Department of Surgery Posters

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  Implementation of Multipronged Approach in Patients with Chest Trauma Reduces VAP and Unplanned Admission to the ICU

  Julie Donnelly, MSN, RN, TRCN; Kristen Firely, MSN, RN; Nicole Olszewski, BSN, RN; Jessica Byrne, MSN, RN-BC; Tiffani Stanley, CSTR; Joshua A. Marks, MD, FACS, FCCM; and George Koenig

  Problem

  The incidence of pulmonary complications in trauma patients with chest trauma has been reported to be as high as 49% (Ruibel L, 2022). However, all trauma patients are at risk for developing pulmonary complications due to a multitude of factors some pre-existing while others injury related sequela. Within our institution, we observed an increase in pulmonary complications through review of our TQIP (Spring 2020) and state registry data.

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  Microaxial Support After Orthotopic Heart Transplantation

  Christopher D. Pritting, Danial Ahmad, Takuma Miyamoto, Taufiek Konrad Rajab, Indranee Rajapreyar, Howard Massey, and Vakhtang Tchantchaleishvili

  Introduction and Objective

  • Impella is a temporary ventricular support device intended for short term use (CP, and ≤ 6 days for Impella 5.0 and LD).
  • There has yet to be a study investigating the outcomes of microaxial support for patients who previously underwent heart transplantation.
  • We aimed to assess utilization patterns of microaxial mechanical circulatory support after heart transplantation in adults and adolescents.

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  Apixaban Discontinuation Prior To Major Surgery: Results From A Prospective Single Center Study

  Edwin Lam, Luis Eraso, Taki Galanis, Walter K. Kraft, Geoffrey Ouma, Lynda Thomson, Eugene Viscusi, Douglas Stickle, Jerald Z. Gong, Suzanne Adams, and Geno Merli

  Primary Objective

  • Estimate the proportion of patients who achieve a plasma apixaban concentration of/mL following at least 48 hours of discontinuation prior to surgery or invasive procedure

  Secondary Objective

  • Perioperative and follow up arterial or venous thromboembolic events, major bleeding, clinically significant non-major bleeding complications. Correlation of apixaban anti-Factor Xa (FXa) activity and plasma apixaban concentrations at pre-admission and prior to surgery

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  Outcomes of Out of Hospital ECMO Transfer: Significance of Initiation Site and Personnel on Survival and Complication Rates

  Toru Mihama, BA; Spencer Liem, BS; Nicholas C. Cavarocchi, MD; and Hitoshi Hirose, MD, PhD

  Objectives

  To investigate the outcomes of ECMO transfer from non-ECMO center to ECMO center

  Determine the impact of cannulation site and personnel on ECMO survival and complication rate

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  Use of Jejunostomy Tubes with Esophagectomy and Inpatient Healthcare Utilization in the National Readmissions Database

  R. Zheng, MD; A. R. Rios-Diaz, MD; S. Liem, BS; C. L. Devin, MD; N. R. Evans, III, MD; E. L. Rosato, MD; F. Palazzo, MD; and A. C. Berger, MD

  Objectives

  Evaluate the readmission rates and mortality associated with j-tubes post-esophagectomy nationally.

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  Generation of CRISPR knockout of IDH1 in pancreatic ductal adenocarcinoma cell line: An optimal model to study pancreatic cancer metabolic reprogramming

  Katerina Dukleska, MD; Mahsa Zarei, PhD; Ali Vaziri-Gohar, PhD; Charles J. Yeo, MD; Jonathan Brody, MD; and Jordan M. Winter, MD

  Introduction

  • Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the US.

  • PDA is resistant to conventional chemotherapy; however, mechanisms that contribute to this chemoresistance are not well-described.

  • The tumor microenvironment in PDA has a dense stromal reaction, which is thought to result in low oxygen and low nutrient conditions (Feig, C., et al. 2012).

  • Isocitrate Dehydrogenase 1 (IDH1) has been identified as an enzyme that plays an important role in chemoresistance in PDA (Zarei, M., et al. In progress).

  • We sought to establish an IDH1 knockout cell line to further study its role in PDA using the CRISPR-Cas9 targeted genome editing system.

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  Total Parenteral Nutrition in Patients Following Pancreaticoduodenectomy: Lessons from 1184 Patients

  Cullen Worsh; Talar Tatarian, MD, PGY-4; Awinder Singh; Michael J. Pucci, MD; Jordan M Winter, MD; Charles J. Yeo, MD; and Harish Lavu, MD

  Poster presented at Sigma XI Student Research Day at Thomas Jefferson University.

  Background:

  Total parenteral nutrition (TPN) has historically been used conservatively in the management of patients after pancreaticoduodenectomy (PD).

  In this study, we evaluate the indications for and outcomes associated with TPN use in a high-volume pancreatic surgery center.

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  Surgical Apgar Score (SAS) Predicts Perioperative Morbidity and Length of Stay in Patients Undergoing Esophagectomy at a High-Volume Center

  Danica Giugliano, MD; Andrew Morgan; Francesco Palazzo, MD; Nathaniel R. Evans III, M.D.; Ernest L Rosato, MD; Adam C. Berger, MD; and Benjamin E Leiby, PhD

  Background:

  Esophagectomy is a procedure that carries considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy at a high-volume institution.

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  Two Separate Colorectal Granular Cell Tumors: A Case Report

  Danica N. Giugliano, MD; Danielle Fortuna, MD; Scott D. Goldstein, MD; Benjamin Philllips, MD; and Gerald A. Isenberg, MD

  Introduction, Case Report, Discussion, Conclusion and References.

