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Article: The effects of the COVID-19 pandemic on oncological surgery.

Kling, Sarah M / Philp, Matthew M

Journal of surgical case reports

2020 Volume 2020, Issue 5, Page(s) rjaa157

Abstract: The COVID-19 global pandemic is changing the practice of oncologic surgery. Accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. Telemedicine is ...

Abstract	The COVID-19 global pandemic is changing the practice of oncologic surgery. Accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. Telemedicine is being widely employed. We present our thoughts on this topic and where we might be in the next several months.
Keywords	covid19
Language	English
Publishing date	2020-05-22
Publishing country	England
Document type	Journal Article
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjaa157
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Article ; Online: Emergency general surgery: can we do better?

Philp, Matthew M / Pitt, Henry A

Lancet (London, England)

2019 Volume 393, Issue 10187, Page(s) 2178–2180

MeSH term(s)	Emergencies ; Humans ; Quality Improvement
Language	English
Publishing date	2019-04-25
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(18)32982-9
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Article: The effects of the COVID-19 pandemic on oncological surgery

Kling, Sarah M. / Philp, Matthew M.

J. Surg. Case Rep.

Abstract	The COVID-19 global pandemic is changing the practice of oncologic surgery. Accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. Telemedicine is being widely employed. We present our thoughts on this topic and where we might be in the next several months.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #343566
Database	COVID19

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Article ; Online: The effects of the COVID-19 pandemic on oncological surgery

Kling, Sarah M / Philp, Matthew M

Journal of Surgical Case Reports

2020 Volume 2020, Issue 5

Abstract: Abstract The COVID-19 global pandemic is changing the practice of oncologic surgery. Accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. ... ...

Abstract	Abstract The COVID-19 global pandemic is changing the practice of oncologic surgery. Accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. Telemedicine is being widely employed. We present our thoughts on this topic and where we might be in the next several months.
Keywords	covid19
Language	English
Publisher	Oxford University Press (OUP)
Publishing country	uk
Document type	Article ; Online
ISSN	2042-8812
DOI	10.1093/jscr/rjaa157
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Controller size matters: User proficiency is affected by endoscopic controller size.

Yong, Valeda / Kahler, Dylan / Schlossberg, Axel / Gilmore, Kimberly / Zhao, Huaqing / Philp, Matthew M

American journal of surgery

2022 Volume 225, Issue 2, Page(s) 378–382

Abstract: Background: Endoscope controllers are traditionally a one-size-fits-all design. However, this design may not fit the modern workforce in endoscopy-related fields. Our study aims to determine if endoscopic controller size, independent of user dexterity, ... ...

Abstract	Background: Endoscope controllers are traditionally a one-size-fits-all design. However, this design may not fit the modern workforce in endoscopy-related fields. Our study aims to determine if endoscopic controller size, independent of user dexterity, affects user proficiency. Methods: 54 endoscopically naive participants completed a baseline dexterity test, followed by large-controller endoscopic and small-controller bronchoscopic simulation exercises. Participants were stratified by surgical glove size (≥7.5 and < 7.5) and gender. Results: Endoscopy time was longer in participants with <7.5 size gloves (p = 0.01) and in females (p < 0.001). However, participants with glove size <7.5 had better dexterity measures (p = 0.04). There was no difference in bronchoscopy time based on glove size (p = 0.61). Conclusions: Participants with larger hands were more proficient with the larger controller despite being less dexterous than their counterparts. This advantage was less pronounced with the smaller controller. Our findings suggest that endoscopic controllers should be modified in design to accommodate all providers.
MeSH term(s)	Female ; Humans ; Hand ; Endoscopy ; Computer Simulation
Language	English
Publishing date	2022-09-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2022.09.048
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Article ; Online: Preoperative Opioid and Benzodiazepine Use: Influence on Abdominal Surgical Outcomes.

Fagenson, Alexander M / Schleider, Christine / Philp, Matthew M / Noonan, Kristin M / Braun, Pamela A / Cowan, Scott / Pitt, Henry A

Journal of the American College of Surgeons

2023 Volume 236, Issue 4, Page(s) 925–934

Abstract: Background: Preoperative opioid use has shown association with worse outcomes after surgery. However, little is known about the effect of preoperative benzodiazepines with and without opioids. The aim of this study was to determine the influence of ... ...

