Surgery in practice and science最新文献

{"title":"Naloxone co-prescriptions for surgery patients prescribed opioids: A retrospective cohort study","authors":"Lyen C. Huang ,&nbsp;Henry Nibley ,&nbsp;Melissa Cheng ,&nbsp;Josh Bleicher ,&nbsp;Hyunkyu Ko ,&nbsp;Jordan E. Johnson ,&nbsp;Marta L. McCrum","doi":"10.1016/j.sipas.2023.100217","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100217","url":null,"abstract":"<div><h3>Background</h3><p>Surgeon-prescribed opioids contribute to 11% of prescription drug overdoses in the United States (US). With prescription opioids involved in 24% of all opioid-related overdose deaths in 2020, the US Centers for Disease Control and Prevention (CDC) recommends naloxone co-prescribing to patients at high-risk of overdose and death as a harm reduction strategy. We sought to 1) examine naloxone co-prescribing rates to surgical patients (using common post-surgical prescribing amounts) and those with potential risk factors for opioid-related overdoses or adverse events, and 2) identify the factors associated with patients receiving naloxone co-prescriptions.</p></div><div><h3>Methods</h3><p>We conducted a single-institution, retrospective study using the electronic medical records of all patients undergoing surgery at an academic institution between August 2020 and May 2021. We included post-surgical adults prescribed opioids that were sent to a pharmacy in our health system. The primary outcome was the percentage of co-prescribed naloxone in patients prescribed opioids.</p></div><div><h3>Results</h3><p>The overall naloxone co-prescription rate was low (1.7%). Only 14.6% of patients prescribed ≥350 morphine milligram equivalents (MME, equivalent to 46.7 oxycodone 5 mg tablets) and 8.6% of patients using illicit drugs were co-prescribed naloxone. On multivariable analysis, patients who were prescribed &gt;350 MME, used illicit drugs or tobacco, underwent an elective or emergent general surgery procedure, self-identified as Hispanic, or had ASA scores of 2-4 were more likely to receive a naloxone co-prescription.</p></div><div><h3>Conclusions</h3><p>Naloxone co-prescribing after surgery remains low, even for high-risk patients. Harm reduction strategies such as naloxone, safe storage, and disposal of leftover opioids could reduce surgeons’ iatrogenic contributions to the worsening US opioid crisis.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49883835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation-induced recto-urinary fistula: A dreaded complication with devastating consequences","authors":"Kyeong Ri Yu ,&nbsp;Lucas Keller-Biehl ,&nbsp;Leon Smith-Harrison ,&nbsp;Sarah Z. Hazell ,&nbsp;William R. Timmerman ,&nbsp;Jeannie F. Rivers ,&nbsp;Thomas A. Miller","doi":"10.1016/j.sipas.2023.100216","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100216","url":null,"abstract":"<div><h3>Purpose</h3><p>This study was undertaken to evaluate our 16-year experience with fistulas between the rectum and urethra or urinary bladder, collectively called recto-urinary fistulas (RUFs), and their devastating consequences in patients treated with radiation for prostate cancer.</p></div><div><h3>Methods</h3><p>We downloaded the records of all patients with radiation-related RUFS from 2004 to 2020 at our institution using the electronic medical record system. Details concerning patient demographics, clinical presentation, diagnostic approaches and surgical management were obtained and assessed.</p></div><div><h3>Results</h3><p>We identified a total of seven patients with radiation-induced RUFS: all were male and had an average age of 66 at diagnosis. Each had a history of prostate cancer that was treated with external, internal (i.e.brachytherapy), or combination radiation therapy. No fistulas were noted in patients treated with radiation for another malignancy. Radiation proctitis with rectal ulcer formation occurred in 6 of 7 patients. Common symptoms included fecaluria, pneumaturia, urine leakage via rectum, rectal pain and urinary tract infection. CT scanning was the most useful diagnostic tool. Once confirmed, fistula management included both urinary and fecal diversion in all patients. Only one patient received definitive repair of the fistula. Five others either died before repair could be attempted or had prohibitive co-morbid diseases. One patient declined repair.</p></div><div><h3>Conclusions</h3><p>Although rare, the development of a recto-urinary fistula is a dreaded complication. Our results indicate that radiation proctitis with rectal ulcer formation precedes fistula formation in most patients and must be aggressively managed. While fecal and urinary diversion can manage fistula symptoms in the majority of patients, definitive fistula repair is only possible in selected individuals.