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Kuhlenschmidt K, Taveras LR, Schuster KM, Kaafarani HM, El Hechi M, Puri R, Crandall M, Schroeppel TJ, Cripps MW. A novel preoperative score to predict severe acute cholecystitis. J Trauma Acute Care Surg 2024:01586154-990000000-00676. [PMID: 38523119 DOI: 10.1097/ta.0000000000004308] [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] [Indexed: 03/26/2024]
Abstract
BACKGROUND In a large multicenter trial, The Parkland Grading Scale(PGS) for acute cholecystitis outperformed other grading scales and has a positive correlation with complications but is limited in its inability to preoperatively predict high-grade cholecystitis. We sought to identify preoperative variables predictive of high-grade cholecystitis(PGS 4 or 5). METHODS In a six-month period, patients undergoing cholecystectomy at a single institution with prospectively graded PGS were analyzed. Stepwise logistic regression models were constructed to predict high-grade cholecystitis. The relative weight of the variables was used to derive a novel score, the Severe Acute Cholecystitis Score(SACS). This score was compared to the Emergency Surgery Acuity Score(ESS), American Association for the Surgery of Trauma(AAST) preoperative score and Tokyo Guidelines(TG) for their ability to predict high-grade cholecystitis. SACS was then validated using the database from the AAST multicenter validation of the grading scale for acute cholecystitis. RESULTS Of the 575 patients that underwent cholecystectomy, 172(29.9%) were classified as high-grade. The stepwise logistic regression modeling identified 7 independent predictors of high-grade cholecystitis. From these variable the SACS was derived. Scores ranged from 0 to 9 points with a C statistic of 0.76, outperforming the ESS(C statistic of 0.60), AAST(0.53), and TG(0.70)(p-value <0.001). Using a cutoff of 4 or more on the SACS correctly identifies 76.2% of cases with a specificity of 91.3% and a sensitivity of 40.7%.In the multicenter database, there were 464 patients with a prospectively collected PGS. The C statistic for SACS was 0.74. Using the same cutoff of 4, SACS correctly identifies 71.6% of cases with a specificity of 83.8% and a sensitivity of 52.2%. CONCLUSIONS The Severe Acute Cholecystitis Score can preoperatively predict high-grade cholecystitis and may be useful for counseling patients and assisting in surgical decision making. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
| | - Luis R Taveras
- Medical City Healthcare, Department of Surgery, Plano, TX
| | | | | | - Majed El Hechi
- Massachusetts General Hospital, Department of Surgery, Boston, MA
| | - Ruchir Puri
- University of Florida Health Jacksonville, Department of Surgery, Jacksonville, MA
| | - Marie Crandall
- University of Florida Health Jacksonville, Department of Surgery, Jacksonville, MA
| | | | - Michael W Cripps
- University of Colorado Anschutz Medical Center, Department of Surgery, Aurora, CO
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Teke ME, Taveras LR, Meier J, Johnson CC, Marshall NJE, Hynan LS, Nwariaku FE, Zeh HJ, Abdelfattah KR. Burnout in Surgical Residents of Underrepresented in Medicine Backgrounds: Key Influencing Factors and Possible Solutions. J Surg Res 2023; 291:51-57. [PMID: 37348436 DOI: 10.1016/j.jss.2023.05.022] [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: 08/26/2022] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Alarming rates of burnout in surgical training pose a concern due to its deleterious effects on both patients and providers. Datum remains lacking on rates of burnout in surgical residents based on race and ethnicity. This study aims to document the frequency of burnout in surgical residents of racially underrepresented backgrounds and elucidate contributing factors. METHODS A 35-question anonymized survey was distributed to general surgery residents from 23 programs between August 2018 and May 2019. This survey was designed from the validated Maslach Burnout Inventory, and included additional questions assessing participant demographics, educational, and social backgrounds. Responses were analyzed utilizing chi-square tests and Wilcoxon rank sum tests. There was also a free response portion of the survey which was evaluated using thematic analysis. RESULTS We received 243 responses from 23 general surgery programs yielding a 9% (23/246) program response rate and 26% (243/935) response rate by surgical residents. One hundred and eighty-five participants (76%) identified as nonunderrepresented in medicine and 58 (24%) of participants identified as underrepresented in medicine. Fifty-three percent were male and 47% female. Overall, sixty-six percent of all surgical residents (n = 161) endorsed burnout with racially underrepresented residents reporting higher rates of burnout at 76% compared to 63% in their nonunderrepresented counterparts (P = 0.07). CONCLUSIONS Although the generalizability of these results is limited, higher rates of reported burnout in racially underrepresented trainees noted in our study illuminates the need for continual dialogue on potential influencing factors and mitigation strategies.
