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Background We aim to investigate factors that may contribute to failure of eradication of dysplastic Barrett’s Esophagus among patients undergoing radiofrequency ablation treatment. Methods A retrospective review of patients undergoing radiofrequency ablation for treatment of Barrett’s Esophagus was performed. Data analyzed included patient demographics, medical history, length of Barrett’s Esophagus, number of radiofrequency ablation sessions, and histopathology. Subsets of patients achieving complete eradication were compared with those not achieving complete eradication. Results A total of 107 patients underwent radiofrequency ablation for Barrett’s Esophagus, the majority white, overweight, and male. Before treatment, 63 patients had low-grade dysplasia, and 44 patients had high-grade dysplasia or carcinoma. Complete eradication was achieved in a majority of patients (57% for metaplasia, and 76.6% for dysplasia). Failure of eradication occurred in 15.7% of patients. The median number of radiofrequency ablation treatments in patients achieving complete eradication was 3 sessions, compared to 4 sessions for failure of eradication (p = 0.06). Barrett’s esophagus length of more than 5 cm was predictive of failure of eradication (p 5 cm was found to be predictive of failure of eradication in patients undergoing radiofrequency ablation.

Background We evaluated postoperative venous thromboembolism (VTE) chemical prophylaxis adherence to assess the preventability of VTEs. Methods A case-control study was performed using the 2011–2015 ACS-NSQIP single institution database. Cases were identified as patients who experienced postoperative VTE within 30 days following surgery. Controls were matched 2:1 on procedure, age, and BMI. Association between inpatient chemical prophylaxis adherence and postoperative VTE was evaluated with conditional logistic regression. Results Seventy-three cases were matched to 145 controls. Complete inpatient VTE chemical prophylaxis adherence did not differ between cases and controls (45.2% vs. 46.2%, p = 1.00). Odds of postoperative VTE increased if a patient's prophylaxis was interrupted (OR 6.34, 95% CI 1.82–22.13). However, 53.7% of instances of interrupted prophylaxis were medically justified by concern for bleeding, spine operation, or for additional upcoming procedure. Conclusions Nearly half of patients who experienced postoperative VTEs received appropriate guideline-driven care. Most interruptions in chemical prophylaxis were justified medically. This further questions the preventability of postoperative VTEs and the utility of this outcome as a valid measure of hospital quality.

Background Emotional intelligence (EI) has been associated with improved work performance and job satisfaction in several industries. We evaluated whether EI was associated with higher measures of work performance and job satisfaction in surgical residents. Methods We distributed the validated Trait EI Questionnaire and job satisfaction survey to all general surgery residents at a single institution in 2015. EI and job satisfaction scores were compared with resident performance using faculty evaluations of clinical competency–based surgical milestones and standardized test scores including the United States Medical Licensing Examination (USMLE) and American Board of Surgery In-Training Examination (ABSITE). Statistical comparison was made using Pearson correlation and simple linear regression adjusting for postgraduate year level. Results The survey response rate was 68.9% with 31 resident participants. Global EI was associated with scores on USMLE Step 2 (r = 0.46, P = 0.01) and Step 3 (r = 0.54, P = 0.01) but not ABSITE percentile scores (r = 0.06, P = 0.77). None of the 16 surgical milestone scores were significantly associated with global EI or EI factors before or after adjustment for postgraduate level. Global EI was associated with overall job satisfaction (r = 0.37, P = 0.04). Of the facets of job satisfaction, global EI was significantly associated with views of supervision (r = 0.42, P = 0.02) and nature of work (r = 0.41, P = 0.02). Conclusions EI was associated with job satisfaction and USMLE performance but not ACGME competency–based milestones or ABSITE scores. EI may be an important factor for fulfillment in surgical training that is not currently captured with traditional in-training performance measures.

OBJECTIVE: To investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. BACKGROUND: Racial disparities in surgical outcomes exist. We hypothesized that ERAS would reduce disparities in pLOS between black and white patients. METHODS: Patients undergoing ERAS in 2015 were 1:1 matched by race/ethnicity, age, sex, and procedure to a pre-ERAS group from 2010 to 2014. After stratification by race/ethnicity, expected pLOS was calculated using the American College of Surgeons National Surgical Quality Improvement Project Risk Calculator. Primary outcome was the observed pLOS and observed-to-expected difference in pLOS. Secondary outcomes were National Surgical Quality Improvement Project postoperative complications including 30-day readmissions and mortality. Adjusted sensitivity analyses on pLOS were also performed. RESULTS: Of 420 patients (210 ERAS and 210 pre-ERAS) examined, 28.3% were black. Black and white patients were similar in age, body mass index, sex, American Anesthesia Association class, and minimally invasive approaches. Within the pre-ERAS group, black patients stayed a mean of 2.7 days longer than expected compared with white patients (P < 0.05). Overall, ERAS patients had a significantly shorter pLOS (5.7 vs 8 days) and observed-to-expected difference (−0.7 vs 1.4 days) compared with pre-ERAS patients (P < 0.01). In the ERAS group, disparities in pLOS were reduced with no differences in readmissions or mortality between black and white patients. On sensitivity analyses, race/ethnicity remained a significant predictor of pLOS among pre-ERAS patients, but not for ERAS patients. CONCLUSIONS: ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications. ERAS may provide a practical approach to reducing disparities in surgical outcomes.

Introduction: Radiofrequency ablation (RFA) of Barrett’s esophagus (BE) is associated with a high rate of complete eradication and a reduced risk of disease progression. Nevertheless, recent data indicate that about one third of patients had disease recurrence after reaching complete remission.

Strategies to address weight recidivism following Roux-en-Y gastric bypass (RYGB) could be developed if patients at risk were identified in advance. This study aimed to determine factors that predict weight regain. Retrospective review was performed of patients who underwent laparoscopic RYGB at a single institution over 10 years. Group-based modeling was used to estimate trajectories of weight regain after nadir and stratify patients based on percent weight change (%WC). Three trajectories were identified from 586 patients: 121 had ongoing weight loss, 343 were weight stable, and 122 regained weight. Male sex (p = 0.020) and white race (p

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for achieving and maintaining weight loss and for improving obesity-related comorbidities. As part of the approval process for bariatric surgery, many insurance companies require patients to have documented recent participation in a supervised weight loss program. The goal of this study was to evaluate the relationship of preoperative weight changes with outcomes following LRYGB. A retrospective review was conducted of adult patients undergoing LRYGB between 2008 and 2012 at a single institution. Patients were stratified into quartiles based on % excess weight gain (0–4.99 % and ≥5 % EWG) and % excess weight loss (0–4.99 % and ≥5 % EWL). Generalized linear models were used to examine differences in postoperative weight outcomes at 6, 12, and 24 months. Covariates included in the final adjusted models were determined using backwards stepwise selection. Of the 300 patients included in the study, there were no significant demographic differences among the quartiles. However, there was an increased time to operation for patients who gained or lost ≥5 % excess body weight (p

Objective Readmission rates after vascular surgery are among the highest within surgical specialties, and lower extremity bypass has the highest readmission rate of vascular surgery procedures. We analyzed how 30-day readmissions and risk factors for readmissions vary by indication for lower extremity bypass. Methods We queried the 2012-2014 American College of Surgeons National Surgical Quality Improvement Program procedure-targeted vascular cohort to identify all patients who underwent lower extremity bypass. Emergent procedures and planned readmissions were excluded. Patients were stratified by surgical indication: claudication, critical limb ischemia rest pain (CLI RP), critical limb ischemia tissue loss (CLI TL), and other. The χ 2 and Wilcoxon rank sum tests were used to test the differences between categorical and continuous variables, respectively. Logistic regression was used to estimate odds ratios for predictors of readmission adjusted for preoperative factors that were selected a priori. Results The overall 30-day readmission rate among the 6112 patients who underwent lower extremity bypass was 14.8%. Readmission rates varied significantly on the basis of the indication for surgery. In unadjusted comparisons, 18.8% of patients with CLI TL were readmitted compared with 16.5% with CLI RP, 9.4% with claudication, and 8.2% with other indications ( P Conclusions The 30-day readmission rates after lower extremity bypass vary significantly by surgical indication. Because lower extremity bypasses are performed for multiple indications, if readmission rates are publically reported and hospitals can be penalized for higher than expected readmission rates, the expected readmission rates should be adjusted for surgical indication.

