Preoperative Prediction of Postoperative Infections Using Machine Learning and Electronic Health Record Data.

Objective: To estimate preoperative risk of postoperative infections using structured electronic health record (EHR) data.

Background: Surveillance and reporting of postoperative infections is primarily done through costly, labor-intensive manual chart reviews on a small sample of patients. Automated methods using statistical models applied to postoperative EHR data have shown promise to augment manual review as they can cover all operations in a timely manner.

Emergency thoracic surgery patients have worse risk-adjusted outcomes than non-emergency patients.

Background: Outcomes for patients undergoing emergency thoracic operations have not been well described. This study was designed to compare postoperative outcomes among patients undergoing emergency versus nonemergency thoracic operations.

Methods: We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2005-2018).

Esophagram should be performed to diagnose esophageal perforation before inter-hospital transfer.

Background: Early recognition of esophageal perforation may prevent morbidity and mortality, and accurate diagnostic imaging facilitates triage. Stable patients with suspected perforation may be transferred to higher levels of care before appropriate work-up and diagnosis confirmation. We reviewed patients transferred for esophageal perforation to critically analyze the diagnostic workflow.

Prospective Evaluation of a Universally Applied Laparoscopic Gastric Ischemic Preconditioning Protocol Prior to Esophagectomy with Comparison with Historical Controls.

Background: Anastomotic leak after esophagectomy is associated with significant morbidity and mortality. Our institution began performing laparoscopic gastric ischemic preconditioning (LGIP) with ligation of the left gastric and short gastric vessels prior to esophagectomy in all patients presenting with resectable esophageal cancer. We hypothesized that LGIP may decrease the incidence and severity of anastomotic leak.

Food Deserts Increase Readmission After Esophagectomy for Cancer: A Multi-institutional Study.

Background: Food deserts are low-income census tracts with poor access to supermarkets and are associated with worse outcomes in breast, colon, and a small number of esophageal cancer patients. This study investigated residency in food deserts on readmission rates in a multi-institutional cohort of esophageal cancer patients undergoing trimodality therapy.

Methods: A retrospective review of patients who underwent trimodality therapy at 6 high-volume institutions from January 2015 to July 2019 was performed.

Does Work Relative Value Unit Measure Surgical Complexity for Risk Adjustment of Surgical Outcomes?

Introduction: The purpose of this study was to determine whether the work relative value unit (workRVU) of a patient's operation can be useful as a measure of surgical complexity for the risk adjustment of surgical outcomes.

Methods: We retrospectively analyzed the American College of Surgeon's National Surgical Quality Improvement Program database (2005-2018). We examined the associations of workRVU of the patient's primary operation with preoperative patient characteristics and associations with postoperative complications.

Lessons learned by thoracic surgeons during the COVID-19 pandemic.

Background: The scale of the coronavirus disease 2019 (COVID-19) pandemic has necessitated healthcare systems to adapt and evolve, altering physician roles and expectations. Thoracic surgeons have seen practice changes from new COVID-19 consults to necessary delay and triage of elective care. The goal of this study was to understand the impact of COVID-19 on thoracic surgeon experiences in order to anticipate roles and changes in practice in future such circumstances.

Preoperative Prediction of Unplanned Reoperation in a Broad Surgical Population.

Introduction: Unplanned reoperation is an undesirable outcome with considerable risks and an increasingly assessed quality of care metric. There are no preoperative prediction models for reoperation after an index surgery in a broad surgical population in the literature. The Surgical Risk Preoperative Assessment System (SURPAS) preoperatively predicts 12 postoperative adverse events using 8 preoperative variables, but its ability to predict unplanned reoperation has not been assessed.

Effect of Present at Time of Surgery on Unadjusted and Risk-Adjusted Postoperative Complication Rate.

Background: Present at the time of surgery (PATOS) is an important measure to collect in postoperative complication surveillance systems because it may affect a patient's risk of a subsequent complication and the estimation of postoperative complication rates attributed to the healthcare system. The American College of Surgeons (ACS) NSQIP started collecting PATOS data for 8 postoperative complications in 2011, but no one has used these data to quantify how this may affect unadjusted and risk-adjusted postoperative complication rates.

Study Design: This study was a retrospective observational study of the ACS NSQIP database from 2012 to 2018.

Development and validation of models for detection of postoperative infections using structured electronic health records data and machine learning.

