Persistent and chronic opioid use after ambulatory surgery in US veterans (2011-2018).

Background: Opioid use beyond the perioperative period is a recognized adverse outcome, primarily studied in inpatients after complex major surgeries. Our goals are to determine the risk after ambulatory surgery and identify risk factors associated with long-term opioid prescriptions.

Methods: Our ambulatory surgery cohort included 1,393,332 veterans from October 1, 2011, to September 30, 2018 (fiscal year [FY] 12-18).

Intraoperative imaging and management of common duct stones during subtotal cholecystectomy.

Background: Subtotal cholecystectomy is advocated in patients with severe inflammation and distorted anatomy preventing safe removal of the entire gallbladder. Not well documented in this surgically complex population is the feasibility of intraoperative imaging and management of common bile duct (CBD) stones. We evaluated these operative maneuvers in our subtotal cholecystectomy patients.

Loss-of-function mutants are associated with gut dysbiosis and alterations in intestinal gene expression in preterm infants.

Loss of Paneth cell (PC) function is implicated in intestinal dysbiosis, mucosal inflammation, and numerous intestinal disorders, including necrotizing enterocolitis (NEC). Studies in mouse models show that zinc transporter ZnT2 () is critical for PC function, playing a role in granule formation, secretion, and antimicrobial activity; however, no studies have investigated whether loss of ZnT2 function is associated with dysbiosis, mucosal inflammation, or intestinal dysfunction in humans. was sequenced in healthy preterm infants (26-37 wks; n = 75), and structural analysis and functional assays determined the impact of mutations.

Clinical Empathy for the Surgical Patient: Lessons From W.H. Auden's Prose and Poetry.

Clinical empathy is a professional skill, representing a conscious commitment to showing patients that they are heard, understood, and accepted. Here, we explore ways in which masters of language, such as the mid-20th century poet W. H.

Image-based assessment of sarcopenic obesity predicts mortality in major trauma.

Background: Patients with obesity are also at risk for sarcopenia, which is difficult to recognize in this population. Our study examines whether sarcopenic-obesity (SO) is independently associated with mortality in trauma.

Methods: Using a retrospective database, we performed logistic regression analysis.

Nudging patients and surgeons to change ambulatory surgery pain management: Results from an opioid buyback program.

Background: Optimal postoperative opioid stewardship combines adequate pain medication to control expected discomfort while avoiding abuse and community diversion of unused prescribed opioids. We hypothesized that an opioid buyback program would motivate patients to return unused opioids, and surgeons will use that data to calibrate prescribing.

Methods: Prospective cohort study of postambulatory surgery pain management at a level II Veterans Affairs rural hospital (2017-2019).

Incidence, risk factors, and outcomes of early postoperative hyperglycemia in surgical patients: a protocol for a systematic review and meta-analysis.

Background: Early postoperative hyperglycemia (POHG) is common and associated with poor postoperative outcomes. Currently, there is no systematic review and meta-analysis that addresses the knowledge gap of the incidence of POHG in surgical patients and that explores the associated risk factors and complications. The objective of this study will be to estimate the pooled incidence, risk factors, and clinical outcomes of early postoperative hyperglycemia in men and women globally.

Macrolets: Outsized Extracellular Vesicles Released from Lipopolysaccharide-Stimulated Macrophages that Trap and Kill Escherichia coli.

Macrophages release a variety of extracellular vesicles (EVs). Here we describe a previously unreported class of EVs that are released from macrophages in response to Escherichia coli endotoxin, lipopolysaccharide (LPS), that we have named "macrolets" since they are extruded as large "droplets" released from macrophages. Morphologically, macrolets are anuclear, bounded by a single lipid membrane and structurally dependent on an actin cytoskeleton.

A common genetic variant in zinc transporter ZnT2 (Thr288Ser) is present in women with low milk volume and alters lysosome function and cell energetics.

Suboptimal lactation is a common, yet underappreciated cause for early cessation of breastfeeding. Molecular regulation of mammary gland function is critical to the process lactation; however, physiological factors underlying insufficient milk production are poorly understood. The zinc (Zn) transporter ZnT2 is critical for regulation of mammary gland development and maturation during puberty, lactation, and postlactation gland remodeling.

Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis.

Introduction: In 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries.

Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis.

Background: The survival rates from breast cancer in Africa are poor and yet the incidence rates are on the rise. In this study, we hypothesized that, in Africa, a continent with great disparities in socio-economic status, race, tumor biology, and cultural characteristics, the survival rates from breast cancer vary greatly based on region, tumor biology (hormone receptor), gender, and race. We aimed to conduct the first comprehensive systematic review and meta-analysis on region, gender, tumor-biology and race-specific 5-year breast cancer survival rates in Africa and compared them to 20-year survival trends in the United States.

Pain and Dysfunction with Sexual Activity after Inguinal Hernia Repair: Systematic Review and Meta-Analysis.

Background: The reported incidence rates of sexual dysfunction (SD) and pain with sexual activity (PSA) after inguinal hernia repair in males vary considerably. This meta-analysis explores the rates of SD and PSA after different surgical and anesthesia types to understand patient risk after inguinal hernia repair.

