Reproduced with limited editing.
Andrea Abbott,
MD
Mount Pleasant, SC
The management of lymph nodes in the setting of breast cancer has evolved tremendously in the last 50 years and with considerable changes in management, the treatment patterns are often slow to catch up to recent recommended practice. The goal of this talk is to present the current evidence of treatment recommendations in accordance with NCCN guidelines and societal recommendations (SSO/ASBrS) regarding the management of lymph nodes for breast cancer patients. At the end of the talk the listener will be provided case based scenarios to demonstrate how to implement current treatment recommendations.
Emad Aboud,
MD
Director Of Microneurosurgery Laboratory, Arkansas
Neuroscience Institute. North Little Rock, AR
Neurosurgeon, National Hospital, Swaida, Syria
I am presenting this talk to answer the question of whether cadaver based surgical training still has a role in training surgery residents and preparing them for the operating room experience without compromising patient safety. I will present the Live cadaver model for surgical training showing its role and efficacy in refining the surgical skills of residents and young surgeons. Additionally, i will explain and demonstrate methods of preparation and use of this model.
The Live Cadaver Model (Aboud Model) combines both real human anatomy with lifelike conditions in a single training model. The model is cadaver based utilising human anatomy prepared by cannulating the major vessels and flushing them with N saline to clean and ensure patency for the recreation of circulation. After that, the arterial side is connected to a pump that provides pulsating pressure to create lifelike conditions that allow for practicing actual surgery on cadavers.
I am presenting this model to the honorable members of the International College of Surgeons and the American Academy of Neurological and Orthopaedic Surgeons to demonstrate how closely this model resembles live surgery compared to other available models and simulators. It is an important and essential teaching tool that is readily available, cost-effective in comparison to other training models, and highly valuable in teaching rare and difficult scenarios, as well as in dealing with complications. This model is a valuable addition to ATOM and ATLS courses and military surgical training. Finally, to encourage the use of this particular approach in surgical training not only for trauma and general surgery but also for all surgical procedures in various surgical fields.
Phillipe Abreu,
MD, PhD, MSc, MBA
Assistant Professor of Surgery, University of Colorado Anschutz Medical Campus Aurora, CO
This lecture will explore the
evolving landscape of robotic surgery, focusing on its application in both
ultracomplex surgical procedures and enhancing healthcare access in remote
areas. Attendees will gain insight into the challenges posed by intricate surgical
interventions and how robotic systems can improve precision, reduce recovery
times, and enhance patient outcomes.
Understanding this
information is critical for healthcare professionals, as robotic surgery
represents a significant advancement in surgical techniques and offers
potential solutions to disparities in healthcare access. After the
presentation, participants will be equipped to assess the feasibility of
robotic systems in their practice, identify best practices for implementation,
and advocate for technology that bridges gaps in healthcare delivery.
The audience will benefit by enhancing their knowledge of cutting-edge surgical technologies, understanding the potential for improved patient care, and learning how to leverage robotic surgery to address healthcare challenges, especially in underserved regions. This session aims to inspire innovation and encourage the integration of robotic systems into diverse surgical environments.
Mansoor Ahmad,
Ex-Chief Consultant Surgeon, Services Hospital Lahore Lahore, Pakistan
Pain and inflammation are interconnected physiological responses that occur in the body as a result of injury, infection, or chronic diseases. Pain is a subjective experience that serves as a protective mechanism, alerting the body to potential harm or damage. It can be acute or chronic and may manifest as a result of tissue injury, nerve damage, or disease processes. Inflammation, on the other hand, is the body's immune response to injury or infection, characterized by redness, swelling, heat, and pain at the affected site. Understanding the mechanisms underlying pain and inflammation has led to the development of effective therapeutic interventions. Nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and corticosteroids are commonly used to manage pain and inflammation. Additionally, advancements in targeted therapies, such as biologics and novel analgesics, have provided new opportunities for pain and inflammation management. Comprehensive understanding of their underlying mechanisms is crucial for developing effective treatment strategies and improving patient outcomes in various medical conditions associated with pain and inflammation.
Asif Al Rawi,
FRCS(Tr&Orth)
Consultant Spinal Surgeon, Lead of Spinal Trauma
The James Cook University Hospital, London, UK
In spinal surgery, we are
witnessing an increasing prevalence of adult spinal deformities, including a
growing number of complex cases. Adult spinal deformities are relatively recent
pathologies that have garnered heightened interest among spine surgeons.
This area is marked by
significant debate regarding various aspects of the condition, including the
absence of a universally accepted classification system and clear indications
for surgical intervention.
Discussions also encompass
surgical techniques, determination of surgical levels, instrumentation choices,
and the identification of the most effective surgical approaches.
While the severity of the
deformity curve and the derangement of various spinal and spinopelvic
parameters can assist in determining surgical candidacy and achieving surgical
goals, these factors do not fully capture the complexities and challenges associated
with intraoperative difficulties.
More critical considerations
likely include prior spinal surgeries, associated comorbidities, bone quality
and osteoporosis, and the overall, the rigidity of the curve, which is
essential for evaluating the feasibility of deformity correction and ultimately
defining outcomes in more complex cases.
The rigidity of the spinal curve deformity is likely the primary factor influencing the complexity of surgery and determining other critical parameters that define associated operative and postoperative risks. These parameters may include the duration of surgery, blood loss, and the stress related to prolonged surgical procedures. Additionally, the rigidity of the curve plays a crucial role in assessing the feasibility of deformity correction, particularly most patients are fragile with suboptimal bone quality.
Asif Al-Rawi,
FRCS(Tr&Orth)
Consultant Spinal Surgeon, Lead of Spinal Trauma
The James Cook University Hospital, UK London, UK
The analysis of stability and
decision-making in thoracolumbar injuries has evolved significantly from the
foundational three-column concept introduced by Denis. In 1994, Magerl and his
team at AO proposed the two-column stability theory, marking a pivotal
advancement in our understanding of thoracolumbar stability.
Today, most trauma spinal
surgeons utilize this two-column AO framework for assessing spinal stability,
guiding classification and surgical decision-making in thoracolumbar injuries.
While the two-column concept is particularly relevant to thoracolumbar junction
injuries, its applicability to more distal lower lumbar and upper dorsal
injuries remain uncertain.
The significant size and
strength of the intervertebral discs and lumbar vertebrae anteriorly, combined
with the contribution of the facet joints laterally and the neural arch with
its associated ligaments posteriorly, challenge the applicability of the two-column
concept to the lower lumbar spine stability. This raises the question of
whether a distinct classification system is necessary for this specific
anatomical region of the spine.
Furthermore, it raises the question of why the
AO surgeons who developed the two-column theory did not extend this framework
to the cervical spine.
In the context of upper
dorsal injuries, the contributions of the ribcage and sternum to stability are
critical factors influencing decision-making.
Additionally, it is essential to evaluate whether the role of facet joints as anchoring points in determining rotational stability has been sufficiently addressed. We argue that the contribution of these joints is so critical that their integrity should be incorporated into the classification system for spinal stability and surgical decision-making.
Osaid Alser,
MD, MSc(Oxon), FICS(Jr.)
Texas Tech University Health Sciences Center Lubbock, TX
Access to safe surgical care is increasingly recognized as a global health concern, particularly in low-to-middle-income countries, and war-torn and heavily populated refugee zones such as Palestine. We aim to conduct the first nationwide and systematic evaluation of surgical capacity in Palestine.
Methods: This was a cross-sectional study conducted between May and October 2023 and included all healthcare facilities that provide general surgery services in Palestine. A modified version of the validated 5-domain Personnel (P), Infrastructure (I), Procedures (Pr), Equipment (E), and Supplies (S) (PIPES) tool was administered in each facility through a face-to-face or phone interview. Facilities’ PIPES indices were summed; data were aggregated and analyzed for differences in geographic location (Gaza and West Bank) and type of facilities (governmental vs. non-governmental) using univariate analysis.
Results: A total of 57 facilities were included in the study; 51 (89.5%) of the data were collected by site-visit interviews while the others were by using phone calls. Of all facilities, 33 (57.9%) were in the West Bank and 24 (42.1%) in Gaza (Figure 1). The majority were non-governmental hospitals (n=37, 64.9%). The mean PIPES score was (P = 28.8, I = 17.2, Pr = 39.7, E = 23.1, and S = 24.6). The total PIPES score was similar between Gaza and West Bank (p=0.450) but was significantly less in non-governmental compared to governmental facilities (125.6 vs. 147.9, p-value = 0.003). The number of hospital beds, functioning operating rooms, and general surgeons (regardless of board-certification status), per 100,000 population were 132.1, 3.8 and 6.9, respectively. General surgery residency training was only available in 17 hospitals (29.8%); most of them were in governmental compared to non-governmental facilities (55.0 vs. 16.2, p=0.002). P score was significantly less in non-governmental hospitals compared to governmental facilities (20.2 vs. 44.8, P-value = <0.001). Pr score was significantly less in Gaza compared to the West Bank (36.8 vs 41.8, p= 0.002). S score was significantly higher in non-governmental hospitals compared to governmental facilities (24.8 vs. 24.3, p <0.001). Laparoscopic surgery was significantly higher in non-governmental compared to governmental facilities (100% vs 80%, P-value = 0.004). Bariatric surgery was more commonly performed in West Bank compared to Gaza (66.7% vs 12.5%, p<0.001) and in non-governmental facilities compared to governmental ones (54.1% vs 25.0%, p=0.035). Open fracture procedures, osteomyelitis management, and amputations were also significantly deficient in Gaza compared to West Bank. Only 13 facilities (22.8%) had a dedicated trauma center with no significant differences in the type of facility or geographical location.
Conclusions: Surgical
capacity assessment in Palestine showed a substantial disparity across all five
domains of the PIPES tool, with disparities more pronounced in Gaza and
governmental hospitals. We hope these results would robust evaluation of
surgical capacity in Palestine which will help direct funding and resources to
improve access to safe surgical care, reduce disparities, and strengthen
surgery training in Palestine.
Domingo T Alvear,
MD
Retired Chief of Pediatric Surgery, Pinnacle Health
System;
Chairman, World Surgical Foundation Mechanicsburg, PA
Esophageal Atresia ( EA ) without an associated Tracheo-esophageal fistula ( TEF ) is the least common of the esophageal anomalies. EA with TEF occurs in 1:5,000 live births worldwide is seen in 87% of the cases while EA without a fistula is seen in 8% of cases. This is also referred as long gap anomaly.When a baby is born with this anomaly, a cervical esophagostomy (spit fistula) is created to allow saliva to be excreted out of the neck to prevent aspiration and a gosatrotmy tube inserted for feeding to allow the infant to grow. This is usually performed in low income countries and in the USA. The other option is to insert a sump suction catheter to the blind upper esophageal pouch and prevent aspiration of the overflow of saliva. The infant will be on parenteral nutrition (TPN) while waiting for the gap between the upper and lower esophagus to grow with 8 weeks. If that occurs the gap between the upper and lower shortens and primary anastomosis can be performed. In low income countries, cervical esophagostomy and a gastrostomy is done.
Replacemnet of the esophagus con
be done with Colon, Gastric Pull up, Reverse Gastric tube or Jejunum. Ideally
this producers can be done when the child is
1 year old and at least 10 kg in weight. Colon interposition has been
the procedure of choice in Honduras for the last 20 years. The technique is
easy to teach to the local Pediatric Surgeons. There is also less chance for
early and late complications. From 1999 to 2023, we have performed 26 colon
interpositions in Honduras ages 3 to 14 years of age. 12 for long gap EA, 12
for complications from a prior EA with TEF repair, 1 formlye burn of the
esophagus and 1 for GSW of the esophagus. Colon prep is done prior the
procedure, GIA Spring device is used to prevent spillage and contamination and
careful preservation of the colon blood supply either the left colic or middle
colic artery. The colon is anastomosed to the stomach and to the upper
esophagus. A contrast study is performed 7 days post op, if no leak the patient
can be stated on oral feeding. The gastrostomy tube is utilized few days post
op and removed once oral intake is adequate for nutrition.
Complications included 2 pneumothorax relieve by insertion of a chest tube. 2 neck leaks which resolved. 1 death from sepsis.
In conclusion, the colon is
the preferred replacement of the esophagus in low income countries because the
technique can be taught to our local counterpart. They are now confident that
they can perform the procedure themselves.
Abhirami Babu,
MD
Junior Intern
Our Lady of Fatima University, College of Medicine Little Elm, TX
The presentation highlights the urgent need for improved surgical care in rural areas, focusing on the Philippines. Challenges include insufficient access to essential procedures like cesarean sections and trauma management, compounded by workforce shortages, inadequate infrastructure, and transportation gaps. These issues significantly hinder Universal Health Coverage (UHC) and Global Surgery 2030 goals
Rural surgical care disparities demand targeted interventions. By exploring innovative models, such as PSGS-accredited training programs in remote areas, the presentation equips stakeholders with actionable solutions. These training hubs can enhance the safety and accessibility of surgery while addressing the unique needs of underserved and isolated populations​
Participants could:
·
Learn strategies
to enhance surgical safety and trauma management through focused training for
non-surgical staff and rural surgeons.
·
Understand the
potential of telesurgery to expand manpower in remote areas and improve patient
outcomes.
· Explore solutions for logistical challenges, including air transport systems for trauma and critical care‹.
The audience will gain
practical insights into strengthening rural surgical systems. The presentation
emphasizes scalable initiatives like:
·
PSGS training
programs to build local surgical capacity.
·
Telesurgery to
overcome workforce gaps.
·
Transport
provisions for timely patient transfer.
·
Revisiting
government-funded initiatives, global surgery mission outreach programs to
bridge healthcare access.‹
Zakhria Belasher,
MD
Orthopedic Spine Surgeon,
Vice Chief of Staff, Associate Program Director of Spine Fellowship, Insight Institute of Neurosurgery & Neuroscience (IINN), Bloomfield Hills, MI
This presentation focuses on
the challenges of cervical myelopathy caused by severe spinal cord compression,
which, if overlooked, can lead to significant mobility loss, often confining
patients to wheelchairs. It will explore surgical interventions aimed at
decompressing the spinal cord and restoring function, emphasizing successful
outcomes where patients regain their ability to walk.
Understanding the latest
surgical techniques and management strategies for cervical myelopathy is
crucial for surgeons, healthcare professionals, and rehabilitation teams. This
knowledge is essential for improving patient outcomes and quality of life, especially
for those experiencing progressive neurological decline.
By the end of the
presentation, learners will be able to:
Identify the signs and
symptoms of cervical myelopathy that warrant surgical intervention.
Understand key surgical
techniques used to treat cervical myelopathy.
Recognize postoperative
rehabilitation approaches that optimize recovery and mobility.
