies, our total revenue has increased 66% over the past 6 years, whereas Academic Support Agreement funds from the College of Medicine concurrently have decreased by 75%.

Self-pay insurance status is associated with failure of medical therapy in patients with acute uncomplicated type B aortic dissection.

Background: Traditionally, acute uncomplicated type B aortic dissections are managed medically, and acute complicated dissections are managed surgically. Self-pay patients with medically managed acute uncomplicated type B aortic dissections may fare worse than their insured counterparts.

Methods: In this single-center, retrospective cohort study, demographics, follow-up, and outcomes of patients with acute type B aortic dissections from 2011 to 2020 were analyzed.

Presentation and Outcomes of Elective and Nonelective Complex Endovascular Repair for Thoracoabdominal and Juxtarenal Aortic Aneurysms.

Background: Endovascular repair of thoracoabdominal aortic aneurysms (TAAA) and juxtarenal aortic aneurysms (JAA) with fenestrated and/or branched endografts (B/FEVAR) has become common. Physician modified endografts for patients presenting with symptomatic or contained ruptures has made B/FEVAR a feasible option in nonelective settings. The purpose of this study was to describe our 10-year institutional experience with endovascular interventions for TAAA in elective and nonelective cases to evaluate differences in outcomes and the clinical risk factors associated with nonelective presentation.

Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender.

Objectives: This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents.

Background: Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy.

Methods: A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021.

Joy and Community in Surgery.

My wife Nancy is a voluminous reader of books (you remember the things printed on paper). After 30 years of marriage, it dawned on me that we have never really shared books. Therefore, we decided to try and enrich our marriage by exchanging books.