The incidence of inflammatory bowel disease (IBD) in minorities is increasing, and health outcome disparities are becoming more apparent. Our aim was to investigate the contribution of race to readmissions in IBD patients undergoing colorectal surgery. The National Surgical Quality Improvement Program database from 2012 to 2013 was queried for all patients with IBD undergoing elective colorectal surgery. After stratifying by race, unadjusted univariate and bivariate comparisons were made. Primary outcome was all-cause 30-day readmission. Predictors of readmission were identified using multivariable logistic regression. Of the 2523 patients with IBD who underwent elective colon surgery, 15.0 % were readmitted within 30 days of index operation. Black patients constituted 7.7 % of the entire cohort. Black patients were significantly different in smoking status (27 vs. 22 %) and Crohn’s diagnosis (84 vs. 73 %) (p

Small bowel obstruction (SBO) is a complication of previous abdominal surgeries, hernias, and other pathologies. Patients can be managed non-operatively or operatively, thus patients are admitted to medical and surgical services. The purpose of this study was to compare characteristics and outcomes associated with admitting service. A retrospective medical record review was conducted of SBO admissions via the emergency department to an academic medical center in 2012. Patients were identified using discharge diagnosis codes in an administrative database. Patients with ileus without mechanical obstruction, lack of obstructive symptoms, and previous abdominal surgery within 30 days were excluded (103 patients with 107 admissions). Univariate and bivariate frequencies were used to describe the population. Chi-square and Wilcoxon rank sums tests were used to examine differences by admission service. 251 patients with 292 admissions were included in the analysis. Approximately half (n=134; 46%) were admitted to medical services; there was no difference in age, sex, race, insurance status, or comorbidities between patients admitted to medicine vs. surgery. The most common etiologies were adhesive disease (60%) and hernias (16%). 205 admissions (70%) were managed non-operatively; 113 (55%) were admitted to medical and 92 (45%) were admitted to surgical services. There was no difference in time to bowel function, use of total parenteral nutrition (TPN), 30-day readmission rates, or mortality for patients managed on medical vs. surgical services (Table 1). Non-operative surgical admissions were associated with lower cost despite equivalent hospital length of stay (LOS). 87 admissions (30%) were managed operatively; 21 (24%) were admitted to medical and 66 (76%) were admitted to surgical services. Time from admission to operation was shorter for patients admitted to surgery (median, 0.9 days; IQR, 0.4-3.6) than medicine (median, 4.6 days; IQR 2.2-8.3; p=0.0002); this held true when excluding patients that were operated on within 24 hours of admission (median, 3.7 days vs. 5.0; p=0.08). Operative intervention in patients admitted to medical services was more likely to require a bowel resection (n= 13; 62%) than surgical admissions (n=18; 27%; p=0.004). Major complications and mortality were also more frequent in medical (n=8; 42%) than surgical admissions (n=7; 15%; p= 0.02). Surgical admissions were associated with shorter hospital and post-operative LOS, less TPN use, lower mortality, and lower cost (Table 2). Patients admitted with SBO were managed more efficiently when admitted to surgical services regardless of whether surgical interventionwas required. Furthermore, patients admitted to themedical service that required surgical intervention had worse outcomes. These data support routine admission to surgical services for patients presenting with SBO. Table 1. Outcomes of Non-Operative Management by Admit Service