Equivalent Pain and Opioid Use Between Transabdominal and Retroperitoneal Adrenalectomy.

Introduction: Laparoscopic transabdominal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA) are safe, effective surgical approaches. A direct comparison of postoperative pain and narcotic use is needed.

Methods: Adults who had laparoscopic adrenalectomy at a tertiary institution from 2015 to 2021 were identified from a surgical database.

Patient Neighborhood Adversity Associated With Access Not Wait Time to Parathyroidectomy.

Introduction: Delays to treatment of primary hyperparathyroidism (PHPT) escalates patient morbidity, which particularly affects individuals from under-resourced areas already facing health disparities. We hypothesized that PHPT patients from socially and economically deprived areas encounter longer waits to surgery.

Methods: Utilizing a prospectively maintained database, we identified PHPT patients aged ≥18 undergoing initial parathyroidectomy between 2013 and 2022 at an academic, tertiary care center.

Variation in Long-Term Postoperative Mortality Risk by Race/Ethnicity After Major Non-cardiac Surgeries in the Veterans Health Administration.

Background: Few large sample studies have examined whether disparities, as measured by the proxy of race/ethnicity, are observed in long-term mortality after high-risk operations performed in a United States national health system. We compared operation year-related mortality risk by race/ethnicity after high-risk operative interventions among patients receiving care within the VHA.

Methods: From the Veterans Affairs Corporate Data Warehouse and Surgical Quality Improvement Program, data were retrieved for 426,695 patients undergoing high-risk surgical procedures in non-cardiac, general, vascular, thoracic, orthopedic, neurosurgery, and genitourinary specialties between 2000 and 2018.

Hospital resource index, race/ethnicity, and postoperative venous thromboembolism risk: A causal mediation analysis.

Background: We examined whether hospital resources mediated the association between race/ethnicity and postoperative VTE, in a national cohort.

Methods: National Inpatient Sample data were restricted to major abdominal surgeries (1993-2020) performed for malignancies. Hospital resource index was as a summary measure of hospital size, teaching status, and private payor proportions.

Results of a novel intervention to increase rates of diagnosis and treatment of primary hyperparathyroidism.

Background: Veterans with primary hyperparathyroidism are under diagnosed and undertreated. We report the results of a pilot study to address this problem.

Methods: We implemented a stakeholder-driven, multi-component intervention to increase rates of diagnosis and treatment for primary hyperparathyroidism at a single VA hospital.

Propensity weighted analysis of chemical venous thromboembolism prophylaxis agents in isolated severe traumatic brain injury: An EAST sponsored multicenter study.

Background: In patients with severe traumatic brain injury (TBI), clinicians must balance preventing venous thromboembolism (VTE) with the risk of intracranial hemorrhagic expansion (ICHE). We hypothesized that low molecular weight heparin (LMWH) would not increase risk of ICHE or VTE as compared to unfractionated heparin (UH) in patients with severe TBI.

Methods: Patients ≥ 18 years of age with isolated severe TBI (AIS ≥ 3), admitted to 24 level I and II trauma centers between January 1, 2014 to December 31, 2020 and who received subcutaneous UH and LMWH injections for chemical venous thromboembolism prophylaxis (VTEP) were included.

Don't chase the adenoma: A probabilistic approach to imaging before parathyroidectomy.

Background: Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of preoperative imaging varies substantially depending on the preoperative probability of having adenoma(s) and (2) that a selective imaging approach based on this probability could avoid unnecessary patient costs and radiation.

Methods: We analyzed 3,577 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2001 to 2022.

The risks of failed nonoperative management of appendicitis in older adults.

Background: The consequences of failed nonoperative management of appendicitis in older patients have not been described.

Methods: We used the 2004-2017 National Inpatient Sample to identify acute appendicitis patients managed nonoperatively (<65 years old: 32,469; ≥65 years old: 11,265). Outcomes included morbidity, length of stay (LOS), inpatient costs, and discharge to skilled facilities.

Is nonoperative management of appendicitis safe and effective in multi-morbid patients?

Background: The purpose of this study was to (1) compare post-treatment outcomes of operative and nonoperative management of acute appendicitis in multi-morbid patients and (2) evaluate the generalizability of prior clinical trials by determining whether outcomes differ in multi-morbid patients compared to the young and healthy patients who resemble prior clinical trial participants.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample from 2004 to 2017. We included 368,537 patients with acute, uncomplicated appendicitis who were classified as having 0 or 2+ comorbidities.

Assessing a Structured Mental Fitness Program for Academic Acute Care Surgeons: A Pilot Study.

Introduction: There is a well-established positive correlation between improved physician wellness and patient care outcomes. Mental fitness is a component of wellness that is understudied in academic medicine. We piloted a structured mental fitness Positive Intelligence (PQ) training program for academic surgeons, hypothesizing this would be associated with improvements in PQ scores, wellness, sleep, and trainee evaluations.

Reassessing surgical guidelines for papillary thyroid cancer impact on survival: Expanding indications for lobectomy.

Background: Comparisons of lobectomy versus total thyroidectomy for papillary thyroid cancer have not addressed significant threats to valid inference from observational data. The purpose of this study was to compare survival after lobectomy versus total thyroidectomy for papillary thyroid cancer while addressing bias from unmeasured confounding.

