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Background: Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown.Methods: We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes.Results: Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 percent]) than in the open group (41 of 834 patients [4.9 percent]; odds ratio, 2.2; 95 percent confidence interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 percent vs. 33.4 percent; adjusted odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 percent confidence interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 percent confidence interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 percent confidence interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 percent vs. 4.0 percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 percent and 14.1 percent, respectively).Conclusions: The open technique is superior to the laparoscopic technique for mesh repair of primary hernias. [ABSTRACT FROM AUTHOR]

The article presents the abstract of the article "The Timing of Elective Colectomy in Diverticulitis: A Decision Analysis," by L. Salem, D. Veenstra and S. D. Sullivan.

Focuses on a study related to the question of whether an open or laparoscopic approach is better for inguinal hernia repair. Description the study; Greater risk of serious complications and recurrence with laparoscopic repair.

The article presents a systematic review on the accuracy of computed tomographic (CT) scanning for diagnosing appendicitis in adults. The two systematic reviews provide interesting insights for the clinician who is faced with the dilemma of a patient with suspected appendicitis. 23 studies used prospective designs to address the diagnostic accuracy of CT scanning. CT features used to diagnose acute appendicitis included appendiceal diameter more than 6 mm with periappendiceal inflammation, non-opacification with oral or rectal contrast material with periappendiceal inflammation, or the presence of an appendicolith. In adults, the use of CT scanning has high sensitivity, specificity, and accuracy for diagnosing acute appendicitis.

BACKGROUND: Cooperative group trials and institutional series reported the risk of MDS and/or AML after adjuvant chemotherapy for early stage breast cancer (eg, NSABP 0.21%, Smith JCO 2003; ECOG 2197 0.5%, Goldstein ASCO 2012). We examined the incidence of MDS and/or AML in breast cancer survivors that are part of the NCCN Breast Cancer Outcomes Database. METHODS: The NCCN Database prospectively identifies all incident breast cancers diagnosed at participating cancer centers, and patients that continue their care at an NCCN site are followed annually with information collected on subsequent treatment, recurrence, and new cancers. Mortality is also ascertained for all diagnosed patients every 2 years through the National Death Index. Women with stages 1-3 breast cancer (BC) diagnosed between 1997- 2008 were included in this analysis. Univariate chi square analyses were used to compare characteristics between patients with BC and BC&MDS and/or AML. Time from BC to MDS and/or AML and 5-/10-year cumulative incidence rates were analyzed using proportional subdistribution hazards regression models that account for death as a competing risk to MDS and/or AML. RESULTS: Among 21563 stage 1-3 BC patients from 8 NCCN sites, 39 (0.18%) subsequently developed MDS and/or AML. Median overall follow-up was 4.7 years and median time from BC to MDS and/or AML was 2.8 years (range, 0.6 to 8.3 years). Cumulative MDS and/or AML incidence was 0.19% at 5y and 0.27% at 10y. Overall, cancer characteristics at BC diagnosis within BC&MDS and/or AML and within BC groups were similar (Caucasian 82%v82%, AA 8% v8%; ER+ 79%v75%, HER2+ 14%v21%, TNBC 15%v14%; contralateral BC 3%v2%; pancreas or ovarian cancer 0%v1%). 13191 had adjuvant chemo (75%v67%; anthracycline 89%v91%, AC-taxane 46%v35%, dose-dense 6%v5%). Trends observed included more patients in BC&MDS and/or AML group with prior radiation (85%v70%, p = 0.06) and older age at BC diagnosis (median age 59v54 years, p = 0.09). Risk for developing MDS and/or AML after BC (adjusted for age at BC and race) was increased in those receiving any chemotherapy versus no chemotherapy (HR 2.16, 95% CI 0.98-4.77, p = 0.06), any RT versus no RT (HR 2.44, 95% CI 1.01-5.88, p = 0.04), and if chemo/RT given versus just chemo or just RT (HR 2.2, 95% CI 1.05-4.59, p = 0.04). No increased risk was observed if a taxane was added to an anthracycline regimen (HR 1.27, 95% CI 0.57-2.81, p = 0.56). CONCLUSIONS: In a large national prospective registry across NCCN sites, risk of MDS and/or AML is increased after adjuvant chemotherapy and/or adjuvant radiation therapy for stages 1-3 breast cancer, especially if both are used. Specific population subsets will be further examined. These rates are similar to those observed in clinical trials, but may underestimate actual numbers due to patients lost to follow-up. In addition, an MDS diagnosis was routinely under-reported in population databases until recently. Strategies to limit risk of subsequent cancers in patients likely to survive early stage breast cancer should be considered at the time of initial diagnosis. Predictors of MDS and/or AML in breast cancer survivors are needed. [ABSTRACT FROM AUTHOR]

