Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management Pathways.

Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes.

Changes in utilization of axillary dissection in women with invasive breast cancer and sentinel node metastasis after the ACOSOG Z0011 trial.

The American College of Surgeons Oncology Group Z0011 (ACOSOG Z0011) trial demonstrated no survival advantage for women with clinical T1-T2 invasive breast cancer with 1-2 positive sentinel lymph nodes (SLN) who received whole-breast radiation, and no further axillary surgery when compared to women who did undergo axillary lymph node dissection (ALND). We used the National Cancer Database (NCDB) to study changes in utilization of ALND after the publication of this trial. NCDB was queried for female patients from 2012 to 2015 who met Z0011 criteria.

Surgical Supply Cost Awareness Is Associated With Lower Costs: A Single-Center Experience.

Surgeons are often unfamiliar with the costs of surgical instrumentation and supplies. We hypothesized that surgeon cost feedback would be associated with a reduction in cost. A multidisciplinary team evaluated surgical supply costs for laparoscopic appendectomies of 7 surgeons (surgeons A-G) at a single-center academic institution.

New cars on the highways: Trends in injuries and outcomes following ejection.

Background: Although ejections from motor vehicles are considered a marker of a significant mechanism and a predictor of severe injuries and mortality, scant recent data exist to validate these outcomes. This study investigates whether ejections increase the mortality risk following a motor vehicle crash using data that reflect the introduction of new vehicles to the streets of a large city in the United States.

Methods: The Trauma and Emergency Medicine Information System of Los Angeles County was queried for patients ≥ 16 years old admitted following a motor vehicle crash between 2002 and 2012.

Is magnetic resonance imaging becoming the new computed tomography for cervical spine clearance? Trends in magnetic resonance imaging utilization at a Level I trauma center.

Background: Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center.

Methods: All blunt trauma patients undergoing a computed tomography (CT) of the C-spine between January 2009 and December 2018 were reviewed.

Treatment at Academic Centers Increases Likelihood of Reconstruction After Mastectomy for Breast Cancer Patients.

Background: Mastectomy rates continue to increase in women diagnosed with breast cancer (BC). There are limited data regarding reconstruction rates at academic centers (AC) versus community hospitals (CH). We aim to determine the effect of facility type on reconstruction rates.

Unexpected complicated appendicitis in the elderly diagnosed with acute appendicitis.

Background: This study determined the prevalence of complicated appendicitis in elderly patients diagnosed preoperatively with uncomplicated appendicitis.

Methods: Patients with a preoperative diagnosis of uncomplicated appendicitis at an academic hospital from 11/2013 to 05/2017 were reviewed. Patients ≥65 years were compared to those younger.

Variation in Intraoperative and Postoperative Utilization for 3 Common General Surgery Procedures.

Objective: The aim of this study was to understand variation in intraoperative and postoperative utilization for common general surgery procedures.

Summary Background Data: Reducing surgical costs is paramount to the viability of hospitals.

Methods: Retrospective analysis of electronic health record data for 7762 operations from 2 health systems.

Patterns in the Use of Axillary Operations for Patients with Node-Positive Breast Cancer After Neoadjuvant Chemotherapy: A National Cancer Database (NCDB) Analysis.

Background: The American College of Surgeons Oncology Group (ACOSOG) Z1071 and Sentinel Neoadjuvant (SENTINA) trials of sentinel node biopsy for node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) demonstrated false-negative rates that varied on the basis of surgical technique. This study evaluated trends in axillary operations before and after publication of these trials.

Methods: This study analyzed patients from National Cancer Database (NCDB) with clinical T0 through T4, N1 and N2, M0 breast cancer who received NAC from 1 January 2012 to 31 December 2015 and sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND).

Surgeon Awareness of the Relative Costs of Common Surgical Instruments.

This study surveys surgeons’ cost knowledge and ability to distinguish subtle price variations between surgical tools with similar functions or indications.

Disparities in Compliance With National Guidelines for the Treatment of Malignant Pleural Mesothelioma.