Abstract	Background: Preoperative opioid use has shown association with worse outcomes after surgery. However, little is known about the effect of preoperative benzodiazepines with and without opioids. The aim of this study was to determine the influence of preoperative substance use on outcomes after abdominal surgery. Study design: Patients undergoing abdominal operations including ventral hernia, colectomy, hysterectomy, cholecystectomy, appendectomy, nephrectomy, and hiatal hernia were identified in an opioid surgical steward program by a regional NSQIP consortium between 2019 and 2021. American College of Surgeons NSQIP data were linked with custom substance use variables created by the collaborative. Univariable and multivariable analyses were performed for 30-day outcomes. Results: Of 4,439 patients, 64% (n = 2,847) were women, with a median age of 56 years. The most common operations performed were hysterectomy (22%), ventral hernia repair (22%), and colectomy (21%). Preoperative opioid use was present in 11% of patients (n = 472), 10% (n = 449) were on benzodiazepines, and 2.3% (n = 104) were on both. Serious morbidity was significantly (p < 0.001) increased in patients on preoperative opioids (16% vs 7.9%) and benzodiazepines (14% vs 8.3%) compared with their naïve counterpart and this effect was amplified in patients on both substances (20% vs 7.5%). Multivariable regression analyses reveal that preoperative substance use is an independent risk factor (p < 0.01) for overall morbidity and serious morbidity. Conclusions: Preoperative opioid and benzodiazepine use are independent risk factors that contribute to postoperative morbidity. This influence on surgical outcomes is exacerbated when patients are on both substances.
MeSH term(s)	Humans ; Female ; Middle Aged ; Male ; Analgesics, Opioid/therapeutic use ; Benzodiazepines/therapeutic use ; Hernia, Ventral/surgery ; Opioid-Related Disorders ; Postoperative Complications/etiology ; Treatment Outcome ; Retrospective Studies
Chemical Substances	Analgesics, Opioid ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2023-01-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000572
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Article ; Online: Colectomy in patients with liver disease: albumin-bilirubin score accurately predicts outcomes.

Kling, Sarah M / Taylor, George A / Peterson, Nicholas R / Patel, Takshaka / Fagenson, Alexander M / Poggio, Juan Lucas / Ross, Howard M / Pitt, Henry A / Lau, Kwan N / Philp, Matthew M

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2024

Abstract: Background: Patients with liver disease undergoing colectomy have higher rates of complications and mortality. The Albumin-Bilirubin score is a recently developed system, established to predict outcomes after hepatectomy, that accounts for liver ... ...

Abstract	Background: Patients with liver disease undergoing colectomy have higher rates of complications and mortality. The Albumin-Bilirubin score is a recently developed system, established to predict outcomes after hepatectomy, that accounts for liver dysfunction. Methods: All patients undergoing colectomy were identified in the 2015-2018 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database. Demographics and outcomes were compared between patients with Albumin-Bilirubin Grade 1 vs. 2/3. Multivariable regression was performed for outcomes including colorectal-specific complications. Areas under the receiver operative characteristic curves were calculated to determine accuracy of the Albumin-Bilirubin score. Results: Of 86,273 patients identified, 48% (N = 41,624) were Albumin-Bilirubin Grade 1, 45% (N = 38,370) Grade 2 and 7% (N = 6,279) Grade 3. Patents with Grade 2/3 compared to Grade 1 had significantly increased mortality (7.2% vs. 0.9%, p < 0.001) and serious morbidity (31% vs. 12%, p < 0.001). Colorectal-specific complications including anastomotic leak (3.7% vs. 2.8%, p < 0.001) and prolonged ileus (26% vs. 14%, p < 0.001) were higher in patients with Grade 2/3. Grade 2/3 had increased risk of mortality (odds ratio 3.07, p < 0.001) and serious morbidity (1.78, p < 0.001). Albumin-Bilirubin had excellent accuracy in predicting mortality (area under the curve 0.81, p < 0.001) and serious morbidity (0.70, p < 0.001). Conclusion: Albumin-Bilirubin is easily calculated using only serum albumin and total bilirubin values. Grade 2/3 is associated with increased rates of mortality and morbidity following colectomy. Albumin-Bilirubin can be applied to risk-stratify patients prior to colectomy.
Language	English
Publishing date	2024-03-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1016/j.gassur.2024.03.012
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Article ; Online: An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis.

Aibuedefe, Bianca / Kling, Sarah M / Philp, Matthew M / Ross, Howard M / Poggio, Juan Lucas

International journal of colorectal disease

2021 Volume 36, Issue 9, Page(s) 2041–2049

Abstract: Background: Pathologic hemorrhoids are common among adults age 45-65. Hemorrhoids are characterized as internal or external, and grades 1-4 based on severity. The type and grade dictate treatment, with surgical treatment reserved for grades 3/4. The aim ...

Abstract	Background: Pathologic hemorrhoids are common among adults age 45-65. Hemorrhoids are characterized as internal or external, and grades 1-4 based on severity. The type and grade dictate treatment, with surgical treatment reserved for grades 3/4. The aim of this study is to compare clinical outcomes of various surgical treatments. Methods: A systematic review was conducted to identify randomized clinical trials that compare surgical treatments for grade 3/4 hemorrhoids. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. Results: A total of 26 studies with 3137 participants and 14 surgical treatments for grade 3/4 hemorrhoids were included. Pain was less in patients with techniques such as laser (OR 0.34, CI 0.01-6.51), infrared photocoagulation (OR 0.38, CI 0.02-5.61), and stapling (OR 0.48, CI 0.19-1.25), compared to open and closed hemorrhoidectomies. There was less recurrence with Starion (OR 0.01, CI 0.00-0.46) and harmonic scalpel (OR 0.00, CI 0.00-0.49), compared to infrared photocoagulation and transanal hemorrhoidal dearterialization. Fewer postoperative clinical complications were seen with infrared photocoagulation (OR 0.04, CI 0.00-2.54) and LigaSure (OR 0.16, CI 0.03-0.79), compared to suture ligation and open hemorrhoidectomy. With Doppler-guided (OR 0.26, CI 0.05-1.51) and stapled (OR 0.36, CI 0.15-0.84) techniques, patients return to work earlier when compared to open hemorrhoidectomy and laser. Conclusion: There are multiple favorable techniques without a clear "gold standard" based on current literature. Open discussion should be had between patients and physicians to guide individualized care.
MeSH term(s)	Adult ; Aged ; Bayes Theorem ; Hemorrhoidectomy/adverse effects ; Hemorrhoids/surgery ; Humans ; Ligation ; Middle Aged ; Surgical Stapling/adverse effects ; Treatment Outcome
Language	English
Publishing date	2021-06-08
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-021-03953-3
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Article ; Online: Use of Preoperative Laboratory Testing Among Low-Risk Patients Undergoing Elective Anorectal Surgery.

Kling, Sarah M / Taylor, George A / Philp, Matthew M / Poggio, Juan Lucas / Ross, Howard M / Kuo, Lindsay E

The Journal of surgical research

2021 Volume 270, Page(s) 421–429

Abstract: Background: Many low-risk patients receive preoperative laboratory testing (PLT) prior to elective outpatient surgery, with no effect on postoperative outcomes. This has not been studied in patients undergoing anorectal surgery. The aim of this study ... ...

Abstract	Background: Many low-risk patients receive preoperative laboratory testing (PLT) prior to elective outpatient surgery, with no effect on postoperative outcomes. This has not been studied in patients undergoing anorectal surgery. The aim of this study was to determine if PLT in this population was predictive of perioperative complications. Materials and methods: The 2015-2018 National Surgical Quality Improvement Program (NSQIP) databases were queried for elective ambulatory anorectal surgeries. PLT was defined as chemistry, hematology, coagulation, or liver function studies obtained ≤30 days preoperatively. American Society of Anesthesiologists (ASA) class 1 and 2 patients were included who underwent elective, ambulatory, benign anorectal surgery. Patient demographics, comorbidities, and postoperative outcomes were compared between those who did and did not receive PLT. Postoperative outcomes were defined as wound-related, procedure-related, major complications, unplanned readmission, and death occurring within 30 days. Multivariate regression analysis determined patient characteristics predictive of receiving testing. Results: Of 3309 patients studied, 48.6% received PLT. On multivariate analysis, older age, female sex, Black race, ASA class 2, and comorbidities were predictive of receiving testing. The complication rates were similar between patients who did and did not receive testing (4.3% versus 3.5%, P = 0.22). Conclusions: PLT is performed in over half of low-risk patients receiving elective anorectal surgery. There was no difference in the rate of postoperative complications between patients who received testing or not, nor with normal versus abnormal results. PLT can be used more judiciously in this population.
MeSH term(s)	Ambulatory Surgical Procedures/adverse effects ; Elective Surgical Procedures/adverse effects ; Female ; Humans ; Patient Readmission ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Preoperative Care/adverse effects ; Retrospective Studies ; Risk ; Risk Factors
Language	English
Publishing date	2021-11-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.08.042
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Article ; Online: Trends in General Surgery Resident Experience with Colorectal Surgery: An Analysis of the Accreditation Council for Graduate Medical Education Case Logs.

Kling, Sarah M / Raman, Swathi / Taylor, George A / Philp, Matthew M / Poggio, Juan Lucas / Dauer, Elizabeth D / Oresanya, Lawrence B / Ross, Howard M / Kuo, Lindsay E

Journal of surgical education

2022 Volume 79, Issue 3, Page(s) 632–642

Abstract: Objective: Colorectal surgery is a core component of general surgery. The volume of colorectal surgery performed by general surgery residents throughout training has not been studied. This study aims to analyze trends observed in colorectal-specific ... ...

Abstract	Objective: Colorectal surgery is a core component of general surgery. The volume of colorectal surgery performed by general surgery residents throughout training has not been studied. This study aims to analyze trends observed in colorectal-specific case numbers logged by general surgery residents over 16 years. Design: Case number data for general surgery residents was extracted from the publicly available, annually published Accreditation Council for Graduate Medical Education (ACGME) database from 2003 to 2019. Cases were categorized as open or laparoscopic colectomy/proctectomy, colectomy with ileoanal pull-thru, abdomino-perineal resection (APR), transanal rectal tumor excision (TRE), anorectal procedure, colonoscopy, and total colorectal cases. The average case numbers per category was calculated for each year. Linear regression analyzed trends in case categories for all residents and those logged as surgeon chief and junior residents. Setting: ACGME accredited general surgery residency programs. Participants: Not applicable. Results: General surgery residents reported increased numbers of all, chief, and junior resident colorectal cases over the study period (124.5-173.7 cases/yr; 38.4-53.0 cases/yr; 86.4-120.6 cases/yr, all p = 0.00). Average cases for all, chief, and junior residents have increased for laparoscopic colectomy/proctectomy (4.6-26.4 cases/year; 2.7-12.9 cases/year; 2.0-13.5 cases/year, all p = 0.00), anorectal surgeries (26.7-37.7 cases/year; 5.4-9.9 cases/year; 21.3-27.8 cases/year, all p = 0.00), and colonoscopies (35.9-70.6 cases/year, p = 0.00; 6.6-14.1 cases/year, p = 0.01; 29.4-56.5 cases/year, p = 0.00). Average cases for all, chief, and junior residents have decreased for open colectomy/proctectomy (52.0-34.9 cases/year; 21.2-14.3 cases/year; 30.9-20.6 cases/year, all p = 0.00), APR (3.3-2.7 cases/year, p = 0.00; 1.8-1.3 cases/year, p = 0.00; 1.5-1.4 cases/year, p = 0.02), TRE (1.9-1.1 cases/year; 0.7-0.4 cases/year; 1.2-0.6 cases/year, all p = 0.00). Ileoanal pull-thru did not demonstrate a linear trend. Conclusions: The increase in exposure to colectomies/proctectomies, anorectal procedures and colonoscopies is encouraging, as these common colorectal operations will be encountered in general surgery practice. The observed low case numbers for TRE, APR, and ileoanal pull-thru suggest a need for specialized training.
MeSH term(s)	Accreditation ; Clinical Competence ; Colorectal Neoplasms ; Colorectal Surgery/education ; Education, Medical, Graduate ; General Surgery/education ; Humans ; Internship and Residency ; United States ; Workload
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2021.12.009
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