Objectives: The American Society of Breast Surgeons (ASBS) Nipple Sparing Mastectomy Registry (NSMR) is a prospective, non- randomized, IRB approved multi-center registry. The ASBS NSMR has been designed to facilitate compilation of information on metrics utilized, techniques utilized, aesthetic outcomes, as well as oncologic outcomes for the nipple sparing mastectomy. The NSMR will be ongoing for 10 years with an initial N of 1000. Patient selection entails all patients undergoing a NSM at the participating institutions who have agreed to participate. We evaluated the incidence rate of nipple or nipple areolar complex ischemia after a nipple sparing mastectomy. Method: The first 173 patients entered into the ASBS NSMR (2011-2012) were analyzed for incidence rate of ischemia of the nipple or nipple areolar complex (NAC). Ischemia is defined as epidermolysis (partial thickness necrosis) or full thickness necrosis. Metrics analyzed included: postoperative NAC status, indication for surgery, patient characteristics, incision utilized, sub areolar and flap dissection technique, as well as cosmetic outcomes. Results: (Thirty-five) surgeons entered 265 NSMs on 173 patients into the ASBS NSM Registry. Indications included invasive carcinoma, DCIS, and prophylaxis. Incisions utilized included radial +/- peri -areolar extension, infra mammary fold, peri- areolar ellipse/ hemi batwing, previous lumpectomy site, and previous mastopexy incisions. Sub areolar and flap dissection technique included sharp +/- tumescent injection, electrocautery, or plasma blade. Reconstruction type included tissue expander, immediate implant, or autologous flap. Median follow-up was 5 months (range 1-16 months). The nipple or NAC in 33 (12%) of 265 mastectomies experienced some degree of ischemia. Out of a total of 265 mastectomies 3 (1%) required surgical debridement, 1 (0.3%) required surgical excision, and 29 (11%) experienced epidermolysis with full recovery (17 topical treatment and 12 no treatment). No correlation in incision type, method of dissection, utilization of separate axillary incision for SLNBx/AXLND, size or location of tumor, type of reconstruction, initial fill volume if tissue expanders utilized, previous breast surgery, previous radiation therapy, previous chemotherapy, smoking history, cup size, degree of ptosis, or indication for surgery was found in NACs undergoing ischemia versus those that did not. Cosmetic outcome assessed by the surgeon as well as patient satisfaction did not vary from the population that did not experience nipple/NAC ischemia. Cosmetic results were rated consistently as good or excellent. Conclusion: We report a 12% incidence rate of nipple or nipple areolar complex ischemia ranging from epidermolysis to full thickness necrosis: 3 (1%) requiring surgical debridement, 1 (0.3%) requiring excision, and 29 (11%) exhibiting epidermolysis with full recovery. Surgical debridement or excision was rarely necessary. Epidermolysis was found to resolve with no bearing on perceived cosmetic outcome. [ABSTRACT FROM AUTHOR]

Triple negative breast cancer (TNBC) represents a highly heterogeneous group of breast cancers, lacking expression of the estrogen (ER) and progesterone (PR) receptors, and human epidermal growth factor receptor 2 (HER2). TNBC are characterized by a high level of mutation and metastasis, poor clinical outcomes and overall survival. Here, we review the epigenetic mechanisms of regulation involved in cell pathways disrupted in TNBC, with particular emphasis on dietary food components that may be exploited for the development of effective strategies for management of TNBC., (Copyright © 2020 Selmin, Donovan, Stillwater, Neumayer and Romagnolo.)