Background: Current guidelines support cancer-directed surgery, chemotherapy, or active surveillance for clinical stages 1 to 3 of epithelial malignant pleural mesothelioma (MPM). Definitive chemotherapy is recommended for sarcomatoid/biphasic histologies. Our objective is to assess compliance with recommendations, measuring their impact on overall survival.

Variability in Critical Care-Related Charge Markups in Medicare Patients.

Charge markups for health care are variable and inflated several times beyond cost. Using the 2015 Medicare Provider Fee-For-Service Utilization and Payment Data file, we identified providers who billed for critical care hours and related procedures, including CPR, EKG interpretation, central line placement, arterial line placement, chest tube/thoracentesis, and emergent endotracheal intubation. Markup ratios (MRs), defined as the amount charged divided by the amount allowable, were calculated and compared; 42.

Imaging utilization affects negative appendectomy rates in appendicitis: An ACS-NSQIP study.

Background: Negative appendectomy rates (NAR) historically ranged from 15 to 25%, but have decreased recently.

Methods: Using the 2016 ACS-NSQIP database, we identified patients who underwent appendectomies for appendicitis. Patients with and without appendicitis on pathology were compared.

Does the Approach Matter? Comparing Survival in Robotic, Minimally Invasive, and Open Esophagectomies.

Background: Our objective was to determine how surgical approach impacts overall survival and postoperative outcomes when comparing robotic-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE).

Methods: The National Cancer Database was queried for patients diagnosed with pathologic Stage 0 to III esophageal cancer from 2010 to 2015. Primary outcome measures evaluated were length of stay, 30-day unplanned readmissions, mortality rates at 30 and 90 days, and overall survival rates.

Firearm legislation, gun violence, and mortality in children and young adults: A retrospective cohort study of 27,566 children in the USA.

Background: Firearm violence results in the death of thousands of children in the US annually. The effects of firearm legislation on gun violence are published but widely contested.

Materials And Methods: The Kid's Inpatient Database from 2000 to 2009 were queried to capture hospitalizations of children diagnosed with a firearm-related injury.

Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study.

Background: Surgical intervention for ischemic colitis is associated with significant postoperative morbidity and mortality. Predictive factors of adverse outcomes have been reported in the literature, but are based on small sample populations. We sought to identify risk factors for mortality after emergent colectomy for ischemic colitis using a clinical outcomes database.

Association of Standardization of Continuous Renal Replacement Therapy and High-Value Care: An Evidence-Based Approach.

This cohort study assesses utilization patterns of continuous renal replacement therapy and attempts to establish evidence-based guidelines to standardize the process flow and to promote meaningful use.

Reconstruction among patients undergoing mastectomy: the effect of surgical deserts.

Background: Surgical deserts (SDs) are defined as the geographic maldistribution of general surgeons of six or less per 100,000 population in underserved/rural counties. Disparities have been reported in breast cancer outcomes; however, the effect of SDs remains unknown. We sought to examine the effect of SDs on breast reconstruction (BR) after mastectomy and the differences between patients in both the cohorts.

Predictors of Failure to Rescue After Esophagectomy.

Background: Failure to rescue (FTR), defined as death after a major complication, is a metric increasingly being used to assess quality of care. Risk factors associated with FTR after esophagectomy have not been previously studied.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent esophagectomy with gastric conduit between 2010 and 2014.

Is Routine Continuous EEG for Traumatic Brain Injury Beneficial?

Severe traumatic brain injury (TBI) is associated with increased risk for early clinical and subclinical seizures. The use of continuous electroencephalography (cEEG) monitoring after TBI allows for identification and treatment of seizures that may otherwise occur undetected. Benefits of "routine" cEEG after TBI remain controversial.

Prospective Trial of House Staff Time to Response and Intervention in a Surgical Intensive Care Unit: Pager vs. Smartphone.

Objective: The objective of the study was to characterize house staff time to response and intervention when notified of a patient care issue by pager vs. smartphone. We hypothesized that smartphones would reduce house staff time to response and intervention.