Treatment of moderate-to-severe psoriasis in adults: An expert consensus statement using a Delphi method to produce a decision-making algorithm.

Background: New highly effective drugs for moderate-to-severe cutaneous psoriasis are regularly marketed, and the hierarchy of treatments thus requires frequent review.

Objectives: A Delphi method was used to enable a structured expert consensus on the use of systemic treatments and phototherapy among adults with moderate-to-severe psoriasis.

Methods: The Delphi method consists in achieving a convergence of opinions among a panel of experts using several rounds of questionnaires with controlled feedback between rounds.

Laparoscopic Indocyanine Green-Guided Sentinel Lymph Node Biopsy for Gallbladder Neoplasms.

Background: Surgical resection, the only potentially curative treatment for gallbladder cancer (GBC), entails an extended cholecystectomy with portal lymphadenectomy. Lymph node dissection is a key staging procedure, but its therapeutic value is unclear. Additionally, it is technically challenging and potentially harmful.

Surgical Trainee Perspectives on the Opioid Crisis: The Influence of Explicit and Hidden Curricula.

Objective: In order to effectively create and implement an educational program to improve opioid prescribing practices, it is important to first consider the unique perspectives of residents on the frontlines of the opioid epidemic. We sought to better understand resident perspectives on opioid prescribing, current practices in pain management, and opioid education as a needs assessment for designing future educational interventions.

Design: This is a qualitative study using focus groups of surgical residents at 4 different institutions.

Comparison of Society Guidelines for the Management and Surveillance of Pancreatic Cysts: A Review.

Importance: The identification of incidental pancreas cystic lesions (PCLs) has increased in recent decades with the expanded use and improved sensitivity of cross-sectional imaging. Because the overall risk of malignancy associated with PCLs is low, yet the relative morbidity of pancreatic surgery is high, evidence-based guidelines are necessary for appropriate surveillance and management. Therefore, this article provides a review of existing guidelines regarding surveillance and management of PCLs and highlights recent advances in the diagnostic evaluation of cysts and the postresection management of mucinous lesions.

Intrahepatic Cholangiocarcinoma: A Summative Review of Biomarkers and Targeted Therapies.

Although rare, intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy and the incidence of ICC has increased 14% per year in recent decades. Treatment of ICC remains difficult as most people present with advanced disease not amenable to curative-intent surgical resection. Even among patients with operable disease, margin-negative surgical resection can be difficult to achieve and the incidence of recurrence remains high.

Development of a Prognostic Nomogram and Nomogram Software Application Tool to Predict Overall Survival and Disease-Free Survival After Curative-Intent Gastrectomy for Gastric Cancer.

Background: We sought to derive and validate a prediction model of survival and recurrence among Western patients undergoing resection of gastric cancer.

Methods: Patients who underwent curative-intent surgery for gastric cancer at seven US institutions and a major Italian center from 2000 to 2020 were included. Variables included in the multivariable Cox models were identified using an automated model selection procedure based on an algorithm.

Does the Volume-Outcome Association in Pancreas Cancer Surgery Justify Regionalization of Care? A Review of Current Controversies.

Introduction: Increasing hospital or surgeon volume is associated with improved outcomes among patients with pancreatic cancer. Promotion of regionalized care is based on this volume-outcome association. However, other research has exposed nuances and complexities inherent to this association that should be considered when promoting regionalized care models.

A narrative review: has regionalization truly achieved its intended goal in the surgical management of pancreatic cancer?

Objective: The purpose of this narrative review is to present the data to date on the volume-outcome association in pancreas cancer surgery and describe the prevalence of and barriers to regionalized pancreas cancer care in western health systems.

Background: Numerous studies have demonstrated an association between increasing hospital or surgeon volume and improved patient morbidity and mortality in patients undergoing surgery for pancreas cancer. However, since the initial promotion of minimum volume standards, regionalization has remained difficult to establish.

Patient preferences for GI cancer surveillance and telemedical follow-up.

Introduction: Surveillance care including routine physical exams and testing following gastrointestinal (GI) cancer treatment can be fiscally and emotionally burdensome for patients. Emerging technology platforms may provide a resource-wise surveillance strategy. However, effective implementation of GI cancer surveillance is limited by a lack of patient level perspective regarding surveillance.

Gender Differences in Entrustable Professional Activity Evaluations of General Surgery Residents.

Objective: To determine differences in entrustable professional activity (EPA) assessments between male and female general surgery residents.

