Subtotal cholecystectomy with omental pedicle plug for the challenging gallbladder: A case report and review of the literature.

If patient anatomy or disease does not allow for a traditional or partial cholecystectomy, an omental pedicle plug may be a viable option to limit the risk of postoperative uncontrolled bile leak from the cystic duct and to control patient symptoms.

Bowel Preparation Before Nonelective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused.

Background: Although strong evidence exists for combined mechanical and oral antibiotic bowel preparation before elective colorectal resection, the utility of preoperative bowel preparation for patients undergoing sigmoid resection after endoscopic decompression of sigmoid volvulus has not been previously examined. The goal of this study was to evaluate the association between bowel preparation and postoperative outcomes for patients undergoing semielective, same-admission sigmoid resection for acute volvulus.

Study Design: Patients from the 2012 to 2019 Colectomy-Targeted American College of Surgeons NSQIP dataset who underwent sigmoid resection with primary anastomosis after admission for sigmoid volvulus were included.

Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.

Background: Prevention of hospital-acquired conditions (HACs) is a focus of trauma center quality improvement. The relative contributions of various HACs to postinjury hospital outcomes are unclear. We sought to quantify and compare the impacts of six HACs on early clinical outcomes and resource utilization in hospitalized trauma patients.

Postoperative Outcomes after Index vs Interval Cholecystectomy for Perforated Cholecystitis.

Background: Gallbladder perforation is a known morbid sequela of acute cholecystitis, yet evidence for its optimal management remains conflicting. This study compares outcomes in patients with perforated cholecystitis who underwent cholecystectomy at the time of index hospital admission with those in patients who underwent interval cholecystectomy.

Study Design: A retrospective analysis was conducted of 654 patients from the American College of Surgeons NSQIP database who underwent cholecystectomy for perforated cholecystitis (2006-2018).

The Relative Impact of Specific Postoperative Complications on Older Patients Undergoing Hip Fracture Repair.

Background: Hip fractures affect a vulnerable population and are associated with high rates of morbidity, mortality, and resource utilization. Although postoperative complications are a known driver of mortality and resource utilization, the comparative impacts of specific complications on outcomes is unknown. This study assessed which complications are associated with the highest effects on mortality and resource utilization for older patients who undergo hip fracture repair.

The Effect of Hypogastric Artery Revascularization on Ischemic Colitis in Endovascular Aneurysm Repair.

Background: The objective of the study was to examine the effect of hypogastric revascularization maneuvers on the rate of postoperative ischemic colitis among patients undergoing endovascular aortoiliac aneurysm repair.

Methods: Using the 2011-2018 Endovascular Aneurysm Repair Procedure-Targeted American College of Surgeons National Surgical Quality Improvement Program Participant Use Files, we analyzed patients undergoing elective endovascular infrarenal aortoiliac aneurysm repairs. Using multivariable modeling techniques, a cohort of patients at high risk for postoperative ischemic colitis was identified.

Pancreatic Fistula and Delayed Gastric Emptying Are the Highest-Impact Complications After Whipple.

Background: Patients undergoing pancreaticoduodenectomy are at risk for a variety of adverse postoperative events, including generic complications such as surgical site infection (SSI) and procedure-specific complications such as postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). Knowing which complications have the greatest effect on these patients can help to maximize the value of quality improvement resources. This study aims to quantify the effect of specific postoperative complications on clinical outcomes and resource utilization after pancreaticoduodenectomy.

Safety in Allowing Residents to Independently Perform Appendectomy: A Retrospective Review.

Background: In an era of competency-based education and concern about graduating resident readiness for practice, early resident autonomy and the ability to safely teach junior residents is becoming increasingly important. In this study, we aimed to understand the effect of "teaching resident" (2 residents operating under the supervision of an attending physician) appendectomy cases on outcomes.

Study Design: We performed a single-center retrospective review of 928 patients who underwent appendectomy within the University of Wisconsin hospital system, from October 2014 to December 2017.

Locoregional anesthesia is associated with lower 30-day mortality than general anesthesia in patients undergoing endovascular repair of ruptured abdominal aortic aneurysm.

Objective: The objective of this study was to compare 30-day postoperative mortality for patients undergoing endovascular repair of ruptured abdominal aortic aneurysm (rAAA) using locoregional vs general anesthesia. Unlike the open approach, endovascular repair of rAAA can be performed using either locoregional or general anesthesia. We hypothesize that mortality after endovascular repair of rAAA is lower when locoregional rather than general anesthesia is used.

Utilization of a specimen retrieval bag during laparoscopic appendectomy for both uncomplicated and complicated appendicitis is not associated with a decrease in postoperative surgical site infection rates.

Background: To determine whether utilization of a retrieval bag during laparoscopic appendectomy for uncomplicated and complicated appendicitis (perforation/abscess) is associated with postoperative surgical site infection rates.

Methods: We studied patients presented in the database of the 2016 Appendectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program who underwent laparoscopic appendectomy for pathology-confirmed appendicitis. The primary predictor variable was intraoperative utilization of a specimen retrieval bag for removal of the appendix from the peritoneal cavity.

Effect of transfer status on outcomes for necrotizing soft tissue infections.