Attendees will gain practical insights into the decision-making process for surgical intervention, patient selection, and postoperative management, enabling them to enhance patient care and help individuals with cervical myelopathy regain independence.
Vinay Bijoor,
BA
Medical Student, SUNY Downstate College of Medicine Briarcliff Manor, NY
Introduction: Neck pain is increasingly prevalent, with projections indicating 269 million cases by 2050, a 33% rise from 2020. This trend underscores the importance of educating students about prevention, diagnosis, and treatment strategies for neck pain. Currently, students learn through mentor guidance and literature evaluation, suggesting a need for accessible online educational resources. The introduction of artificial intelligence (AI), particularly ChatGPT, has gained attention for its potential to provide reliable health information. Previous studies have tested ChatGPT's efficacy in various medical topics, showing promising results for conditions like low back pain and degenerative spinal issues. However, there is a gap in literature regarding its responses to general neck pain inquiries. This study aims to assess the accuracy and quality of ChatGPT v3.5 and v4.0 in providing information on neck pain management by using established guidelines from the American Physical Therapy Association (APTA).
Methods: The study utilized the APTA guidelines to create 21 queries related to neck pain. Each query was derived from the guidelines by rephrasing headings into questions. Both ChatGPT v3.5 and v4.0 were prompted with these queries, and responses were assessed for accuracy, readability, quality, understandability, and actionability. To ensure unbiased evaluation, the memory of the chatbots was cleared before each input. The assessment tools included a five-point Likert scale for misinformation, the Flesch-Kincaid Grade Level score for readability, the DISCERN instrument for quality evaluation, and the Patient Education Materials Assessment Tool for Printable Materials (PEMAT) for understandability and actionability. Data analysis involved statistical tests to compare responses across the two versions of ChatGPT, including independent samples t-tests and Cohen’s kappa for interrater reliability.
Results: Both versions of ChatGPT demonstrated no misinformation, with a median Likert score of 1 for both. There was no significant difference in readability (Flesch-Kincaid Grade Level) between ChatGPT v3.5 and v4.0, both scoring above a 12th-grade reading level. However, ChatGPT v4.0 produced significantly longer responses (318.8 words) compared to v3.5 (229.3 words). Interrater reliability for the quality assessment (DISCERN) was fair (κ = 0.31). Both chatbots scored similarly on the overall quality measure, while ChatGPT v3.5 outperformed v4.0 regarding treatment-related information. The PEMAT results indicated high understandability (>76%) but low actionability scores, with both chatbots providing less than 11% actionable information.
Conclusions: The findings
indicate that both ChatGPT versions deliver accurate and readable responses
regarding neck pain, with ChatGPT v3.5 providing higher-quality treatment
information despite being the older version. Although the responses lacked completeness
and prioritization based on evidence, the study highlights the potential of AI
tools like ChatGPT in enhancing medical education. The moderate-quality outputs
suggest that these chatbots could support student learning about neck pain, a
growing concern in clinical practice. Future iterations of AI could address
current limitations and become valuable resources for educational purposes in
healthcare.
Vinay Bijoor,
BA
Medical Student, SUNY Downstate Health Sciences University, College of Medicine, Briarcliff Manor, NY
Purpose: The purpose of this study was to investigate the relationship between preoperative red-blood-cell transfusion (prRBCT) and postoperative complications in patients undergoing primary total shoulder arthroplasty (TSA). While previous studies have identified an association between preoperative anemia and increased postoperative complications in TSA, there remains a gap in the literature regarding the optimal management of anemia in this patient population. This study aims to contribute to the understanding of the impact of preoperative transfusions on TSA outcomes.
Methods: This study utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients who underwent primary TSA from 2012 to 2020. A total of 38,260 patients were included in the analysis, with 87 patients receiving a prRBCT. Demographic data, baseline health status, and procedure characteristics were collected, and postoperative complications, including mortality, readmission, length of stay, and other surgical outcomes, were assessed. Univariate and multivariable logistic regression models were used to adjust for confounders and analyze the association between prRBCT and various outcomes.
Results: Patients receiving prRBCT had significantly higher rates of detrimental postoperative outcomes compared to those who did not receive transfusions. These included increased rates of mortality (4.6% vs. 0.1%), prolonged length of stay (6 days vs. 1 day), institutional discharge (58% vs. 8.2%), and postoperative complications such as transfusion, infections, and other procedure-related complications (PRC). Multivariable logistic regression identified prRBCT as a predictor for several adverse outcomes, including mortality (OR 7.93), prolonged length of stay (OR 2.38), and institutional discharge (OR 4.47), though no significant relationship was found with reoperation, AKI, or UTI.
Discussion: This study adds
to the body of evidence on the relationship between prRBCT and postoperative
outcomes following TSA, providing valuable insights into an area with limited
prior research. While previous studies have shown that preoperative anemia is
associated with poorer outcomes, the role of preoperative transfusion as a
management strategy for such anemia has not been fully examined. The findings
suggest that patients receiving prRBCT may be at higher risk for certain
postoperative complications, which could imply the need for more careful
preoperative management. These results highlight the importance of further
research into the effects of anemia and transfusion strategies on TSA outcomes,
and may help guide future investigations into optimal care practices for this
patient population.
Saptarshi Biswas,
MD
Attending Trauma and Acute Care Surgeon, Program
Director-Surgical Critical Care Fellowship, Associate Program, Director-General
Surgery Residency, Director- Surgical Research and Surgical Simulation Grand
Strand Medical Center, Myrtle Beach, SC
Traumatic rhabdomyolysis is a
systemic manifestation of muscle injury. Crush syndrome and compartment
syndrome are common etiologies.
The frequency of Crush
syndrome has increased in the setting of ‘found down’ patients from drug
overdoses. Signs and symptoms of the injured limb vary from pressure-induced
skin changes to neurologic deficits and paralysis. Severe injuries can lead to
an associated Compartment Syndrome. Diagnosing Compartment Syndrome in a
patient with Crush Syndrome can be difficult but is important to distinguish
because it affects treatment.
The degree of muscle damage,
viability of the remaining muscular compartment, and presence of elevated
compartment pressures dictate the need for surgical intervention in the form of
fasciotomy. Surgical outcomes from Crush Syndrome and delayed Compartment
Syndrome result in similar high morbidity and surgical complications.
Our presentation defines and classifies the types of traumatic rhabdomyolysis and summarizes the outcomes to facilitate timely diagnosis and appropriate management for this population to reduce morbidity associated with these conditions.
Kathryn Campos,
BA
Global Health and Surgery Trainee Seattle, WA
Background/Introduction: The
effectiveness of Emergency Medical Teams (EMTs) and emergency surgical response
in conflict and humanitarian settings hinges on well-structured training
programs and skill development initiatives. This review explores the role of
tailored training in enhancing EMT preparedness and building capacity for
effective trauma care in crises.
Objectives: This review aims
to assess current training capacities, identify gaps in emergency surgical and
trauma care, promote best practices, foster local integration, and enhance
global health security through recommendations for improved training and
capacity building.
Method/Description: An
extensive review of 2,347 reports from PubMed, Embase, and Google Scholar was
conducted. Studies were included if they addressed civil-military emergency
medical operations, humanitarian surgical strengthening, and their impact on global
health security in conflict or disaster zones.
Results/Outcomes: Thirty-two
reports met the criteria, highlighting the importance of targeted training and
capacity building for EMTs. Key findings include the critical role of local
healthcare workers, humanitarian organizations (HMOs), non-governmental
organizations (NGOs), and civil-military actors in developing and executing
health security programs. Successful models of training emphasize local
engagement to ensure contextual relevance and sustainability, thus improving
the effectiveness of surgical care in crisis situations.
Conclusion: The review reveals a significant gap in integrating civil-military trauma care with broader humanitarian and health security efforts. It emphasizes the need for locally tailored training programs that empower responders and improve surgical care. Strengthening these capacity-building initiatives is crucial for enhancing the resilience of health systems and ensuring effective trauma care in conflict and disaster settings, ultimately contributing to stronger global health security.
Stephen Carryl,
MD
Assistant Clinical Professor of Surgery, Columbia University; CEO, The Community Hospital Trinidad & Tobago Glen Cove, NY
Noncommunicable Diseases are
the number one cause of illness and death worldwide
Understanding NCDs in the
English-speaking Caribbean
Low resource communities have
a special challenge in putting in measures to reduce risk factors
Learner will hear and understand ways of combating NCDs in the context of international medicine as applied to the English-speaking Caribbean working as a physician leader in a private hospital
Paulo Roman Castro,
Jr, MD, PhD
Professorial Lecturer in Orthopaedic Surgery and
Traumatology, Pasig City General Hospital, Pasig City, Philippines
This presentation is an
overview of hospital operations and surgical practice focusing on gender
sensitivity and inclusivity which are often neglected in institutional
settings. The lack of sensitivity among marginalized sectors such as women and
children, persons with disabilities (PWD), stigmatized populations such as LGBT
community or commercial sex workers affects surgical care and management of
these groups.
The learner will be able to
know the design, infrastructure, protocols especially in the operating rooms.
The audience will have an awareness of the appropriate care and management sensitive to the needs of the marginalized groups.
The presentation also aims to manifest studies with cross-cultural differences, various protocols in managing marginalized groups such as surgeon-patient sex concordance and its outcomes.
Radek Chvatal,
MD
Head of Gyn. and Obst. Department, SEF endometriosis clinic, Znojmo Hospital, Consultant for the Treatement of Endometriosis SEF Zentrum AKH Melk A, Consultant for the Oncogynaecology Onkocentre Jihlava Znojmo, Czech Republic
The small pelvis is an
anatomical region where surgery, neurosurgery, gynecology, and urology
intersect. Let’s focus on the gynecological perspective, with the
understanding that there are analogous procedures in the male pelvis.
Anatomically, most
specialized procedures in this region are performed retroperitoneally. This is
a topographically complex space containing autonomic, motor, and sensory nerve
plexuses covered by the endopelvic fascia, massive venous plexuses of the internal
iliacs with rich anastomoses, a relatively clear arterial supply, ureters,
bladder, uterus, and rectosigmoid. Minimally invasive laparoscopic and robotic
procedures are particularly valuable in this area, as they are both
conservative and nerve-sparing (e.g., endometriosis, urogynecology), as well as
ablative (oncology).
The boundaries between
specialties are often blurred, depending on the surgical experience or the
specific traditions of individual institutions or countries. Some procedures
are extremely delicate and require overlapping competencies. Examples include ureterolysis
of the juxtavesical portion of the ureter, its resection and anastomosis,
neurolysis of the hypogastric nerve bundle, bladder liberation, resection, and
suture, dissection of the obturator fossa, neurolysis of the lumbosacral trunk,
femoral nerve, and sacral roots, systematic lymphadenectomy, and shaving of the
rectosigmoid. Extrafascial or intrafascial resection of the rectosigmoid and
its anastomosis has traditionally been performed by surgeons in our country.
In the case of
non-oncological diseases (endometriosis), this boundary is not as sharp. There
is a growing number of clinical centers where these procedures and their
modifications (diskoid resection, NOSE) are performed by gynecologists or
urologists. Based on my many years of experience with retroperitoneal surgery
of the small pelvis, involving approximately a thousand operations of varying
degrees of difficulty, I, along with my colleagues, believe that a new,
advanced specialization of small pelvis surgery should be created to unify
these disciplines. This specialty would correlate with the future epidemiology
of pelvic pathologies and the development of minimally invasive and robotic
surgery.
In essence, the abstract discusses the complex anatomy of the small pelvis and the overlapping roles of different surgical specialties in this region. It argues for the creation of a new, specialized field of small pelvis surgery to address the increasing complexity of procedures and the need for a more unified approach.
Lauren Cox,
BA
Medical Student, Medical University of South Carolina, Charleston, SC
Purpose: An increase in global surgical needs has been observed over the recent years by various world organizations including the Lancet Commission on Global Surgery (LCoGS). However, with this growing demand comes the reality of the current lack of exposure to global surgical training amongst medical trainees. This study aimed to assess global surgical involvement of all medical schools, including both allopathic and osteopathic programs, across the United States to determine the projected versus actual global engagement of these institutions through Global Surgery Student Alliance (GSSA) affiliation and several parameters- academics, research, partnerships, bidirectionality and service. We hope to provide a thorough overview of these programs, as well as transparency on the legitimacy and reach of efforts, and hopefully a foundation for future streamlining of programs in this field.
Methods: A total of 195 MD and DO schools were used in our review. Schools who had global surgery Involvement or a GSSA affiliation, but did not have a global health center, institute, or program were excluded from the study. A team of second year medical students conducted a mixed-methods study to evaluate and compare key fields outlined in GSSA’s mission including advocacy, education, research, international engagement and physician mentorship across programs. A secondary analysis was performed for included schools listed as GSSA chapters to evaluate the contributions of the respective GSSA organization. Data for each program was collected through online investigations into the chapter/institution website and social media pages and was input into an Excel matrix categorically according to the aforementioned parameters for statistical analyses.
Results: Of the 195 MD and DO medical school institutions across the United States, 41 had a comprehensive global surgery program. Of the 155 institutions without global surgery programs, 46 had some global surgery partnership, mission trip, international surgical elective or rotation, residency program, exchange or GSSA affiliation. 14 of the 41 institutions with global surgery programs had GSSA affiliations. 40 of the programs were MD institutions, and 20 were public institutions. Regionally, 9 of the 41 programs were located Central US, 10 Mid-Atlantic, 7 Northeast, 6 South, and 8 West.
Conclusion: In response to
the worldwide call for a global surgery workforce, medical institutions across
the United States have curated student alliances to minimize gaps in pivotal
areas such as medical training, research and international partnerships.
Through our review of institutions, we have found a discrepancy between the
number of reported GSSA chapters versus the number of chapters producing
tangible output aligning with GSSA’s core values. Takeaways from this study
can be used to address longitudinal decreases in GSSA membership activity while
targeting areas for global surgery growth in the nation.
Karen Cruz,
BA (Premed) Pending
University of Washington School of Public Health, Seattle, WA
Introduction: Rural
communities in the United States face significant challenges in accessing
trauma and surgical care, contributing to higher rates of trauma-related
mortality and poorer surgical outcomes. This abstract focuses on the unique
barriers to healthcare access in these regions and explores their impact on the
quality of surgical care.
Methods: A comprehensive
review of existing literature was conducted, analyzing studies from various
databases such as PubMed and JSTOR. The review targeted research that
highlights disparities in surgical and trauma care access, the inadequacies in
healthcare infrastructure, and the socio-economic factors affecting rural
populations in the United States.