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Affiliation(s)
- Martha E Teke
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Courtney C Johnson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicholas J E Marshall
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Linda S Hynan
- Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fiemu E Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kareem R Abdelfattah
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Taveras LR, Scrushy MG, Cripps MW, Kuhlenschmidt K, Crandall M, Puri R, Schroeppel TJ, Schuster KM, Dumas RP. From mild to gangrenous cholecystitis, laparoscopic cholecystectomy is safe 24 hours a day. Am J Surg 2023:S0002-9610(23)00045-4. [PMID: 36746709 DOI: 10.1016/j.amjsurg.2023.01.029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Laparoscopic cholecystectomy (LC) at night remains controversial. Prior studies have not controlled for disease severity. We analyzed outcomes of LC performed day vs. night while controlling for the Parkland Grading Scale for Cholecystitis (PGS). METHODS Analysis of the AAST multicenter evaluation of cholecystitis database was performed. Exclusion criteria included non-operative cases, open operations, and missing PGS. Cases were divided based on operation start time. PGS was used to control for disease severity. Outcomes included operative time, use of bailout techniques and complications. RESULTS Of 759 procedures identified, 16% were nighttime LC. No differences in demographics, comorbidities, physiologic variables and PGS were noted. Operative time (108.6 min vs 105.6), bailout techniques (8.3% vs 7.4%) and complications (9.9% vs 11.3%) were similar between groups. CONCLUSION Regardless of severity, laparoscopic cholecystectomy is safe 24-h a day. Operations performed at night have a similar complication profile to those performed during the day.
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Affiliation(s)
- L R Taveras
- University of Texas Southwestern, Department of General Surgery, USA
| | - M G Scrushy
- University of Texas Southwestern, Department of General Surgery, USA.
| | - M W Cripps
- University of Colorado, Department of Surgery, Trauma and Acute Care Surgery, USA
| | - K Kuhlenschmidt
- University of Texas Southwestern, Department of General Surgery, USA
| | - M Crandall
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida, Department of Surgery, USA
| | - R Puri
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida, Department of Surgery, USA
| | - T J Schroeppel
- University of Colorado, Department of Surgery, Trauma and Acute Care Surgery, USA
| | - K M Schuster
- Yale School of Medicine New Haven, Connecticut, Department of Surgery, USA
| | - R P Dumas
- University of Texas Southwestern, Department of General Surgery, USA
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Khoury MK, Jones RE, Gee KM, Taveras LR, Boniakowski AM, Coleman DM, Abdelfattah KR, Rectenwald JE, Minter RM. Trainee Reliance on Public Service Loan Forgiveness. J Surg Educ 2021; 78:1878-1884. [PMID: 34266790 PMCID: PMC8648921 DOI: 10.1016/j.jsurg.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Public Service Loan Forgiveness (PSLF) program is an option to trainees to help alleviate federal education debt. The prevalence of PSLF utilization and how this may impact career decisions of trainees is unknown. The purpose of this study was to understand the prevalence, impact, and understanding of PSLF participation on trainees. DESIGN IRB-approved anonymous survey asking study subjects to report demographics, financial status, and reliance on PSLF. In addition, study subjects were asked to report their participation in PSLF, the possible impact of PSLF participation on career decisions, and to identify the qualifications needed to complete PSLF. SETTING Online anonymous survey. PARTICIPANTS The survey was offered to all physician trainees in all specialties at the University of Texas, Southwestern, University of Wisconsin, Madison, and University of Michigan, Ann Arbor. RESULTS There were 934 respondents, yielding a 37.6% response rate. A total of 416/934 (44.5%) respondents were actively or planning on participating in the PSLF program with 175/934 (18.7%) belonging to a surgical specialty. Those belonging to a surgical specialty were more likely to be PSLF participants compared to medical specialties (53.1% versus 42.6%, p = 0.01). For those participating in PSLF, 82/416 (19.7%) stated this participation impacted career decisions. A total of 275/934 (29.4%) respondents obtained and 437/934 (46.8%) wanted to receive formal training/lectures in regards to the PSLF program. Of those actively or planning on participating in the PSLF program, only 58/416 (13.9%) were able to correctly identify all of the qualifications/criteria to complete the program. CONCLUSIONS A large proportion of trainees rely on the PSLF program for education loan forgiveness with approximately 20% reporting participation impacted career decisions. Additionally, the majority may not fully understand PSLF criteria. Programs should strongly consider providing a formal education regarding PSLF to their trainees.