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  Dual Kidney Allocation Score: A Novel Algorithm Utilizing Expanded Donor Criteria for the Allocation of Dual Kidneys in Adults

  Adam P. Johnson, MD, MPH; Thea P. Price, MD; Benjamin E Leiby, PhD; and Cataldo Doria, MD, PhD, FACS

  Background:

  Dual kidney transplantation (DKT) of expanded criteria donors is a cost intensive procedure to help increase the pool of available deceased organ donors. In studies to day, expanded criteria single kidney (eSKT) or dual kidney transplantation (DKT) have demonstrated equivalence, but a more rigorous allocation system is needed to optimize limited resources for improved operative outcomes.

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  Role of Target Specific Oral Anticoagulation After Operative Management of Venous Thoracic Outlet Syndrome

  Jeontaik Kwon, MD; Paul J. DiMuzio, MD; Babak Abai, MD; Dawn Salvatore, MD; Taki Galanis, MD; Geno J. Merli, MD; and Luis H. Eraso, MD

  Background:

  The purpose of this study is to review the efficacy of Target Specific Oral Anticoagulants (TSOAC) versus vitamin K antagonist (VKA) for post-surgical anticoagulation in patient with primary subclavian vein thrombosis. Rivaroxaban, a factor Xa inhibitor, was the first TSOAC approved by the FDA in 2012 for the treatment and prevention of deep vein thrombosis. However, the efficacy and safety of TSOAC for prevention of recurrent deep vein thrombosis after revascularization of upper extremity compression syndromes is largely unknown.

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  Optimal Timing of Free Flap Breast Reconstruction in a Highly Radiated Population

  W. Mohiuddin; Kamini D. Patel; Steven E. Copit, MD; and Patrick J. Greaney, MD, FACS

  Introduction

  There has been an increasing use of postmastectomy radiation therapy (PMRT) in breast cancer patients, especially in cases of large tumors (T3 or greater) or node-positive disease (N1 or greater).1 When radiation for the treatment of breast cancer is expected, tissue-based breast reconstruction is generally preferred to implant-based reconstruction. This distinction is attributed to the high rate of complications with postoperative radiation after implant-based reconstruction, ranging from 20% to 70%.2

  In cases when the need for radiation is likely, breast reconstruction with autologous tissue is typically deferred until the completion of the radiation therapy. Reasons for deferring include avoiding additional morbidity that may delay adjuvant therapy, avoiding irradiating the flap, and maintaining a planar field to optimize radiation delivery.3-9 Additionally, radiation is known to cause tissue fibrosis, edema, and vasculitis, all of which can interfere with wound healing.3 These reasons must be balanced against the increased psychological discomfort of delayed breast reconstruction, as defect of the breast can affect a woman’s self-esteem.10 Few studies have examined the effects of prior radiotherapy on autologous breast reconstruction.11,12 The purpose of this study is to delineate the effects of postmastectomy radiation therapy on outcomes of lower abdominal free flap breast reconstruction by a single surgeon.

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  Higher Body Mass Index (BMI) and Low-Volume Surgeons Confer Increased Operative Complications in Anterior Spinal Exposures

  Aisha Shaheen, MD, MHA; Naveed A. Rahman; Abhay Mathur, BS; Deepika Koganti, MD, PGY-4; Alec C. Beekley, MD, FACS; John R. Eisenbrey, PhD; Joshua A. Marks, MD; Michael S. Weinstein, MD, FACS, FCCM; and Murray J. Cohen, MD, FACS

  Background

  Anterior spinal exposures performed by spine or vascular surgeons have a known complication rate of 2-11%. We present the largest single institution experience of anterior spinal exposures performed by Acute Care Surgeons.

  The purpose of this study was to characterize the incidence of vascular and visceral injuries during spinal exposures and to identify risk factors contributing to operative complications during the exposure. We hypothesized that patients with a BMI >30 as well as low-volume surgeons (<20>operations) would have an increased complication rate.

  Poster presented at: American Association for Surgery of Trauma (AAST) in Hawaii

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  Evaluating the Sensitivity of the NanoStrong nCounter® Analysis System to Determine Gene Expression Changes Associated with Chemotherapy Treatment

  Katerina Dukleska, MD; Christopher W. Schultz, BS; Mahsa Zarei, PhD; David McKeown, MD; Charles J. Yeo, MD; Jonathan Brody, PhD; and Jordan M. Winter, MD

  Introduction

  • Pancreatic ductal adenocarcinoma (PDA) remains a deadly disease with a 5-year survival of 8% for all stages combined (Siegel RL et al.). Currently, it’s the third leading cause of cancer-related deaths in the United States and by 2020 it is projected to become the second leading cause (Rahib L, et al).
  • The poor prognosis in PDA is in part due to the limited therapies that are currently available.
  • This highlights the importance of high-throughput technologies for gene expression analyses and drug screens.
  • A recently developed NanoString Technologies nCounter® analysis system, an example of high-throughput technology, utilizes a color-coded barcode to directly measure multiple mRNA transcripts simultaneously.
  • Our ability to study RNA expression has classically been limited by low detection rate (microarrays) or high cost (RNA-Seq).
  • We utilized the nCounter® analysis system to measure changes in cancer-associated gene expression in PDA cell lines caused by different drug treatment.
  • We then validated these results using traditional assays to evaluate the sensitivity of the nCounter® analysis system.

  Poster presented at: Metro Philadelphia Chapter of the American College of Surgeons in Philadelphia PA, United States.