Restricted accessAbstractFirst published online September 26, 2023Topic: Esophagus Benign-GERD, Achalasia, Motility Abstract ID: 40 The Influence of Psycho-Emotional Health on Type of Laparoscopic Anti-Reflux Surgery and Quality of Life in GERD PatientsKatherine Walsh, Charles Hill, […], Joseph Stautner, Wenqiao Wang, Stephanie Doggett, Elisa Furay, and FP Buckley+4-4View all authors and affiliationsVolume 3, Issue 3https://doi.org/10.1177/26345161231189102

As blunt thoracic aortic injury (BTAI) treatment has shifted from open to thoracic endovascular aortic repair (TEVAR), logistical challenges exist in creating and maintaining inventories of appropriately sized stent-grafts, including storage demands, shelf-life management and cost. We hypothesized that most injured aortas can be successfully repaired with a narrow range of stent-graft sizes and present a value-based anatomic approach to optimizing inventory. CT-scans of all patients with BTAI admitted to our Level I trauma center from Apr 2010-Dec 2018 were reviewed. Patients with anatomy incompatible with TEVAR were excluded. For each patient, after aortic sizing a set of two stent-grafts most likely to be utilized was selected from a list of twenty commercially available GORE conformable TAG endografts based on manufacturer instructions. Stent-graft sizes were then ranked based on the number of cases they would be suitable for. MATLAB was utilized to determine the combinations of stent-grafts which would cover the most patients. Twenty-eight patients with BTAI were identified and three were excluded based on iliac diameter. Most patients were male (68

Restricted accessAbstractFirst published online September 26, 2023Topic: Esophagus Benign-GERD, Achalasia, Motility Abstract ID: 42 Short Term Outcomes for Patients Undergoing Roux-en-Y Gastric Bypass as Salvage Therapy for End-Stage Reflux Disease With Preservation of FundoplicationKatherine Walsh, Joseph Stautner, […], Wenqiao Wang, Charles Hill, Stephanie Doggett, FP Buckley, and Elisa Furay+4-4View all authors and affiliationsVolume 3, Issue 3https://doi.org/10.1177/26345161231189156

Paraesophageal hernias (PEH) represent a minority of hiatal hernias and yet have the highest potential for catastrophic consequences for patients. Patients with paraesophageal hernias tend to be older with more comorbidities. The risk to benefit calculation in the treatment of patients with a minimally symptomatic PEH can complicated. Surgical repair and management of hiatal hernias has come a long way since the first repairs were undertaken. Surgical risk has become minimal, while gains in quality of life have increased. Decisions for surgery should be undertaken by well informed patients who have benefited from consultation with a gastroenterologist and foregut surgeon. For most patients suffering with a symptomatic PEH, the risk benefit calculation has swung firmly toward surgical repair when a multi-specialty approach is taken.

Introduction: Failed extubation in critically ill patients is associated with poor outcomes. In critically ill trauma patients who have failed extubation, providers must decide whether to proceed with tracheostomy or attempt extubation again. The aim of this study was to describe the natural history of failed extubation in trauma patients and determine whether tracheostomy or a second attempt at extubation is more appropriate. Methods: Trauma patients admitted to our level I trauma center from 2013 to 2019 were identified. Patients who failed extubation, defined as an unplanned reintubation within 48 h of extubation, were included. Patients who immediately underwent tracheostomy were compared with those who had subsequent attempts at extubation. The primary outcome was mortality, and the secondary outcomes were intensive care unit (ICU) length of stay (LOS), ventilator days, and hospital LOS. Results: The population included 93 patients who failed extubation and met inclusion criteria. A total of 53 patients were ultimately successfully extubated, whereas 40 patients underwent a tracheostomy. There was no statistically significant difference in demographics or injury patterns. Patients who underwent tracheostomy had a longer ICU LOS and more ventilator days. There was no difference in mortality or hospital LOS between the two groups. Conclusions: In trauma patients, those who underwent subsequent attempts at extubation did not experience higher rates of mortality than those who received a tracheostomy. Tracheostomy was associated with longer ICU LOS and ventilator days. In certain situations, it is appropriate to consider subsequent attempts at extubation in trauma patients who fail extubation rather than proceeding directly to tracheostomy. (C) 2022 Elsevier Inc. All rights reserved.