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Affiliation(s)
- Mitri K Khoury
- University of Texas, Southwestern Medical Center; Department of Surgery; Dallas, Texas; University of Wisconsin, Madison; Department of Surgery; Madison, Wisconsin.
| | - R Ellen Jones
- University of Texas, Southwestern Medical Center; Department of Surgery; Dallas, Texas
| | - Kristin M Gee
- University of Texas, Southwestern Medical Center; Department of Surgery; Dallas, Texas
| | - Luis R Taveras
- University of Texas, Southwestern Medical Center; Department of Surgery; Dallas, Texas
| | - Anna M Boniakowski
- University of Michigan, Ann Arbor; Department of Surgery; Ann Arbor, Michigan
| | - Dawn M Coleman
- University of Michigan, Ann Arbor; Department of Surgery; Ann Arbor, Michigan
| | - Kareem R Abdelfattah
- University of Texas, Southwestern Medical Center; Department of Surgery; Dallas, Texas
| | - John E Rectenwald
- University of Wisconsin, Madison; Department of Surgery; Madison, Wisconsin
| | - Rebecca M Minter
- University of Wisconsin, Madison; Department of Surgery; Madison, Wisconsin
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Clark AT, Song J, Yao X, Carlson D, Huebinger RM, Mei Liu M, Madni TD, Imran JB, Taveras LR, Weis HB, Arnoldo BD, Phelan HA, Wolf SE. Muscle Homeostasis Is Disrupted in Burned Adults. J Burn Care Res 2021; 41:33-40. [PMID: 31738430 DOI: 10.1093/jbcr/irz190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Severe burn leads to substantial skeletal muscle wasting that is associated with adverse outcomes and protracted recovery. The purpose of our study was to investigate muscle tissue homeostasis in response to severe burn. Muscle biopsies from the right m. lateralis were obtained from 10 adult burn patients at the time of their first operation. Patients were grouped by burn size (total body surface area of <30% vs ≥30%). Muscle fiber size and factors of cell death and muscle regeneration were examined. Muscle cell cross-sectional area was significantly smaller in the large-burn group (2174.3 ± 183.8 µm2 vs 3687.0 ± 527.2 µm2, P = .04). The expression of ubiquitin E3 ligase MuRF1 and cell death downstream effector caspace 3 was increased in the large-burn group (P < .05). No significant difference was seen between groups in expression of the myogenic factors Pax7, MyoD, or myogenin. Interestingly, Pax7 and proliferating cell nuclear antigen (PCNA) expression in muscle tissue were significantly correlated to injury severity only in the smaller-burn group (P < .05). In conclusion, muscle atrophy after burn is driven by apoptotic activation without an equal response of satellite cell activation, differentiation, and fusion.