Results: The review
identified key challenges faced by rural communities, including geographical
isolation, shortages of healthcare professionals, and under-resourced
healthcare facilities. Socio-economic factors further compound these issues,
leading to disparities in surgical outcomes. The findings emphasize the urgent
need for tailored solutions that address both the systemic and
location-specific barriers in rural healthcare.
Conclusion: This review
exposes critical gaps in trauma and surgical care for rural communities in the
United States. To mitigate these disparities, strategies such as improving
healthcare infrastructure, expanding telemedicine services, and developing community-based
care models are essential. Culturally sensitive, accessible solutions must be
prioritized to ensure that rural populations receive equitable healthcare and
improved outcomes. Addressing these challenges is vital not only for improving
surgical care but also for reducing overall healthcare inequities in the United
States.
Keywords: Rural healthcare,
United States, trauma care, surgical care, healthcare disparities, healthcare
infrastructure, geographical isolation, telemedicine, socio-economic factors,
community-based healthcare, healthcare equity, healthcare access.
Learning Objectives:
Recognize the barriers to
trauma and surgical care access in rural U.S. communities, including healthcare
infrastructure gaps and socio-economic challenges.
Understand the findings of
literature reviews that examine the disparities in healthcare outcomes for
rural populations.
Identify potential strategies to improve trauma and surgical care in rural areas, such as enhancing telemedicine, strengthening healthcare infrastructure, and fostering community-based approaches.
The problem / surgical
intervention the presentation covers: The presentation addresses the
disparities in trauma and surgical care access in rural communities across the
United States. It focuses on the challenges posed by geographical isolation,
inadequate healthcare infrastructure, and socio-economic barriers that prevent
timely and effective surgical intervention. Additionally, it covers potential
solutions such as the expansion of telemedicine, strengthening of healthcare
systems, and the implementation of community-based care models to improve
surgical outcomes.
Why the audience needs to
know this information: Healthcare professionals, policymakers, and community
leaders need to understand the severity of the challenges faced by rural
populations. Awareness of these disparities is crucial to drive change, allocate
resources more effectively, and implement strategies that can bridge gaps in
trauma and surgical care. Without addressing these issues, rural populations
will continue to experience higher rates of preventable trauma-related deaths
and poor surgical outcomes, exacerbating health inequities.
What the learner will be able
to accomplish after the presentation: After the presentation, learners will be
equipped to:
-Identify the key challenges
affecting trauma and surgical care access in rural areas.
-Understand the
socio-economic and structural barriers contributing to poor health outcomes in
these populations.
-Propose and implement
strategies that can enhance healthcare access in rural settings, such as
telemedicine, -infrastructure improvements, and community-based healthcare
initiatives.
-Advocate for policies and
initiatives that support equitable healthcare access for rural populations.
How the audience will benefit from the presentation: By gaining a deeper understanding of the obstacles to rural surgical care, the audience will be better prepared to contribute to solutions that improve patient outcomes. Healthcare providers can enhance their practice by adopting innovative care models and telemedicine, while policymakers can advocate for funding and infrastructure development. Ultimately, this knowledge empowers the audience to take action toward reducing healthcare disparities, leading to more equitable and effective care for rural communities.
Mert Marcel Dagli,
MD
Sharpe Postdoctoral Research Fellow, Department of Neurosurgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
Manual chart review (MCR) for extracting surgical data from Electronic Health Records (EHRs) is time-consuming, prone to error, and a significant bottleneck in clinical research and quality control. This study aimed to develop and validate a novel artificial intelligence (AI) framework that integrates Natural Language Processing (NLP) with a Large Language Model (LLM) to automate the extraction of relevant clinical data from spinal surgery EHRs and automate postoperative billing.
This study was supported by
the TRIPOD+AI guidelines. We utilized three institutional databases comprising
thoracolumbar adult spinal deformity cases (N=646), lumbar endoscopic spinal
surgery cases (N=182), and lumbar decompression cases (N=5,998). The AI
framework was replicated ten times to address hallucinations.
The primary outcome was the accurate identification of surgical details, including surgery type, levels operated, number of disks removed, levels fused, incidental durotomies, and postoperative billing. Secondary objectives explored time efficiency and costs. Performance metrics such as accuracy, sensitivity, AUC-ROC, F1-score, and positive predictive value were calculated with 95% confidence intervals using bootstrapping.
The NLP+LLM framework
achieved a sensitivity of 0.999 and an AUC-ROC of 0.997 for clinical data
extraction, demonstrating similar performance in billing automation,
outperforming the human control. The use of a majority vote, utilizing data
from the deduplicated (ten replications) run, eliminated all errors from
singular runs.
Tokenization and cost analyses indicated substantial time savings (38.8 seconds overall) and cost savings ($9.04 overall) compared to manual chart reviews.
We demonstrated that the
integration of NLP and LLM within an AI framework can significantly improve the
accuracy, time, and cost efficiency of clinical data extraction and
postoperative billing. These results suggest the potential for widespread
adoption in healthcare. Further research will focus on enhancing the
sensitivity and validating the model in broader clinical settings to further
optimize billing automation and clinical documentation processes.
Mert Marcel Dagli,
MD
Sharpe Postdoctoral Research Fellow Department of
Neurosurgery,
Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
Introduction: Adolescent
idiopathic scoliosis (AIS) is the most common form of pediatric scoliosis,
affecting 2-4% of adolescents and potentially leading to severe spinal
deformities if untreated. Surgical outcomes after posterior spinal fusion (PSF)
are highly variable, and predicting post-operative success is crucial for
optimizing surgical strategies. This study aimed to develop and validate a
machine learning model to predict post-operative thoracic Cobb angle (TCA)
correction, focusing on identifying patients with a correction greater than
75%.
Methods: This project was
funded by an NIH grant (R21AR075971). This retrospective study was supported by
the STROBE, TRIPOD+AI, and CLAIM guidelines. Data were sourced from an
institutional AIS registry consisting of 83 patients who underwent PSF between
2014 and 2022. Pre-operative and post-operative radiographic data, patient
demographics, and surgical variables were collected. The machine learning model
was trained using extreme gradient boosting (XGBoost) with hyperparameter
tuning via grid search. Key variables included pre-operative TCA, lumbar Cobb
angle (LCA), operative time, and estimated blood loss (EBL). Missing data,
affecting less than 1% of the dataset, were imputed using random forest-based
multiple imputation. Model performance was evaluated using accuracy,
sensitivity, precision, F1-score, area-under-the-curve (AUC), and
precision-recall curve.
Results: There were no
significant differences in demographics and baseline characteristics (P
> 0.05) between the two outcome groups. Of the 83 AIS patients, 43 (52%)
achieved a post-operative TCA correction greater than 75%, while 40 patients (48%)
had a correction of 75% or less. The XGBoost model achieved an overall accuracy
of 94.1%, with an AUC of 0.99 and PRC of 0.99.
Conclusions: The machine learning model demonstrated excellent performance in predicting post-operative thoracic Cobb angle correction in AIS patients, achieving high accuracy, AUC, and PRC. This model may serve as a valuable tool for pre-operative planning, aiding surgeons and informing patients.
Mert Marcel Dagli,
MD
Sharpe Postdoctoral Research Fellow, Department of
Neurosurgery
Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA
Introduction: Adolescent idiopathic
scoliosis (AIS) affects a significant portion of the adolescent population,
leading to severe spinal deformities if untreated. Diagnosis, surgical
planning, and outcome assessments heavily rely on measuring the thoracic Cobb
angle (TCA) using anteroposterior spinal radiographs. This study aimed to
develop and validate an artificial intelligence (AI) tool utilizing a keypoint
region-based convolutional neural network (R-CNN) to automate TCA measurements
from coronal whole-spine standing radiographs. Secondary outcomes included
comparison of model performance to other models prior reported in the
literature.
Methods: This project was
funded by an NIH grant (R21AR075971). This retrospective study was conducted
following established guidelines, including STROBE, TRIPOD+AI, and CLAIM. The
R-CNN was trained on Dataset from SpineWeb. This dataset consisted of
609 whole-spine anteroposterior X-ray images of adolescent idiopathic scoliosis (AIS) patients.
Validation was performed using an institutional AIS registry containing 83rd Annual
Surgical Update patients who underwent posterior spinal fusion (PSF) surgery.
Performance metrics were assessed, including mean absolute error (MAE), median
absolute error (MedAE), mean squared error (MSE), symmetric mean absolute
percentage error (SMAPE), and intraclass correlation coefficient (ICC).
Results: During validation,
the R-CNN achieved an MAE of 2.22 (95% CI: 1.06-3.39), MedAE of 1.47
(0.89-3.15), MSE of 9.1, SMAPE of 4.29, and ICC of 0.98, significantly
outperforming existing automated methods such as VLTENet and Auto-CA. By
comparison, VLTENet achieved a SMAPE of 5.44 on the test subset of the AASCE
dataset, which dropped to 13.9 when applied to external clinical data.
Conclusions: The keypoint R-CNN demonstrates exceptional accuracy in automating coronal TCA measurements and outperforms existing methods. Its further development, scaling, and adoption could streamline scoliosis screening, surgical planning, and postoperative assessment, improving overall patient outcomes and reducing manual workload. Further validation across diverse populations and imaging modalities is warranted.
Anthony Dardano,
DO
Professor of Plastic Surgery, Chief, Plastic Surgery Trauma, Boca Raton, FL
Intraoperative laser angiography is a vascular imaging modality traditionally used in ophthalmology. It can be applied both intraoperatively and post-operatively to visualize blood flow in the trauma patient with soft tissue injury. The procedure utilizes indocyanine green to allow for visual assessment of blood flow in superficial tissues. By providing real-time tissue perfusion assessment, it has proven beneficial in improving clinical outcomes in various settings. Crushing injuries, tissue avulsion, burns, road rash and infections can all be evaluated with imaging and guide the management. Moreover, it also supports real-time decision-making processes, including flap design and tissue resection. With a suitable safety profile and short half-life, this also enables its repeated use within short timeframes. This technique has been applied successfully in reconstructive surgeries to allow early risk stratification and reduce the development of necrosis and other complications In contrast, alternative means of intraoperative
Kim de la Cruz,
MD
Co-Director, Aortic Disease Program, UVA Health, Associate Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia School of Medicine, Newton, MA
Thoracic and thoracoabdominal
aortic aneurysms (TAAAs) are rare but highly complex conditions that pose
significant surgical and endovascular challenges. These aneurysms involve
critical segments of the aorta, often extending into vital visceral and renal
territories, making their management intricate. This presentation will cover
the pathophysiology, diagnosis, and contemporary management strategies,
including open surgical repair and thoracic endovascular aortic repair (TEVAR).
Special attention will be given to patient selection, preoperative
optimization, and intraoperative adjuncts aimed at mitigating complications
like spinal cord ischemia and renal dysfunction.
This session is crucial for
clinicians managing patients with aortic pathologies, as it will discuss the
latest evidence and evolving techniques in the field. Attendees will gain
insights into decision-making frameworks, particularly for high-risk cases or
patients with connective tissue disorders, where long-term durability is
critical.
By the end of the
presentation, learners will be able to:
1. Differentiate between open
and endovascular repair options for thoracic and thoracoabdominal aortic
aneurysms.
2. Assess patient risk
factors and anatomical considerations to tailor optimal intervention
strategies.
3. Integrate evidence-based
adjuncts for reducing perioperative complications into their practice.
4. Develop strategies for
postoperative surveillance and long-term management to improve patient
outcomes.
This session will empower the audience to make informed decisions in managing these high-risk pathologies, ultimately improving surgical outcomes and enhancing patient safety.
Sleeve Gastrectomy versus GLP-1 Receptor Agonist to Improve Access to Kidney Transplantation in End-Stage Renal Disease Patients with Obesity: A Decision Analysis
Marissa Di
Napoli, MD
Research Fellow, University of Colorado, Aurora; Resident, Willis-Knighton Health System, Shreveport, Aurora, CO
Purpose: The prevalence of obesity among transplant candidates continues to increase over time. Obesity can be a barrier to accessing kidney transplantation as there is significant variability in body mass index (BMI) criteria among transplant centers. Effective weight loss strategies are crucial for improving access to kidney transplantation in the morbidly obese end-stage renal disease (ESRD) population.
Methods: A decision-analytic Markov state transition model was created to simulate the outcomes of morbidly obese patients with ESRD who were ineligible for kidney transplantation unless they achieved a BMI <35 kg/m2. Life expectancy following diet and exercise (DE), sleeve gastrectomy (SG), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were estimated. Base case patients were defined as a 45-year-old patient with a pre-intervention BMI of 45 kg/m2. Model inputs were obtained from literature review.
Results: SG resulted in 14% of patients receiving a kidney transplant at 10 years, compared to 2.5% of patients in the GLP-1 RA group, and <1% of patients with DE. Upon sensitivity analysis, SG demonstrated a survival advantage over both DE and GLP-1 RAs above a BMI of 34.4 kg/m2 and 37.5 kg/m2, respectively, assuming 100% of patients continued the medication.
Conclusions: SG improves access to kidney transplantation
compared to DE and GLP-1 RAs. As new obesity medications continue to be
developed and increase in popularity, the risks and benefits of these therapies
should be compared to the currently available weight loss therapies in an
effort to optimize obesity management in this population.
Marissa Di
Napoli, MD
Transplant Surgery Research Fellow, University of Colorado - Anschutz Medical Campus, Aurora, CO
Similar to the general U.S.
population, the prevalence of obesity among transplant candidates continues to
increase over time. In 2022, 41.3% of adult liver transplant candidates and
46.3% of adult kidney transplant candidates had a BMI ≥ 30 kg/m². Obesity is
associated with a higher risk of wound complications, delayed graft function,
acute rejection, and graft loss in kidney transplant recipients. Obese liver
transplant candidates experience an increased risk of death while on the
waitlist. Among liver transplant recipients, obesity is associated with an
increased incidence of wound complications, infection, biliary complications,
and mortality in the perioperative period. Additionally, obesity can be a
barrier to accessing transplantation as there is significant variability in BMI
criteria among transplant centers.
Obesity management is a
crucial component in the care of the transplant patient. Weight loss options
include lifestyle modification with diet and exercise, bariatric surgery, and
pharmacologic therapy. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs)
have emerged as a powerful tool in obesity management. In clinical trials GLP-1
RAs have been shown to result in 10-21% weight loss depending on the
medication. Furthermore, GLP-1 RAs have shown potential in reducing chronic
kidney disease (CKD) progression, reducing risk of Nonalcoholic steatohepatitis
(NASH) disease recurrence after liver transplant, and have been effective in
improving blood glucose control post-transplant in diabetic patients. While
early data has shown promising results, more studies are needed on GLP-1
medications in the solid organ transplant population.