Background:A frequently encountered problem in laparoscopic surgery is an impaired visual field. The Novel Intracavitary Laparoscopic Cleaning Device (NILCD) is designed to adequately clean a laparoscopic lens quickly and efficiently without requiring removal from the surgical cavity. Animal and cadaver studies showed good efficacy and a short learning curve. This study aims to describe the efficacy and initial human experience with the device during laparoscopic operations.Methods:Since 2020, NILCD was used in 167 cases with surgeons at 12 different institutions in Texas, California, and Massachusetts. The rate of scope removal in each case was examined. Following each trial, users were asked to rank the NILCD on ease of set up, insertion, adjustment, and cleaning efficacy. A survey was then used to evaluate surgeon satisfaction.Results:The NILCD was tested in a variety of cases, including colorectal, gynecological, general, pediatric, hepatobiliary, thoracic, bariatric and foregut surgery. NILCD usage eliminated the need for scope removal in 90.14% of debris events, with only 97 removals in 984 events. Eighty-six percent of users reported that the NILCD improved their visual field. When asked to rate specific qualities of the device using a 5-point Likert scale, surgeons gave an average score of 4.56 for ease of setup, 4.10 for ease of insertion, and 4.12 for ease of adjusting and cleaning efficacy.Conclusion:In an initial analysis of 167 cases, the NILCD proved to be an effective and convenient method of cleaning the laparoscopic lens in-vivo. It was associated with good surgeon satisfaction.

Measures of mood and effective coping strategies have notable correlations with quality of life and treatment responses. There is evidence that patients with previously diagnosed anxiety disorders have less improvement in patient-reported outcome measures (PROMs) after laparoscopic anti-reflux surgery (LARS) and that objective pathology does not correlate well with symptom severity. We were interested in investigating whether anxiety and hypervigilance, as measured preoperatively with the esophageal hypervigilance anxiety scale (EHAS), is associated with the improvement in GERD-specific PROMs and EHAS scores 6 months after LARS. We performed a retrospective cohort study of 102 adult patients (31% men, average age 64) who underwent LARS. In the preoperative evaluation, baseline gastroesophageal reflux disease-health-related quality of life (GERD-HRQL), laryngopharyngeal reflux symptom index (LPR-RSI) and EHAS scores were collected in addition to the standard reflux workup, including endoscopy, manometry, barium swallow, and pH study. For all three surveys, a higher score represents worse symptom severity. At 6 months postoperatively, 70 patients completed repeat GERD-HRQL, LPR-RSI, and EHAS surveys. We then analyzed for surgical and patient-related factors associated with improvement in the 6-month postoperative GERD-HRQL and LPR-RSI scores. There was a statistically significant decrease in the GERD-HRQL (25 vs. 2, p < 0.001), LPR-RSI (17 vs. 3, p < 0.001) and EHAS (34 vs. 15, p < 0.001) 6 months after LARS. On multivariable linear regression, a higher baseline EHAS score was independently associated with a greater improvement in GERD-HRQL (β 0.35, p < 0.001) and LPR-RSI (β 0.19, p = 0.03) 6-months after LARS. Additionally, the degree of improvement in EHAS, GERD-HRQL, and LPR-RSI was not influenced by the type of LARS performed or by the severity of disease. These findings are consistent with literature suggesting that measures of psychoemotional health correlate better with symptom intensity than objective pathology. We found that patients with a higher EHAS score have greater symptom severity and lower quality of life at baseline. Novel findings to this study are that patients with a higher preoperative EHAS, a measure of psychoemotional health, actually benefitted more from surgery and not less, which has been the traditional view in the literature. Future studies are warranted to establish directionality and explore the role of preoperative cognitive behavioral therapy with LARS for patients with significant symptoms of hypervigilance and anxiety.

