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Martin WT, Ball J, Patterson AK, Snyder KB, Bonds M, Stewart K, Sarwar Z, Raines AR, Cross A. Not all cholecystitis is created equal: Disparities contributing to ED presentation and failure of the outpatient algorithm. Am J Surg 2023; 226:835-839. [PMID: 37481409 DOI: 10.1016/j.amjsurg.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The majority of final surgical pathology (FSP) from both emergency department (ED) and outpatient clinic (OC) patients is chronic cholecystitis. We aimed to differentiate these presentations and identify disparities associated with ED utilization and OC failure. METHODS Retrospective chart review of single institution ED and OC cholecystectomies for cholelithiasis. Clinical presentation, FSP, demographics, and zip code poverty (ZCP) levels were evaluated. Data analysis by summary statistics, bivariate comparisons, and logistic regression. RESULTS Of 299 OC and 308 ED patients, OC was more likely to be Caucasian (78% vs 46%, p < 0.0001) and insured (89% vs. 32%, p < 0.0001). 71.8% of OC with ZCP <10% had insurance versus only 32.5% in ZCP >20%. Uninsured ED OR was 13.1 (95% CI 8.7-22.9). CONCLUSION Uninsured ED patients are vulnerable to fail the outpatient algorithm, especially when misdiagnosed by US. Clinical diagnosis of cholecystitis in this population should warrant offering of urgent cholecystectomy.
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Affiliation(s)
| | - Jonathan Ball
- University of Oklahoma General Surgery Department, USA.
| | | | | | - Morgan Bonds
- University of Oklahoma General Surgery Department, USA.
| | | | - Zoona Sarwar
- University of Oklahoma General Surgery Department, USA.
| | | | - Alisa Cross
- University of Oklahoma General Surgery Department, USA.
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Jeffery CS, Stewart KE, Hayhurst JL, Hall CM, Regner JL, Raines AR. Survey shows all surgical residents have exposure to robotic surgery yet no formalized curricula exist amongst programs: A Southwest Surgical Congress Survey. Am J Surg 2023; 226:878-881. [PMID: 37558517 DOI: 10.1016/j.amjsurg.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Increased robotic surgery exposure during general surgery training occurs at many institutions without a formal education curriculum. Our study evaluates the current state of general surgery robotic training within programs represented by the Southwestern Surgical Congress (SWSC). METHODS A web-based survey regarding robot-assisted surgery (RAS) and general surgery training was developed and sent to member institutions of the SWSC. General surgery program directors were asked to voluntarily complete the survey. Results were evaluated in aggregate. Descriptive analysis was used. RESULTS In total, 28 programs responded. All reported resident exposure to RAS during training. Case mix was diverse with exposure to multiple general surgical subspecialties. 89% of programs reported the presence of a formal RAS curriculum, however, only 53% reported recognition of training completion. Case volumes also varied amongst programs with 46% of programs reporting residents logging 21-40 cases and 35% logging more than 40 cases in total. CONCLUSION Exposure to RAS among SWSC residency programs is ubiquitous, however, there is significant variation between programs in case volumes, case types, and elements of RAS curricula.
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Affiliation(s)
- Christopher S Jeffery
- University of Oklahoma College of Medicine, Department of Surgery, 800 Stanton L. Young Blvd., Suite 9000, Oklahoma City, OK, 73104, USA.
| | - Kenneth E Stewart
- University of Oklahoma College of Medicine, Department of Surgery, 800 Stanton L. Young Blvd., Suite 9000, Oklahoma City, OK, 73104, USA.
| | - Joseph L Hayhurst
- University of Oklahoma College of Medicine, Department of Surgery, 800 Stanton L. Young Blvd., Suite 9000, Oklahoma City, OK, 73104, USA.
| | - Chad M Hall
- Baylor Scott & White Health, Department of Surgery, 2401 S. 31st St, Temple, TX, 76508, USA.
| | - Justin L Regner
- Baylor Scott & White Health, Department of Surgery, 2401 S. 31st St, Temple, TX, 76508, USA.
| | - Alexander R Raines
- University of Oklaoma College of Medicine, Department of Surgery, 800Stanton L. Young Blvd, Ste 9000, Oklahoma City, OK, 73104, USA.
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Lee JS, Khan AD, Quinn CM, Colborn K, Patel DC, Barmparas G, Margulies DR, Waller CJ, Kallies KJ, Fitzsimmons AJ, Kothari SN, Raines AR, Mahnken H, Dunn J, Zier L, McIntyre RC, Urban S, Coleman JR, Campion EM, Burlew CC, Schroeppel TJ. Patient characteristics and diagnostic tests associated with syncopal falls: A Southwestern surgical congress multicenter study. Am J Surg 2022; 224:1374-1379. [PMID: 35940931 DOI: 10.1016/j.amjsurg.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients suspected of syncope frequently undergo laboratory and imaging studies to determine the etiology of the syncope. Variability exists in these workups across institutions. The purpose of this study was to evaluate the utilization and diagnostic yield of these workups and the patient characteristics associated with syncopal falls. METHODS A multi-institutional retrospective review was performed on adult patients admitted after a fall between 1/2017-12/2018. Syncopal falls were compared to non-syncopal falls. RESULTS 4478 patients were included. There were 795 (18%) patients with a syncopal fall. Electrocardiogram, troponin, echocardiogram, CT angiography (CTA), and carotid ultrasound were more frequently tested in syncope patients compared to non-syncope patients. Syncope patients had higher rates of positive telemetry/Holter monitoring, CTAs, and electroencephalograms. CONCLUSION Patients who sustain syncopal falls frequently undergo diagnostic testing without a higher yield to determine the etiology of syncope.