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Affiliation(s)
- Audra T Clark
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch - Galveston
| | - Xiao Yao
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Deborah Carlson
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Ryan M Huebinger
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Ming Mei Liu
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Tarik D Madni
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Jonathan B Imran
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Luis R Taveras
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Holly B Weis
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Brett D Arnoldo
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Herb A Phelan
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch - Galveston
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Ross SW, Kuhlenschmidt KM, Kubasiak JC, Mossler LE, Taveras LR, Shoultz TH, Phelan HA, Reinke CE, Cripps MW. Association of the Risk of a Venous Thromboembolic Event in Emergency vs Elective General Surgery. JAMA Surg 2021; 155:503-511. [PMID: 32347908 DOI: 10.1001/jamasurg.2020.0433] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Trauma patients have an increased risk of venous thromboembolism (VTE), partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery (EGS). Objectives To investigate whether emergency case status is independently associated with VTE compared with elective case status and to test the hypothesis that emergency cases would have a higher risk of VTE. Design, Setting, and Participants This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, to December 31, 2016, for all cholecystectomies, ventral hernia repairs (VHRs), and partial colectomies (PCs) to obtain a sample of commonly encountered emergency procedures that have elective counterparts. Emergency surgeries were then compared with elective surgeries. The dates of analysis were January 1 to 31, 2019. Main Outcomes and Measures The primary outcome was VTE at 30 days. A multivariable analysis controlling for age, sex, body mass index, bleeding disorder, disseminated cancer, laparoscopy approach, and surgery type was performed. Results There were 604 537 adults undergoing surgical procedures over 12 years (mean [SD] age, 55.3 [16.6] years; 61.4% women), including 285 847 cholecystectomies, 158 500 VHRs, and 160 190 PCs. The rate of VTE within 30 days was 1.9% for EGS and 0.8% for elective surgery, a statistically significant difference. Overall, 4607 patients (0.8%) had deep vein thrombosis, and 2648 patients (0.4%) had pulmonary embolism. A total of 6624 VTEs (1.1%) occurred in the cohort. As expected, when VTE risk was examined by surgery type, the risk increased with invasiveness (0.5% for cholecystectomy, 0.8% for VHR, and 2.4% for PC; P < .001). On multivariable analysis, EGS was independently associated with VTE (odds ratio [OR], 1.70; 95% CI, 1.61-1.79). Also associated with VTE were open surgery (OR, 3.38; 95% CI, 3.15-3.63) and PC (OR, 1.86; 95% CI, 1.73-1.99). Conclusions and Relevance In this cohort study, emergency surgery and increased invasiveness appeared to be independently associated with VTE compared with elective surgery. Further study on methods to improve VTE chemoprophylaxis is highly recommended for emergency and more extensive operations to reduce the risk of potentially lethal VTE.
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Affiliation(s)
- Samuel W Ross
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kali M Kuhlenschmidt
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - John C Kubasiak
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Lindsey E Mossler
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Luis R Taveras
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas H Shoultz
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Herbert A Phelan
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Caroline E Reinke
- Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael W Cripps
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
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Comish PB, Madni TD, Nakonezny PA, Mayo H, Imran JB, Kuhlenschmidt KM, Taveras LR, Vela RJ, Goldenmerry YL, Clark AT, Weis HB, Cripps MW, Wolf SE. An analysis of surgical literature trends over four decades. Am J Surg 2020; 221:53-54. [PMID: 32711859 DOI: 10.1016/j.amjsurg.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Paul B Comish
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Helen Mayo
- Department of Education, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | | | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Ryan J Vela
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | | | - Audra T Clark
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Holly B Weis
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Cunningham HB, Scielzo SA, Nakonezny PA, Bruns BR, Brasel KJ, Inaba K, Brakenridge SC, Kerby JD, Joseph BA, Mohler MJ, Cuschieri J, Paulk ME, Ekeh AP, Madni TD, Taveras LR, Imran JB, Wolf SE, Phelan HA. Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients. J Burn Care Res 2020; 39:1000-1005. [PMID: 29771351 DOI: 10.1093/jbcr/iry027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.