Importance: The association between exposure to hormone-modulating therapy (HMT) as breast cancer treatment and neurodegenerative disease (NDD) is unclear., Objective: To determine whether HMT exposure is associated with the risk of NDD in women with breast cancer., Design, Setting, and Participants: This retrospective cohort study used the Humana claims data set from January 1, 2007, to March 31, 2017. The Humana data set contains claims from private-payer and Medicare insurance data sets from across the United States with a population primarily residing in the Southeast. Patient claims records were surveyed for a diagnosis of NDD starting 1 year after breast cancer diagnosis for the duration of enrollment in the claims database. Participants were 57 843 women aged 45 years or older with a diagnosis of breast cancer. Patients were required to be actively enrolled in Humana claims records for 6 months prior to and at least 3 years after the diagnosis of breast cancer. The analyses were conducted between January 1 and 15, 2020., Exposure: Hormone-modulating therapy (selective estrogen receptor modulators, estrogen receptor antagonists, and aromatase inhibitors)., Main Outcomes and Measures: Patients receiving HMT for breast cancer treatment were identified. Survival analysis was used to determine the association between HMT exposure and diagnosis of NDD. A propensity score approach was used to minimize measured and unmeasured selection bias., Results: Of the 326 485 women with breast cancer in the Humana data set between 2007 and 2017, 57 843 met the study criteria. Of these, 18 126 (31.3%; mean [SD] age, 76.2 [7.0] years) received HMT, whereas 39 717 (68.7%; mean [SD] age, 76.8 [7.0] years) did not receive HMT. Mean (SD) follow-up was 5.5 (1.8) years. In the propensity score-matched population, exposure to HMT was associated with a decrease in the number of women who received a diagnosis of NDD (2229 of 17 878 [12.5%] vs 2559 of 17 878 [14.3%]; relative risk, 0.89; 95% CI, 0.84-0.93; P < .001), Alzheimer disease (877 of 17 878 [4.9%] vs 1068 of 17 878 [6.0%]; relative risk, 0.82; 95% CI, 0.75-0.90; P < .001), and dementia (1862 of 17 878 [10.4%] vs 2116 of 17 878 [11.8%]; relative risk, 0.88; 95% CI, 0.83-0.93; P < .001). The number needed to treat was 62.51 for all NDDs, 93.61 for Alzheimer disease, and 69.56 for dementia., Conclusions and Relevance: Among patients with breast cancer, tamoxifen and steroidal aromatase inhibitors were associated with a decrease in the number who received a diagnosis of NDD, specifically Alzheimer disease and dementia.

Purpose: Using a large resource linking genealogy with decades of cancer data, a non-traditional approach was used to estimate individualized risk for breast cancer (BC) based on specific family history extending to first cousins, providing a clearer picture of the contribution of various aspects of both close and distant combinations of affected relatives., Methods: RRs for BC were estimated in 640,366 females for a representative set of breast cancer family history constellations that included number of first- (FDR), second-(SDR), and third-degree relatives (TDR), maternal and paternal relatives, and age at earliest diagnosis in a relative., Results: RRs for first-degree relatives of BC cases ranged from 1.61 (= 1 FDR affected, CI 1.56, 1.67) to 5.00 (≥ 4 FDRs affected, CI 3.35, 7.18). RRs for second-degree relatives of probands with 0 affected FDRs ranged from 1.04 (= 1 SDR affected, CI 1.00, 1.08) to 1.71 (≥ 4 SDRs affected, CI 1.26, 2.27) and for second-degree relatives of probands with exactly 1 FDR from 1.54 (0 SDRs affected, CI 1.47, 1.61) to 4.78 (≥ 5 SDRs; CI 2.47, 8.35). RRs for third-degree relatives with no closer relatives affected were significantly elevated over population risk for probands with ≥ 5 affected TDRs RR = 1.32, CI 1.11, 1.57)., Conclusions: The majority of females in the Utah resource had a positive family history of BC in FDRs to TDRs. Presence of any number of affected FDRs or SDRs significantly increased risk for BC over population risk; and more than four TDRs, even with no affected FDRs or SDRs, significantly increased risk over population risk. Risk prediction derived from the specific and extended family history constellation of affected relatives allows identification of females at increased risk even when they do not have a conventionally defined high-risk family; these risks could be a powerful, efficient tool to individualize cancer screening and prevention.

