Streamlining and Consistency in Surgery: Lean Six Sigma to Improve Operating Room Efficiency.

Background: Improving perioperative efficiency helps reduce unnecessary surgical expenditure, increase operating room throughput, improve patient safety, and enhance staff and patient satisfaction. Lean Six Sigma (LSS) is a quality improvement model that has been successfully applied to eliminate inefficiencies in the business sector but has not yet been widely adopted in medicine. This study investigates the adaptation of LSS to improve operative efficiency for plastic surgery procedures.

Pancreatic Cancer Patient-derived Organoids Can Predict Response to Neoadjuvant Chemotherapy.

Objective: To evaluate if patient-derived organoids (PDOs) may predict response to neoadjuvant (NAT) chemotherapy in patients with pancreatic adenocarcinoma.

Background: PDOs have been explored as a biomarker of therapy response and for personalized therapeutics in patients with pancreatic cancer.

Methods: During 2017-2021, patients were enrolled into an IRB-approved protocol and PDO cultures were established.

Objective assessment of robotic surgical skills: review of literature and future directions.

Background: Evaluation of robotic surgical skill has become increasingly important as robotic approaches to common surgeries become more widely utilized. However, evaluation of these currently lacks standardization. In this paper, we aimed to review the literature on robotic surgical skill evaluation.

Thriving or surviving? A critical examination of funding models for fellowship council fellowships.

Background: Since 1997, the Fellowship Council (FC) has evolved into a robust organization responsible for the advanced training of nearly half of the US residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable. This study aimed to investigate the current funding models of FC fellowships.

Pregnant patients requiring appendectomy: comparison between open and laparoscopic approaches in NY State.

Introduction: Even though acute appendicitis is the most common general surgical condition encountered during pregnancy, the preferred approach to appendectomy in pregnant patients remains controversial. Current guidelines support laparoscopic appendectomy as the treatment of choice for pregnant women with appendicitis, regardless of trimester. However, recent published data suggests that the laparoscopic approach contributes to higher rates of fetal demise.

Considering delay of cholecystectomy in the third trimester of pregnancy.

Introduction: Current guidelines support laparoscopic cholecystectomy as the treatment of choice for pregnant women with symptomatic gallbladder disease, regardless of the trimester. Early intervention has remained the standard of care, but recent evidence has challenged this practice in pregnant women. We sought to compare surgical and maternal-fetal outcomes of antepartum versus postpartum cholecystectomy in New York State.

Development of cancer after bariatric surgery.

Background: Although bariatric surgery has been associated with a reduction in risk of obesity-related cancer, data on the effect of bariatric interventions on other cancers are limited.

Objectives: This study aimed to examine the relationship between bariatric interventions and the incidence of various cancers after bariatric surgery.

Setting: Administrative statewide database.

Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.

Background: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation.

Correction: Direct therapeutic targeting of immune checkpoint PD-1 in pancreatic cancer.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Patients insured by Medicare and Medicaid undergo lower rates of bariatric surgery.

Background: Although the number of weight loss procedures is increasing, bariatric surgery is not used equitably in the United States. As obesity is more prevalent in minorities, higher priorities are placed toward improvement of access to care for these groups.

Objectives: To evaluate whether patient insurance status has any effect on use of bariatric surgery for patients in New York State.

Preoperative anticoagulation in patients undergoing bariatric surgery is associated with worse outcomes.

Introduction: Management of patients on chronic anticoagulation (AC) in bariatric surgery may present a challenge, as there is a delicate balance between risks of bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The purpose of this study was to evaluate and compare rates of bleeding, thrombotic events, and outcomes of patients on preoperative AC during bariatric surgery.

Methods: The MBSAQIP data sets for 2015 and 2016 was used to identify all patients undergoing adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB).

Bariatric peri-operative outcomes are affected by annual procedure-specific surgeon volume.

Background: There is limited data examining specific annual surgeon procedural volumes associated with improvement of postoperative outcomes following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Objectives: Effect of surgeon volume on procedural outcomes.

