Advanced Surgical Skills for Exposure in Trauma (ASSET) course improves military surgeon confidence.

Objective: Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011.

Implementation of a Surgical Problem-Based Learning Curriculum: A One-Year Single-Center Experience.

Background: Problem-Based Learning (PBL) has become an integral part of medical student education for preclinical curricula, but few studies have evaluated the benefits of a PBL curriculum for clinical education. This study aims to assess the 1-year experience after implementing a resident-led PBL program for the third-year (MS3) surgery clerkship and compare students' self-reported preparedness following PBL sessions to traditional faculty-led lectures.

Methods: Surgical faculty and residents developed a PBL curriculum to address common topics in surgical education.

Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions.

Background: Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community.

Methods: We retrospectively queried a level 1 trauma registry for pediatric (0-18 y) MVC patients from October 2013 to December 2018.

Role of Empiric Antifungal Therapy in Patients with Perforated Peptic Ulcers.

It is unclear if the addition of antifungal therapy for perforated peptic ulcers (PPU) leads to improved outcomes. We hypothesized that empiric antifungal therapy is associated with better clinical outcomes in critically ill patients with PPU. The 2001-2012 Medical Information Mart for Intensive Care (MIMIC-III) database was searched for patients with PPU and the included subjects were divided into two groups depending on receipt of antifungal therapy.

Nationwide Outcomes and Readmission After Pediatric Laparoscopic and Open Fundoplication.

Fundoplications are a common operation in the pediatric population. This study aims to explore outcomes comparing laparoscopic versus open operative techniques. From 2010 to 2014 the Nationwide Readmissions Database was used to identify patients aged 0-18 years who underwent a fundoplication.

Ovarian Preservation and Recurrent Torsion in Children: Both Less Common Than We Thought.

Purpose: Surgical management of pediatric ovarian torsion includes total oophorectomy (TO) or ovarian preservation surgery (OPS). This study sought to identify factors contributing to surgical management and readmission outcomes for ovarian torsion.

Methods: The Nationwide Readmission Database from 2010-2014 was used to identify patients < 18 years admitted with ovarian torsion.

Pediatric Gastrostomy Tube Placement: Less Complications Associated with Laparoscopic Approach.

There are few nationwide studies comparing outcomes of open, laparoscopic (LAP), and percutaneous endoscopic (PEG) gastrostomy tube (GT) placement in the pediatric population. The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients ≤18 years (excluding newborns) who underwent GT placement. Demographics, hospital characteristics, and outcomes were compared by the GT approach.

Outcomes for Ladd's procedure: Does approach matter?

Background: Laparoscopic Ladd's procedure has been proven safe and effective for the treatment of malrotation. However, the nationwide utilization and outcomes of elective Ladd's procedure are largely unknown.

Methods: The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients 0-18 years (excluding newborns) with malrotation who underwent elective Ladd's procedure.

Advanced Statistics: Multiple Logistic Regression, Cox Proportional Hazards, and Propensity Scores.

Randomized controlled trials (RCTs) are generally regarded as the gold standard for demonstrating causality because they effectively mitigate bias from both known and unknown confounders. However, conducting an RCT is not always feasible because of logistical and ethical considerations. This is especially true when evaluating surgical interventions, and non-randomized study designs must be utilized instead.

The hidden burden of unplanned readmission after emergency general surgery.

Background: There are no national studies of nonelective readmissions after emergency general surgery (EGS) diagnoses that track nonindex hospital readmission. We sought to determine the rate of overall and nonindex hospital readmissions at 30 and 90 days after discharge for EGS diagnoses, hypothesizing a significant portion would be to nonindex hospitals.

Methods: The 2013 to 2014 Nationwide Readmissions Database was queried for all patients 16 years or older admitted with an EGS primary diagnosis and survived index hospitalization.

Discordance in Appendicitis Grading and the Association with Outcomes: A Post-Hoc Analysis of an EAST Multicenter Study.

Background: The American Association for the Surgery of Trauma (AAST) appendicitis severity grading criteria use independent subscales for radiologists (Rad), surgeons (Surg), and pathologists (Path). We reviewed the EAST Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database to determine rates of discordance and clinical consequences of inaccuracy.

Materials And Methods: A confusion matrix was constructed for pairs among Rad, Surg, and Path.

The Usefulness of the Pretreatment Neutrophil/Lymphocyte Ratio as a Predictor of the 5-Year Survival in Stage 1-3 Triple Negative Breast Cancer Patients.

Background: We have previously shown that the neutrophil/lymphocyte ratio (NLR) is a predictor of survival among breast cancer patients. The aim of this study was to determine the predictive value of NLR among different nodal and chemotherapy subgroups of triple negative breast cancer (TNBC).

Methods: Patients with stage 1-3 TNBC who underwent treatment from 2007 to 2014 and had blood counts prior to treatments were included.

Do all cardiac surgery patients benefit from antifibrinolytic therapy?

Background: In trauma patients, the recognition of fibrinolysis phenotypes has led to a re-evaluation of the risks and benefits of antifibrinolytic therapy (AF). Many cardiac patients also receive AF, but the distribution of fibrinolytic phenotypes in that population is unknown. The purpose of this hypothesis-generating study was to fill that gap.

The Key to Combat Readiness Is a Strong Military-Civilian Partnership.

Introduction: In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents <0.5% of military hospital admissions and not all team members have daily clinical responsibilities. Military surgeon clinical experience has been described, but no data exist for other members of the FRST.

One-year outcomes of congenital diaphragmatic hernia repair: Factors associated with recurrence and complications.

Purpose: Congenital diaphragmatic hernia (CDH) is a congenital anomaly associated with lifelong multisystem morbidity. This study sought to identify factors contributing to hospital readmission after CDH repair.

Methods: The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients with CDH who underwent surgical repair.

Impact of Delay in Appendectomy on the Outcome of Appendicitis: A Post Hoc Analysis of an EAST Multicenter Study.

Association between time-to-appendectomy and clinical outcomes is controversial with conflicting data regarding risk of perforation. The purpose of this study was to explore the associations between in-hospital delay in treatment of simple appendicitis with the incidence of complicated appendicitis discovered at appendectomy. The Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database was queried and patients with acute appendicitis diagnosed on imaging were included.

Readmission for venous thromboembolism after emergency general surgery is underreported and influenced by insurance status.

Background: Prior studies of venous thromboembolism (VTE) after emergency general surgery (EGS) are not nationally representative nor do they fully capture readmissions to different hospitals. We hypothesized that different-hospital readmission accounted for a significant number of readmissions with VTE after EGS and that predictive factors would be different for same- and different-hospital readmissions.

Methods: The 2014 Nationwide Readmissions Database was queried for nonelective EGS hospitalizations.

Readmission for infection after blunt splenic injury: A national comparison of management techniques.

Background: As nonoperative management (NOM) of blunt splenic injury (BSI) increases, understanding risks, especially infectious complications, becomes more important. There are no national studies on BSI outcomes that track readmissions across hospitals. Prior studies demonstrate that infection is a major cause of readmission after trauma and that a significant proportion is readmitted to different hospitals.

Pexy of intraperitoneal LVAD driveline to relieve small bowel obstruction.

Background: Left ventricular assist device (LVAD) implantation is a lifesaving intervention in advanced heart failure. However, LVAD is not without complication. In this case, an inadvertent intraperitoneal driveline caused small bowel obstruction, subsequently requiring pexy of the driveline to the abdominal wall to avoid future complications.