A semi-automated assessment of sarcopenia using psoas area and density predicts outcomes after pancreaticoduodenectomy for pancreatic malignancy.

Background: Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy.

Young surgeons on speaking up: when and how surgical trainees voice concerns about supervisors' clinical decisions.

Background: Poor communication is a known contributor to disasters in aviation and medicine. Crew members are trained to raise concerns about superiors' plans, yet literature exploring surgical trainees' responses to analogous concerns is sparse.

Methods: Surgical residents were interviewed about approaches to concerns about supervisors' clinical decisions using a semistructured guide.

Radiographic Sarcopenia and Self-reported Exhaustion Independently Predict NSQIP Serious Complications After Pancreaticoduodenectomy in Older Adults.

Introduction: Sarcopenia is linked to poor outcomes after abdominal surgery. We hypothesized that radiographic sarcopenia metrics enhance prediction of complications after pancreaticoduodenectomy (PD) when combined with clinical and frailty data.

Methods: Preoperative geriatric assessments and CT scans of patients undergoing PD were reviewed.

Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit.

A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications.

Defining the Benefit of Adjuvant Therapy Following Resection for Intrahepatic Cholangiocarcinoma.

Background: Intrahepatic cholangiocarcinoma (ICC) is rare but is increasing in incidence. While hepatectomy can be curative, the benefit of adjuvant therapy (AT) remains unclear. We utilized the National Cancer Data Base (NCDB) to isolate predictors of overall survival, describe the national pattern of AT administration, and identify characteristics of patients who experience a survival benefit from AT following resection for ICC.

Surgical management of acute right lower-quadrant pain in pregnancy: a prospective cohort study.

Background: The etiology of right lower-quadrant pain in pregnant patients is a challenge in diagnosis. We discuss the surgical issues among pregnant patients with right lower-quadrant pain and demonstrate the method to diagnosis.

Study Design: This was a prospective cohort study with enrollment during 2 years.

Diagnosis of gastrointestinal anastomotic dehiscence after hospital discharge: Impact on patient management and outcome.

Background: Anastomotic leaks are inevitable complications of gastrointestinal surgery. Early hospital discharge protocols have increased concern regarding outpatient presentation with anastomotic leaks.

Methods: One hundred anastomotic leaks in 5,387 intestinal operations performed at a single institution from 2002 to 2007 were identified from a prospectively maintained database.