Revisional bariatric surgery at a single institution.

Background: Bariatric surgery, although safe, can have long-term complications that require revision. Our series illustrates the spectrum of primary procedures, indications for surgery, and strategies for revision.

Methods: The study was a retrospective chart review.

Assessing compliance with national quality measures to improve colorectal cancer care at the VA.

Background: The US Department of Veterans Affairs (VA) Office of Quality and Performance's July 2009 report detailed the quality of VA colorectal cancer (CRC) care on the basis of 10 quality indicators (QIs). Of 21 Veterans Integrated Service Networks (VISNs), the authors' VISN ranked last or near last on more than half of the QIs. The aim of this study was to compare a national-level assessment of performance with an institutional-level clinical review.

Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program.

Objectives: Deep vein thrombosis (DVT) is a major source of postoperative morbidity and mortality and is currently a major quality improvement initiative. Mechanical and pharmacological prophylaxis is effective in preventing postoperative thromboembolic events, yet it remains underutilized in the clinical setting. Thus, the objective of this study was to develop and implement a computerized DVT risk assessment program in the electronic medical record and determine its effect on compliance with DVT prophylaxis guidelines.

Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature.

Background: Outcomes after cancer resections have been shown to be better for high-volume surgeons compared with low-volume surgeons; however, reasons for this relationship have been difficult to identify. The objective of this study was to assess studies examining the effect of surgeon training and experience on outcomes in surgical oncology.

Methods: A systematic review of the literature was performed to assess articles examining the impact of surgeon training, certification, and experience on outcomes.

Retrievable inferior vena cava filters in high-risk patients undergoing bariatric surgery.

Background: Placement of retrievable inferior vena cava filters (rIVCF) may be beneficial in high-risk morbidly obese patients undergoing bariatric procedures. Patients with a previous history of venous thromboembolism (VTE) are at high risk for postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE).

Methods: A prospective database of bariatric surgery patients was studied from April 2003 to May 2007.

Quality of pancreatic cancer care at Veterans Administration compared with non-Veterans Administration hospitals.

Background: National efforts are underway to monitor the quality of patient care at Veterans Administration (VA) hospitals. The objective of this study was to examine treatment utilization and outcomes for localized pancreatic cancer at VA compared with non-VA hospitals.

Methods: Using the National Cancer Data Base, patients with pretreatment clinical stage I/II pancreatic adenocarcinoma were identified.

Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients.

Background: Venous thromboembolism (VTE), manifest as deep venous thrombosis (DVT) or pulmonary embolus, remains an important complication in bariatric operation patients. Our purpose was to determine the incidence of VTE in a consecutive series of patients undergoing Roux-en-Y gastric bypass (RYGB) to guide appropriate therapy.

Methods: We prospectively examined a consecutive series of RYGB patients with bilateral lower-extremity venous duplex scan (DS) preoperatively, on postoperative day (POD)#2, and approximately POD#14.

Are young surgeons competent to perform alimentary tract surgery?

Background: Assessment of competency during residency training has received increased attention recently. There has been less attention given to the competency of residents after training.

Hypothesis: Patient outcomes for alimentary tract surgery (ATS) should be similar for surgeons who recently completed their residency training compared with more experienced surgeons, indicating that the younger surgeons had achieved clinical competency on completion of their residency training.

Questioning skills: the effect of wait time on accuracy of medical student responses to oral and written questions.

Background: Pauses (wait time) after asking questions in pre-college classes result in improved discussion and answer accuracy. The authors hypothesized that this would extend to medical students.

Method: Third-year surgery clerks were randomized to three-second or six-second wait times after questions asked of them during a scripted lecture.

A learning prescription permits feedback on feedback.

Background: Students consistently identified inadequate feedback as a deficiency in our third-year clerkship.

Methods: We asked students to solicit one faculty and one resident every 2 weeks for written feedback on a "feedback prescription pad." Each prescription requested four comments: two things the student did well and two things the student needs to improve.

Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience.

Background. We examined patient outcomes for colon resection to determine if they varied according to surgeon-specific factors including: (1) American Board of Surgery (ABS) certification, (2) colorectal surgery subspecialty certification, (3) site of residency training (university-based vs nonuniversity-based), and (4) years of experience since ABS certification. Methods.

Surgical management of obesity.

Bariatric surgery has undergone significant change in the past several decades. There are now several attractive surgical options for the management of clinically severe obesity (body mass index > 40 kg/m2). Gastric restrictive procedures predominate and have been performed with acceptable complication rates.

Risk factors for conversion of laparoscopic to open cholecystectomy.

Background: Laparoscopic cholecystectomy (LC) has become the treatment of choice for symptomatic gallstones; however conversion to open cholecystectomy (OC) remains a possibility. Unfortunately, preoperative factors indicating risk of conversion are unclear. Therefore, we aimed to identify risk factors associated with conversion of LC to OC.

CT scan in the management of acute appendicitis.

Background: Recent studies demonstrate a 98% accuracy of a CT scan in the diagnosis of acute appendicitis. We aimed to determine the accuracy and clinical value of CT scans in patients suspected of having acute appendicitis.

Patients And Materials: We reviewed outcomes of 125 patients over a 5-month period who had CT scans for the initial diagnosis of acute appendicitis.

Laparoscopic ventral hernia repair: an initial institutional experience.

Background: Ventral and incisional hernias remain a problem for surgeons with reported recurrence rates of 25-50% for open repairs. Laparoscopic approaches offer several theoretical advantages over open repairs.

Materials And Methods: All patients undergoing a laparoscopic ventral hernia repair from April to December 2000 were prospectively entered in a database.