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There is some concern that wedge resection of gastric gastrointestinal stromal tumors is not feasible in certain anatomic locations, such as the cardia or antrum. We sought to review our experience with treatment of gastric gastrointestinal stromal tumors with a particular focus on nonanatomic wedge resections in these challenging locations.Patients undergoing resection of gastrointestinal stromal...
Evidence suggests that multimodal prehabilitation programs comprising interventions directed at physical activity, nutrition, and anxiety coping can improve functional recovery after colorectal cancer operations; however, such programs may be more clinically meaningful and cost-effective if targeted to specific subgroups. This study aimed to estimate the extent to which patients with poor baseline...
Early mobilization is considered an important element of postoperative care; however, how best to implement this intervention in clinical practice is unknown. This systematic review summarizes the evidence regarding the impact of specific early mobilization protocols on postoperative outcomes after abdominal and thoracic surgery.The review was performed according to PRISMA guidelines. We searched...
Current methods for teaching and assessing competencies that characterize expert intraoperative performance are inconsistent, subjective, and lack standardization. This mixed-methods study was designed to define and establish expert consensus on the most important competencies required to perform a thyroidectomy safely.Cognitive task analyses for thyroidectomy were performed with semistructured interviews...
Guidelines recommend 24–48 hours of intensive monitoring after resection of pheochromocytoma. However, many patients do not require it. The objective of this study is to identify preoperative risk factors associated with postoperative hemodynamic instability (HDI) so as to select patients who may not require intensive postoperative monitoring.Medical records of patients undergoing pheochromocytoma...
Few studies have investigated the effectiveness of enhanced recovery pathways (ERP) for lung resection. This study estimates the impact of an ERP for lobectomy on duration of stay, complications, and readmissions.Patients undergoing open lobectomy were identified from an OR database between 2011 and 2013. Beginning September 2012, all patients were managed according to a 4-day multidisciplinary ERP...
Surgical innovations are introduced to improve “recovery,” a complex construct often operationalized by the use of patient-reported outcomes. The minimal clinically important difference (MCID) is the smallest change in an outcome sufficiently important to influence management and is crucial for designing and interpreting comparative effectiveness trials. Our objective was to generate MCID estimates...
Enhanced recovery pathways (ERP) decrease morbidity and duration of stay after colorectal surgery. There is little information about their role in complex procedures, such as esophagectomy. The purpose of this study was to determine the impact of an ERP on duration of stay, complications, and readmissions after esophagectomy.Patients undergoing esophagectomy for cancer or high-grade dysplasia from...
Although the “learning curve” is commonly analyzed by splitting the data into arbitrary chunks of experience, this does not allow for precise estimation of where the curve plateaus or the rate at which learning is achieved. Our objective was to describe a simple way to characterize the learning curve for a fundamental laparoscopic task.Sixteen medical students performed 40 repetitions of the Fundamentals...
Although many surgical innovations are said to “shorten recovery,” recovery has not been consistently defined or measured. The goal of this study was to assess the validity of a physical activity questionnaire (The Community Health Activities Model Program for Seniors [CHAMPS]) as an indicator of postoperative recovery.CHAMPS includes 41 questions asking the subject to estimate the time spent on a...
Although aggressive fluid hydration prevents a decrease in renal cortical perfusion (RCP) during laparoscopic donor nephrectomy, excess fluid is deleterious. We assessed whether goal-directed fluid administration, based on hemodynamic measures, would maintain RCP during pneumoperitoneum with less fluid loading.In a pilot study of 7 pigs, goal-directed fluid administration was guided by monitoring...
Background. At the elite level of hockey, groin injuries can threaten a player's career. The aim of this review is to describe the clinical presentation and evaluate our operative approach to ''hockey groin syndrome'' in National Hockey League (NHL) players. Methods. Between November 1989 and June 2000, 22 NHL players with debilitating groin pain underwent operative exploration. A repair, including...
Background. Surgical success has traditionally been judged from the surgeon's perspective. A more complete evaluation of outcome incorporates the patient's, surgeon's, and payor's perspectives. Because gastroesophageal reflux disease (GERD) is primarily a quality-of-life (QOL) problem, the evaluation of laparoscopic fundoplication (LF) is a useful model for evaluating outcomes from these 3 perspectives...
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