Join our Emergency General Surgery team as we talk about a popular and controversial issue in surgery: dealing with complicated cases in pancreatitis. We discuss two hard-hitting cases and cover principles of diagnosis, early management and disposition, and things to look out for every step of the way.



We cover some common and some rare but particularly problematic complications. Although there is no right answer to every case of pancreatitis, we try to help learners to develop an approach to pancreatitis that considers the morbidity and benefits of every option.



Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross



Learning Objectives:

- Review the diagnostic criteria for acute pancreatitis

- Learn to anticipate common and major complications of acute pancreatitis

- Develop an approach to complications of pancreatitis accounting for patient, family, practitioner, and institutional factors

- Understand the risks and benefits of various methods for dealing with pancreatic necrosis and infection



TENSION trial

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32404-2/fulltext

MISER trial

https://pubmed.ncbi.nlm.nih.gov/30452918/



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Clinical Challenges in Emergency General Surgery: Complicated Pancreatitis

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The American Board of Surgery In-Training Examination will officially be switching from reporting percentile scores by year level to percent of questions correct. What does this change mean for residents? Podcast hosts Dr. Ananya Anand, Dr. Joe L’Huillier, and Dr. Rebecca Moreci are joined by three fellow CoSEF members for this discussion: Dr. Gus Godley, Dr. Colleen McDermott, and Dr. Josh Roshal. 



Hosts:



–Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, ananya_anand@stanford.edu



–Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101, josephlh@buffalo.edu



–Dr. Rebecca Moreci, Louisiana State University, @md_moreci, morecir@med.umich.edu



–COSEF: @surgedfellows



Special guests: 



-Dr. Gus Godley, University of Chicago, frederick.godley@uchicagomedicine.org, @GusGodley



-Dr. Colleen McDermott, University of Utah, colleen.mcdermott@hsc.utah.edu



-Dr. Josh Roshal, Brigham and Women’s Hospital, jaroshal@utmb.edu, @Joshua_Roshal



Learning Objectives: 



Listeners will:

 – Understand the changes to the ABSITE score reporting by the American Board of Surgery 



– Describe both positive impacts and limitations of this change from the resident perspective



– List possible ideas for further refinements to standardized exams in medicine  



References:

 -Yeo HL, Dolan PT, Mao J, Sosa JA. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surg. Jan 1 2020;155(1):22-30. doi:10.1001/jamasurg.2019.4081 https://pubmed.ncbi.nlm.nih.gov/31617872/



-Sathe TS, Wang JJ, Yap A, Zhao NW, O’Sullivan P, Alseidi A. Proposed Reforms to the American Board of Surgery In-Training Examination (ABSITE). https://www.ideasurg.pub/proposed-absite-reforms/



-Miller AT, Swain GW, Midmar M, Divino CM. How Important Are American Board of Surgery In-Training Examination Scores When Applying for Fellowships? J Surg Educ. 2010;67(3):149-151. doi:10.1016/j.jsurg.2010.02.007 

https://pubmed.ncbi.nlm.nih.gov/20630424/



-Savoie KB, Kulaylat AN, Huntington JT, Kelley-Quon L, Gonzalez DO, Richards H, Besner G, Nwomeh BC, Fisher JG. The pediatric surgery match by the numbers: Defining the successful application. J Pediatr Surg. 2020;55(6):1053-1057. doi:10.1016/j.jpedsurg.2020.02.052 https://pubmed.ncbi.nlm.nih.gov/32197826/



-Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Annals of Vascular Surgery. 2023;94:195-204. doi:10.1016/j.avsg.2023.04.018 

https://pubmed.ncbi.nlm.nih.gov/37120072/



-Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross‐sectional study. Health Sci Rep. 2020;3(2):e2161. doi:10.1002/hsr2.161 https://pubmed.ncbi.nlm.nih.gov/32318628/



-Lucey CR, Saguil A. The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue. Academic Medicine. 2020;95(3):351. doi:10.1097/ACM.0000000000002939 https://pubmed.ncbi.nlm.nih.gov/31425184/



-Natanson H, Svrluga S. The SAT is coming back at some colleges. It’s stressing everyone out. Washington Post. https://www.washingtonpost.com/education/2024/03/18/sat-test-policies-confuse-students/. Published March 19, 2024. Accessed April 5, 2024.



-de Virgilio C, Yaghoubian A, Kaji A, Collins JC, Deveney K, Dolich M, Easter D, Hines OJ, Katz S, Liu T, Mahmoud A, Melcher ML, Parks S, Reeves M, Salim A, Scherer L, Takanishi D, Waxman K.. Predicting Performance on the American Board of Surgery Qualifying and Certifying Examinations: A Multi-institutional Study. Archives of Surgery. 2010;145(9):852-856. doi:10.1001/archsurg.2010.177 https://pubmed.ncbi.nlm.nih.gov/20855755/



-Weighted test content from the ABS: 

https://www.absurgery.org/wp-content/uploads/2023/01/GS-ITE.pdf



-USMLE program announces upcoming policy changes | USMLE. Accessed April 9, 2024. https://www.usmle.org/usmle-program-announces-upcoming-policy-changes

 

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Scoring Changes to the ABSITE: The Trainee Perspective on Impact and Ramifications

The ABSITE score report is changing… what does it mean? CEO of the American Board of Surgery Dr. Jo Buyske discusses ABSITE and MUCH more.  



Hosts: Dr. Scott Steele, Dr. Nina Clark, Dr. Jessica Millar

Guest: Dr. Jo Buyske, President/CEO of the American Board of Surgery



Resources: 

Announcement - ABSITE Percentiles: 

https://www.absurgery.org/wp-content/uploads/2024/02/ABSITE-Percentiles.pdf 



ABSITE Data Tools:

https://sandbox.absurgery.org/default.jsp?publicdata  



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ABSITE Updates and the Future of Boards with Dr. Jo Buyske

In this episode our team dives into the diagnosis, workup and management of malignant pleural mesothelioma. