Association of Residency Applicants' Hobbies and Subsequent Technical Proficiency Ratings as General Surgery Chief Residents: A Multi-Institutional Study.

Objective: To determine whether participation in certain hobbies (e.g., participation in sports, playing musical instruments, or other hobbies requiring fine motor skills), preresidency, are associated with higher technical skills ratings at the time of residency graduation.

Impact of Automated Reminder Calls in a Safety-Net Setting on Surgical Clinic No-Show Rates.

In surgical clinics, missed appointments may lead to delayed diagnosis and postponed surgical intervention. Automated reminder calls (robocalls) have replaced live staff phone calls in many systems as a cost-saving measure. This study aims to evaluate whether robocalls reduced the outpatient appointment no-show rate for surgical patients in a county hospital.

Faculty Scoring of General Surgery Residency Interviewees: A Comparison of In-Person and Virtual Interview Formats.

Objective: With new rules regarding social distancing and non-essential travel bans, we sought to determine if faculty scoring of general surgery applicants would differ between the in-person interview (IPI) and virtual interview (VI) platforms.

Design: A single institution, retrospective review comparing faculty evaluation scores of applicant interviewees in the 2019 and 2020 MATCH® application cycles (IPIs) and the 2021 and 2022 application cycle (VIs) was conducted. Faculty scored applicants using a 5-point Likert scale in 7 areas of assessment and assigned each student to 1 of 4 tiers (tier 1 highest).

A Sisyphean Task for Residents: Preparing Literature Reviews About Adverse Events Presented at Morbidity and Mortality Conferences.

Objective: Surgery Morbidity and Mortality (M&M) presentations include a thorough literature review. This requires a significant amount of time expenditure frequently incompatible with the current surgical resident work hours. Additionally, literature reviews can be redundant for commonly encountered adverse events.

Should Robotic Surgery Training Be Prioritized in General Surgery Residency? A Survey of Fellowship Program Director Perspectives.

Objective: Robotic surgery has been increasingly incorporated into the subspecialties of colorectal (CRS), minimally invasive/bariatric (MIS/Bar), and surgical oncology/hepatobiliary (SO/HPB) surgery, yet its impact on fellowship applicant evaluation and contribution to postresidency training remains undefined. The aim of our study was to evaluate how robotic training during General Surgery (GS) residency affects an applicant's competitiveness from the perspective of fellowship programs.

Design: A web-based survey was sent to all 235 accredited fellowship programs in CRS (n = 66), MIS/Bar (n = 122), and SO/HPB (n = 47) within the United States and Canada.

Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis.

Paraesophageal hernia (PEH) repair is typically performed electively. Complex PEHs (obstructed or gangrenous) require more urgent repair and can have significant complications. Although elective repair is primarily laparoscopic, limited data are available on the use of laparoscopy for complex cases.

Outcomes of Combined Hernia Repair and Peritoneal Dialysis Catheter Placement: A NSQIP Analysis.

Historically, hernias were repaired before peritoneal dialysis (PD) catheter placement to obviate hernia complications, or after PD catheter placement once hernias became symptomatic or complicated. The aim of this study was to evaluate the outcomes and safety of combined hernia repair and PD catheter placement (HPD) compared with PD catheter placement alone. Within the NSQIP databases (2005-2014), 4406 patients who underwent PD catheter placement alone and 330 patients who underwent HPD were identified.

Association of Early vs Delayed Cholecystectomy for Mild Gallstone Pancreatitis With Perioperative Outcomes.

This study uses 2011-2014 ACS NSQIP data to compare perioperative outcomes for early vs delayed cholecystectomy treatment among 1937 adult patients with mild gallstone pancreatitis.

Can Deficiencies in Performance Be Identified Earlier in Surgical Residency? An Initial Report of a Surgical Trainee Assessment of Readiness Exam.

Objective: Identifying gaps in medical knowledge, patient management, and procedural competence is difficult early in surgical residency. We designed and implemented an end-of-year examination for our postgraduate year 1 residents, entitled Surgical Trainee Assessment of Readiness (STAR). Our objective in this study was to determine whether STAR scores correlated with other available indicators of resident performance, such as the American Board of Surgery in-training exam (ABSITE) and Milestone scores, and if they provided evidence of additional discriminatory value.

Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study.

Introduction: Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures.

Effectiveness of systems changes suggested by simulation of adverse surgical outcomes.

Background: Simulation of adverse outcomes (SAO) has been described as a technique to improve effectiveness of root cause analysis (RCA) in healthcare. We hypothesise that SAO can effectively identify unsuspected root causes amenable to systems changes.