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Affiliation(s)
- Holly B Cunningham
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Shannon A Scielzo
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Clinical Science and Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Brandon R Bruns
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Karen J Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health Science University, Portland, OR, USA
| | - Kenji Inaba
- Division of Acute Care Surgery and Critical Care, University of Southern California, Los Angeles, CA, USA
| | | | - Jeffrey D Kerby
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bellal A Joseph
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - M J Mohler
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Joseph Cuschieri
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Mary E Paulk
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Akpofure P Ekeh
- Department of Surgery, Wright State University, Dayton, OH, USA
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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9
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Imran JB, Madni TD, Taveras LR, Cunningham HB, Clark AT, Cripps MW, GoldenMerry YP, Diwan W, Wolf SE, Mokdad AA, Phelan HA. Analysis of operating room efficiency between a hospital-owned ambulatory surgical center and hospital outpatient department. Am J Surg 2019; 218:809-812. [DOI: 10.1016/j.amjsurg.2019.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 11/24/2022]
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10
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Weis HB, Weis JJ, Clark AT, Taveras LR, Napier RH, Farmer SJ, Zeh HJ, AbdelFattah KR. Surgical Faculty Emotional Intelligence is Associated with Resident Evaluations. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Weis HB, Meinhardt KE, Minhajuddin A, Viroslav H, Colletti M, Weis JJ, Taveras LR, Madni TD, Imran JB, Clark AT, Pickett ML, Phelan HA, Ambardekar AP. Administration of Tumescence in Pediatric Burn Patients Causes Significant Hypertension. J Burn Care Res 2019; 40:752-756. [DOI: 10.1093/jbcr/irz081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractThe effects of injecting tumescence containing phenylephrine in pediatric burn patients are unknown, but anecdotally our clinicians note a high incidence of hypertension requiring treatment. This study sought to determine whether tumescence with phenylephrine was associated with hypertension requiring treatment in our pediatric burn patients. This was a retrospective cohort study of pediatric burn patients who underwent tangential excision with split-thickness autografting, excision alone, or autografting alone from 2013 to 2017. Records were reviewed for hypertensive episodes, defined as ≥2 consecutive blood pressure readings that were >2 SD above normal. Published intraoperative age- and sex-adjusted standards were used to define reference values. Parametric and nonparametric tests were used when appropriate. In total, 258 operations were evaluated. Mean patient age was 7.6 ± 5.2 years, and 64.7% were male. Patients were predominately white (69.8%). Overall, there was a 62.8% incidence of hypertension. On univariate logistic regression analysis, duration of operation, estimated blood loss, treated TBSA, and weight-adjusted volume of tumescence were significant predictors of intraoperative hypertension (P < .01). On multivariate analysis, weight-adjusted volume of tumescence alone was significantly associated with the presence of hypertension with an odds ratio of 2.0 (95% confidence interval: 1.33–3.04). Of the 162 operations which exhibited at least one episode of significant hypertension, 128 cases (79%) were treated. Intraoperative administration of phenylephrine-containing tumescence in pediatric burn patients is associated with clinically significant hypertension requiring treatment. This practice should be conducted with caution in pediatric burn operations until its clinical implications are defined.
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Affiliation(s)
- Holly B Weis
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Kyle E Meinhardt
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Hannah Viroslav
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas
| | - Meaghan Colletti
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Joshua J Weis
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Audra T Clark
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Maryanne L Pickett
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Aditee P Ambardekar
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas
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Taveras LR, Imran JB, Cunningham HB, Pickett ML, Madni TD, Clark AT, Ahmed F, Phelan HA, Cripps MW, Roaten K. 71 Standardized Suicide Screening in Adult Burn Patients to Determine Risk. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L R Taveras
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - J B Imran
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - H B Cunningham
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - M L Pickett
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - T D Madni
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - A T Clark
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - F Ahmed
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - H A Phelan
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - M W Cripps
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - K Roaten
- University of Texas Southwestern, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
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Cunningham HB, Scielzo SA, Nakonezny PA, Bruns BR, Brasel KJ, Inaba K, Brakenridge SC, Kerby JD, Joseph BA, Mohler MJ, Cuschieri J, Paulk ME, Ekeh AP, Madni TD, Taveras LR, Imran JB, Wolf SE, Phelan HA. Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients. Am J Hosp Palliat Care 2019; 36:669-674. [DOI: 10.1177/1049909118823182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.