Study Design: We performed a systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search 3 databases (EMBASE, MEDLINE, and Cochrane Library).

The Role of Genetic Variant rs13266634 in SLC30A8/ZnT8 in Postoperative Hyperglycemia After Major Abdominal Surgery.

Context: Following major surgery, postoperative hyperglycemia (POHG) is associated with suboptimal outcomes among patients with diabetes and nondiabetic patients. A specific genetic variant, rs13266634 (c.973C>T; p.

The Impact of Minimally Invasive Gastrectomy on Survival in the USA.

Background: Minimally invasive surgical approaches for gastric adenocarcinoma are increasing in prevalence. Although recent studies suggest such approaches are associated with improvements in short-term outcomes, long-term outcomes have not been well studied. This study aimed to evaluate the impact of minimally invasive gastrectomy on long-term survival.

Exhortation to lose weight prior to complex ventral hernia repair: Nudge or noodge?

Background: Exercise and weight loss are recommended for patients with obesity undergoing elective complex ventral hernia repair (cVHR).

Methods: Weight and BMI trajectory data on 230 obese patients undergoing cVHR from 2012 to 2017 were retrospectively analyzed from 12 months prior to first visit with the hernia surgeon to 12 months after surgery.

Results: One year prior to initial visit, 76 (33%) patients had lost > 1kg/m, 98 (43%) had gained> 1kg/m, and 56 (24%) had no change in body mass index (BMI).

Postoperative hyperglycemia in patients undergoing cytoreductive surgery and HIPEC: A cohort study.

Background: Hyperglycemia following elective or emergency surgery is generally associated with an increased risk of complications. The impact of hyperglycemia following surgery for peritoneal surface malignancy remains unclear.

Materials And Methods: Records of patients undergoing cytoreduction and HIPEC for peritoneal surface malignancy were reviewed at two institutions.

Excess Dietary Zinc Intake in Neonatal Mice Causes Oxidative Stress and Alters Intestinal Host-Microbe Interactions.

Scope: Greater than 68% of young infants are exposed to dietary zinc (Zn) levels that are higher than the Tolerable Upper Intake Limit. However, the consequences of excess dietary Zn during early life on intestinal function and host-microbe interactions are unknown.

Methods And Results: Neonatal mice are gavaged with 100 Zn µg d from postnatal day (PN) 2 through PN10 and indices of intestinal function and host-microbe interactions are compared to unsupplemented mice.

Cost-utility analysis of smoking cessation to prevent operative complications following elective abdominal colon surgery.

Background: Smoking is a known risk factor for postoperative complications after colectomy. Using the perspective of the provider, this study evaluated the cost-effectiveness of the pharmacologic interventions for smoking cessation.

Methods: A decision tree model was constructed to represent a provider's decision to provide either bupropion, nicotine replacement therapy, varenicline, or no cessation therapy to all patients presenting for elective colectomy.

Nonalcoholic Fatty Liver Disease as a High-Value Predictor of Postoperative Hyperglycemia and Its Associated Complications in Major Abdominal Surgery.

Background: For patients undergoing major abdominal operations, acute postoperative hyperglycemia (POHG) is associated with suboptimal outcomes and higher costs of care. This study was performed to determine whether CT-derived indices of nonalcoholic fatty liver disease (hepatic steatosis) or visceral adiposity may serve as predictors of POHG and its consequences in such patients.

Study Design: We reviewed records and preoperative abdominal CT images of 129 patients undergoing complex open ventral hernia repair (cVHR) from 2012 to 2016, with 90-day follow-up.

Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias.

Background: After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care.

Methods: Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR.

Results: In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.

Temporally Distinct Regulation of Pathways Contributing to Cardiac Proteostasis During the Acute and Recovery Phases of Sepsis.

Background: Cardiac dysfunction is a common manifestation of sepsis and is associated with early increases in inflammation and decreases in myocardial protein synthesis. However, little is known regarding the molecular mechanisms regulating protein homeostasis during the recovery phase after the removal of the septic nidus. Therefore, the purpose of this study was to investigate diverse signal transduction pathways that regulate myocardial protein synthesis and degradation.

The 1990s and the Association for Academic Surgery.

This lecture reviews the progress of the Association for Academic Surgery during the 1990s, a decade of sweeping innovations in technology, communication, and biomedical sciences; a well as a decade of transition in the demographics of surgical trainees; and a decade of new and previously unimagined possibilities for new directions in academic surgical careers.

Immune and metabolic responses in early and late sepsis during mild dietary zinc restriction.

Background: Mild dietary zinc (Zn) deficiency is widespread in human populations, but its influence on recovery after acute illness is poorly understood. In a mouse model of abdominal sepsis (cecal ligation puncture), systemic immune responses and liver metabolism were monitored in early (24 h) and late (5 d) phases, under control conditions and during mild dietary Zn restriction.

Methods: Mice were fed diets adequate or marginally deficient (ZM) in Zn (30 versus 10 mg zinc/kg diet) for 4 wk, before undergoing laparotomy alone (nonseptic control) or cecal ligation puncture (septic).