Methods: Systems changes were developed and tested for effectiveness in a modified simulation, which was performed eight times, recorded and analysed.

Clamshell incision versus left anterolateral thoracotomy. Which one is faster when performing a resuscitative thoracotomy? The tortoise and the hare revisited.

Background: The clamshell incision (CI) offers a better exposure than the left anterolateral thoracotomy (LAT) as a resuscitative thoracotomy. Most surgeons will have to manage a heart wound only once or twice in their career. The patient's survival depends on how fast the surgeon can control the heart wound; however, it is unclear which of the two incisions allows for faster control in the hands of inexperienced surgeons.

Impact of infusion rates of fresh frozen plasma and platelets during the first 180 minutes of resuscitation.

Background: Whether high-ratio resuscitation (HRR) provides patients with survival advantage remains controversial. We hypothesized a direct correlation between HRR infusion rates in the first 180 minutes of resuscitation and survival.

Study Design: This was a retrospective analysis of massively transfused trauma patients surviving more than 30 minutes and undergoing surgery at a level 1 trauma center.

To TQIP or not to TQIP? That is the question.

The Trauma Quality Improvement Program (TQIP) reports a feasible mortality prediction model. We hypothesize that our institutional characteristics differ from TQIP aggregate data, questioning its applicability. We conducted a 2-year (2008 to 2009) retrospective analysis of all trauma activations at a Level 1 trauma center.

Using simulation to improve root cause analysis of adverse surgical outcomes.

Objective: The purpose of this study was to develop and test a simulation method of conducting investigation of the causality of adverse surgical outcomes.

Design: Six hundred and thirty-one closed claims of a major medical malpractice insurance company were reviewed. Each case had undergone conventional root cause analysis (RCA).

Impact of hormonal protection in blunt and penetrating trauma: a retrospective analysis of the National Trauma Data Bank.

Over the last decade, gender and age-related hormonal status of trauma patients have been increasingly recognized as outcome factors. In the present study, we examine a large cohort of trauma patients to better appraise the effects of gender and age on patient outcome after blunt and penetrating trauma. We hypothesize that adult females are at lower risk for complications and mortality relative to adult males after both blunt and penetrating trauma.

When enough is enough: impact of packed red blood cells in massive transfusion outcomes.

Massive transfusion protocol (MTP) with fresh-frozen plasma and packed red blood cells (PRBCs) in a 1:1 ratio is one of the most common resuscitative strategies used in patients with severe hemorrhage. There are no studies to date that examine the best postoperative hematocrit range as a marker for survival after MTP. We hypothesize a postoperative hematocrit dose-dependent survival benefit in patients receiving MTP.

Initial assessment on the impact of crystalloids versus colloids during damage control resuscitation.

Background: High ratios of fresh frozen plasma:packed red blood cells in damage control resuscitation (DCR) are associated with increased survival. The impact of volume and type of resuscitative fluid used during high ratio transfusion has not been analyzed. We hypothesize a difference in outcomes based on the type and quantity of resuscitative fluid used in patients that received high ratio DCR.

Complications of liver resection: laparoscopic versus open procedures.

Background And Objective: Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection.

Methods: We performed a single-center retrospective chart review.

Bilateral anterior thoracotomy (clamshell incision) is the ideal emergency thoracotomy incision: an anatomic study.

Background: Emergency thoracotomy (ET) is a procedure that provides rapid access to intrathoracic structures for thoracic trauma patients arriving at the hospital in extremis. This study assesses the accessibility of intrathoracic structures provided by six different ET incisions. We hypothesize that the bilateral anterior thoracotomy ("clamshell" incision) provides the most rapid and definitive accessibility to intrathoracic structures.

Impact of inverse ratios on patients with exsanguinating vascular injuries: should more be the new paradigm?

Background: Resuscitation strategies in patients with severe hemorrhage have evolved throughout the years. Optimal resuscitation ratios for civilian exsanguinating vascular injuries has not been determined. We hypothesize improved outcomes in patients with exsanguinating vascular injuries when an aggressive hemostatic resuscitation is used with an inverse ratio of fresh frozen plasma (FFP) to packed red blood cell (PRBC).

Damage control immunoregulation: is there a role for low-volume hypertonic saline resuscitation in patients managed with damage control surgery?

Hypertonic saline (HTS) is beneficial in the treatment of head-injured patients as a result of its potent cytoprotective effects on various cell lines. We hypothesize that low-volume resuscitation with 3 per cent HTS, when used after damage control surgery (DCS), improves outcomes compared with standard resuscitation with isotonic crystalloid solution (ICS). This is a 4-year retrospective review from two Level I trauma centers.