Background: Postoperative infections constitute more than half of all postoperative complications. Surveillance of these complications is primarily done through manual chart review, which is time consuming, expensive, and typically only covers 10% to 15% of all operations. Automated surveillance would permit the timely evaluation of and reporting of all operations.

Informational Needs of Surgical Oncology Patients: A Cross-Sectional Patient Survey.

Introduction: Patients newly diagnosed with cancer often seek information prior to being seen by a specialist. Little is known about the type of information desired and the sources used. We asked how patients find information about their new cancer diagnoses to improve information provision.

Barriers and Facilitators in Implementation of an Esophagectomy Care Pathway: a Qualitative Analysis.

Introduction: A new postoperative esophagectomy care pathway was recently implemented at our institution. Practice pattern change among provider teams can prove challenging; therefore, we sought to study the barriers and facilitators toward pathway implementation at the provider level.

Methods: This qualitative study was guided by the Theoretical Domains Framework (TDF) to study the adoption and implementation of a post-esophagectomy care pathway.

Aortic Valve Repair: A Portable, Low-Cost Simulator.

Simulation is a key adjunct to surgical training by allowing repetitive and deliberate practice. We created a low-cost, portable aortic valve simulator that can easily be re-created by any trainee. This simulator allows practice of the challenging hand movements and needle angles required in aortic valve repair and may facilitate acquisition of operating room skills and autonomy.

Inpatient Versus Outpatient Surgery: A Comparison of Postoperative Mortality and Morbidity in Elective Operations.

Background: Operations performed outpatient offer several benefits. The prevalence of outpatient operations is growing. Consequently, the proportion of patients with multiple comorbidities undergoing outpatient surgery is increasing.

Making a Painless Drain: Proof of Concept.

Chest tubes account for a large proportion of postoperative pain after cardiothoracic operations. The objective of this study was to develop a novel, cost-effective, easy-to-use, lidocaine-eluting coating to reduce pain associated with postoperative chest tubes. A lidocaine-eluting hydrogel was developed by dispersing lidocaine-loaded nanoparticles in an aqueous solution containing gelatin (5%).

Development and validation of a model for surveillance of postoperative bleeding complications using structured electronic health records data.

Background: Postoperative bleeding complications surveillance is done primarily through manual chart review. The purpose of this study was to develop and validate a detection model for postoperative bleeding complications using structured electronic health records data.

Methods: Patients who underwent operations at 1 of 5 hospitals within our local health system between 2013 and 2019 and whose complications were reported by the American College of Surgeons National Surgical Quality Improvement Program were included.

Associations Between Preoperative Risk, Postoperative Complications, and 30-Day Mortality.

Background: Comorbidities and postoperative complications increase mortality, making early recognition and management critical. It is useful to understand how they are associated with one another. This study assesses associations between comorbidities, complications, and mortality.

Does Adding a Measure of Social Vulnerability to a Surgical Risk Calculator Improve Its Performance?

Background: Emerging literature suggests that measures of social vulnerability should be incorporated into surgical risk calculators. The Social Vulnerability Index (SVI) is a measure designed by the CDC that encompasses 15 socioeconomic and demographic variables at the census tract level. We examined whether adding the SVI into a parsimonious surgical risk calculator would improve model performance.

Development and validation of a prediction model for conversion of outpatient to inpatient surgery.

Background: Unplanned hospital admission after intended outpatient surgery is an undesirable outcome. We aimed to develop a prediction model that estimates a patient's risk of conversion from outpatient surgery to inpatient hospitalization.

Methods: This was a retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program database, 2005 to 2018.

Sustainability of Palliative Care Principles in the Surgical Intensive Care Unit Using a Multi-Faceted Integration Model.

Understanding patient goals of care is essential in any setting, and especially so in an urban, safety net trauma centers' Surgical Intensive Care Units (SICU). This underscores the need for implementation of palliative care principles and practices, such as identification of surrogate decision makers, goals-of-care discussions, and CPR directives, in the SICU. A pragmatic, quality improvement study utilizing a retrospective, pre- and post-intervention continuum analysis.

Simvastatin Inhibits Histologic Changes Associated with Gastroduodenal Reflux in a Murine Model.

Background: Observational studies demonstrate a protective effect of statins on the development and progression of esophageal adenocarcinoma. The role of statins in the prevention of reflux-induced esophageal changes remains unknown.

Aims: Using a mixed gastroduodenal reflux mouse model, we hypothesized that oral administration of simvastatin would attenuate reflux-induced mucosal changes of the distal esophagus.