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 < 0.001). Conclusions: Radiofrequency ablation for dysplastic Barrett's Esophagus is a proven and effective treatment modality, associated with a high rate of complete eradication. Our rates of eradication from a center starting an ablation program are comparable to previously published studies. Length of Barrett's segment > 5 cm was found to be predictive of failure of eradication in patients undergoing radiofrequency ablation.

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 inmortality, readmissions, and most postoperative complications. ERAS may provide a practical approach to reducing disparities in surgical outcomes.

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. (C) 2017 Elsevier Inc. All rights reserved.

vessel -, and perineural invasion showed trends towards poorer outcomes in the LMVRgroup (see table ).Long-term oncological outcomes showed clinically significant differences in distant metastatic disease P=0.23) and rectal cancer death rates (LMVR 13.8% vs. non-LMVR 6.1%; P=0.13).There was 1 local recurrence in the LMVR group (3.4%), compared to 13 in the non-LMVR group (5.3%).Comparing long-term outcomes pathologic stage for stage did not demonstrate statistically significant differences; however, small numbers might cause Type II errors.Median recurrent disease free survival and overall survival also showed no significant differences.Conclusions Despite the fact that all patients in this cohort received an R0-resection, the patients who underwent a local multivisceral resection after neoadjuvant treatment for a transmural tumor are at higher risk for distant disease recurrence and disease related death, compared to those who received neoadjuvant treatment for a transmural tumor but did not undergo a multivisceral resection.

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.

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.

Wahl, Tyler S. MD; Gullick, Allison A.; DeRussy, Aerin J. MPH; Morris, Melanie S. MD; Chu, Daniel I. MD Author Information

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.

Background: Helicobacter pylori (HP) is a carcinogenic and prevalent infection in the US.The role of HP eradication prior to bariatric surgery is a topic of controversy.Equally controversial are the efficacy of the available non-invasive studies for the diagnosis of active HP infection, including antibody titer and urea breath test (UBT).As such, there are no standards for evaluation nor recommendations for treatment of HP in this population .The aim of this study was to determine the concordance between serology and UBT in accurately diagnosing active HP infection in an ethnically diverse obese patient population.Methods: We performed a retrospective analysis of patients undergoing evaluation for bariatric surgery at our MBS-AQIP Comprehensive Accredited program between May 2011 and June 2015.All patients who were evaluated for HP infection by both HP antibody titer and urea breath test were included in the study.Results: 76 patients were evaluated by both serology and UBT.HP prevalence by a positive serology was 37%.82% were female and the mean age was 43.6 years.The ethnic distribution was 52.6% African American (AA), 30.3%Hispanic and 15.8% White.The concordance between serology and UBT were 79%, 53% and 68% for IgG, IgA and IgM, respectively.True negative rates were 96%, 82% and 78% for IgG, IgA and IgM, respectively, and true positive rates for all serology isotypes were below 50% (range 11-50%).The concordance (true positive and true negative) between IgG and UBT was significant (Figure 1).Among AA and White patients, concordance was highest between IgG and UB T (78%, 86%).For Hispanic patients, concordance was highest between IgM and UBT (82%).The positive predictive value (PPV) of the serology isotypes was poor (0-50%) among all ethnic groups.The negative predictive value (NPV) was 67-100%, with IgG having the highest NPV (92-100%) among ethnic groups (Figure 2).The overall concordance of IgG and UBT was significantly different across ethnic groups (p <.001).Conclusion: Helicobacter pylori antibody titer has a poor PPV in our ethnically diverse, morbid obese patient population with a relatively high prevalence of HP infection and is not sufficient to make the diagnosis of active HP infection.Serology has a very high negative predictive value and is sufficient to rule-out active HP infection in this patient population.

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. Published by Elsevier Inc.

Gunnells, Drew J. Jr. MD; Chu, Daniel I. MD; Gullick, Allison A.; Morris, Melanie S. MD Author Information

Giglia, Matthew D. MD; DeRussy, Aerin J. MPH; Ferrara, Marco MD; Gullick, Allison A.; Knight, Sara J. PhD; Morris, Melanie S. MD; Chu, Daniel I. MD Author Information

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 χ2 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 < .001). After adjustment for preoperative factors, 30-day readmissions were higher for patients with CLI TL (odds ratio, 1.67; 95% confidence interval, 1.35-2.06) and CLI RP (odds ratio, 1.70; 95% confidence interval, 1.38-2.09) compared with patients with claudication. 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.

IV, 4%.The mean preop PGRN level was 53.3± 12.5 pg/ml.When compared to preop levels, significantly elevated (p<0.0001)mean levels (pg/ml) were noted on postop day (POD) 1 (65.8±15.2; n=92), POD 3 (73.0±17.8,n=85),n=68),n=26) , n=20) and on POD 28-34 (72.8± 17.1, n=22; p=0.0003).Conclusion: Plasma PGRN levels were significantly elevated over baseline for 1 month after MICR for CRC.The early increase after surgery may be due to the short lived acute inflammatory response.The elevation noted during weeks 2 and 4 may be related to wound healing since PGRN stimulates fibroblast accumulation and promotes angiogenesis in wounds.Elevated levels of PGRN may stimulate angiogenesis in residual tumor deposits after surgery.Further investigation is warranted.

Introduction: DBE is often performed during the evaluation of OGIB because of the potential for diagnostic and therapeutic benefits. This study was conducted to investigate the demographics and DBE findings for inpatients versus outpatients experiencing overt or occult OGIB.Table 1: Results by Hospitalization Status (Inpatients vs. Outpatients)Methods: Data were collected using retrospective chart review from May 2013 to June 2014 consisting of all patients undergoing DBE for OGIB at a single academic institution. Information on patient's demographics, indications, endoscopic findings, and outcomes were collected. Patients were excluded if undergoing DBE for indications other than OGIB and/or incomplete DBE. Results: From May 2013 to June 2014, 210 DBEs were performed at UAB. 122 studies were conducted for evaluation of OGIB. 85 were excluded for indications other than OGIB and 3 DBE studies were incomplete. The mean age for the sample was 62.93 years comprised of 63% males and 37% females. Most DBE studies were anterograde (76%). The most common indication for DBE was overt OGIB (78%). 53% of patients had prior video capsule endoscopy (VCE). DBE yielded a significant clinical finding for the majority of patients (74%), most commonly angioectasia (30%) followed by healing ulcers (12%), fresh blood/erosions (8%), jejunopathy(8%), and polyps (6%). Compared to outpatients, inpatients undergoing DBE for OBIG were more likely to be male (p=0.02), though the two populations did not differ in terms of age, BMI, prior VCE, or use of anticoagulation. Inpatients were much more likely to present with overt OGIB (93%), compared to outpatients (48%, p=0.007). While in addition to overt OGIB, outpatients were more likely to present with other indications including anemia (p=0.020) and occult GI bleed (p=0.007) than inpatients. Compared to 46% of outpatients, 85% of inpatients undergoing DBE had a significant finding (p=0.049). Outpatients were also less likely to require an intervention (p=0.039). 45% of inpatients required argon plasma coagulation compared to 15% of outpatients (P=0.009). Both inpatients (48%) and outpatients (49%) with significant findings on DBE were more likely to have undergone previous VCE than those with insignificant findings (p=0.009, p < 0.001). Conclusion: Inpatients undergoing DBE for OGIB presented more with overt GI bleed and were more likely to require therapeutic intervention than compared to outpatients. Previous CE findings were a good predictor of bleed on DBE in both groups.