Background: Whether patients with necrotizing soft tissue infections (NSTI) who presented to under-resourced hospitals are best served by immediate debridement or expedited transfer is unknown. We examined whether interhospital transfer status impacts outcomes of patients requiring emergency debridement for NSTI.

Methods And Materials: We conducted a retrospective review studying patients with an operative diagnosis of necrotizing fasciitis, Fournier's gangrene, or gas gangrene in the 2010-2015 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files.

Patient-Centered Outcome Spectrum: An Evidence-based Framework to Aid in Shared Decision-making.

Objective: Our objective was to develop an alternate construct for reporting anticipated outcomes after emergency general surgery (EGS) that presents risk in terms of a composite measure.

Background: Currently available prediction tools generate risk outputs for discrete as opposed to composite measures of postoperative outcomes. A construct to synthesize multiple discrete estimates into a global understanding of a patient's likely postoperative health status is lacking and could augment shared decision-making conversations.

The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization.

Objective: The aim of this study was to investigate the volume-outcome relationship in kidney transplantation by examining graft and patient outcomes using standardized risk adjustment (observed-to-expected outcomes). A secondary objective was to examine the geographic proximity of low, medium, and high-volume kidney transplant centers in the United States.

Summary Of Background Data: The significant survival benefit of kidney transplantation in the context of a severe shortage of donor organs mandates strategies to optimize outcomes.

Predictors of 30-day postoperative major adverse clinical events after carotid artery stenting: An analysis of the procedure-targeted American College of Surgeons National Surgical Quality Improvement Program.

Background: Information about carotid artery stenting (CAS) is largely derived from clinical trials, consensus statements, and outcomes comparisons between CAS and carotid endarterectomy. Given these limitations, the goal of this study was to identify risk factors for adverse outcomes after CAS among hospitals participating in the CAS-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

Methods: Our study sample consisted of patients from the 2012 to 2015 CAS-targeted ACS NSQIP data set.

Current practice of thoracic outlet decompression surgery in the United States.

Background: Thoracic outlet syndrome (TOS) and its management are relatively controversial topics. Most of the literature reporting the outcomes of surgical decompression for TOS derives from single-center experiences. The objective of our study was to describe the current state of TOS surgery among hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program database.

Carotid artery stenting is associated with a higher incidence of major adverse clinical events than carotid endarterectomy in female patients.

Background: The optimal approach to carotid revascularization in female patients with carotid artery stenosis is widely debated. Information available is largely derived from clinical trials that include only highly selected patients. The goal of this study was to compare the early clinical outcomes in women who undergo carotid artery stenting (CAS) vs carotid endarterectomy (CEA).

Targeting the most important complications in vascular surgery.

Objective: This study was conducted to identify the most clinically relevant and costly perioperative complications occurring in vascular surgery patients.

Methods: The analysis included patients in the 2012 to 2014 National Surgical Quality Improvement Program database undergoing one of four high-risk vascular procedures. The procedures-aortic reconstruction, lower extremity bypass, lower extremity amputation, and carotid endarterectomy (CEA)-were selected because they have been established as high risk in the literature, rendering them natural targets for quality improvement initiatives.

Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma.

Background: There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults.

Methods: A retrospective review of the National Trauma Data Bank was performed for patients with blunt trauma who were ≥65 years old and had rib fractures between 2009 and 2012 (N = 67,695).

Associations of Specific Postoperative Complications With Outcomes After Elective Colon Resection: A Procedure-Targeted Approach Toward Surgical Quality Improvement.

Importance: Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes.

Objective: To quantify the associations of specific postoperative complications with outcomes after elective colon resection.

Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports.

Purpose: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries.

Methods: All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality.

Management of blunt pancreatic trauma in children: Review of the National Trauma Data Bank.

Purpose: This study aims to examine the current management strategies and outcomes after blunt pancreatic trauma in children using a national patient registry.

Methods: Using the National Trauma Data Bank (NTDB) from 2007-2011, we identified all patients ≤18years old who suffered blunt pancreatic trauma. Patients were categorized as undergoing nonoperative pancreatic management (no abdominal operation, abdominal operation without pancreatic-specific procedure, or pancreatic drainage alone) or operative pancreatic management (pancreatic resection/repair).

Nonoperative Management Is as Effective as Immediate Splenectomy for Adult Patients with High-Grade Blunt Splenic Injury.

Background: The comparative effectiveness of nonoperative management (NOM) vs immediate splenectomy (IS) for hemodynamically stable adult patients with grade IV or V blunt splenic injury (BSI) has not been clearly established in the literature.

Study Design: We performed a retrospective analysis of adult patients, from the 2013 to 2014 American College of Surgeons Trauma Quality Improvement Program (TQIP) Participant Use Data Files, who sustained grade IV or V BSI. Outcomes after IS vs attempted NOM were compared using propensity score analysis in order to adjust for patient- and injury-related variables.

Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery.

Background: Because preoperative risk factor modification is generally not possible in the emergency setting, complication prevention represents an important focus for quality improvement in emergency general surgery (EGS). The objective of our study was to determine the overall impact that specific postoperative complications have in this patient population.

Study Design: Our study sample consisted of patients from the 2012-2013 ACS-NSQIP database who underwent an EGS procedure.