Hill, Charles E. MD; Rajagopalan, Dayal BS; Nofal, Yousef BS; Doggett, Stephanie PA; Walsh, Katherine BS; Yan, Derek BS; Alexander, Jeremiah BS; Holan, Cole BS; Furay, Elisa MD; Buckley, Francis P. III MD, FACS Author Information

Patient-reported outcomes (PROs) are integral to determining the success of foregut surgical interventions and psychoemotional factors have been hypothesized to impact the quality of life of patients. This study evaluates the correlation between PROs-specifically the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) and the Laryngopharangeal Reflux Symptom Index (LPR-RSI)-and the recently validated Esophageal Hypervigilance Anxiety Scale (EHAS). We hypothesize that patients with higher EHAS scores have significantly elevated GERD-HRQL LPR-RSI compared to those with normal scores. EHAS has been developed and validated in chronic esophageal disorders, but clinical impact is unknown. In this retrospective study, 197 patients (38% men, average age 56 ± 16) completed the following surveys:(1) EHAS, (2) GERD-HRQL, and (3) LPR-RSI. All patients referred for surgical evaluation of GERD completed the surveys as part of their pre-operative workup and post-operative follow-up In bivariate analysis, EHAS correlated with both GERD-HRQL (r 0.53, P = <0.001) and LPR-RSI (r 0.36, P = 0.009). Accounting for potential confounding with sex and age in multivariable linear regression models, a higher GERD-HRQL score (β 0.38; 95% CI 0.29 to 0.48; P = <0.001; Semipartial R2 0.20) and a higher LPR-RSI score (β 0.21; 95% CI 0.13 to 0.29; P = <0.001; Semipartial R2 0.08) were independently associated with higher EHAS. The observed relationship between mental health and GERD symptom intensity is consistent with the biopsychosocial paradigm of illness. Future studies focused on post-surgical outcomes following the incorporation of EHAS into perioperative care is needed to evaluate its effectiveness as a clinical decision support tool in ARS.

Background In patients who have had proximal digit amputation, metacarpal distraction osteogenesis is an option to improve digital length and function. One drawback is that traditional external distraction devices are large and cumbersome; the option of a low-profile internal device is therefore appealing. Internal distractors are commonly used in craniofacial reconstruction, but use in the hand has not been reported. We describe a case series of the novel use of an internal distractor in metacarpal lengthening. Methods In this single-center case series, patients who underwent metacarpal distraction by the senior author using a uniplanar internal distractor were reviewed, and indications, outcomes, and complications were analyzed. Results There were 5 cases in 4 patients (age range: 7-33 years). Indications were traumatic amputation in 4 cases and congenital hypoplasia in 1. All were successfully distracted, with a mean final length gain of 1.3 cm (range: 1.0-1.7 mm). Mean time from device placement to consolidation was 3.5 months. Complications included activation arm site infection in 2 cases, both occurring after the distraction period, necessitating device removal before full consolidation. In these cases, the device was removed after the distraction period and replaced with a Kirschner wire for stabilization through the consolidation period. Conclusions Metacarpal distraction was successfully achieved with an internal distraction device. Although infection was common, it occurred after the distraction period and did not preclude length gain. We feel that this low-profile device offers advantages over cumbersome external devices typically used for metacarpal lengthening.