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49883834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed access to essential surgical care in Uganda: A tertiary multi-center study","authors":"Emmanuel Adupa ,&nbsp;Andrew Marvin Kanyike ,&nbsp;Joshua Mwebembezi ,&nbsp;Daniel Safari Nteranya ,&nbsp;Mercy Ndibalema ,&nbsp;Dissan Matovu ,&nbsp;Victor Niwenyesiga ,&nbsp;Smarco Arinda ,&nbsp;Kenneth Agaba","doi":"10.1016/j.sipas.2023.100215","DOIUrl":"10.1016/j.sipas.2023.100215","url":null,"abstract":"<div><h3>Background</h3><p>Surgery has been largely neglected within global public health despite growing evidence that the overall burden of disease requiring surgical intervention is rapidly growing and affordable access to surgical care can avert many deaths and disabilities. This study assessed the factors influencing delayed access to essential surgical care in Uganda.</p></div><div><h3>Methods</h3><p>A descriptive multi-center cross-sectional survey was carried out in three hospitals designated for major surgeries in Uganda from December 2019 to December 2021 across three regions of the country in a prospective manner. Patients admitted to the hospitals that required surgical intervention were included. Bivariate analysis using the chi-square test or Fischers’ exact test and multivariable logistic regression models to adjust for confounders were carried out.</p></div><div><h3>Findings</h3><p>A total of 635 patients participated in the study of which the majority were males (<em>n</em> = 399, 63%) from the Northern region (<em>n</em> = 347, 54.7%.). Most patients and sought surgical help immediately (<em>n</em> = 406, 63.9%) and were operated on time (<em>n</em> = 402, 63.3%), however only 23.3% (<em>n</em> = 148) were able to reach the hospital for care on time. Caretakers’ hesitancy on the surgical procedure (aOR: 2.41 95% CI: 1.07 – 5.43; <em>p</em> = 0.035), hospital inaccessibility (aOR: 5.35 95% CI: 1.82 – 5.75; <em>p</em> = 0.002), and delayed surgical procedure performance (aOR: 6.37 95% CI: 2.64 – 5.34; <em>p</em>&lt;0.001) contributed to surgical delays among other factors.</p></div><div><h3>Interpretation</h3><p>All three factors contribute to surgical delay but most significantly access to hospital. Several socioeconomic factors like education, long distances, and poverty interplay in a complex web to hamper access to essential surgical care.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45144804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing an imaging protocol for pediatric trauma in a rural hospital","authors":"Vrutant Patel ,&nbsp;Rahima Khatun ,&nbsp;Mary Carmack ,&nbsp;Jeanet Calhoun ,&nbsp;Joon K. Shim","doi":"10.1016/j.sipas.2023.100186","DOIUrl":"10.1016/j.sipas.2023.100186","url":null,"abstract":"<div><h3>Background</h3><p>Rural hospitals cover 20% of the United States (US) population with only 10% of physician coverage. A mismatch exists in pediatric trauma resources as there is overwhelming trauma support concentrated in urban trauma centers. Well-established guidelines for evaluating pediatric trauma patients in resource-limited environments are currently not available. Herein we identify the imaging practices at a level III rural trauma center to establish a protocol for handling pediatric traumas.</p></div><div><h3>Materials and Methods</h3><p>The National Trauma Data Bank was used to identify 155 pediatric trauma patients (age &lt;17 years) between 2017 and 2021. A single-center retrospective chart review was performed to identify patient demographics, mechanism of injury, imaging performed and pertinent imaging findings, and management of the patient i.e., whether they were discharged, admitted, or transferred.</p></div><div><h3>Results</h3><p>Blunt mechanisms were responsible for most traumas (90%). There were 64 patients (41.3%) who received imaging. Falls (49.3%) were the most common injury. Most of the patients were discharged home (73.4%) and 23.9% were transferred to a tertiary center. The mean time for transfer to a tertiary center was ∼176 min. The most frequently performed type of surgical intervention was orthopedic (59.3%).</p></div><div><h3>Conclusion</h3><p>An established pediatric trauma imaging protocol is warranted to adopt a higher level of pediatric trauma care for treatment and/or stabilization purposes. Using a tertiary care model and established pediatric trauma guidelines, we propose a model for use in resource-limited rural settings and aim to reduce unnecessary imaging of pediatric trauma patients and overall radiation exposure.