Methods: This retrospective cohort study included 84,300 patients treated with lobectomy or total thyroidectomy for papillary thyroid cancer in the National Cancer Database from 2004 to 2017.

Outcomes of Nonoperative vs Operative Management of Acute Appendicitis in Older Adults in the US.

Importance: Although the incidence of acute appendicitis among adults 65 years and older is high, these patients are underrepresented in randomized clinical trials comparing nonoperative vs operative management of appendicitis; it is unclear whether current trial data can be used to guide treatment in older adults.

Objective: To compare outcomes following nonoperative vs operative management of appendicitis in older adults and assess whether they differ from results in younger patients.

Design, Setting, And Participants: This retrospective cohort study used US hospital admissions data from the Agency for Healthcare Research and Quality's National Inpatient Sample from 2004 to 2017.

Early VTE prophylaxis in severe traumatic brain injury: A propensity score weighted EAST multicenter study.

Background: Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE).

Methods: A retrospective review of adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, ≥ 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted.

Hospital Performance on Failure to Rescue Correlates With Likelihood of Home Discharge.

Introduction: Failure to rescue (FTR) (avoiding death after complications) has been proposed as a measure of hospital quality. Although surviving complications is important, not all rescues are created equal. Patients also place considerable values on being able to return home after surgery and resume their normal lives.

Evaluating population histories in Patagonia and Tierra del Fuego, Chile, using ancient mitochondrial and Y-chromosomal DNA.

Objectives: This study aims to characterize the genetic histories of ancient hunter-gatherer groups in Fuego-Patagonia (Chile) with distinct Marine, Terrestrial, and Mixed Economy subsistence strategies. Mitochondrial (mtDNA) and Y-chromosome data were generated to test three hypotheses. H: All individuals were drawn from the same panmictic population; H: Terrestrial groups first populated the region and gave rise to highly specialized Marine groups by ~7,500 cal BP; or H: Marine and Terrestrial groups represent distinct ancestral lineages who migrated independently into the region.

Chief Residents Can Safely Operate on Older and Frail Patients.

Introduction: Older age and frailty increase the risk of poor recovery after surgery. We hypothesized that general surgery operations performed by supervised chief residents, as opposed to attending physicians, would still be safe for these vulnerable patients.

Materials And Methods: We used the Veterans Affairs Surgical Quality Improvement Program database to identify 114,525 patients age 65+ y, including 18,030 patients age 80+ y and 47,555 categorized as frail, who had a general surgery procedure from 1999 to 2019 that was performed by an attending physician or by a supervised chief resident.

Comparison of Postoperative Outcomes of Laparoscopic vs Open Inguinal Hernia Repair.

Importance: Advocates of laparoscopic surgery argue that all inguinal hernias, including initial and unilateral ones, should be repaired laparoscopically. Prior work suggests outcomes of open repair are improved by using local rather than general anesthesia, but no prior studies have compared laparoscopic surgery with open repair under local anesthesia.

Objective: To evaluate postoperative outcomes of open inguinal hernia repair under general or local anesthesia compared with laparoscopic repair.

Parallel evolution in human populations: A biocultural perspective.

Parallel evolution-where different populations evolve similar traits in response to similar environments-has been a topic of growing interest to biologists and biological anthropologists for decades. Parallel evolution occurs in human populations thanks to myriad biological and cultural mechanisms that permit humans to survive and thrive in diverse environments worldwide. Because humans shape and are shaped by their environments, biocultural approaches that emphasize the interconnections between biology and culture are key to understanding parallel evolution in human populations as well as the nuances of human biological variation and adaptation.

Age is associated with increased morbidity after laparoscopic appendectomy.

Background: Laparoscopic appendectomy is one of the most common emergency general surgery procedures in the United States. Little is known about its postoperative outcomes for older adults because appendicitis typically occurs in younger patients. The purpose of this study was to examine the association between age and postoperative complications after appendectomy.

Resident Involvement in Inguinal Hernia Repair Is Safe but Associated With Increased Operative Time.

Introduction: Understanding how resident participation in surgery affects outcomes is critical for academic surgeons. The purpose of this study was to evaluate if resident participation was associated with adverse outcomes for inguinal hernia repair.

Methods: We used the Veterans Affairs Surgical Quality Improvement Program to look at 61,737 patients aged ≥18 y who had open inguinal hernia repairs from 1998 to 2018.

Machine Learning Improves Prediction Over Logistic Regression on Resected Colon Cancer Patients.

Introduction: Despite advances, readmission and mortality rates for surgical patients with colon cancer remain high. Prediction models using regression techniques allows for risk stratification to aid periprocedural care. Technological advances have enabled large data to be analyzed using machine learning (ML) algorithms.

Provider Perception of Time During Trauma Resuscitation: A Prospective Quantitative Trauma Video Review Analysis.

Introduction: Delays in transition to the next phase of care result in increased mortality. Prehospital literature suggests emergency medical service technicians underestimate transport times by as much as 20%. What remains unknown is clinician perception of time during the trauma resuscitation.