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Affiliation(s)
| | - Shannon A. Scielzo
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Brandon R. Bruns
- Department of Surgery, University of Maryland, College Park, MD, USA
| | - Karen J. Brasel
- Department of Surgery, Oregon Health Science University, Portland, OR, USA
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - Jeffrey D. Kerby
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bellal A. Joseph
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - M. J. Mohler
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Joseph Cuschieri
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Mary E. Paulk
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | | | - Tarik D. Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Luis R. Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B. Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Herb A. Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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Imran JB, Madni TD, Taveras LR, Clark AT, Cunningham HB, GoldenMerry YP, Cripps MW, Phelan HA, Wolf SE. Ambulatory Surgical Center vs Inpatient Hospital Operating Room Efficiency. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
INTRODUCTION The standard of care for locally advanced rectal cancer includes neoadjuvant chemoradiation with subsequent total mesorectal excision. This approach has shown various degrees of response to neoadjuvant chemoradiation (ranging from complete response to further tumor growth), which have substantial prognostic and therapeutic implications. A total regression of the tumor is a predictor of superior oncologic outcomes compared with partial responders and non-responders. Further, this concept has opened the possibility of nonoperative strategies for complete responders and explains the widespread research interest in finding clinical, radiographic, pathologic, and biochemical parameters that allow for identification of these patients. Areas covered: The present review evaluates the most recent efforts in the literature to identify predictors of patients likely to achieve a complete response following neoadjuvant treatment for the management of rectal cancer. This includes clinical predictors of pathologic complete response such as tumor location, size, and stage, molecular predictors such as tumor biology and microRNA, serum biomarkers such as carcinoembryogenic antigen and nomograms. Expert commentary: There has been significant progress in our ability to predict pathological complete response. However, more high-quality research is still needed to use this concept to confidently dictate clinical management.
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Affiliation(s)
- Corey Timmerman
- a University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Luis R Taveras
- a University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Sergio Huerta
- a University of Texas Southwestern Medical Center , Dallas , TX , USA.,b VA North Texas Healthcare System , Dallas , TX , USA
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Taveras LR, Cunningham HB, Imran JB. Can We Reliably Predict a Clinical Complete Response in Rectal Cancer? Current Trends and Future Strategies. Curr Colorectal Cancer Rep 2018. [DOI: 10.1007/s11888-018-0401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cunningham HB, Weis JJ, Taveras LR. Current Trends in the Rate of Rectal Cancer Restorative Operations in the Era of Neoadjuvant Chemoradiation. Curr Colorectal Cancer Rep 2018. [DOI: 10.1007/s11888-018-0400-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
A hernia containing the vermiform appendix [de Garengeot hernia (DGH)] is an exceedingly rare event. Most cases of DGH are made during inguinal exploration. In the present report, we discuss a patient who underwent an operation which revealed a DGH with appendicitis. This case is unusual because it occurred in a nonagenarian male veteran patient. The unique aspect of this case is that it was performed in its entirety under local anesthetic.
Introduction A hernia containing the vermiform appendix [de Garengeot hernia (DGH)] is an exceedingly rare event. Appendicitis occurring in this setting if further unusual. Most cases of DGH are made during inguinal exploration. In the present report, we discuss a patient who underwent an operation which revealed a DGH with appendicitis. Presentation of a case A 94-year-old man with a past medical history significant for hypertension and Parkinson’s disease was admitted to the hospital for the management of an event of CHF exacerbation. He developed acute onset of a painful right inguinal bulge. He had no prior hernia history. On physical exam, he had a 3-cm, tender, non-reducible right inguinal bulge without skin changes. Laboratory analyses were normal without leukocytosis. An acute abdominal series was obtained and demonstrated no obstruction. A groin exploration was performed under local anesthetic. An abscess was found associated with a femoral hernia containing the vermiform appendix. An appendectomy was performed through the hernia sac. The hernia was repaired via a McVay technique. At thirty days after his procedure, he had no complications and no signs of recurrence. Conclusion Most cases of DGH are diagnosed intraoperatively. Limited work up might be sufficient for adequate management. Several surgical strategies are acceptable. Groin exploration, plus and minus an appendectomy, and tissue repair versus mesh placement are acceptable surgical strategies. Laparoscopic approach for the management of DGH has been reported.
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Affiliation(s)
- Luis R Taveras
- VA North Texas Health Care System, University of Texas Southwestern, Department of Surgery, Dallas, TX, United States
| | - Sergio Huerta
- VA North Texas Health Care System, University of Texas Southwestern, Department of Surgery, Dallas, TX, United States.
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