The topics covered in this presentation are relevant to the fields of Transplant Surgery, Bariatric Surgery, General Surgery, and Minimally Invasive Surgery. The goals and objectives for this presentation include, 1) Explain the relationship between obesity and the transplant patient, 2) Discuss the obesity management for patients with end-stage kidney disease and end-stage liver disease, including lifestyle modifications, bariatric surgery, and pharmacotherapy, 3) Describe the use of GLP-1 receptor agonists as a tool to increase access to transplantation, and 4) Discuss the effect of GLP-1 receptor agonists on post-transplant outcomes.
References:
1. Lentine KL, Smith JM, Lyden GR, et al. OPTN/SRTR 2022
Annual Data Report: Kidney. Am J Transplant. Feb 2024;24(2s1):S19-s118.
doi:10.1016/j.ajt.2024.01.012
2. Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2022 Annual
Data Report: Liver. Am J Transplant. Feb 2024;24(2s1):S176-s265.
doi:10.1016/j.ajt.2024.01.014
3. Shi B, Ying T, Xu J, Wyburn K, Laurence J, Chadban SJ.
Obesity is Associated With Delayed Graft Function in Kidney Transplant
Recipients: A Paired Kidney Analysis. Transpl Int. 2023;36:11107.
doi:10.3389/ti.2023.11107
4. Oniscu GC, Abramowicz D, Bolignano D, et al. Management
of obesity in kidney transplant candidates and recipients: A clinical practice
guideline by the DESCARTES Working Group of ERA. Nephrol Dial Transplant. Dec
24 2021;37(Suppl 1):i1-i15. doi:10.1093/ndt/gfab310
5. Haugen CE, Holscher CM, Luo X, et al. Assessment of
Trends in Transplantation of Liver Grafts From Older Donors and Outcomes in
Recipients of Liver Grafts From Older Donors, 2003-2016. JAMA Surg. May 1
2019;154(5):441-449. doi:10.1001/jamasurg.2018.5568
6. Spengler EK, O'Leary JG, Te HS, et al. Liver
Transplantation in the Obese Cirrhotic Patient. Transplantation. Oct
2017;101(10):2288-2296. doi:10.1097/tp.0000000000001794
7. Garvey WT, Batterham RL, Bhatta M, et al. Two-year
effects of semaglutide in adults with overweight or obesity: the STEP 5 trial.
Nat Med. Oct 2022;28(10):2083-2091. doi:10.1038/s41591-022-02026-4
8. Wadden TA, Chao AM, Machineni S, et al. Tirzepatide after
intensive lifestyle intervention in adults with overweight or obesity: the
SURMOUNT-3 phase 3 trial. Nat Med. Nov 2023;29(11):2909-2918.
doi:10.1038/s41591-023-02597-w
9. Michos ED, Bakris GL, Rodbard HW, Tuttle KR.
Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: A review
of their kidney and heart protection. Am J Prev Cardiol. Jun 2023;14:100502.
doi:10.1016/j.ajpc.2023.100502
10. Atthota S, Joyal K, Cote M, et al. Modern glucose-lowering
drugs in liver transplant recipients: improvement in weight, glycemic control,
and potentially allograft steatosis. Front Transplant. 2023;2:1223169.
doi:10.3389/frtra.2023.1223169
11. Kim ER, Park JS, Kim JH, et al. A GLP-1/GLP-2 receptor dual
agonist to treat NASH: Targeting the gut-liver axis and microbiome. Hepatology.
Jun 2022;75(6):1523-1538. doi:10.1002/hep.32235
12. Kukla A, Hill J, Merzkani M, et al. The Use of GLP1R Agonists for the Treatment of Type 2 Diabetes in Kidney Transplant Recipients. Transplant Direct. Feb 2020;6(2):e524. doi:10.1097/txd.0000000000000971
Gerald Greenfield,
Jr, MD, MS
Orthopaedic Surgeon, South Texas Spinal Clinic,
San Antonio, TX
Intramedullary fixation of intertrochanteric hip fractures has evolved and is now standard. This report discusses mechanisms of failure of this technique. Use of shorter and smaller diameter rods may result in periprosthetic fractures, especially in osteoporotic bone. Methods to reduce this risk include the use of longer and larger diameter rods, placement of distal locking screws, and the use of 130 rather than 125-degree blade angle in the rod. Cement augmentation offers improved fixation in osteoporotic femoral heads.
Riley Grogan,
MD
Surgical Critical Care Fellow, Medical University of South Carolina Charleston, SC
For many rural communities, the threat of an imminent disaster can seem obscure or distant; after all, it is easy to feel insulated from disaster when isolation is often what defines a rural community. The reality, however, is that disasters can strike anywhere, at any time, and can come in many different forms. So how can a rural surgeon effectively prepare for a disaster, particularly when there may be resource limitations? Well, preparedness starts with a plan – or more aptly the planning process – and surgeons should be a key figure in this process. Former General and President Dwight D. Eisenhower once said, “Plans are nothing; planning is everything.†In this session, we will focus on the planning processes that allow for effective disaster response and identify principles of that process that can applied to any setting, so that rural surgeons can contribute effectively to hospital disaster readiness and response.
Jaskeerat Gujral,
BA, MSE
Undergraduate Student, Sharpe Research Scholar, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Surgical management of cervical radiculopathy involves either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). While both procedures have advantages and disadvantages, it is still unclear which surgical approach is superior and clinically favorable. Thus, this study aimed to compare ACDF and PCF outcomes utilizing the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database.
Conducting and reporting of this study were supported by the Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines. This retrospective observational study screened the NSQIP database. Inclusion criteria were patients who underwent single-level ACDF or PCF, based on CPT codes, from 2005 to 2022. Exclusion criteria were non-availability of extracted variables in their respective years of collection, cases involving additional procedures or surgeries by non-neurosurgery or orthopedic surgeons. Baseline characteristics, surgical details, and postoperative outcomes were extracted. Primary outcomes of this study were differences in operative time, hospital length of stay (LOS), post-operative complications (overall surgical site-infection (SSI), superficial SSI, deep incisional SSI, organ space SSI, cardiovascular, respiratory, neurological, renal, thromboembolic), 30-day readmission, 30-day readmission for SSI (overall, superficial, deep-incisional, organ space), and re-operation rate. Propensity-scored stabilized inverse probability of treatment weighting (SIPTW) was applied to adjust for confounding factors and absolute standardized mean differences (aSMD) were used to evaluate balancing. Subsequent weighted analysis of the treatment effect was performed using regression models with 95% confidence intervals calculated based on weighted means, variances, and standard errors. P-values of primary outcomes and subgroup analyses were adjusted for multiplicity testing with the Benjamini-Hochberg correction at a false discovery rate of 0.05.
After screening of the NSQIP database (N = 11,634,075) and application of inclusion and exclusion criteria, 9,362 (ACDF: 7,323, PCF: 2,039) patients who underwent surgery from 2012 to 2020 were included in the analysis. After SIPTW all 42 baseline characteristics were well balanced (aSMD<0.10). The PCF group had a significantly higher rate of postoperative overall SSI (proportion difference 2.9%, 95% CI 2.1% to 3.7%, P=0.003), superficial SSI (proportion difference 1.9%, 95% CI 1.2% to 2.5%, P=0.003), and deep incisional SSI (proportion difference 0.8% 95% CI 0.4% to 1.2%, P=0.003). 30-day readmission for any SSI (proportion difference 1.2%, 95% CI 0.7% to 1.7%, P=0.003) and deep incisional SSI (proportion difference 0.8%, 95% CI 0.4% to 1.2%, P=0.003) were significant. The PCF group had more systemic sepsis occurrences (proportion Difference: 0.8%, 95% CI 0.3% to 1.3% P=0.003), shorter hospital LOS (mean difference -0.7 days, 95% CI -0.9 to -0.5, P=0.003), and operative time (mean difference -32.4 min, 95% CI -35.2 to -29.5 min, P =0.003).
Compared to ACDF, PCF was
significantly associated with a higher rate of postoperative overall SSI,
superficial SSI, deep-incisional SSI, post-operative sepsis, 30-day readmission
for overall SSI, superficial SSI, and deep-incisional SSI, but shorter operative
time and LOS. These findings suggest that ACDF may be the ideal procedure in
avoiding these complications at cost of hospital resource utilization.
Jaskeerat Gujral,
BS, MSE
Sharpe Postdoctoral Research Fellow, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Introduction: The volume of
lumbar spinal surgeries performed in the United States has been rising
steadily, and surgical site infections (SSIs) represent a significant
postoperative complication. This study aimed to develop, and internally and
externally validate, an artificial intelligence (AI) model using extreme
gradient boosting (XGBoost) to predict reoperation following SSIs in lumbar
spine surgery.
Methods: This study was
supported by the TRIPOD+AI guidelines. We used the ACS NSQIP database to
identify patients who underwent lumbar spine surgery based on surgical
procedure codes. Given the rarity of SSIs, the analysis included superficial
SSI, deep incisional SSI, and organ/space SSI. Candidate predictors variables
were identified by a panel of clinicians, statisticians, and research fellows.
11 predictors were included in the AI model.
After initial analysis,
weighted extreme gradient boosting (XGBoost) was identified as the optimal
machine learning method. A comprehensive grid search was conducted, and model
performance was assessed through internal and external validation. An institutional
database was used for external validation. Performance metrics included
accuracy, recall (sensitivity), area-under-curve
receiver-operating-characteristic (AUC-ROC), area-under-precision-recall-curve,
F1-score, and positive predictive value (PPV). Bootstrapping was used to
calculate 95% confidence intervals (CIs), and feature importance analysis was
performed.
Results: The study cohort
included 96,216 patients who underwent lumbar spinal surgery. The weighted
XGBoost model demonstrated an exceptional accuracy of 0.994, a sensitivity of
0.800, and an AUC-ROC of 0.997. Feature analysis revealed that the most important
predictors of reoperation following SSIs included wound infection types,
preoperative albumin levels, and ASA classification.
Conclusions: This study
demonstrated the accuracy and reliability of an AI-based extreme gradient
boosting model for predicting reoperation due to SSIs following lumbar spine
surgery. The implementation of AI models for SSI prediction enables improved risk
stratification and optimized resource allocation.
Steven Hanish,
MD
Professor of Surgery, MUSC, Charleston, SC
There continues to be a gap
between the number of recipients needing organ transplant and those organs
available for transplantation. In 2021, the FDA approved the first of its kind
Normothermic machine perfusion pump for donor livers which has quickly expanded
in use and led to surge in the number of DCD livers available which has now
increased the transplant volume by almost 19% leading to shorter wait times and
more lives saved. Absent this
technology, one would surmise, that this growth would be non-existent given the
poor outcomes and regulatory scrutiny of the US transplant system.
The learner will understand the challenges posed in the supply/demand struggle in liver transplant and also how these machines have expanded the donor pool in heart transplant.
Ioannis Hatzaras,
MD, MPH, PhD
Assistant Professor of Surgery, University of Athens, Greece, Brooklyn, NY
Colorectal Cancer is the third most common solid tumor in the United States. Approximately half of the patients with colorectal cancer, will develop liver metastasis. Over the last 25 years management of this complex clinical scenario has evolved tremendously; patients can now expect a much improved prognosis. The talk will describe the current status of colorectal liver metastases management and will offer insights on the priorities of treatment.
Sara Hijer,
MPH
MPH Candidate, Columbia University New York, NY
This presentation highlights the resurgence of polio amid humanitarian crises, emphasizing the severe health threat posed by deteriorating living conditions. It underscores the critical relationship between public health and geopolitical conflicts. Using the story of Paul Alexander, the last man to live in an iron lung, the presentation connects historical and contemporary challenges of polio. Alexander’s life exemplifies the devastating effects of the disease and the stark differences in access to healthcare between regions like the United States and Gaza.
The audience needs to understand the magnitude of the crisis to advocate for and implement effective public health measures. Learning about the intersection of healthcare and human rights will equip attendees with strategies to address similar challenges in conflict zones.
After the presentation, learners will be able to identify the critical factors leading to polio resurgence, propose strategies for containment in resource-limited settings, and advocate for international collaboration in addressing public health emergencies.
The audience will benefit
from this presentation by gaining a deeper understanding of the broader
implications of healthcare access in conflict zones. This knowledge empowers
them to influence policy, support global vaccination campaigns, and integrate public
health considerations into surgical interventions, ultimately saving lives and
preventing the spread of preventable diseases like polio.
Sarah Kim,
MD
University of Illinois Chicago,Homer Glen, IL
Primary pulmonary follicular lymphoma is an extremely rare subset of extra-nodal non-Hodgkin’s lymphoma. We present a successful work-up and surgical management of this disease entity. The patient is a 74-year-old man who presented with an enlarging ground glass opacity on his computed tomography scan. Percutaneous biopsy was not diagnostic for malignancy but given the underlying malignant potential, he underwent definitive operative resection rather than additional invasive diagnostic testing. Our case highlights challenges in the management of nondiagnostic preliminary pathology as well as the role of a multidisciplinary approach to treatment of a rare lung pathology. Additionally, we discuss current recommendations based on extensive literature review available as well as highlight considerations of early operative interventions rather than prolonged surveillance imaging even in the setting of nondiagnostic initial pathology in patients with higher risks of malignancy.
Eric Klipsch,
MD
Resident, Medical University of South Carolina, SC
Purpose: In patients undergoing induction therapy for esophageal cancer (EC), the degree of pathologic response post-esophagectomy is associated with improved overall and disease-free survival. Current restaging mechanisms are unable to reliably predict pathologic complete response (pCR). Herein we assessed the ability of volumetric analysis of hypermetabolic esophageal tissue to predict pCR.
Methods: Patients who underwent neoadjuvant chemoradiotherapy and esophagectomy for EC at a tertiary care center between 2013 and 2023 were retrospectively reviewed. Patients with pre- and post-induction therapy positron emission tomography (PET) scans available were included. Volumetric analysis of the hypermetabolic esophageal tissue was performed by review of patient records to confirm the location and size of the neoplasm followed by manual isolation of the hypermetabolic tissue to determine total volume, using SECTRA IDS7 and verified by radiologists. Cases with circumferential lesions with a large volume esophageal lumen were excluded due to inability to accurately exclude the lumen. Cases with post-treatment esophagitis and/or gastritis as determined by radiologist review were excluded as the lesion could not be isolated from background hypermetabolic uptake. Patients were classified by pathologic response. Statistical analysis of the change in volumes, tumor size, and max standardized uptake value (SUV) pre- and post-induction therapy was performed.
