Guideline Concordant Extended Pharmacologic Venous Thromboembolism Prophylaxis Utilization After Colorectal Cancer Resection Is Low Regardless of Patient Factors or Hospital Characteristics.

Background: Venous thromboembolism after colorectal cancer resection is common and highly morbid. Extended pharmacologic venous thromboembolism prophylaxis after cancer surgery lowers venous thromboembolism risk and is recommended by major professional societies. Adherence is low in contemporary local and regional studies.

Extended Pharmacologic Prophylaxis for Venous Thromboembolism After Colon Cancer Surgery Is Associated With Improved Long-term Survival: A Natural Experiment in the Chemotherapeutic Benefit of Heparin Derivatives.

Objective: This large database study assessed whether extended pharmacologic prophylaxis for venous thromboembolism after colon cancer resection was associated with improved oncologic survival.

Background: Heparin derivatives may confer an antineoplastic effect via a variety of mechanisms (eg, inhibiting angiogenesis in the tumor microenvironment). Studies evaluating the oncologic benefit of heparin and its derivatives have been limited in postsurgical patients.

Surgical Decision-Making in Familial Adenomatous Polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder affecting patients with germline mutations of the adenomatous polyposis coli (APC) tumor suppressor gene. The surgical treatment of colorectal disease in FAP, which has the goal of colorectal cancer prevention, varies based on both patient and disease factors but can include the following: total colectomy with ileorectal anastomosis, proctocolectomy with stapled or hand-sewn ileal pouch-anal anastomosis, or total proctocolectomy with end ileostomy. The operative options and extent of resection, as well as the use of endoscopy and chemoprevention for the management of polyposis, will be discussed in detail in this article.

Implementation, Feasibility, and Perception of Facilitated Process Groups in Surgical Residency.

Objective: Recent studies have demonstrated burnout in surgeons, with trainees affected at alarming levels. However, few studies have focused on specific wellbeing initiatives in surgical residency. We implemented facilitated process groups at our residency program and aimed to understand the feasibility and perception of this program.

A pilot study characterizing longitudinal changes in fecal microbiota of patients with Hirschsprung-associated enterocolitis.

Purpose: Hirschsprung disease is a neurointestinal disease that occurs due to failure of enteric neural crest-derived cells to complete their rostrocaudal migration along the gut mesenchyme, resulting in aganglionosis along variable lengths of the distal bowel. Despite the effective surgery that removes the aganglionic segment, children with Hirschsprung disease remain at high risk for developing a potentially life-threatening enterocolitis (Hirschsprung-associated enterocolitis). Although the etiology of this enterocolitis remains poorly understood, several recent studies in both mouse models and in human subjects suggest potential involvement of gastrointestinal microbiota in the underlying pathogenesis of Hirschsprung-associated enterocolitis.

Disparity in prehospital scene time for geriatric trauma patients.

Background: Geriatric patients face disparities in prehospital trauma care. We hypothesized that geriatric trauma patients are more likely to experience prolonged prehospital scene time than younger adults.

Methods: Retrospective analysis of the 2017 National Emergency Medical Services Information System.

Do surgeons adjust clinical productivity after maternity leave?

Background: It has been speculated that women's productivity decreases after maternity leave. In this study, we measured if surgeon clinical productivity decreases after a maternity leave or other types of leave.

Methods: Data from a large medical center was used to measure surgeon productivity before (pre) and after (post) a leave of absence.

Optimal timing for Soave primary pull-through in short-segment Hirschsprung disease: A meta-analysis.

Background: The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease.

Annual Incidence of Hospitalization for Nonfatal Firearm-Related Injuries in New York From 2005 to 2016.

Importance: In the US, approximately 40 000 people die due to firearm-related injuries annually. However, nonfatal firearm-related injuries are less precisely tracked.

Objectives: To assess the annual incidence of hospitalization for nonfatal firearm-related injuries in New York and to compare the annual incidence by sex, race/ethnicity, county of residence, and calendar years.

Contribution of unequal new patient referrals to female surgeon under-employment.

Background: The literature shows that female surgeons have lower operative volumes than male surgeons. Since volume is dependent on new patient referrals for most surgeons, inequities in referrals may contribute to this employment disparity.

Methods: Using 1997-2018 data from a large medical center, we examined the number of new patient referrals for surgeons.

Underemployment of Female Surgeons?