Background: Genes associated with hereditary breast and ovarian cancer (HBOC) and colorectal cancer (CRC) predisposition have been shown to play a role in pancreatic cancer susceptibility. Growing evidence suggests that pancreatic cancer may be useful as a sentinel cancer to identify families that could benefit from HBOC or CRC surveillance, but to date pancreatic cancer is only considered an indication for genetic testing in the context of additional family history., Methods: Preliminary data generated at the Huntsman Cancer Hospital (HCH) included variants identified on a custom 34-gene panel or 59-gene panel including both known HBOC and CRC genes for respective sets of 66 and 147 pancreatic cancer cases, unselected for family history. Given the strength of preliminary data and corresponding literature, 61 sequential pancreatic cancer cases underwent a custom 14-gene clinical panel. Sequencing data from HCH pancreatic cancer cases, pancreatic cancer cases of the Cancer Genome Atlas (TCGA), and an unselected pancreatic cancer screen from the Mayo Clinic were combined in a meta-analysis to estimate the proportion of carriers with pathogenic and high probability of pathogenic variants of uncertain significance (HiP-VUS)., Results: Approximately 8.6% of unselected pancreatic cancer cases at the HCH carried a variant with potential HBOC or CRC screening recommendations. A meta-analysis of unselected pancreatic cancer cases revealed that approximately 11.5% carry a pathogenic variant or HiP-VUS., Conclusion: With the inclusion of both HBOC and CRC susceptibility genes in a panel test, unselected pancreatic cancer cases act as a useful sentinel cancer to identify asymptomatic at-risk relatives who could benefit from relevant HBOC and CRC surveillance measures.

Background: The aims of this study were to assess the safety and tolerability of nanoparticle albumin bound paclitaxel (nab-paclitaxel), doxorubicin, and cyclophosphamide as combination therapy for breast cancer patients in the neoadjuvant setting and to assess the overall clinical response and pathologic complete response (pCR)., Patients and Methods: Twenty-six women with newly diagnosed stage II to III histologically or cytologically proven adenocarcinoma of the breast with negative HER2 status were enrolled. Patients were treated with nab-paclitaxel 100 mg/m 2 , doxorubicin 50 mg/m 2 , and cyclophosphamide 500 mg/m 2 on day 1 and nab-paclitaxel 100 mg/m 2 on day 8 in a 21-day cycle for 6 cycles total., Results: Most adverse events attributed to treatment were decreased white blood cell count, neutropenia, anemia, thrombocytopenia, and lymphopenia with a median duration of 8 days. Fifteen of 23 (65.2%; 95% confidence interval [CI], 45.7%-84.6%) had a complete clinical response and 8 of 23 (34.7%; 95% CI, 15.2%-54.1%) had a partial clinical response for an overall clinical response rate of 100%. Thirteen of 23 patients (56.5%; 95% CI, 36.2%-76.7%) had a pCR. All 10 triple-negative breast cancer (TNBC) patients (100%) achieved a pCR., Conclusion: The regimen of nab-paclitaxel, doxorubicin, and cyclophosphamide chemotherapy was well tolerated and resulted in high clinical as well as pathologic responses, particularly in TNBC., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Palliative care competencies in surgical training are recognized to improve the care of surgical patients with advanced or life-threatening illnesses. Formal programs to teach these competencies are lacking. The study aims to assess the feasibility and utility of a unique surgical palliative care immersion training program., Study Design: A half-day Surgical Palliative Care Immersion Training (SPCIT) was developed using the American College of Surgeon's manual titled "Surgical Palliative Care: A Resident's Guide" as a framework. The training format was modeled after the highly successful University of Arizona Center on Aging's Interprofessional Chief Resident Immersion Training (IP-CRIT) Program to teach palliative care competencies to general surgery residents. Objective and self-assessments were performed at baseline, immediately post training and 5-months after training. For all pre-test, post-test comparisons on Likert scale, Wilcoxon Signed Rank Test was used. For aggregate scores a repeated-measures analysis of variance was used., Results: Forty of the forty-eight residents (83%) completed the learner's needs assessment survey. Thirty-four (71%) of the forty-eight residents in the residency program participated in the SPCIT. Significant improvement was noted in objective assessment of post-test aggregate scores (Mean difference 2.15, 95% CI 0.52-3.77, p = 0.0083). There was a significant increase in proportion of residents who felt confident in discussing palliative care options (96.5% vs. 27.5%, p < 0.0001); end-of-life care (86.2% vs. 52.5%, p < 0.0065); code status (86% vs. 15%, p < 0.0001); prognosis (96% vs. 35%, p < 0.001); or withholding or withdrawing life support (79.2% vs. 45%, p = 0.0059) with patient/families after the SPCIT., Conclusion: The newly developed SPCIT program drastically improves knowledge, attitudes and perceived skills of general surgery residents. Similar training can be implemented in other surgical residency programs., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: The anticancer activity of valproic acid (VPA) is attributed to the inhibition of histone deacetylase. We previously published the genomically derived sensitivity signature for VPA (GDSS-VPA), a gene expression biomarker that predicts breast cancer sensitivity to VPA in vitro and in vivo. We conducted a window-of-opportunity study that examined the tolerability of VPA and the ability of the GDSS-VPA to predict biologic changes in breast tumors after treatment with VPA., Patients and Methods: Eligible women had untreated breast cancer with breast tumors larger than 1.5 cm. After a biopsy, women were given VPA for 7 to 12 days, increasing from 30 mg/kg/d orally divided into two doses per day to a maximum of 50 mg/kg/d. After VPA treatment, serum VPA level was measured and then breast surgery or biopsy was performed. Tumor proliferation was assessed by using Ki-67 immunohistochemistry. Histone acetylation of peripheral blood mononuclear cells was assessed by Western blot. Dynamic contrast-enhanced magnetic resonance imaging scans were performed before and after VPA treatment., Results: Thirty women were evaluable. The median age was 54 years (range, 31-73 years). Fifty-two percent of women tolerated VPA at 50 mg/kg/d, but 10% missed more than two doses as a result of adverse events. Grade 3 adverse events included vomiting and diarrhea (one patient) and fatigue (one patient). The end serum VPA level correlated with a change in histone acetylation of peripheral blood mononuclear cells (ρ = 0.451; P = .024). Fifty percent of women (three of six) with triple-negative breast cancer had a Ki-67 reduction of at least 10% compared with 17% of other women. Women whose tumors had higher GDSS-VPA were more likely to have a Ki-67 decrease of at least 10% (area under the curve, 0.66)., Conclusion: VPA was well tolerated and there was a significant correlation between serum VPA levels and histone acetylation. VPA treatment caused a decrease in proliferation of breast tumors. The genomic biomarker correlated with decreased proliferation. Inhibition of histone deacetylase is a valid strategy for drug development in triple-negative breast cancer using gene expression biomarkers., Competing Interests: Window-of-Opportunity Study of Valproic Acid in Breast Cancer Testing a Gene Expression BiomarkerThe following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or po.ascopubs.org/site/ifc.Adam L. CohenResearch Funding: AbbVie, Bristol-Myers Squibb, Novartis, Roche/Genentech, MerrimackLeigh NeumayerNo relationship to discloseKen BoucherNo relationship to discloseRachel E. FactorNo relationship to discloseGajendra ShresthaNo relationship to discloseMark WadeNo relationship to discloseJohn G. LambStock and Other Ownership Interests: Synergy PharmaceuticalsKylee ArbogastNo relationship to discloseStephen R. PiccoloNo relationship to discloseJoanna RiegertNo relationship to discloseMatthias SchabelNo relationship to discloseAndrea H. BildPatents, Royalties, Other Intellectual Property: Dr Bild has patents related to biomarkers for breast cancer risk and oncogenic signaling.Theresa L. WernerResearch Funding: Abbvie, Roche/Genentech, Novartis, Mirati Therapeutics, (© 2017 by American Society of Clinical Oncology.)