Results: A total of 66 patients were included in the study (17 pCR, 18 grade 1 response, 27 grade 2 response, and 4 grade 3 response). For the pCR group, esophageal volume (50.98 vs. 14.97 cm3, p=0.029) and max SUV (19.75 vs. 4.83, p<0.001) were significantly different when comparing PET scans pre- and post-induction therapy. In the grade 1 response group, tumor size (4.65 vs. 1.29 cm, p=0.0002) and max SUV (13.06 vs. 4.91, p=0.002) were significantly different pre-and post-induction. In the grade 2 response group, tumor size (4.57 vs. 1.79 cm, p<0.0001), esophageal volume (54.07 vs. 24.35 cm3, p=0.0026), and max SUV (12.88 vs. 5.10, p=0.0001) were all significantly different. Finally, the grade 3 response group had no significant differences when analyzing change in tumor size, esophageal volume, or max SUV. Logistic regression predicting pCR identified change in max SUV as a significant predictor (OR= 0.94; 95% CI 0.89 – 0.99, p=0.026). No significant relationship between pCR and change in tumor size or change in esophageal neoplasm volume was observed.
Conclusion: This novel method
to evaluate pathologic response in EC after chemoradiation showed significant
change in max SUV and esophageal volume pre- and post-induction in the pCR and
grade 2 response groups. Volumetric analysis may be beneficial in counseling
high risk surgical patients deciding between resection and active surveillance,
but further work is needed to confirm our findings in other patient
populations.
Rifat Latifi,
MD
The University of Arizona, and Tucson Medical Center, Tucson, AZ
Over the past 25 years, I have been involved in the publishing process, resulting in the creation of 21 books in the field of surgery, telemedicine and nutrition. Throughout this journey, I have learned numerous strategies that can help busy clinicians achieve similar success. In this workshop, I will concentrate on several key issues that I believe are essential for navigating the complexities of publishing effectively. We will explore how writing serves as a powerful platform for disseminating knowledge and improving surgical practices. Structured time management is another vital aspect of success in publishing. I will discuss practical methods for efficiently managing your time, including how to establish specific writing periods within a hectic clinical schedule, ensuring consistent progress on your manuscripts. Collaborative efforts are integral to enriching the content and lightening the workload. I will share insights from my own experience with co-editing and co-authoring, highlighting the value of diverse perspectives in enhancing written work. I will also dive into the importance of incorporating clinical experience into your writing. Drawing from your own buys daily practice provides real-world insights that can enhance the relevance of your work. Furthermore, I will emphasize the role of utilizing technology to streamline the writing and editing process. Tools such as dictation software and reference management programs can significantly enhance efficiency, making the publishing journey more manageable. As we discuss developing a niche, I will share my journey in focusing on specific areas of expertise—such as nutrition, telemedicine, and complex surgery, reoperative surgery and surgical decision—that have allowed me to find an amazing pleasure in the work establish some authority and engage interest in my work. There is no better learning technique that writing about it. Continuous learning is vital for any author, and I will explore strategies for staying current with the latest developments in surgery and how ongoing education can inspire fresh ideas. Challenge yourself and learn to write about things you do not know that well. The significance of mentorship and guidance cannot be overstated. I will discuss how seeking mentorship from established authors not only provides valuable insights but also serves as motivation for new writers. I have seized the opportunity to collaborate with my mentors, harnessing their interests and passions to build upon their work. You carry on the work of your mentors and enriches the surgical literature. Use your ideas to engage your students, residents, fellows, colleagues from your institution but reach out as well. In conclusion, by concentrating on these key issues, I aim to empower surgeons’ clinicians like you to navigate the complexities of publishing successfully. Through dedication, resilience, and a commitment to knowledge sharing, we can all make meaningful contributions to our field. My own experiences, including the opportunity to collaborate with my esteemed mentors, have played a significant role in shaping my publishing journey, allowing me to discover and establish my niche. I look forward to sharing these insights with you and helping you embark on your own publishing endeavors.
Tessa London-Bounds,
MD/MPH
Associate Professor of Cardiac Surgery, University of Kentucky, Lexington, KY
Endocarditis is becoming a
global epidemic and rapidly becoming one of the underlying causes of mortality
world wise especially for younger populations.
We will be reviewing the current literature and guidelines supporting
the implementation of a multi-disciplinary team approach to endocarditis. We will review the current epidemiology
endocarditis
Globally, Trends, IVDU, effects on youth, gender, economic affects of endocarditis. Additionally, we will review the current literature on the effects of IV drug use with Infective endocarditis mortality. We will then go through the concept of multi-disciplinary team reviewing the survival benefits and literature from our own institution. Lastly, we will review the current algorithm, recommendations from aats, esc, and sts as well as potential roadblocks and unforeseen benefits. This approach has been proven to reduce the mortality of these patients and we are actively working on adjusting the guidelines in North America to reflect this important team-based approach to endocarditis.
Manish Mandal,
MD
Professor and Head, Department of Surgical Gastroenterology & Liver Transplant, Medical Superintendent, IGIMS Patna, India
Problem : We face problems in Carcinoma Gall Bladder ( CaGB) as
follows :
1. The Usual Problems are : Regarding Early detection, PET
CT, Pre Operative Diagnosis, Extent of Resection, Lympadenectomy , Excision of
Bile Duct , Incidental CaGB (Staging laproscopy , Port Site Excision), Locally Advanced Ca GB(Jaundice , Extent of
Resection), Role of Neoadjuvant Therapy , Adjuvant Therapy , Management of
Metastatic Ca GB.
2. Pertaining to the India / Rural Areas: Presence of
different risk factors from the West, presence of mimics of Ca GB combined with
Poor Socioeconomic Status, Illiteracy and poor primary health care
facility.
Surgical Intervention
Preoperative detected Ca GB : Role of Staging Laparoscopy , Peritoneal
Cytology , Incidental Ca GB Role of
staging, perioneal fluid cytology Intraoperatively detected Ca GB - Role of
Imprint Cytology and Frozen section
Xnathogranomatous cholecystits and other mimics of CaGB
Why audience need to know this information
It is a non-western disease with highest
incidences among less developed regions – highest in Chile and Asian
countries like India, Pakistan, India and China, even having a huge divide
among the North and South India. Risk factors for CAGB are multifactorial but
prominent in india are Gall Stones and GB Polpys and Diet (Mustard Oil, use of
well water, high levels of Arsenic). Management of CaGB should be done keeping
in mind the disease which is occurring in the high incidence areas then to
follow the Guidelines from areas which are less exposed.
Learner Take Home Message
The target audience will get
an insight regarding the intricacy in the management of the Ca GB in developing
counties with minimum resources. They will also be knowing about how we
surgical remove the Gall Bladder with the use of Kelly-Clysis and Prevention
& Management of post operative bile leaks which are common.
Audience benefits by this
presentation
Use of PET- CT, Minimally Invasive Techniques,
are not necessary for optimal management but they can be achieved by:
1. Meticulous thinking,
2. High Clinical Suspicion in
Ca GB mimics, using rationales of Anticipatory Extended Cholecystectomy.
3. Appropriate timing for surgery in Incidental Ca GB
Sushmita Mantravadi,
MD
Presenting for Mohan YS, MD; Head of the Dept. of Neurosurgery, Garden City Hospital, Garden City, MI, Rochester Hills, MI
A subdural hematoma is a form of intracranial hemorrhage characterized by bleeding into the space between the dura and arachnoid membranes surrounding the brain. Subdural hematomas can recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence include alcoholism, seizure disorder, coagulopathy, history of Ventriculoperitoneal shunt, greater midline shift, heterogenous and higher density hematomas.
Case Presentation
We present a case of a
70-year-old male with a past medical history of hypothyroidism, hypertension
and anxiety who presented after a fall at home. He had a history of fall 2
months before this presentation as well and CT head at that time was negative for
acute pathology. CT Head this admission showed an isodense right subdural
hematoma with mass effect on the right hemisphere resulting in a 7.4 mm right
to left midline shift, and chronic-appearing left holohemispheric subdural
hygroma. Review of systems was positive for lightheadedness and constipation.
On exam, he was alert and oriented but had left lower extremity mono paresis
4/5. He underwent right temporoparietal craniotomy and evacuation of subdural
hematoma and left burr hole and evacuation of subdural hygroma. He had
continued drainage from the surgical site.
Post operative CT showed persistent subdural collections. These findings coupled with persistent wound drainage of clear CSF-like fluid suggested an element of hydrocephalus ex vacuo contributing to the persistent hygroma. He then had a left subdural peritoneal shunt with antibiotic-impregnated catheter insertion. Repeat CT Head showed resolution of the left-sided hygroma with persistent slightly larger right-sided subdural hematoma and associated midline shift. The patient was asymptomatic . He then had a right temporal burr hole evacuation of acute on chronic subdural hematoma(cSDH) and insertion of a right subdural peritoneal shunt. The reason for recurrent bleeding was thought to be the right middle meningeal artery, and elective right Middle Meningeal artery embolization was successful.
Discussion cSDH is thought to
evolve from prior traumatic acute subdural hemorrhage that develops between the
dura and arachnoid layer. Although this acute hematoma may resolve completely,
in many cases the processes of inflammation, fibrinolysis, and/or angiogenesis
lead to formation of a vascularized neomembrane that results in fluid exudation
and subsequent hemorrhage, leading to volume expansion and neurological
deficits(1-2). Histologically, the outer neomembrane is composed of friable
sinusoidal neovessels that rupture spontaneously, which causes recurring
hemorrhage. These neovessels derive blood supply from the middle meningeal
artery (MMA), which transverses the dura to connect to these fragile
vessels(3-4).
Most recurrent subdural
hematomas can be managed successfully via Burr hole with closed-system
drainage. Refractory hematomas recurring more than twice may require a
subduroperitoneal shunt, a reservoir with serial tapping, or middle meningeal
artery embolization.
MMA embolization in
combination with surgery is done for refractory cases that do not respond to
surgical evacuation alone. In these cases, while surgical evacuation is used to
relieve symptoms, MMA embolization is employed to prevent recurrence. The rationale
for utilizing this treatment was to decrease acute mass effect through direct
surgical evacuation and endovascular MMA embolization to disrupt the
reaccumulation chronic cycle (4). Some studies found that postsurgical
embolization of the MMA reduced the recurrence rate of cSDH from 14% to 4% (5).
Tranexamic acid (TXA) is one
of the many drugs that have been tested in the conservative management of cSDH.
It is hypothesized that TXA simultaneously has fibrinolytic and
anti-inflammatory effects by inhibiting plasminogen activator and plasmin and
reducing vascular permeability and leukocyte migration in the outer hematoma
membrane.
Nicole Marker,
BA
Medical Student, University of Kentucky College of Medicine, Lexington, KY
Cardiac tumors affect fewer than 1 in 2,000 people. 75% of primary tumors are benign and the most common primary tumor in adults is myxoma. As a regional referral center, UK healthcare provides ‘standard of care’ treatment for these patients. This study is a retrospective review of diagnostic procedures, surgical management, and outcomes in patients treated for tumors of the heart in our institution. We compare our management approaches, clinical and surgical outcomes with those reported in the literature.
The study population includes patients 7-79 years old that presented to University of Kentucky Healthcare for tumors of the heart from July 2004 - January 2023. With IRB approval, subjects for this study were identified by searching the University of Kentucky database on the CPT codes for tumors of the heart (benign neoplasm of the heart or malignant tumor). CCTS Data Warehouse has provided data based on CPT codes. All data was stored on REDCap.
Operative treatment was offered to 52 people; 47 had resection and 5 had biopsy. The patient population consisted of 29 females and 23 males. The average patient age was 54 years old with the oldest being 79 and the youngest being 7. Most patients were Caucasian (49) followed by unknown (2) and black/African American (1). The most common presentation symptoms were shortness of breath, dyspnea, and fatigue. The most common diagnosis methods were transthoracic echocardiogram, transesophageal echocardiogram, cardiac MRI, and CT scan. Surgical treatments included 47 resections and 5 biopsies; a certain number of people required closure of septum with or without a patch. The most common postoperative complication was respiratory insufficiency (22) and sepsis (2). 48 patients were diagnosed with a benign neoplasm of the heart and 4 diagnosed with a malignant tumor. There were 49 primary tumors and 3 secondary tumors. The most common location of the tumor was the left atrium. The largest size number was 337.5 cm3 and the smallest was 0.042 cm3. The most common diagnosed cell type for the cardiac tumors was myxoma (32), followed by papillary fibroelastoma (11), fibroma (2), hemangioma (2), fatty infiltration, fibrosis and myocyte hypertrophy (1), metastatic hepatocellular carcinoma (1), metastatic neuroendocrine tumor (1), metastatic squamous cell carcinoma (1), and primary intimal sarcoma (1). The average length of stay in the hospital was 12.5 days with the longest being 59 days and shortest being 0.75 days. 39 patients were discharged home in a stable condition. The study population had one operative mortality (death within 30 days after surgery). 43 of the 52 patients treated are alive after 2 years.
Clinical outcomes such as
discharge status, post-operative condition, and length of survival after
procedures are non-inferior to those from other referral centers for such
conditions. 83% of patients in this study surgically treated for cardiac tumors
are alive after 2 years. This study shows surgical removal offers the best
chance of cure for cardiac tumors.
Jiri Matyas,
MD
Head of ICU,
Head of Central Operation Theatres, Surgery Clinic, General Hospital, Pardubice, Czech Republic Pardubice, Czech Republic
There is an increasing number of people using anticoagulant therapy in the population and many of them have to undergo surgery. Surgeons often find themselves in difficult situations - to decide on discontinuation of this treatment and whether or not to administer antidotes. The situation is especially difficult when the operation is acute or even urgent.
We were studying the occurrence of bleeding complications in patients taking long-term anticoagulant therapy and also we were monitoring the occurrence of thromboembolic complications after their withdrawal or after administration of antidots. One group consisted of patients undergoing planned (elective) surgery and the second of patients undergoing acute and emergency surgery We develop specific recommendations for individual situations in elective and acute surgery. These recommendations are specified both according to the urgency of the operation and according to the type of anticoagulant drug used. These recommendations are in line with the recommendations of the professional societies of hematology, surgery, and intensive care. This lecture is very useful for all surgeons - general, abdominal, endosurgery, and also traumatologists, neurosurgeons, and intensivists My lecture takes 15 miutes
Caitlin McPartland,
Medical Student
Medical Student at the University of South Carolina School of Medicine Columbia, Columbia, SC
Background: Traumatic brain injuries (TBI) are a
significant and growing health issue, leading to over 200,000 hospitalizations
annually in the United States. Cranial nerve (CN) injuries accompanying TBI can
severely impact patients’ quality of life. This review aims to address the
gap in research regarding the severity, mechanisms of injury, and associated
intracranial injuries, emphasizing early detection and intervention.
Methods: A comprehensive
literature search was conducted across databases such as PubMed and Ovid using
key terms including “cranial nerve injury,†“cranial nerve palsy,†“traumatic brain injury,†and “Glasgow Coma Scale.†Inclusion criteria encompassed studies reporting CN
injuries with TBI, categorized by Glasgow Coma Scale (GCS) scores, and the
mechanisms of injury. A total of 21 studies were reviewed, integrating data
from adult and pediatric populations.
Results: The incidence of CN
injuries in TBI patients varies in the literature, with studies reporting rates
between 5-23%. Data revealed significant occurrences of CN injuries in mild
(GCS 13-15), moderate (GCS 9-12), and severe TBIs (GCS<9). Common mechanisms
of injury included automobile accidents, falls, and crush injuries in pediatric
patients. Associated injuries included skull base fractures (38.9%), subdural
hematomas (16.6%), epidural hematomas (18.9%), and subarachnoid hemorrhage
(25.6%). Early detection and intervention were found to be critical in
improving patient outcomes, with delays leading to increased disability and
poor prognosis.
Conclusion: The classification of traumatic brain injuries via the Glasgow Coma Scale does not confirm the presence or absence of concomitant cranial nerve injury, as even mild head injuries can result in cranial nerve palsy. However, acknowledging common mechanisms of injury and associated intracranial injuries can elucidate the possibility of cranial nerve damage in order to facilitate early recognition and treatment.
Mathew Mendoza,
BS
Medical Student, University of Houston Tilman J. Fertitta Family College of Medicine, Katy, TX
This study aimed to assess and compare outcomes of robotic inguinal hernia repair (RIHR) in patients under and over 70 years old, performed by a fellowship-trained robotic surgeon at a single institution.
A retrospective analysis of patients undergoing robotic primary transabdominal preperitoneal inguinal hernia repair between 2020 and 2022, was conducted. Patients were categorized into two age groups: those under 70 years and 70 years and older. Data were collected through chart reviews with a mean follow-up of 30 days. Concurrently, a systematic review (SR) of relevant high-level literature was carried out.
Among the 37 patients studied, 75.7% (n=28) were male, with a mean age of 64.8 years. Demographic features did not significantly differ based on age groups. Patients >70 years had a higher incidence of reported complications (52.3% vs. 87.5%, p<0.461). There were no differences in operative time or length of stay between the groups. In the SR, only 23.7% (n=9) of studies provided age-related conclusions. Three studies identified age over 70 as a risk factor for postoperative complications, while two studies suggested that RIHR is feasible and safe in patients aged 80 years and older.
Patients over 70 years old
demonstrated a higher incidence of complications compared to younger patients.
However, current literature indicates that the robotic approach may offer a
safe and minimally invasive option for inguinal hernia repair in both younger
and older adults.
Jaycee Mudd,
BS
Medical Student, University of Missouri, Columbia, Springfield, MO
Purpose: Large language models
such as ChatGPT have gained mainstream popularity since their launch; though,
the role of ChatGPT in the healthcare sector has not yet been defined. Our
study was developed to investigate the utility of ChatGPT in generating CPT
codes from plastic surgery operative reports.
Methods: A retrospective
chart review was conducted for a total of forty-eight patients who underwent
one of the following procedures: mammoplasty reduction, open treatment of
orbital floor fracture, tendon repair, or excision of soft tissue. Operative reports
from three plastic surgeons at the University of Missouri – Columbia were
systematically deidentified. Deidentified operative reports were input into
ChatGPT alongside the prompt “what is the CPT code?†This process
was replicated using prompt engineering to evaluate the learning and adaptive
capacity of ChatGPT when given a zero-shot, few-shot, chain of thoughts, and
tree of thoughts prompt. Generated CPT codes were then assessed and classified
as either accurate or inaccurate.
Results: During the initial
trial, ChatGPT was able to correctly provide the CPT code for a mammoplasty
reduction in 10 of 12 cases (83.3%); CPT codes were inaccurate for the other
operations. Utilizing prompt engineering, ChatGPT accurately provided the CPT
code for mammoplasty reduction in 47 of 48 trials (97.9%). The few-shot, chain
of thoughts, and tree of thoughts prompts all preformed equally. ChatGPT was
not able to provide any accurate CPT codes for orbital floor fracture repair.
Using the soft tissue excision operative reports, 3 of 48 (6.25%) CPT codes
were accurate. ChatGPT identified at least one CPT code correctly for 6 of 48
(12.5%) prompts, but could not provide a comprehensive list of CPT codes for a
soft tissue excision. For tendon repairs, 3 of 48 (6.25%) CPT codes were
accurate. Similarly, in 20 of 48 (41.67%) prompts, at least one CPT code was
correct, but ChatGPT could not provide a comprehensive list of CPT codes
necessary for an individualized tendon repair. Independent of operation or surgeon,
the chain of thoughts prompt was most beneficial as ChatGPT produced 15 of 48
(31.25%) CPT codes accurately. Zero-shot prompting in ChatGPT yielded 13 of 48
(27.1%) CPT codes accurately. Similarly, 13 of 48 (27.1%) CPT codes were
accurate using the tree of thoughts prompt. The few-shot prompt yielded 12 of
48 (25%) CPT codes accurately.
Conclusions: ChatGPT consistently and accurately identified CPT codes for mammoplasty reductions; however, it could not generate the comprehensive list of required CPT codes for operation with numerous or varying CPT codes. Chain of thoughts prompting in ChatGPT yielded the most accurate CPT codes followed by zero-shot and tree of thoughts prompting. In its current form, ChatGPT has limited utility for purposes such as medical billing. Moving forward, a large language model trained on a CPT codebook may be developed and evaluated.
Patricia Numann,
MD
ACS Past President, SUNY Upstate Medical University, Syracuse, NY
Often we are interested in exploring a new avenue of interest of increasing our work in our given field. The course of action which may be most effective can be difficult to see. The discussion will focus on strategies to achieve your goals including the role of serendipity. The learner will have better tools to achieve their goals.
Narayan Osti,
MBBS
Chief Resident, Harlem Hospital Center, Columbia University, NYC Bronx, NY
Background Pulmonary Embolism
(PE) is a rare but dreaded complication post bariatric surgery prompting
studies on pre-bariatric surgery Inferior Vena Cava Filter (IVCF) placement.
Existing research consistently demonstrates IVCF's limited protective role.
This retrospective analysis utilizes the up-to-date MBSAQIP database to
reassess its role.
Objectives This study aims to
examine IVCF trends preoperatively and compare outcomes between patients with
and without IVCF. It further contrasts patients receiving IVCF within 30 days
against those with pre-existing IVCF. Primary outcome: PE; Secondary outcomes:
post-bariatric surgery DVT, reoperation, 30-day intervention, readmission,
death, overall morbidity, and serious morbidity.
Methods Using the MBSAQIP
database from 2015 to 2021, we identified 1,192,875 cases encompassing sleeve
gastrectomy, Roux-en-Y Gastric Bypass (RYGB), and duodenal switch procedures.
Analysis involved comparing IVCF and non-filter groups for preoperative variables
and outcomes, alongside a comparison between pre-existing IVCF and 30-day IVCF
groups. Propensity matching, Chi-square tests, and multivariate regression
analysis were conducted.
Results Among 1,192,875
cases, 5690 (0.48%) had IVCF, with 3246 (57%) receiving it within 30 days
pre-bariatric surgery. The yearly trend for 30-day pre-surgery IVCF showed a
declining pattern from 32% (2015) to 5% (2021). IVCF patients had more Black individuals
(37.28% vs 18.63%) and a higher proportion of males (27.7% vs 19.24%) than the
non-filter group. Factors predisposing patients to PE saw a higher likelihood
of IVCF placement. No significant difference was observed in post-op PE between
pre-existing or 30-day IVCF groups compared to the non-filter group. However,
higher odds of 30-day intervention (3.54, CI 2.66-4.73, p<0.01) and
reoperation (1.63, CI 1.05-2.51, p=0.028) were noted compared to the matched
cohort. Furthermore, the filter group displayed elevated odds of postoperative
Deep Vein Thrombosis (DVT) (2.43, CI 1.50-3.96, p<0.01) and Readmission
(1.29, CI 1.08-1.5, p=0.004) compared to the overall non-filter group, a
distinction absent in the matched cohort.
Conclusions Prophylactic IVCF placement pre-bariatric surgery has seen a decreasing trend. Despite this, extensive analysis doesn't support IVCF's benefit, showing an association with increased intervention and readmission.
Rodolfo Oviedo,
MD
Medical Director of Bariatric Surgical Services and Robotics, Nacogdoches Medical Ctr; Clinical Professor, Univ. of Houston Tilman J. Fertitta Family College of Medicine; Clinical Professor, Sam Houston State University College of Osteopathic Medicine, Nacogdoches, TX
Robotic surgical education has been industry-driven for a long time, and more recently based on a few established residency or fellowship curricula in the USA and a few countries with access to the technology and with dedicated surgical educators. However, a new era of robotic surgical education combining augmented and virtual reality training as well as AI with hands-on examination and feedback is becoming a reality. This type of innovative curriculum is a much anticipated solution to democratize robotic surgical education and teach surgeons from around the world from different backgrounds and with limited resources. This lecture aims to describe this new trend and illustrate its effectiveness and feasibility.
Guido Parquet,
MD
Chair Minimally Invasive Surgery Service,
Department of Surgery, Institute of Social Welfare, Asuncion, Paraguay
Stricture is a common complication of bilioenteric anastomosis. Surgical reanastomosis is dificult, has a high incidence of complications and restrictures. We use a percutaneous method using percutaneous biliary drainage and ballon dilatation of the stricture. Succes is similar to open surgery but incidence complications and patient recovery is much better.
Mark Perlmutter,
MD
Orthopaedic Surgeon, Private Practice Rocky Mount, NC
The problem at this presentation addresses is how modern conflict zones have an ever greater impact or noncombatants. This information is valuable in preparation for the healthcare delivery logistics and the management of civilian populations not just in conflict zones but also in other austere environments. Throughout history, significant advancements in medicine have been realized by adapting techniques for the emergency management of injured soldiers and civilians during conflict. As the nature of armed conflict evolves, so do the injuries and this necessitates a better understanding of healthcare methodologies necessary to accommodate these changes
Mark Perlmutter,
MD
Orthopaedic Surgeon, Private Practice, Rocky Mount, NC
The problem at this presentation addresses is how modern conflict zones have an ever greater impact or noncombatants. This information is valuable in preparation for the healthcare delivery logistics and the management of civilian populations not just in conflict zones but also in other austere environments. Throughout history, significant advancements in medicine have been realized by adapting techniques for the emergency management of injured soldiers and civilians during conflict. As the nature of armed conflict evolves, so do the injuries and this necessitates a better understanding of healthcare methodologies necessary to accommodate these changes
Roxana Ponce,
BS
Medical Student, University of Kentucky College of Medicine, Bowling Green, Bowling Green, KY
Coronary artery bypass graft surgery is the tenth most common surgery in USA. Despite the improvements in medical management stroke remains a devastating complication after coronary artery bypass graft surgery and is associated with significant mortality and morbidities
Study was approved by the IRB. This is a retrospective chart review with 3,126 cases treated at the UK Healthcare from 2016 to 2023 who underwent a CABG procedure. Patients for this study were identified by searching the UKHC electronic medical records.
Out of 3,126 patients who underwent a CABG procedure, stroke was diagnosed in 41(1.3%) patients. Age ≥61 years, male sex, and white were characteristics that were strong predictors of stroke after CABG. In addition, preoperative characteristics such as diabetes mellitus, hyperlipidemia, history of atrial fibrillation and especially, hypertension, were commonly observed in every patient with stroke after CABG, having incidence of 75.6%, 87.8%, 26.7% and 95% respectively. Mortality for stroke patients was 6 (14.5%) in hospital, 4 (9.7%) at 30 days after discharge, and 2 (4.9%) at 5 years of discharge, having a total of 12 (29.3%) deaths. Furthermore, postoperative characteristics such as respiratory failure were observed in our study as a common factor in patients who died after stroke after CABG with incidences 92.7%.
With this retrospective
study, we are able to observe that UK Healthcare has a stroke incidence after
CABG that is very similar to other institutions. Careful assessment and
management of the different preoperative, intraoperative, and postoperative
factors specific to this institution and its population should be implemented
to reduce complications after CABG.
Subbareddy Raghupathi,
MBBS, MS, MCh, PhD
Professor, Department of Cardiovascular and Thoracic Surgery, Punjab, India
Signs and Symptoms &
Hemodynamic complications are same for the following Congenital Acyanotic Heart
Diseases:
·
Patent Ductus
Arteriosus (PDA)
·
Atrial Septal
Defect (ASD)
·
Ventricular
Septal Defect (VSD)
Common Symptoms for the
above:
·
Repeated
respiratory tract infections
·
Retardation of
the growth and weight
·
Initially no
signs & symptoms of cyanosis and clubbing
·
Expect ASD - VSD
& PDA may have the symptoms of endocarditis with fever etc.,
· Difficulty in breathing, chest pain and cough with expectoration
Common Signs:
·
Signs of secondary
pulmonary hypertension like chest pain, breathlessness
·
Signs of right
ventricular hypertrophy (RVH)
·
Signs of right
heart failure (JVP + RVH) type of apical impulse and liver enlargement pedal
oedema
·
Signs of
pulmonary oedema
· Signs of arrhythmias, palpitations, syncopal attack, right to left shunt - Eisenmenger Syndrome – patient may becomes extremely weak and tiredness
·
Surgery is not
possible except Heart and Lungs
Transplant for Eisenmenger Syndrome
Treatment of the above
diseases:
·
ASD will not
close spontaneously
·
Perimenbranous
VSD may close spontaneously within 5 years
· PDA will close spontaneously within 2 years
For the above diseases with
regular margin may be closed with umbrella like devices by interventional
procedures.
The complications of above
procedures are Endocarditis, may be slipped away which may need removal of the
devices.
Number of ASD patients seen
between 1978 till date (46 years) – 2600
VSD – 3400, PDA – 4200
All these patients were
screened by me in Government General Hospital, Chennai and was conducted free
Cardiac camps in 1000 rural areas throughout India.
The surgical procedures for
ASD, VSD & PDA patients in whom no spontaneous closures had not occurred.
Gazanfar Rahmathulla,
MBBS, MD
Associate Professor, Neurosurgery Mayo Clinic , Sr Assoc Consultant Neurosurgery, Mayo Clinic health system, Eau Claire, WI Eau Claire, WI
Degenerative Cervical
Myelopathy (DCM) is the most common cause of non-traumatic, chronic spinal cord
dysfunction worldwide, causing debilitating disability with a diminishing
quality of life. It has different components of either radicular symptoms (CSR)
vs myelopathic symptoms (CSM) or a combination (CSMR) of both. Its natural
history also varies but once it has causes progressive neurological symptoms
and signs, surgical intervention is warranted. Multi-level involvement is not
uncommon and given the constellation of symptoms and signs it becomes
challenging for the surgeon to decide the best approach, anterior vs posterior
vs a combination of surgeries to decompress the cord and the nerve roots. I
will be reviewing literature in regard to the approaches and using case-based
presentations to describe optimal surgical strategies
Research methodology: Literature review and case based clinical
assessment and outcomes to discuss optimal surgical approaches to this complex
condition
Conclusion: Both anterior and posterior as well as circumferential approaches work well for patients with CSMR and factors include patient related factors and surgical experience dealing with these challenging cases
Sudhir Rao,
MD
Orthopaedic Surgeon, Private Practice, Big Rapids, MI
Flexor profundus tendon rupture is an uncommon injury often seen in contact sports. The injury is sometimes missed and late diagnosis can affect treatment and outcome. The presentation will focus on a clinical case and discuss types of injury, diagnostic tools and treatment options
Arya Rao,
BA
MD-PhD Candidate, Harvard Medical School; Chair, Medically Engineered Solutions in Healthcare AI Subgroup, Massachusetts General Hospital Boston, MA
PURPOSE Overutilization of imaging services in the emergency department (ED) remains a significant source of increased expenditure for hospitals. Large language models (LLMs) offer an innovative solution to help triage patients and allocate imaging resources. Here, we evaluate the Generative Pre-Trained Transformer 4 LLM architecture’s capacity to determine the appropriate imaging modality for patients presenting to the ED with lower back pain, a common presenting symptom that often results in advanced imaging and increased cost to the patient and system, which can lead to increased burden in downstream surgical decision-making.
Retrospective data was collected from 422 patients who presented between December 2017 and June 2018 to the ED of a ~1000-bed major urban academic medical center with a chief complaint of lower back pain and had a lumbar spine MRI ordered. A customized LLM utilizing Generative Pre-Trained Transformer 4 (GPT-4) architecture embedded with the 2021 American College of Radiology (ACR) Appropriateness Criteria for Low Back Pain was compared with a publicly available GPT-4 version, and with real-world imaging. An analysis of professional services resource use by work relative value units (wRVUs) was conducted to determine if either model would have saved resources compared to real-world imaging orders.
The native GPT-4 model generated ACR-concordant recommendations for 72.0% (304/422) of cases, as compared to 68.7% (292/422) by our custom embedded model. Both models demonstrated greater alignment with ACR criteria than real-world decisions as measured by Cohen’s kappa (0.43 and 0.46, respectively, compared to 0.02). Actual resource utilization was 629 wRVUs across the study period. The native GPT-4 and ACR criteria-embedded model would have resulted in a total expenditure of 481.74 and 428.44 wRVUs respectively. 100% adherence to the ACR criteria would have resulted in 481.86 wRVUs used.
Our results demonstrate the
use of LLMs to allocate imaging resources for patients with back pain, with
potential to reduce costs, increase efficiency, and improve the patient
experience by minimizing the unwarranted utilization of imaging services. By reducing
unnecessary imaging, LLMs can not only enhance diagnostic yield but also can
streamline surgical consultations and reduce the number of cases referred for
surgery without clinical justification.
Badi Rawashdeh,
MD
Transplant Surgeon, Medical College of Wisconsin, Milwaukee, WI
This presentation addresses
the challenges in the allocation of deceased donor kidneys, specifically
focusing on communication between transplant coordinators and transplant
surgeons. This process is critical for ensuring accurate, timely matches, which
directly impacts survival rates and quality of life for patients with end-stage
renal disease on the transplant waiting list. Given the high demand for
transplants and the reliance on telephone communication, common issues such as
miscommunication, delays, and decision fatigue can hinder effective organ
allocation. Moreover, the strain of frequent after-hours calls and extended
on-call responsibilities contributes to burnout among transplant surgeons,
underscoring the need for a more sustainable communication approach.
Our presentation introduces a solution—a collaborative Excel spreadsheet on the Microsoft® Teams® platform—to streamline communication and reduce these challenges. The new workflow provides real-time updates, centralized data storage, and a color-coded system for quick status recognition, significantly enhancing response times and reducing on-call workload. Attendees will learn how to implement and use this system to improve communication efficiency, organ offer response, and team satisfaction in high-stress transplant settings. By the end of the session, participants will be equipped with a practical strategy to optimize transplant coordination and improve overall patient care.
Razia Rehmani,
MD
Cleveland Clinic Foundation Austin, TX
Spine surgery is a crucial intervention for various spinal disorders, but it carries a risk of complications that can adversely affect patient outcomes. Radiological imaging plays a vital role in the early detection, characterization, and management of these complications, making it an indispensable tool in postoperative care. This abstract provides an overview of common complications associated with spine surgery from a radiological perspective, with a focus on the latest imaging techniques and their clinical implications.
Postoperative complications of spine surgery include hardware malposition or failure, infection, hematoma, cerebrospinal fluid (CSF) leaks, and adjacent segment disease, among others. Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are central to diagnosing these complications. CT is particularly effective for assessing hardware-related issues, such as screw misplacement, loosening, or breakage, due to its excellent spatial resolution. MRI, on the other hand, is superior in evaluating soft tissue complications, including infections like discitis and osteomyelitis, which present as abnormal signal intensity and enhancement on T1- and T2-weighted images with contrast.
CSF leaks, often presenting as pseudomeningoceles, are best visualized with MRI, where high T2 signal collections near the surgical site can indicate the presence of a leak. Hematomas, another significant complication, can be detected on both CT and MRI, with MRI providing more detailed information about their size, extent, and impact on surrounding neural structures. Adjacent segment disease, a long-term consequence of spinal fusion surgery, involves the degeneration of segments next to the fusion site and is optimally assessed using MRI to detect changes such as disc degeneration, stenosis, or spondylolisthesis.
The role of radiologists
extends beyond mere detection; they are critical in guiding clinical decisions
through detailed interpretation of imaging findings and recommendations for
further management. Emerging imaging techniques, including advanced MRI sequences
and the integration of artificial intelligence in image analysis, hold promise
for enhancing the detection and characterization of spine surgery
complications, potentially leading to improved patient outcomes.
In conclusion, radiologists
are integral to the multidisciplinary management of spine surgery patients.
Their expertise in recognizing and diagnosing postoperative complications
through advanced imaging techniques ensures prompt and effective treatment, ultimately
improving the safety and efficacy of spine surgical interventions.
Razia Rehmani,
MD
Associate Professor of Radiology, Cleveland Clinic Foundation, Director of It Alliance Medical System, New York, NY
Artificial Intelligence (AI) is
increasingly being integrated into radiology workflows to enhance efficiency
and accuracy. One of the emerging applications is the use of AI for preliminary
dictation, where AI systems generate initial radiology reports based on key
findings identified by radiologists. This approach aims to streamline the
reporting process, reduce workload, and minimize errors, ultimately improving
clinical outcomes.
Objectives:
To evaluate the effectiveness
of AI in generating preliminary dictations based on key findings provided by
radiologists.
To assess the impact of
AI-assisted preliminary dictation on workflow efficiency and report accuracy.
To explore the challenges and future directions of AI integration in radiology reporting.
Materials, Methods, and
Procedures
A review of recent studies (2020-2023) was conducted to assess the use of AI in preliminary dictation after radiologist-identified key findings. Databases including PubMed, Scopus, and IEEE Xplore were searched using terms like AI in radiology reporting, preliminary dictation, and natural language processing in radiology. Selected studies were analyzed for AI performance in report generation, accuracy, and time efficiency compared to traditional reporting methods.
Results
AI systems, particularly
those using natural language processing (NLP) and deep learning techniques,
have shown substantial promise in generating accurate preliminary reports based
on key findings provided by radiologists. In studies, AI-generated preliminary
reports matched the content accuracy of radiologist-completed reports in 85-90%
of cases, while reducing average dictation time by up to 30%. AI systems also
demonstrated the ability to reduce errors in reporting, such as typographical
errors and inconsistencies in clinical terminology.
AI-assisted preliminary dictation offers several benefits, including reduced workload for radiologists, faster turnaround times, and consistent use of clinical terminology. However, challenges such as ensuring the clinical context's accuracy, maintaining patient data privacy, and developing systems that can adapt to varied reporting styles. AI systems must continue to evolve to better understand complex clinical findings and nuances to achieve optimal integration into radiology workflows.
Significance
AI shows significant
potential in assisting with preliminary dictation after key findings are
identified by radiologists, enhancing efficiency and consistency in radiology
reporting. Continued advancements in NLP and deep learning are essential to
address existing challenges and maximize AI's impact on clinical practice.
Peter Rhee,
MD, MPH
Professor of Surgery, City University of New York Uniformed Services University of the Health Sciences Bronx, NY
Trauma has now become the
leading cause of death for individuals under the age of 50 in the United
States. As the nation undergoes unprecedented demographic shifts, its
population is both growing and aging, while the birth rate continues to
decline. Advances in technology and safety measures, along with increased
firearm availability and evolving trauma mechanisms, have profoundly
transformed the field of trauma care.
This presentation will analyze U.S. Census data, which is collected every decade, to illustrate the evolution of trauma care over time. It will also compare trauma-related deaths to those caused by cancer and heart disease, highlighting key trends and disparities. Understanding these changes in medical trends is essential for effectively allocating funding and resources to areas of greatest need.
Syed Ali Rizvi,
DO, MPH
Vascular Surgeon, NYC Health and Hospitals/Harlem, New York, NY
The workshop is designed to proivde a hands-on learning experience promoting best practices regarding suturing and vascular anastomosis.
Participants will improve their competence and performance, being better prepared to perform vascular anastomosis.
Reza Saidi,
MD
Associate Professor of Surgery, Chief of Transplantation, Director, Kidney Transplant Program, Surgical Director of Kidney Transplantation, Division of Transplant Services, Department of Surgery, Upstate Transplant Center, SUNY Upstate Medical University Syracuse, NY
Background We aim to compare
the long-term survival outcomes of patients who have received liver transplants
as a result of primary hepatocellular carcinoma (HCC).
Methods and materials A
retrospective registry analysis of SRTR database was done for liver transplants
that were performed in the United States from January 2000 to June 2023.
Results A total of 143717
liver transplant (LT) cases have met both the inclusion and the exclusion
criteria and were included in the final analysis. The most common primary
diagnosis in the non-HCC cohort were hepatitis C virus (HCV) (14813 cases,
27%), and alcoholic cirrhosis (6631 cases, 12.1%) in the 2001-2010 cohort, and
alcoholic cirrhosis (18370 cases, 20.7%), and non-alcoholic steatohepatitis
(NASH) (13997 cases,15.8%) in the 2011-2023 cohort. The data analysis showed a
significant overall One- and five-year allograft survival improvement in the
2011-2023 timeframe compared to the 2001-2010 group in both HCC and non-HCC
patients. The allograft survival difference became more significant after the 5
years of follow-up with a 10% difference between the two timeframes in both HCC
and non-HCC groups. Patients who met and were selected based on Milan’s
criteria had significantly better outcomes in both cohorts. Five-year allograft
and patient survival were also significantly higher in the patients who met
Milan’s criteria in 2011-2023 cohort, compared to 2001-2010 cohort (74.4% vs.
66.1%, P-value <0.001, and 76% vs. 68.7%, P-value <0.01, respectively).
Acute and chronic rejections were significantly higher in the non-HCC groups in
both timeframes. It was 6.5% vs. 4.8%, P=0.03 in 2001-2010, and 13.6% vs. 8.2%,
P=0.0007 in 2011-2023, for acute rejection and 10.8% vs. 6.7%, P=0.0001 in
2001-2010, and 14.1% vs. 10.3%, P=0.01 in 2011-2023, for chronic rejection.
Conclusion Short- and long-term outcomes of liver transplant is almost equal to the other causes of liver transplantation in the recent decade, which can significantly overcome the dilemma of doing liver transplant in patients with HCC diagnosis, who need liver transplant. Adhering to the Milan criteria is crucial for optimizing outcomes, as demonstrated by our study's findings, which highlight significantly better allograft and patient survival rates among those who meet these criteria.
Michael Samotowka,
MD
Med Global Board of Directors; Lead Faculty Surgeon for Trauma Training in Ukraine Jacksonville, FL
Discussion and understanding
of current needs in a hostile environment for Trauma surgeons
It is important for trauma
surgeons to have a good understanding of trauma surgeries role in hostile
environments, and the audience should have a better appreciation of what the
needs are to properly function in this type of environment
The audience should have a better appreciation and understanding of these conditions and what trauma surgeons can do to help provide optimal care for patients in this environment.
Luke Schwartz,
BS
Medical Student, SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, Roslyn, NY
The purpose of this study was to report on the treatment, results, and longer-term outcomes of patients who sustained a tibial plateau fracture with an associated leg compartment syndrome (CS). A total of 766 patients who sustained 766 tibial plateau fractures met inclusion criteria. Fourteen patients (1.8%) were diagnosed with CS in association with a tibial plateau fracture during their initial hospitalization, 13 at the time of presentation and 1 delayed. The treatment protocol consisted of initial external fixation and fasciotomy, followed by irrigation and debridement, and eventual closure. Fasciotomy cases included 2/14 (14.3%) single incision approaches and 12/14 (85.7%) dual incision approaches. Operative treatment of the tibial plateau fracture was performed at the time of final closure or once soft tissues were permitted. One case of CS that developed following definitive fixation was treated with fasciotomy and delayed primary closure after initial stabilization. Ten (71.4%) were available at 1-year follow-up. We compared these 10 cases to the patients with operative tibial plateau fractures without CS to assess for surgical, radiographic, clinical, and functional outcomes. We used a propensity match based on age, body mass index, sex, Charleson comorbidity index, and fracture type to reduce the presence of confounding biases. Standard statistical methods were employed. Those in the CS cohort were younger males (p < 0.05). At latest follow-up, function did not differ between those in the CS group compared with the non-CS cohort (p > 0.05). Clinically, knee flexion (130.7 vs. 126; p = 0.548), residual depression (0.5 vs. 0.2; p = 0.365), knee alignment (87.7 vs. 88.3; p = 0.470), and visual analog scale pain scores (3.0 vs. 2.4; p = 0.763) did not differ between the cohorts. Although infection was higher in the CS cohort, the overall complication rates did not differ between the CS patients and non-CS cohort (p > 0.05). Early identification and standardized treatment protocols for the management of CS that develops in association with a tibial plateau fracture lead to outcome scores that were not significantly different from patients who did not develop CS.
Luke Schwartz,
BS
Medical Student, SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, Roslyn, NY
Introduction: Osteonecrosis
(ON) of the humeral head is defined as “avascular†when the death
of bone is due to a disrupted blood supply. It is a known complication
following proximal humeral fractures and can lead to poor long-term outcomes
and even additional revision surgeries.