Objective: To compare the complexity of operations performed by female versus male surgeons.

Background: Prior literature has suggested that female surgeons are relatively underemployed when compared to male surgeons, with regards to operative case volume and specialization.

Methods: Operative case records from a large academic medical center from 1997 to 2018 were evaluated.

Lack of Data-driven Treatment Guidelines and Wide Variation in Management of Chronic Pelvic Pain in Adolescents and Young Adults.

Study Objective: Current literature lacks data-driven guidelines for surgical treatment of adolescent and young adult (AYA) patients with chronic pelvic pain. We hypothesized that there is a significant variation in treatment of these patients, which might be an indicator of over- or undertreatment by some providers.

Design And Setting: We completed a retrospective population-based analysis of the Nationwide Inpatient Sample from 1998 to 2016.

Beyond insurance: race-based disparities in the use of metabolic and bariatric surgery for the management of severe pediatric obesity.

Background: It is unknown whether previously noted racial disparities in the use of metabolic and bariatric surgery (MBS) for the management of pediatric obesity could be mitigated by accounting for primary insurance.

Objectives: To examine utilization of pediatric MBS across race and insurance in the United States.

Setting: Retrospective cross-sectional study.

Design and Impact of a Novel Surgery-Specific Second Victim Peer Support Program.

Background: Surgeons are prone to feelings of sadness, guilt, and anxiety when involved in major adverse events. We aimed to create and evaluate a second victim peer support program for surgeons and surgical trainees.

Study Design: The second victim peer support program was an intervention performed in the Department of Surgery at a tertiary care academic medical center.

Practice patterns and work environments that influence gender inequality among academic surgeons.

Background: Practice pattern and work environment differences may impact career advancement opportunities and contribute to the gender gap within highly competitive surgical specialties.

Methods: Using a 2000-2015 New York statewide dataset, we compared board-certified pediatric surgeons by specialist case volume and Herfindahl-Hirschman Index (HHI), which quantifies surgeon focus within specialist case mix.

Results: 51 pediatric surgeons were analyzed for 461 surgeon-years.

"Yes, I'm the Doctor": One Department's Approach to Assessing and Addressing Gender-Based Discrimination in the Modern Medical Training Era.

While gender-based bias and discrimination (GBD) is known to exist in medical training, there is limited guidance for training programs on how to understand and combat this issue locally. The Massachusetts General Hospital Department of Surgery established the Gender Equity Task Force (GETF) to address GBD in the local training environment. In 2017, members of the GETF surveyed residents in surgery, anesthesia, and internal medicine at 2 academic hospitals to better understand perceived sources, frequency, forms, and effects of GBD.

Pathologic discordance to clinical management decisions suggests overtreatment in pediatric benign breast disease.

Purpose: Breast masses in pediatric patients are often managed similarly to adult breast masses despite significant differences in pathology and natural history. Emerging evidence suggests that clinical observation is safe. The purpose of this study was to quantify the clinical appropriateness of the management of benign breast disease in pediatric patients.

Heller myotomy is the optimal index procedure for esophageal achalasia in adolescents and young adults.

Background: There is limited and conflicting data on the optimal intervention for the treatment of achalasia in adolescents and young adults (AYA), Heller myotomy (HM), esophageal dilation (ED) or botulinum toxin injection (botox). The goal of this study is to determine the most appropriate index intervention for achalasia in the AYA population.

Methods: We completed a longitudinal, population-based analysis of the California (2005-2010) and New York (1999-2014) statewide databases.

A Longitudinal Population Analysis of Cumulative Risks of Circumcision.

Background: Circumcision is widely accepted for newborns in the United States. However, circumcision carries a risk of complications, the rates of which are not well described in the contemporary era.

Methods: We performed a longitudinal population analysis of the California Office of Statewide Health Planning and Development database between 2005 and 2010.

A population-based analysis of pediatric breast cancer.

Purpose: The purpose of this study was to evaluate trends in demographics and outcomes of pediatric breast cancer in a United States population-based cohort.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant breast tumors between 1973 and 2014. Analysis was performed using Stata Statistical Software version 13.

Pediatric enteric neuropathies: diagnosis and current management.

Purpose Of Review: Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric enteric neuropathies and their diagnosis and management, emphasizing insights and discoveries from the most recent literature available.

Recent Findings: The embryologic and histopathologic causes of enteric neuropathies are varied.