Objectives: A decrease in Ki67 during neoadjuvant therapy predicts response to tamoxifen. Previous trials have shown a decreased Ki67 in breast tumors with as little as two or more weeks of preoperative tamoxifen. Shortening the preoperative treatment time in window of opportunity clinical trials makes these trials more attractive to women. POWERPIINC examined the effect of 7 days of preoperative tamoxifen on breast tumor proliferation and patient symptoms., Methods: Women with untreated stage I/II, ER-positive, invasive breast cancer with no contraindications to tamoxifen were enrolled. Women received 20 mg of tamoxifen for 7 days up to the day of surgery. Proliferation was assessed by Ki67 immunohistochemistry before and after 7 days of tamoxifen. Symptoms and QOL were assessed by the FACT-ES and MENQOL. Adherence was measured by pill counts., Results: 52 women were enrolled, and 44 were evaluable for Ki67. The median age was 58.5 years, and the median tumor diameter was 1.2 cm. Most women (73%) were post-menopausal. Most tumors were PR positive (88%) and HER2-negative (92%). The Ki67 decreased by a geometric mean of 40% (95% CI 29%-63%), and 73% (95% CI 57%-85%) of women had tumors with decreased proliferation (p = 0.0001 by paired t-test). Adherence to taking tamoxifen during the preoperative period was 100%. Women reported minimal bother from psychosocial or physical symptoms at baseline or on the day of surgery., Conclusion: Seven days of tamoxifen showed a similar relative decrease in Ki67 as that reported for longer courses, was acceptable to women, and could be considered for window of opportunity studies., Competing Interests: The authors declare they have no conflicts of interest related to this research., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

To enhance shared decision-making for patients with breast cancer, we developed an evidence-based educational breast cancer video (BCV) providing an overview of breast cancer biology, prognostic indicators, and surgical treatment options while introducing health care choice. By providing patients access to a BCV with information necessary to make informed surgical decisions before seeing a surgeon, we aimed to increase patient participation in the decision-making process, while decreasing distress. Patients with a new diagnosis of breast cancer were provided a link to the BCV. Group 1 participated in online pre- and postvideo questionnaires, with the BCV embedded in between. The questionnaires evaluated self-reported baseline knowledge of breast cancer and perceived distress related to the diagnosis. Changes in self-reported responses were analyzed using the Wilcoxon matched pairs test. Group 2 received a survey collecting demographics, decision-making information, and perceptions of the BCV at the time of clinic visit before meeting the surgeon. Group 1 included 69 subjects with 62 per cent reporting improved knowledge and 30 per cent reporting reduced distress in regard to their breast cancer diagnosis. Group 2 included 87 subjects; 94 to 98 per cent felt the BCV provided information and stimulated thoughts and questions to assist in breast cancer treatment decision-making. The BCV was positively received by participants and feasible to implement into clinical practice. Evidence-based media tools improve knowledge and reduce distress in patients with a new diagnosis of breast cancer as well as contributing to the shared decision-making process.

Objective: The aim of this study was to assess the seasonal variation in emergency general surgery (EGS) admissions., Background: Seasonal variation in medical conditions is well established; however, its impact on EGS cases remains unclear., Methods: The National Inpatient Sample (NIS) database was queried over an 8-year period (2004-2011) for all patients with diagnosis of acute appendicitis, acute cholecystitis, and diverticulitis. Elective admissions were excluded. The following data for each admission were recorded: age, sex, race, admission month, major operative procedure, hospital region, and mortality. Seasons were defined as follows: Spring (March, April, May), Summer (June, July, August), Fall (September, October, November), and Winter (December, January, February). X11 procedure and spectral analysis were performed to confirm seasonal variation., Results: A total of 63,911,033 admission records were evaluated of which 493,569 were appendicitis, 395,838 were cholecystitis, and 412,163 were diverticulitis. Seasonal variation is confirmed in EGS (F = 159.12, P < 0.0001) admissions. In the subanalysis, seasonal variation was found in acute appendicitis (F = 119.62, P < 0.0001), acute cholecystitis (F = 37.13, P < 0.0001), and diverticulitis (F = 69.90, P < 0.0001). The average monthly EGS admission in Winter was 11,322 ± 674. The average monthly EGS admission in Summer was higher than that of Winter by 13.6% (n = 1542; 95% CI: 1180-1904, P < 0.001)., Conclusions: Hospitalization due to EGS adheres to a consistent cyclical pattern, with more admissions occurring during the Summer months. Although the reasons for this variability are unknown, this information may be useful for hospital resource reallocation and staffing.