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42618557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic, laparoscopic, and open liver resection for hepatocellular carcinoma: A propensity score matched analysis of perioperative outcomes","authors":"R.M. O'Connell ,&nbsp;M. Bucheeri ,&nbsp;O. Quidwai ,&nbsp;M. Bourke ,&nbsp;TK Gallagher ,&nbsp;E Hoti","doi":"10.1016/j.sipas.2023.100196","DOIUrl":"10.1016/j.sipas.2023.100196","url":null,"abstract":"<div><h3>Introduction</h3><p>Minimally invasive surgery may confer perioperative benefit to patients with resectable Hepatocellular Carcinoma (HCC) but published data are limited. Robotic resection for HCC has recently been introduced in our institution, and the goal of this study is to benchmark patient outcomes against open and laparoscopic surgery.</p></div><div><h3>Methods</h3><p>A retrospective evaluation was performed of all patients undergoing liver resection for HCC in our institution between September 2012 and November 2022 using a prospectively maintained database. Data were collected relating to demographics, pre-operative staging, co-morbidities, type of resection, operative time, surgical technique, histology, length of stay, and post-operative complications. A propensity score matched analysis was performed to compare outcomes for open, laparoscopic, and robotic surgery.</p></div><div><h3>Results</h3><p>106 patients were identified. 66 (62%) had open, 26 (25%) laparoscopic, and 14 (13%) had a robotic resection. Using propensity matched analysis, robotic liver resections for HCC were associated with a non-significantly lower risk of ICU admission than open surgery (0 v 21%, <em>p</em> = 0.16). A lower risk of conversion to open than laparoscopic surgery was seen within the unmatched cohort (0 v 23%, <em>p</em> = 0.07), albeit there was a significantly longer median operative times than open or laparoscopic resection (285 min v 192 and 147 respectively, <em>p</em>&lt;0.001).</p></div><div><h3>Conclusion</h3><p>Our data show that robotic hepatectomy is a safe alternative to open and laparoscopic resection for HCC in terms of perioperative outcomes despite increased operative times. Longer-term data will be needed to confirm the oncological safety of this approach.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41647401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an objective assessment of surgical skill in arthroscopic management of meniscal tear: A pilot study","authors":"Rachel S. Bronheim ,&nbsp;Majd Marrache ,&nbsp;Alexander E. Loeb ,&nbsp;Johnathan A. Bernard ,&nbsp;Dawn M. LaPorte","doi":"10.1016/j.sipas.2023.100198","DOIUrl":"10.1016/j.sipas.2023.100198","url":null,"abstract":"<div><h3>Introduction</h3><p>As resident evaluation moves to a competency-based system, validated tools for assessment of surgical skill are increasingly important. We created and validated a checklist to measure resident surgical skill for arthroscopic management of meniscal tear.</p></div><div><h3>Materials and Methods</h3><p>Using a Delphi survey method, we created an objective, structured assessment of surgical skill for treatment of meniscal tears. The Meniscus Treatment Task List (MTTL) comprises 5 domains: diagnostic arthroscopy, medial meniscectomy, lateral meniscectomy, medial meniscal repair, and lateral meniscal repair. Orthopaedic surgery residents were recruited to perform diagnostic arthroscopy, partial meniscectomies, and all-inside meniscal repairs with cadaveric models. Arthroscopic videos were graded by fellowship-trained surgeons using the MTTL and the validated Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale (GRS). Postgraduate year (PGY), operative time, and case logs were recorded for each resident. Data were analysed using bivariate correlation, analysis of variance, pairwise comparison, Pearson's correlation coefficient, and intraclass correlation coefficient. α=0.05.</p></div><div><h3>Results</h3><p>Twenty-two orthopaedic surgery residents (PGY1–PGY4) participated. MTTL scores were higher in the PGY4 class than in the PGY1 class (mean difference, 11 points, <em>p</em> = 0.04). Operative time was inversely correlated with number of cases logged (<em>r</em> = –0.53, <em>p</em> = 0.01), number of arthroscopic cases logged (<em>r</em> = –0.50, <em>p</em> = 0.02), and MTTL score (<em>r</em> = –0.46, <em>p</em> = 0.03). MTTL score was positively correlated with number of cases (<em>r</em> = 0.44, <em>p</em> = 0.04) and number of arthroscopic cases logged (<em>r</em> = 0.50, <em>p</em> = 0.02). MTTL scores were positively correlated with the ASSET GRS (<em>r</em> = 0.71, <em>p</em>&lt;0.001). Intraclass correlation coefficient of 0.89 and Pearson's correlation coefficient of 0.89 demonstrated strong interrater reliability of MTTL scores (<em>p</em>&lt;0.01).</p></div><div><h3>Conclusions</h3><p>This pilot study demonstrates the validity and reliability of the MTTL for assessing resident proficiency in arthroscopic management of meniscal tears in cadaveric specimens. Expansion of this model to other orthopaedic procedures for objective assessment of surgical skill may be useful.