Open or Closed? Management of Skin Incisions After Emergency General Surgery Laparotomies.

Introduction: We sought to determine if there was a relationship between skin management and surgical site infections (SSIs) among patients undergoing a laparotomy for emergency general surgery (EGS). We hypothesize that skin closure technique is not associated with SSI.

Methods: We performed a retrospective review of adult patients (>18 y) who underwent an exploratory laparotomy for EGS conditions within 6 h of surgical consultation from 2015 to 2019.

Identifying Factors Associated With Code Status Changes After Emergency General Surgery.

Introduction: Surgical emergencies are time sensitive. Identifying patients who may benefit from preoperative goals of care discussions is critical to ensuring that operative intervention aligns with the patient's values. We sought to identify patient factors associated with acute changes in a patient's goals using code status change (CSC) as proxy.

Effect of Frailty on the Management of Suspected Choledocholithiasis.

Introduction: The American Society for Gastrointestinal Endoscopy and The Society of American Gastrointestinal and Endoscopic Surgeons (ASGE-SAGES) guidelines for managing choledocholithiasis (CDL) omit patient-specific factors like frailty. We evaluated how frail patients with CDL undergoing same-admission cholecystectomy were managed within ASGE-SAGES guidelines.

Methods: We analyzed patients undergoing same-admission cholecystectomy for CDL and/or acute biliary pancreatitis (ABP) from 2016 to 2019 at 12 US academic medical centers.

Comorbidities Matter as Distressed Communities Index Fails to Predict Mortality in Necrotizing Soft Tissue Infection.

Necrotizing soft tissue infections (NSTIs) are life-threatening infections requiring prompt intervention. The Distressed Communities Index (DCI) is a comprehensive ranking of socioeconomic well-being based on zip code. We sought to identify the role of DCI in predicting mortality in NSTI, because it remains unknown.

How Should We Discuss Inequity and Iatrogenic Harm in Academic Health Centers?

Discussing errors and quality improvement is a tradition in academic health centers, particularly in morbidity and mortality conferences embedded in surgical training and during teaching rounds. Little, if any, attention is typically given to iatrogenic harms from structural racism, however. This article canvasses ways in which training programs recognize and address health care-generated harm from inequity and identifies areas for improvement.

Outcomes after emergency general surgery and trauma care in incarcerated individuals: An EAST multicenter study.

Background: The US incarcerates more individuals than any other country. Prisoners are the only population guaranteed health care by the US constitution, but little is known about their surgical needs. This multicenter study aimed to describe the acute care surgery (ACS) needs of incarcerated individuals.

Top Ten Tips Palliative Care Clinicians Should Know About Their Work's Intersection with Clinical Ethics.

Palliative care (PC) subspecialists and clinical ethics consultants often engage in parallel work, as both function primarily as interprofessional consultancy services called upon in complex clinical scenarios and challenging circumstances. Both practices utilize active listening, goals-based communication, conflict mediation or mitigation, and values explorations as care modalities. In this set of tips created by an interprofessional team of ethicists, intensivists, a surgeon, an attorney, and pediatric and adult PC nurses and physicians, we aim to describe some paradigmatic clinical challenges for which partnership may improve collaborative, comprehensive care.

Should Anesthesiologists and Surgeons Take Breaks During Cases?

Anesthesiologists regularly take breaks during operations, whereas surgeons do so more rarely. This article considers the origins of this difference in practice in relation to different characteristics of the work of these 2 specialties as well as differences in professional identity, both of which can contribute to varying break practices and perceptions of the value of breaks. The authors draw upon current literature about the influence of breaks on attention, focus, and stamina and then reflect on the influence of breaks on the relationships between anesthesiologists and surgeons.

Delivering Hospital-based Medical Care to Incarcerated Patients in North Carolina State Prisons: A Call for Communication and Collaboration.

Many incarcerated patients will require in-hospital care outside prison facilities. Often, this care is provided by clinicians unfamiliar with the correctional context. In this article, we reflect on our experiences caring for incarcerated inpatients in non-carceral settings in North Carolina and highlight sources of misunderstanding and potential conflicts that arise in the care of these patients.

Fellowship or Family? A Comparison of Residency Leave Policies With the Family and Medical Leave Act.

Background: In 1993, the Family and Medical Leave Act (FMLA) mandated 12 weeks of unpaid, job-protected leave. The current impact of taking 12 weeks of leave during residency has not been evaluated.

Methods: We examined the 2018 Accreditation Council for Graduate Medical Education (n = 24) specialty leave policies to determine the impact of 6- and 12-week leave on residency training, board eligibility, and fellowship training.

Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training.

Importance: Prior studies demonstrate a high prevalence of burnout and depression among surgeons. Limited data exist regarding how these conditions are perceived by the surgical community.

Objectives: To measure prevalence of burnout and depression among general surgery trainees and to characterize how residents and attendings perceive these conditions.

and Photographic Perspective of Roadside Trauma.

David Nance's photographs invite us to cross the liminal space between road and roadside and to consider the experience that trauma surgeons share with injured patients and the families of the injured and the dead. Just as trauma surgeons use the tools of science and surgery to make order out of the chaos of "the scene," so patients' families use art, found objects, and grief to transform anonymous roadsides into specific, personal remembrances. Bound together by the uncertainties of trauma, we can all stand at the side of the road bearing witness to both the inevitability and unpredictability of death.

What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence?

In the past, trauma centers have almost exclusively focused on caring for patients who suffer from physical trauma resulting from violence. However, as clinicians' perspectives on violence shift, violence prevention and intervention have been increasingly recognized as integral aspects of trauma care. Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context.

Surgery in Shackles: What Are Surgeons' Obligations to Incarcerated Patients in the Operating Room?

Incarcerated patients frequently require surgery outside of the correctional setting, where they can be shackled to the operating table in the presence of armed corrections officers who observe them throughout the procedure. In this circumstance, privacy protection-central to the patient-physician relationship-and the need to control the incarcerated patient for the safety of health care workers, corrections officers, and society must be balanced. Surgeons recognize the heightened need for gaining a patient's trust within the context of an operation.