Summary Background Data: Evaluations play a critical role in career advancement for physicians. However, female physicians in training receive lower evaluations and underrate their own performance.

Liver transplantation for perihilar cholangiocarcinoma: patient selection and outcomes.

: Peri-hilar cholangiocarcinoma is an aggressive bile duct cancer. Long-term survival is possible with margin-negative surgery. Historically, unresectable disease was approached with non-curative treatment options.

Clinical and Cost Profile of Controlled Grade B Postoperative Pancreatic Fistula: Rationale for Their Consideration as Low Risk.

Background: Despite standardization, the 2016 ISGPF criteria are limited by their wider applicability and oversimplification of grade B POPF. This work applied the 2016 ISGPF grading criteria within a US academic cancer center to verify clinical and fiscal distinctions and sought to improve grading criteria for grade B POPF.

Methods: The 2008-2018 cost and NSQIP data from pancreaticoduodenectomy to postoperative day 90 were merged.

A telephone-based surgical transitional care program with improved patient satisfaction scores and fiscal neutrality.

Background: Limited data exist regarding the downstream effects of surgical transitional care programs. We explored the impact of such programs on patient satisfaction and fiscal metrics.

Methods: A telephone-based surgical transitional care program enrolled patients undergoing complex abdominal surgery between 2015 to 2017.

Surgeon Variability Impacts Costs in Laparoscopic Cholecystectomy: the Volume-Cost Relationship.

Background: Physician variation in adherence to best practices contributes to the high costs of health care. Understanding surgeon-specific cost variation in common surgical procedures may inform strategies to improve the value of surgical care.

Methods: Laparoscopic cholecystectomies at a single institution were identified over a 5-year period and linked to an institutional cost database.

Sentinel lymph node biopsy is associated with increased cost in higher risk thin melanoma.

Introduction: National Comprehensive Cancer Network guidelines recommend that sentinel lymph node biopsy (SLNB) be discussed with patients with thin melanoma at higher risk for lymph node metastasis (T1b or T1a with positive deep margins, lymphovascular invasion, or high mitotic index). We examined the association between SLNB and resource utilization in this cohort.

Methods: We conducted a retrospective cohort study of patients that underwent wide local excision for higher risk thin melanomas from 2009 to 2018 at a tertiary care center.

Emerging pathways for precision medicine in management of cholangiocarcinoma.

Cholangiocarcinoma (CCA) is the second most common biliary tract malignancy with a dismal prognosis. Surgical resection with a negative microscopic margin offers the only hope for long-term survival. However, the majority of patients present with advanced disease not amenable to curative resection, mainly due to late presentation and aggressive nature of the disease.

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation.

Introduction: Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and cost in pancreaticoduodenectomy patients.

Methods: Hospital cost data from date of discharge to postoperative day 90 were merged with 2008-2018 NSQIP data.

What Drives High Costs of Cytoreductive Surgery and HIPEC: Patient, Provider or Tumor?

Introduction: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is utilized for peritoneal malignancies and is associated with significant resource use. To address potentially modifiable factors contributing to excessive cost, we sought to determine predictors of high cost of care for patients undergoing CRS/HIPEC.

Methods: An institutional CRS/HIPEC database was queried for adult patients from 2014 to 2018.

Operative Delay in Adults with Appendicitis: Time is Money.

Background: Evidence suggests that operative delay of up to 24 h is not associated with adverse outcomes among patients undergoing emergent appendectomy. However, the fiscal implication of operative delay is not well described in adults. We sought to examine the effect of delayed appendectomy on clinical outcomes and hospital cost.

Summary perioperative risk metrics within the electronic medical record predict patient-level cost variation in pancreaticoduodenectomy.

Background: Automated data extraction from the electronic medical record is fast, scalable, and inexpensive compared with manual abstraction. However, concerns regarding data quality and control for underlying patient variation when performing retrospective analyses exist. This study assesses the ability of summary electronic medical record metrics to control for patient-level variation in cost outcomes in pancreaticoduodenectomy.

Rehabilitation of speech disorders following glossectomy, based on ultrasound visual illustration and feedback.

Intraoral surgery for tongue cancer usually induces speech disorders that have a negative impact on communication and quality of life. Studies have documented the benefit of tongue ultrasound imaging as a visual articulatory feedback for speech rehabilitation. This study aims to assess specifically the complementary contribution of visual feedback to visual illustration (i.

[Children with psoriasis in secondary care: Clinical aspects and comorbidities diverge from the generally published data].

Background: Psoriasis affects 0.2-0.7 % of children and is associated with obesity.