Methods: Using the SPARCS Administrative database, patients undergoing laparoscopic RYGB or SG between 2010-2014 were analyzed.

Early cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York.

Introduction: The timing of cholecystectomy for acute cholecystitis has been debated with most studies favoring early cholecystectomy (< 72 h of onset). However, most reported studies are from single institution studies with only a few population-based studies. The purpose of this study is to compare clinical outcomes of patients undergoing cholecystectomy within 72 h of emergency department (ED) presentation to patients undergoing cholecystectomy following 72 h in a large statewide database.

Early cholecystectomy (≤ 8 weeks) following percutaneous cholecystostomy tube placement is associated with higher morbidity.

Introduction: Percutaneous cholecystostomy tube (PCT) placement is often the initial management approach to severe acute cholecystitis in the unstable patient. However, the timing of cholecystectomy after PCT has not been carefully examined. The purpose of this study was to compare outcomes of early versus late cholecystectomy following PCT placement.

Hospital utilization 4 years after bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass.

Background: While sleeve gastrectomy (SG) has lower perioperative risk compared with Roux-en-Y gastric bypass (RYGB), long-term data about their differential impact on overall health are unclear. Hospital use after bariatric surgery is an important parameter for improving peri- and postoperative care.

Objective: This present study was aimed to compare SG and RYGB in terms of their effect on long-term hospital-based healthcare utilization.

Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay?

Background: Current guidelines suggest that cholecystectomy during the third trimester of pregnancy is safe for both the woman and the fetus. However, no population-based study has examined this issue. The aim of this analysis was to compare the results of cholecystectomy during the third trimester of pregnancy with outcomes in women operated on in the early postpartum period in a large population.

Defying public expectations: Publicly reported hospital scores do not always correlate with clinical outcomes.

Background: Publicly reported hospital scores are used by patients to make health care-related decisions; however, their relationship to clinical outcomes is unknown.

Methods: Through the use of the New York Statewide Planning and Research Cooperative System database, the association between two commonly used scores (Healthgrades and Centers for Medicare & Medicaid Services Hospital Compare) and four clinical outcomes was evaluated in several surgical fields (general, colorectal, hepatobiliary, foregut, and bariatric).

Results: After adjusting for patient-level factors, patients from facilities with greater Healthgrades scores were less likely to develop any complication after general surgery operations (P = .

Marginal ulcer continues to be a major source of morbidity over time following gastric bypass.

Background: Marginal ulcerations (MU) are a common and concerning complication following Roux-en-Y gastric bypass (RYGB) surgery. The aim of the present study was to examine the progression of MU and identify risk factors for the need for surgical intervention in patients with MU following RYGB.

Methods: A New York state longitudinal administrative database was queried to identify patients who underwent RYGB between 2005 and 2010 and who were followed for at least 4 years for the development of MU using ICD-9 and CPT codes.

Population Level Analysis of Adhesive Small Bowel Obstruction: Sustained Advantage of a Laparoscopic Approach.

Objective: The objective of this study was to determine the effects of open versus laparoscopic surgery on the development of adhesive small bowel obstruction (aSBO).

Summary Background Data: aSBO is a significant contributor to short and long-term postoperative morbidity. Laparoscopy has demonstrated a protective effect in colorectal surgery, but these effects have not been generalized to other abdominal procedures.

Surgical trainee impact on bariatric surgery safety.

Background: Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) are commonly performed bariatric procedures that are associated with a significant learning curve. The effect of surgeon experience on perioperative outcomes and safety is established, but the effect of trainee participation remains unclear. The purpose of this study was to assess the impact of trainees on early perioperative safety of bariatric surgery.

Direct therapeutic targeting of immune checkpoint PD-1 in pancreatic cancer.

Background: Pancreatic cancer (PC) hijacks innate cellular processes to promote cancer growth. We hypothesized that PC exploits PD-1/PD-L1 not only to avoid immune responses, but to directly enhance growth. We also hypothesized that immune checkpoint inhibitors (ICIs) have direct cytotoxicity in PC.