BACKGROUND:We hypothesize that patients with compensated cirrhosis undergoing elective UHR have an improved mortality compared to those undergoing emergent UHR. METHOD:The NIS was queried for patients undergoing UHR by CPT code, and ICD-10 codes were used to define separate patient categories of non-cirrhosis (NC), compensated cirrhosis (CC) and decompensated cirrhosis (DC). RESULTS:A total of 32,526 patients underwent UHR, 97% no cirrhosis, 1.1% compensated cirrhosis, 1.7% decompensated cirrhosis. On logistic regression, cirrhosis was found to be independently associated with mortality (OR 2.841, CI 2.14-3.77). On subset analysis of only cirrhosis patients, elective repair was found to be protective from mortality (OR 0.361, CI 0.15-0.87, p = 0.02). CONCLUSIONS:In this retrospective review, cirrhosis as well as emergent UHR in cirrhotic patients were independently associated with mortality. More specifically, electively (rather than emergently) repairing an umbilical hernia in cirrhotic patients was independently associated with a 64% reduction in mortality.

Hill, Charles E. MD; Daley, Mitchell J. PharmD; Addison, Janci PharmD; Hodge, Emily PharmD; Hecht, Jonathan CNS; Acosta, Victoria APN; Brown, Carlos V.R. MD, FACS; Ben Coopwood, Thomas MD Author Information

The 2014 West African Ebola virus disease (EVD) outbreak is the largest and deadliest EVD epidemic to date, resulting in fivefold more cases than all other outbreaks combined. This outbreak was particularly devastating to healthcare workers in West Africa and resulted in several EVD patients being medically evacuated for treatment in the U.S. and Europe. Governmental agencies provide recommendations for triaging and testing patients with EVD, however best laboratory practices are still unknown and are very resource dependent.

1Seton Family Healthcare, University of Texas, Austin, TX 2University of Texas-Health Science Center at San Antonio, San Antonio, TX 3Dell Medical School at The University of Texas, Austin, TX 4University Medical Center Brackenridge, Austin, TX

Objectives: To evaluate all patients who received gentamicin for open fracture treatment and determine the incidence of, and risk factors for, kidney injury in this population. Design: Retrospective, case control. Setting: Single institution; Level 1 trauma center. Patients/Participants: A retrospective chart review identified patients who received gentamicin for open fracture antibiotic treatment from January 2008 to December 2012. Overall, 371 patients met the inclusion criteria and were categorized into 2 groups using risk, injury, failure, loss of kidney function, and end-stage kidney disease criteria: normal kidney function (74.9%) versus abnormal kidney function (25.1%). Intervention: Use of gentamicin in open fracture antibiotic treatment. Main Outcome Measurements: Kidney function; injury and treatment characteristics (eg, mechanism of injury; Gustilo-Anderson classification; number of surgical debridements, timing of definitive wound coverage, and type of wound coverage); and patient information (eg, age, height, weight, and body mass index, tobacco use, diabetes mellitus, human immunodeficiency virus, hepatitis, and current chemotherapy treatment). Results: Those with abnormal kidney function had lower baseline creatinine (P < 0.001) and higher injury severity scores (16.5 vs. 11.8, P < 0.001) and were more likely to require intensive care unit admission (P < 0.001) than the normal group. Female sex (P = 0.015), and higher weight (P = 0.004), ICU admission (P < 0.001), and use of CT contrasted imaging (P < 0.001) were independently associated with abnormal kidney function. Abnormal kidney function incidence also sharply increased with age. Conclusions: Females and heavier individuals are at-risk of kidney injury while receiving gentamicin. ICU admission and concurent CT contrasted imaging are strongly associated with kidney injury in patients receiving gentamicin for open fracture treatment, and gentamicin should be avoided in those >60 years of age. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

: The problem of deriving an analytic expression which would relate low flying aircraft trajectories to terrain cross-section has not been solved. A computer simulation has been devised which generates synthetic flight paths which are coupled to a terrain input and are dependent on the values of five input parameters. Simulations have been generated which best match a series of actual test flights. The input parameters which generated the best fit to actual flights are examined to determine their statistical properties. Tests of hypotheses are conducted to determine goodness of fit and equality of means and variances among parameter sets related to specific terrains and speeds. A sampling procedure is suggested whereby a random series of flights might be generated over an arbitrary terrain cross-section subject to speed restrictions. (Author)