Case Report: Patient AP
developed symptomatic ON, 3 years following repair of a 4-part valgus impacted
proximal humerus fracture. The point of interest in this case is the length of
time from injury at which she developed symptomatic ON. Following surgical
repair, she was seen at standard intervals, 6 weeks, 3-, 6-, and 12- month
follow-ups and demonstrated an excellent recovery. By the 1 year follow-up
appointment, she had obtained a range of motion in her left shoulder of 170°
forward elevation and 60° in external rotation. At this point, she was able to
discontinue physical therapy and was radiographically and clinically healed.
However, 2 years after, she began experiencing sudden onset of pain with
shoulder ROM and progressive limitation. She was diagnosed with an ON of her
proximal humerus. The patient was prescribed a 3-month course of
corticosteroid, 3 months following her operation for a gynecological-related
issue. However, with strong progress being made 9 months after this
prescription, and problems occurring over 2 years after taking the medication,
it is unclear whether the ON was related to her fracture pattern or developed
as a result of the corticosteroid usage or a combination of the 2 due to a
“double hit.”
Conclusion: This case review
points out the potential need for continued monitoring even after radiographic
and clinical healing is achieved in these injuries.
Learning Point of the Article: “Double hit” mechanism of fracture pattern and corticosteroid usage the potential contributing factors of ON.
Ridwan Shabsigh,
MD
Chairman, Department of Surgery, SBH Health System, Bronx, NY; Professor of Clinical Urology, Weill Cornell Medical School, New York, NY, Bronx, NY
The problem / surgical intervention the presentation covers: In health crisis, such as the COVID19 pandemic, shortages of physicians are frequently encountered putting healthcare delivery at substantial risks.
Why the audience needs to know this information: The successful experience of cross training of surgeons in critical care during the COVID19 pandemic provides a model of the efficient creation of additional critical care physician workforce at times of high demand and shortage of such physicians.
What the learner will be able
to accomplish after the presentation: Understand the characteristics of health
crisis in the setting of acute care hospitals
Learn the planning and execution of cross training of surgeons in critical care during health crisis
How the audience will benefit from the presentation: Improve the preparedness for future healthcare crisis, based on lessons learned from the COVID19 pandemic
Ridwan Shabsigh,
MD
Chairman, Department of Surgery, SBH Health System,
Bronx, NY;
Professor of Clinical Urology, Weill Cornell Medical School, New York, NY, Bronx, NY
The problem / surgical intervention the presentation covers: Recently results of major clinical trials of testosterone replacement therapy were published addressing important issues and closing substantial knowledge gaps about the treatment of male hypogonadism. Dissemination of the conclusions of these important clinical trials will benefits clinicians and their patients.
Why the audience needs to know this information: Male hypogonadism is highly prevalent characterized by low testosterone and sexual and metabolic symptoms with significant morbidity. In the past, there had been numerous questions about the efficacy and safety of testosterone replacement therapy. Recently concluded major clinical trials provide fulfilling answers to many of such questions.
What the learner will be able
to accomplish after the presentation:
·
Understand the
definition and the diagnosis of clinical hypogonadism
·
Learn the sexual
and metabolic symptoms and signs of male hypogonadism
·
Understand the
efficacy of testosterone replacement therapy
· Learn the safety of testosterone replacement therapy including among others cardiovascular safety and prostate safety.
How the audience will benefit
from the presentation:
·
Clinicians will
be better able to counsel their patients about hypogonadism and testosterone
replacement therapy.
Feroze Sidhwa,
MD, MPH
Trauma and Critical Care Surgeon, San Joaquin General Hospital, French Camp, CA; Assistant Professor of Surgery, California Northstate University, Elk Grove, CA, Lathrop, CA
Humanitarian and global surgical interventions require an understanding of the etiologies of surgical disease in countries experiencing conflict. These etiologies are typically multifactorial and largely driven by social determinants of health, which themselves are often determined by social and political decisions, often made outside of the affected country. After this presentation the learner will understand some of the social determinants of health affecting surgical disease and outcomes in the Gaza Strip.
Kristopher Spring,
Executive Editor, Clinical Medicine Books, Springer
Nature, East Hanover, NJ
The field of surgery is constantly evolving, driven by advancements in technology, research, and clinical practices. Consequently, the demand for high-quality surgical literature has never been greater. Surgical textbooks and guides play a crucial role in educating the next generation of surgeons, providing them with essential knowledge and skills needed to perform procedures safely and effectively. However, many potential authors, including seasoned surgeons and medical professionals, often feel overwhelmed by the intricacies of the publishing process. A workshop dedicated to teaching the nuances of publishing surgical books addresses this gap, empowering participants with the tools and knowledge to share their expertise and contribute to the body of surgical literature. Understanding the book publication process is essential for surgeons to effectively share their expertise and contribute to the advancement of surgical knowledge, ensuring their insights reach a wider audience and enhance medical education.
The primary objective of the workshop is to review with attendees a comprehensive understanding of the surgical publishing landscape, from conception to completion. Participants will learn how to identify relevant and impactful topics, structure their manuscripts effectively, and navigate the peer review process. Additionally, the workshop aims to demystify the publishing options available ”be it traditional publishing, self-publishing, or open access allowing participants to make informed decisions that align with their goals. By the end of the workshop, attendees will have actionable insights into marketing their surgical books and building their author platforms, ultimately fostering a culture of knowledge sharing and collaboration within the surgical community.
Jeffrey Sutton,
MD
Assistant Professor of Surgery, Division of Oncologic and Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Appendiceal malignancies, ranging from low-grade appendiceal mucinous neoplasms to poorly differentiated adenocarcinomas with signet ring cell features, often metastasize to the peritoneal cavity. While traditional systemic chemotherapy is a mainstay of the treatment algorithm for many of these malignancies, the peritoneal lining limits the effective delivery of chemotherapy into the cavity itself and is limited in its peritoneal tumor penetration. Cytoreductive surgery and intraperitoneal chemotherapy (CRS-HIPEC) is an adjunctive therapy utilized beyond traditional systemic chemotherapy for treatment of limited metastatic peritoneal disease burden. CRS-HIPEC has demonstrated efficacy in both progression-free and overall survival for selected patients with metastatic appendiceal malignancies. In this presentation, various appendiceal histologies will be reviewed, the process of appropriate patient selection will be outlined, the CRS-HIPEC procedure will be described, and data on the short- and long-term outcomes of CRS-HIPEC will be reviewed. At the conclusion of this presentation, the audience should be able to name the various appendiceal malignancy histologies, review the workup and decision-making for proper patient selection for CRS-HIPEC, and understand the surgical procedure of CRS-HIPEC. As a significant proportion of appendiceal malignancies are identified incidentally during routine laparoscopic appendectomy or during radiographic or laparoscopic evaluation for vague abdominal symptoms, surgeons of various specialties will benefit from the information presented within this talk.
Julie Valenzuela,
MD
Assistant Professor of Surgery, Division of Trauma, Surgical Critical Care and Burns, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine; Medical Director, Ryder Trauma Center / Jackson Memorial Health, Miami, FL
The prevalence of Adverse Childhood Events (ACE) is vastly underrecognized. A sentinel study by Kaiser not only shows the wide prevalence of ACEs but that it is linked to poorer health outcomes such as obesity, depression, and cancer. There is also a lack of education on trauma-informed care for surgeons and surgical specialties, in particular trauma surgery. Trauma-informed care principles provide a framework to address health inequity by recognizing the effects of trauma and adversity on health and behavior. As surgical leaders and trauma surgeons who are also dealing with the challenges of addressing immediate life-threatening injuries, it is also critical to implement trauma-informed care approach starting from the resuscitation bay. The Committee on Trauma supports trauma-informed care principles so strongly that it is being added to the 11th edition of ATLS which is currently being revised. The audience will benefit from staying ahead of upcoming knowledge/practice coming down the pipeline. The learner will be educated on the core principles of trauma-informed care and how to implement them into their practice.
I will highlight the
implementation challenges within the trauma surgery field and in the
resuscitation bay but why it is needed and how to overcome the challenges.
Importantly, trauma informed care approach is not only relevant to how we interact with our patients but how we interface with our own peers. Thus, the principles and framework is relevant on numerous levels and all levels of leadership.
Furthermore, now that the leading cause of death for children in our country is firearms-related, many trauma centers are building community partnerships to develop hospital-based violence intervention programs. A key component is the collaboration with credible messengers with lived experience and providing peer support for the critically injured. This is a foundational principle of trauma informed care approach which shows how this extends beyond the resuscitation bay that can impact the recovery of individuals. The components of hospital based violence intervention programs will be discussed to show how surgeons can be involved with improving health equity beyond surgical repair of injuries.
Abdul Waheed,
MD
Saint Josepha Hospital, Tampa, FL
Timely screening for breast cancer plays a pivotal role in early detection and treatment; however, Afghan refugee females face significant barriers that hinder their access to these life-saving screening services. Cultural norms, socioeconomic factors, proficiency with the English language, and the challenges of navigating foreign healthcare systems contribute to low screening rates within this population. The current review article seeks to identify barriers to breast cancer screening in the Afghan refugee population in the United States (US) and address possible measures to overcome these challenges.
A comprehensive review of PubMed articles from 1981-2021, using specific keywords and BOOLEAN operators, identified five key studies on breast cancer screening among Afghan female refugees, focusing on their perceptions and barriers. This selection included cross-sectional surveys and semi-structured interviews to capture the nuanced views within this population.
Breast Cancer Knowledge and
Education Level
A fundamental barrier
identified across the studies was a lack of breast cancer knowledge,
encompassing symptoms, risk factors, and screening procedures. This issue was
closely linked to the education level of the community, where limited
educational backgrounds hindered their understanding and awareness of breast
cancer.
Cultural, Religious, and
Language Barriers
Cultural and religious
beliefs also emerged as significant barriers, with concerns about modesty and
privacy leading to a preference for female physicians. Language barriers
further complicated access to and understanding of health care services, as
many in the Afghan community do not speak English as their primary language.
Socioeconomic Factors and
Household Dynamics
Socioeconomic status was a
critical barrier, with many individuals lacking insurance, access to health
services, and transportation. Patriarchal household dynamics also played a
role, where men often make healthcare decisions, potentially delaying or preventing
women from seeking screening. Social isolation limited women's engagement with
healthcare services, as they rarely leave their homes without accompaniment.
Psychological Barriers
Psychological factors, including the fear of cancer and fatalistic beliefs, were also significant. The fear of a cancer diagnosis, associated with death and societal shame, along with the belief that health outcomes are predetermined by divine will, deterred individuals from participating in screening programs.
With the ongoing arrival of
Afghan refugees in the U.S., it is essential to implement targeted breast
cancer screening programs. These initiatives should aim to address the unique
barriers faced by this population, enhancing early detection and treatment of
breast cancer, and ultimately reducing the incidence of late-stage diagnoses
among Afghan refugee women.
Maurice Wright,
MD
Senior Associate Dean Columbia University Irving Medical Center, Academic Affiliation at NYC H&H/Harlem, Assistant Clinical Professor, CUIMC, CMO, NYC H&H/Harlem New York, NY
Fifteen years later, our surgical department stands as one with outstanding quality outcomes, excellent surgeons and the correct scope for the community we serve. The redesign of the service was intentional, to cover multiple disease processes with high prevalence in our community as well as pediatric and adult trauma. Our successful journey and efforts will be addressed in this presentation.
Mohan YS,
MD
Head, Dept of Neurosurgery, Garden City Hospital, Garden City, MI Rochester Hills, Mi
Introduction: Restorative neurostimulation is a relatively new approach to recalcitrant mechanical chronic low back pain (absent of radiculopathy and surgical needs). Multifidus muscle dysfunction can underlie mechanical chronic low back pain contributing to feelings of instability.1 Direct stimulation of the dorsal rami medial branch nerves elicits multifidi muscle contractions to restore motor control, dynamic intervertebral stability, improve pain and disability by a mechanism that accrues with continued use of the implanted device.2,3 An evaluation of 5-year follow-up data from a pivotal restorative neurostimulation sham-controlled randomized clinical trial (Clinicaltrials.gov Identiï¬er: NCT02577354) would demonstrate meaningful durable improvements for this challenging population.
Methods: A prospective registry of cases was established as part of the post market requirements for the use of the restorative neurostimulation system (ReActiv8®, Mainstay Medical, Inc., Dublin, Ireland) in the United States (US), Australia, and Europe. randomized clinical trial operations complied with US Food and Drug Administration regulations, ISO 14155, International Conference on Harmonization, and Declaration of Helsinki. Consented participants (N=204, age=47±9yrs; F110; BMI=28±4kg/m2; pain duration=14.2±10.6yrs) were implanted over 21 months and randomized. Prespecified outcome measures included visual analog scale, Oswestry Disability Index, and quality of life (measured by Euroquol EQ-5D-5L) documented at intervals out to five years. Completer analysis and mixed-effects models for repeated measures for missing data imputations were conducted.
Results: A cohort with
complete five-year post-implantation records (N=126) was identified. Cohort
changes from baseline for mean(±SE) visual analog scale, Oswestry Disability
Index, and EQ-5D-5L were -4.9(±0.2) cm, -22.7(±1.4), and 0.231(±0.018), respectively
(all p<0.0001). Of this cohort, 71.8% experienced greater than or equal to
50% pain reduction, and 78.2% experienced either greater than or equal to 50%
pain reduction and/or greater than or equal to 20-point Oswestry Disability
Index reduction. No lead migrations were observed.
Discussion: Restorative
neurostimulation 5-year data from this multi-center registry revealed
significant reductions in mechanical chronic low back pain symptoms and
function with increased quality of life.
Conclusion: Patients with mechanical chronic low back pain and multifidus dysfunction with implanted neurostimulation received substantial improvements in pain and disability with durable results. They also were provided five years of substantial improvements in quality of life. With a favorable safety profile, restorative neurostimulation may give clinicians an evidence-based avenue to treat these patients.
References:
1. Goubert, D., Van Oosterwijck, J., Meeus, M. &
Danneels, L. Structural Changes of Lumbar Muscles in Non-specific Low Back
Pain: A Systematic Review. Pain Physician 19, E985–E1000 (2016).
2. Gilligan, C. et al. An implantable
restorative-neurostimulator for refractory mechanical chronic low back pain: a
randomized sham-controlled clinical trial. Pain 162, 2486–2498 (2021).
3. Russo, M. et al. Muscle Control and Non-specific Chronic
Low Back Pain. Neuromodulation 21, 1–9 (2018).
Acknowledgements: The support
of Mainstay Medical, Inc. for this project is gratefully acknowledged.