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47965261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymph node harvest as a predictor of survival for colon cancer: A systematic review and meta-analysis","authors":"Simarpreet Ichhpuniani ,&nbsp;Tyler McKechnie ,&nbsp;Jay Lee ,&nbsp;Jeremy Biro ,&nbsp;Yung Lee ,&nbsp;Lily Park ,&nbsp;Aristithes Doumouras ,&nbsp;Dennis Hong ,&nbsp;Cagla Eskicioglu","doi":"10.1016/j.sipas.2023.100190","DOIUrl":"10.1016/j.sipas.2023.100190","url":null,"abstract":"<div><h3>Background and Objectives</h3><p>The number of lymph nodes found harboring metastasis can be impacted by the extent of harvest. Guidelines recommend 12 lymph nodes for adequate lymphadenectomy to predict long-term oncologic outcomes, yet different cut-offs remain unevaluated. The aim of this review was to determine cut-offs that may predict survival outcomes.</p></div><div><h3>Methods</h3><p>Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared overall survival (OS) or disease-free survival (DFS) above and below a lymph node harvest cut-off. Studies solely examining rectal cancer or stage-IV disease were excluded. Pairwise meta-analyses using inverse variance random effects were performed.</p></div><div><h3>Results</h3><p>From 2587 citations, 20 studies with 854,359 patients (51.9% female, mean age: 68.9) were included, with 19 studies included in quantitative synthesis. A lymph node harvest cut-off of 12 predicted improved five-year OS (7 studies; OR 1.11, 95% CI 1.08–1.14, <em>p</em>&lt;0.00001). A cut-off as low as 7 was associated with improved five-year OS (2 studies; OR 1.16, 95% CI 1.08–1.25, <em>p</em>&lt;0.0001) and DFS (3 studies; OR 1.66, 95% CI 1.32–2.10, <em>p</em>&lt;0.00001). All cut-offs greater than 12 demonstrated improved survival.</p></div><div><h3>Conclusions</h3><p>A lymph node cut-off of 12 distinguishes differences in five-year oncologic outcomes. Contrarily, lymph node harvests other than 12 have not been rigorously studied and thus lack the statistical power to derive meaningful conclusions compared to the 12-lymph node cut-off. Nonetheless, it is possible that a lymph node harvest cut-offs less than 12 may be adequate in predicting long-term survival. Further prospective study evaluating cut-offs below 12 are warranted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41583956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A modern-day research model for large academic institutions: A fellow-based solution","authors":"Alan Pang ,&nbsp;Jad Zeitouni ,&nbsp;Ferris Zeitouni ,&nbsp;Jennifer Kesey ,&nbsp;John Griswold","doi":"10.1016/j.sipas.2023.100193","DOIUrl":"10.1016/j.sipas.2023.100193","url":null,"abstract":"<div><h3>Introduction</h3><p>In the aftermath of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, research has become a more important component of residency applications. Time is a finite resource, and clinicians, both academic and private practice, struggle to balance research within their schedules. We aim to provide a model to produce impactful research efficiently.</p></div><div><h3>Methods</h3><p>We describe our experience in developing a modern-day research model that was developed to create a robust research program at our institution. A grassroots initiative of researchers, including academicians, a burn fellow, residents, and students, has become a research model that large academic institutions should leverage for efficiency and productivity.</p></div><div><h3>Results</h3><p>What began as one attending, one fellow, four medical students, and one burn center grew in several months to include over 170 students, a student organization, five fellows from varying specialties, seven residents, and 22 faculty members in 15 disciplines. In addition, our collaboration includes interdisciplinary research involving other institutional departments such as mathematics, medical education, biostatistics, industrial engineering, and computer engineering. Tenably, we have over 150 projects in the works, 22 publications, 47 podium presentations, 47 poster presentations, and over 150 approved IRB proposals, along with four grants— all in 16 months.</p></div><div><h3>Discussion</h3><p>As we move into the era of the ungraded medical student, the importance of research experience and productivity is rising. Academic institutions that adapt to this change in the medical education landscape have the opportunity to increase innovation and their institution's contributions to academic medicine while producing well-rounded graduates with skills vital to efficacious patient care.