Publications by authors named "Christopher F Janowak"

Introduction: Thoracobiliary fistula (TBF) is a rare and highly morbid complication of hepatic trauma. There is a paucity of literature regarding incidence, disease course, and treatment. This study identifies etiologic factors and outcome patterns in patients at risk for TBF.

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Introduction: Prior work has demonstrated utility in using operative time to measure surgeon learning for surgical stabilization of rib fractures (SSRF); however, no studies have used operative time to evaluate the benefit of proctoring in subsequent generations of surgeons. We sought to evaluate whether there is a difference in learning between an original series (TOS) of self-taught surgeons versus the next generation (TNG) of proctored surgeons using cumulative summation (CUSUM) analysis. We hypothesized that TNG would have a comparatively accelerated learning curve.

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Introduction: Sarcopenia has been shown to portend worse outcomes in injured patients; however, little is known about the impact of thoracic muscle wasting on outcomes of patients with chest wall injury. We hypothesized that reduced pectoralis muscle mass is associated with poor outcomes in patients with severe blunt chest wall injury.

Methods: All patients admitted to the intensive care unit between 2014 and 2019 with blunt chest wall injury requiring mechanical ventilation were retrospectively identified.

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Background: Over the last two decades, the acute management of rib fractures has changed significantly. In 2021, the Chest Wall injury Society (CWIS) began recognizing centers that epitomize their mission as CWIS Collaborative Centers. The primary aim of this study was to determine the resources, surgical expertise, access to care, and institutional support that are present among centers.

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Article Synopsis
  • - The study explores the incidence and characteristics of surgical stabilization of rib fractures (SSRF) at various trauma centers, highlighting the CWIS initiative to identify exemplary centers for this treatment.
  • - An analysis of 26,084 patient cases revealed that 24% had rib fractures, with only 2% of all patients and 8% of those with rib fractures undergoing SSRF, emphasizing variations based on age and injury severity.
  • - The findings suggest that SSRF rates are higher in specific age groups, particularly those aged 50-69, indicating potential disparities in treatment across different age ranges that warrant further examination.
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  • Publication bias leads to a preference for publishing positive results over negative ones, which can distort the perceived effectiveness of treatments in meta-analyses, particularly in surgical studies.
  • A review of 318 meta-analyses in plastic surgery journals from 2002 to 2022 revealed that only 64% acknowledged publication bias, and just 6.3% actively assessed and attempted to correct for it.
  • The study found that journals with higher impact factors were more likely to recognize and evaluate publication bias, highlighting a gap in rigorous assessment in recent literature.
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Objective: Despite increasing female representation in General Surgery (GS) residency training programs, proportional improvement of female enrollment in surgical fellowships has yet to be quantified. We aimed to assess if female enrollment in surgical fellowships has improved at an equivalent rate in 7 different surgical fellowship options after GS.

Design And Setting: Data were collected from Accreditation Council for Graduate Medical Education (ACGME) resources which disclosed active resident and fellow characteristics.

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Immune checkpoint inhibitors are increasingly used as powerful anti-neoplastic therapies in the setting of melanoma. Colitis is a known complication of immune checkpoint inhibitors that if often medically managed. We present a patient with stage IV melanoma with demonstrated in-transit disease undergoing immune checkpoint inhibitor therapy.

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Background: Surgical stabilization of rib fractures (SSRF) is an accepted efficacious treatment modality for patients with severe chest wall injuries. Despite increased adoption of SSRF, surgical learning curves are unknown. We hypothesized intraoperative duration could define individual SSRF learning curves.

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Background: Blunt pulmonary contusions are associated with severe chest injuries and are independently associated with worse outcomes. Previous preclinical studies suggest that contusion progression precipitates poor pulmonary function; however, there are few current clinical data to corroborate this hypothesis. We examined pulmonary dynamics and oxygenation in subjects with pulmonary contusions to evaluate for impaired respiratory function.

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Background: Intrapleural fibrinolytic instillation is second-line treatment for retained hemothorax. Dornase alfa (DNase) has demonstrated efficacy in parapneumonic effusion, but the lack of deoxyribonucleoproteins limits direct extrapolation to traumatic retained hemothorax treatment.

Objective: This study evaluated the effectiveness of intrapleural tissue plasminogen activator (tPA) with and without DNase in the treatment of retained traumatic hemothorax.

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Background: Blunt chest wall injury accounts for 15% of trauma admissions. Previous studies have shown that the number of rib fractures predicts inpatient opioid requirements, raising concerns for pharmacologic consequences, including hypotension, delirium, and opioid dependence. We hypothesized that intercostal injection of liposomal bupivacaine would reduce analgesia needs and improve spirometry metrics in trauma patients with rib fractures.

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Background: Pulmonary contusions (PCs) have historically been viewed as a serious complicating factor in thoracic injury. Recently, there has been conflicting evidence regarding the influence of PCs on outcomes; however, many studies do not stratify contusions by severity and may miss clinical associations. We sought to identify if contusion severity is associated with worse outcomes.

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Article Synopsis
  • Chest wall injuries can lead to serious health issues, and this study investigates whether two common injury severity scoring systems (Organ Injury Scale and Abbreviated Injury Scale) correlate with clinical outcomes like mortality and complications.
  • Analyzing data from over 3,000 patients with rib or sternal fractures, researchers found that the Abbreviated Injury Scale was often higher than the Organ Injury Scale, but both scored poorly at predicting in-hospital outcomes and readmissions.
  • Ultimately, the study suggests that current chest wall injury scoring systems may need updates to better reflect their association with patient outcomes in healthcare settings.
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Article Synopsis
  • - The study aimed to understand the rates and factors related to unexpected reevaluation and readmission of patients who suffered from rib fractures, particularly after blunt trauma, using data from a Level I trauma center between 2014 and 2016.
  • - Out of 1,717 patients with moderate to severe rib injuries, 23.1% required reevaluation within 90 days of discharge, and 10.3% were readmitted, with specific considerations for those returning for chest-related issues.
  • - Key predictors of reevaluation and readmission included higher injury severity scores, prolonged hospital stays, worsening chest x-rays at discharge, and certain health conditions like psychiatric disorders and smoking.
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Background: We previously demonstrated that unidentified aliased patients, John Doe's (DOEs), are one of the highest risk and most medically fragile populations of injured patients. Aliasing can result in misplaced information and confusion that must be overcome by health care professionals. DOE alias use is institutionally dependent and not uniform, which may lead to significant variation in perception of confusion and error.

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Trauma patients are vulnerable to medication error given multiple handoffs throughout the hospital. The purpose of this study was to assess trends in medication errors in trauma patients and the role these errors play in patient outcomes. Injured adults admitted from 2009 to 2015 to a Level I trauma center were included.

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Objective: The Surgical Apgar Score is a validated prognostic tool that is based on select intraoperative variables (heart rate, mean arterial pressure, and blood loss). It has been shown to be a strong predictor of morbidity and mortality in a variety of surgical populations. Esophagectomy for malignancy represents a unique subset of patients at high risk for postoperative complications.

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