Direct innominate artery access for transcatheter aortic valve replacement.

Hostile vascular disease can pose a challenge for transcatheter aortic valve replacement, for which the preferred access is via a common femoral artery. However, extensive peripheral arterial disease may also preclude traditional points of alternative access in some patients. Herein, we describe two patients in whom successful transcatheter aortic valve replacement was performed via direct innominate artery access.

Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery.

Infants undergoing congenital heart surgery (CHS) with cardiopulmonary bypass (CPB) are at risk of acute kidney injury (AKI) and fluid overload. We hypothesized that placement of a passive peritoneal drain (PPD) can improve postoperative fluid output in such infants. We analyzed 115 consecutive patients, age birth to 60 days, admitted to the PICU after CHS with CPB between 2012 and 2018.

Surgical coaching to achieve the ABMS vision for the future of continuing board certification.

In February 2019, the American Board of Medical Specialties (ABMS) released the final report of the Continuing Board Certification: Vision for the Future initiative, issuing strong recommendations to replace ineffective, traditional mechanisms for physicians' maintenance of certification with meaningful strategies that strengthen professional self-regulation and simultaneously engender public trust. The Vision report charges ABMS Member Boards, including the American Board of Surgery (ABS), to develop and implement a more formative, less summative approach to continuing certification. To realize the ABMS's Vision in surgery, new programs must support the assessment of surgeons' performance in practice, identification of individualized performance gaps, tailored goals to address those gaps, and execution of personalized action plans with accountability and longitudinal support.

Pre-simulation orientation for medical trainees: An approach to decrease anxiety and improve confidence and performance.

Background: We assessed the effect of basic orientation to the simulation environment on anxiety, confidence, and clinical decision making.

Methods: Twenty-four graduating medical students participated in a two-week surgery preparatory curriculum, including three simulations. Baseline anxiety was assessed pre-course.

Guidelines for the management of a brain death donor in the rhesus macaque: A translational transplant model.

Introduction: The development of a translatable brain death animal model has significant potential to advance not only transplant research, but also the understanding of the pathophysiologic changes that occur in brain death and severe traumatic brain injury. The aim of this paper is to describe a rhesus macaque model of brain death designed to simulate the average time and medical management described in the human literature.

Methods: Following approval by the Institutional Animal Care and Use Committee, a brain death model was developed.

Independent risk factors for prolonged postoperative ileus development.

Background: Postoperative ileus (POI) has a significant impact on patient wellbeing, and with a 15% incidence in colectomy patients costs US hospitals >$1.3 billion per year. Although some causative mechanisms have been identified, little is known about what places patients at risk for ileus.

Development of Technical Skills: Education, Simulation, and Maintenance of Certification.

The goal of this article is to provide a focused overview of technical skills education inside the operating room (OR), opportunities for learning outside of the OR (with a focus on simulation), and methods for measuring technical skills. In addition, the authors review the role of maintenance of certification in continuing education and quality improvement and consider the role that simulation plays in this process. The perspectives on teaching in the OR of both residents and faculty going into the case affect the learning environment, and preoperative interactions between attendings and residents to establish learning needs and goals are important.

Postoperative Ileus--More than Just Prolonged Length of Stay?

Purpose: Given that postoperative ileus is common in colectomy patients, we sought to examine the association of ileus with adverse events in this patient population.

Methods: The ACS NSQIP puf file from 2012 to 2013 was queried for non-emergent colectomy cases. Predictors of other poor postoperative outcomes in patients who experienced postoperative ileus were assessed using chi-squared and multivariable regression analyses.

Is there a relationship between patient satisfaction and favorable outcomes?

Objective: Patient satisfaction with the health care experience has become a top priority for Centers for Medicare and Medicaid Services. With resources and efforts directed at patient satisfaction, we evaluated whether high patient satisfaction measured by HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys correlates with favorable outcomes.

Methods: Medical centers were identified from the University HealthSystem Consortium database from 2011 to 2012.

Colon Cancer Staging in Vulnerable Older Adults: Adherence to National Guidelines and Impact on Survival.

Background: There is concern that elders are not adequately evaluated prior to colon cancer surgery. We sought to determine adherence with ACOVE-3 (Assessing Care of Vulnerable Elders) quality indicators for pre-operative staging prior to colectomy for colon cancer utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (1992-2005).

Methods: We determined the proportion of patients aged 75 and older who had preoperative staging prior to colectomy for colon adenocarcinoma.

Is there any role for antithymocyte induction in renal transplantation?

The use of an antibody induction agent in kidney transplantation lowers the risk of an acute rejection episode and may improve graft outcomes. Antithymocyte globulin (ATG) is the most commonly used antibody induction agent for kidney transplantation in the United States, despite its significant side effect profile and cost compared to the interleukin-2 receptor antagonists (IL2-RA). Our review suggests the IL2-RA are safe and well tolerated, and provide equal clinical benefit to ATG at a lower cost.

Can the blood alcohol concentration be a predictor for increased hospital complications in trauma patients involved in motor vehicle crashes?

The goal of this report is to assess the relationship of varying levels of blood alcohol concentration (BAC) and hospital complications in patients admitted after motor vehicle crashes. Data for the study was collected by a retrospective review of the University of Wisconsin Hospital trauma registry between 1999 and 2007 using the National Trauma Registry of the American College of Surgeons (NTRACS). Of 3729 patients, 2210 (59%) had a negative BAC, 338 (9%) <100 mg/dL, 538 (14%) 100-199 mg/dL, and 643 (17%) >200 mg/dL.

Can 'extreme' pancreas donors expand the donor pool?

Purpose Of Review: The present review investigates donor qualities that impact pancreas and islet transplantation, with a focus on donors that have been historically underutilized, including those of extreme age, extreme size, and donors after cardiac death.

Recent Findings: The increasing waiting time caused by the shortage of available pancreata and the growing number of patients with uncontrolled diabetes has led to the expansion of acceptance criteria for transplantable pancreata. The possible increased perioperative risks and/or foreshortened graft survival associated with the use of 'extreme' donors should be weighed against the mortality of uremic diabetics on the waiting list and the risk of dying from a hypoglycemic-unawareness episode.

Mycotic carotid artery pseudoaneurysm following stenting--a case report and lessons learned.

Carotid stenting is assuming an important role in the management of carotid disease. Surgeons although hesitant to embrace catheter treatment for the management of primary carotid artery disease, are more enthusiastic regarding it's use in the treatment of recurrent stenoses. This report suggests that caution should be exercised in the selection of patients to be treated with carotid stenting for recurrent disease.