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Affiliation(s)
- Janet S Lee
- Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Abid D Khan
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Chicago, Chicago, IL, USA.
| | - Christopher M Quinn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Deven C Patel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Daniel R Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | - Kara J Kallies
- Department of Medical Research, Gundersen Health System, La Crosse, WI, USA.
| | - Alec J Fitzsimmons
- Department of Medical Research, Gundersen Health System, La Crosse, WI, USA.
| | - Shanu N Kothari
- Department of General Surgery, Prisma Health, Greenville, SC, USA.
| | - Alexander R Raines
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
| | - Heidi Mahnken
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
| | - Julie Dunn
- Department of Trauma and Acute Care Surgery, UCHealth Medical Center of the Rockies, Loveland, CO, USA.
| | - Linda Zier
- Department of Trauma and Acute Care Surgery, UCHealth Medical Center of the Rockies, Loveland, CO, USA.
| | - Robert C McIntyre
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Shane Urban
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Julia R Coleman
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA.
| | - Eric M Campion
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA.
| | - Clay C Burlew
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA.
| | - Thomas J Schroeppel
- Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA.
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Magoteaux SR, Notrica DM, Langlais CS, Linnaus ME, Raines AR, Letton RW, Alder AC, Greenwell C, Eubanks JW, Lawson KA, Garcia NM, St Peter SD, Ostlie DJ, Leys CM, Bhatia A, Maxson RT, Tuggle DW, Ponsky TA. Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study. J Pediatr Surg 2017; 52:979-983. [PMID: 28363471 DOI: 10.1016/j.jpedsurg.2017.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/09/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Children with blunt liver or spleen injury (BLSI) requiring early transfusion may present without hypotension despite significant hypovolemia. This study sought to determine the relationship between early transfusion in pediatric BLSI and hypotension. METHODS Secondary analysis of a 10-institution prospective observational study was performed of patients 18years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension. RESULTS Of 1008 patients with BLSI, 47 patients met inclusion criteria. 22 (47%) had documented hypotension. There was no statistical difference in median time to first transfusion for those with or without hypotension (2h vs. 2.5h, p=0.107). The hypotensive group was older (median 15.0 versus 9.5years; p=0.007). Median transfusion volume in the first 24h was 18.2mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9mL/kg (IQR: 8.3, 21.0) for those without (p=0.220). Mortality was 14% (3/22) in children with hypotension and 0% (0/25) in children without hypotension. CONCLUSION Hypotension occurred in less than half of patients requiring early transfusion following pediatric BLSI suggesting that hypotension does not consistently predict the need for early transfusion. TYPE OF STUDY Secondary analysis of a prospective observational study. LEVEL OF EVIDENCE Level IV cohort study.
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Affiliation(s)
| | | | | | | | - Alexander R Raines
- Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| | - Robert W Letton
- Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| | - Adam C Alder
- Children's Medical Center Dallas, Dallas, TX, United States
| | | | - James W Eubanks
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Karla A Lawson
- Dell Children's Medical Center, Austin, TX, United States
| | - Nilda M Garcia
- Dell Children's Medical Center, Austin, TX, United States
| | - Shawn D St Peter
- Children's Mercy Hospital-University of Missouri, Kansas City, MO, United States
| | | | | | - Amina Bhatia
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - R Todd Maxson
- Arkansas Children's Hospital, Little Rock, AR, United States
| | - David W Tuggle
- Dell Children's Medical Center, Austin, TX, United States
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Thompson BM, Sparks RA, Seavey J, Wallace MD, Irvan J, Raines AR, McClure H, Nihira MA, Lees JS. Informed consent training improves surgery resident performance in simulated encounters with standardized patients. Am J Surg 2015; 210:578-84. [DOI: 10.1016/j.amjsurg.2014.12.044] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/17/2014] [Accepted: 12/22/2014] [Indexed: 01/16/2023]
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6
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Wicks RF, Raines AR, Garwe T, Enix JL, Irvan J, Mantor PC, Albrecht R. Abdominal aortic and iliac injury in blunt trauma: a single center's experience. Am Surg 2015; 81:E174-E175. [PMID: 25831170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ryan F Wicks
- Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
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Wicks RF, Raines AR, Garwe T, Enix JL, Irvan J, Mantor PC, Albrecht R. Abdominal Aortic and Iliac Injury in Blunt Trauma: A Single Center's Experience. Am Surg 2015. [DOI: 10.1177/000313481508100414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ryan F. Wicks
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
| | - Alexander R. Raines
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
| | - Tabitha Garwe
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
| | - Jessica L. Enix
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
| | - Jeremy Irvan
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
| | - P. Cameron Mantor
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
| | - Roxie Albrecht
- Department of Surgery Oklahoma University Health Sciences Center Oklahoma City, Oklahoma
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Johnson JJ, Garwe T, Raines AR, Thurman JB, Carter S, Bender JS, Albrecht RM. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center. Am J Surg 2013; 205:317-20; discussion 321. [DOI: 10.1016/j.amjsurg.2012.10.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/16/2012] [Accepted: 10/19/2012] [Indexed: 11/16/2022]
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