</p></div><div><h3>Conclusion</h3><p>This research model allows for interdisciplinary collaboration and efficient research productivity in large academic institutions. We aim to inspire other institutions to consider implementing a similar research model and continue to contribute to the innovation and advancement of medicine.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41690635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of image defined risk factors on outcomes for primary resection of neuroblastoma","authors":"Charbel Chidiac ,&nbsp;Andrew Hu ,&nbsp;Emily Dunn ,&nbsp;Daniel S. Rhee","doi":"10.1016/j.sipas.2023.100195","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100195","url":null,"abstract":"<div><h3>Background</h3><p>The presence of image‑defined risk factors (IDRF) in neuroblastoma plays a large role in decision making for primary resection versus neoadjuvant chemotherapy. This study investigates how the number and type of IDRFs affect surgical outcomes for primary resection of neuroblastoma.</p></div><div><h3>Materials and methods</h3><p>A retrospective review was performed including patients diagnosed with neuroblastoma with at least one IDRF who underwent primary resection of their tumor between 2003 and 2017. Cross sectional imaging was reviewed by a single pediatric radiologist for determination of IDRFs. Surgical outcomes were compared by &lt;5 versus ≥5 IDRFs and vascular or non‑vascular involvement.</p></div><div><h3>Results</h3><p>A total of 28 patients were included in the study, 18 with &lt;5 IDRFs and 10 with ≥5 IDRFs. Fifteen patients had vascular involvement and 13 did not. Nine were adrenal, 6 were cervicothoracic, and 5 were abdominal non-adrenal. Patients with ≥5 IDRFs were found to have an increased rate of complications (40% vs 0%; <em>p</em>&lt;0.01), operative time (318 vs 148 min; <em>p</em>&lt;0.01), estimated blood loss (187 mL vs 45 mL; <em>p</em>&lt;0.01), length of stay (9.6 vs 4.9 days; <em>p</em>&lt;0.01), and hospital readmission (20% vs 0%; <em>p</em> = 0.04). No differences were found in degree of resection (<em>p</em> = 0.06). All complications occurred with vascular involvement IDRFs compared to non‑vascular IDRFs (27% vs 0%; <em>p</em> = 0.04).</p></div><div><h3>Conclusion</h3><p>The presence of ≥5 IDRFs and vascular involvement increases complications associated with primary resection of neuroblastoma. Our findings underscore the importance of neoadjuvant chemotherapy prior to resection. Further studies are required to determine how different IDRFs influence surgical risk.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49775418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of YouTube as an online educational tool in teaching laparoscopic Roux-en-Y gastric bypass: A LAP-VEGaS study","authors":"Armaun D. Rouhi ,&nbsp;Jeffrey L. Roberson ,&nbsp;Emily Kindall ,&nbsp;Yazid K. Ghanem ,&nbsp;William S. Yi ,&nbsp;Noel N. Williams ,&nbsp;Kristoffel R. Dumon","doi":"10.1016/j.sipas.2023.100199","DOIUrl":"10.1016/j.sipas.2023.100199","url":null,"abstract":"<div><h3>Background</h3><p>General surgery residents frequently access YouTube® for educational walkthroughs of surgical procedures. The aim of this study is to evaluate the educational quality of YouTube® video walkthroughs on Laparoscopic Roux-en-Y gastric bypass (LRYGB) using a validated video assessment tool.</p></div><div><h3>Methods</h3><p>A retrospective review of YouTube® videos was conducted for “laparoscopic Roux-en-Y gastric bypass”, “laparoscopic RYGB”, and “laparoscopic gastric bypass.” The top 100 videos from three YouTube® searches were gathered and duplicates were removed. Included videos were categorized as Physician (produced by individual physician), Academic (university/medical school), or Society (professional surgical society) and rated by three independent investigators using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool (0–18). The data were analyzed using one-way ANOVA with Bonferroni correction and Spearman's correlation test.</p></div><div><h3>Results</h3><p>Of 300 videos gathered, 31 unique videos met selection criteria and were analyzed. The average LAP-VEGaS score was 8.67 (SD 3.51). Society videos demonstrated a significantly higher mean LAP-VEGaS score than Physician videos (<em>p</em> = 0.023). Most videos lacked formal case presentation (71%), intraoperative findings (81%), and operative time (76%). No correlation was demonstrated between LAP-VEGaS scores and number of likes or views, video length, or upload date.</p></div><div><h3>Conclusions</h3><p>LRYGB training videos on YouTube® generally do not adhere to the LAP-VEGaS guidelines and are of poor educational quality, signaling areas of improvement for educators.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42384742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}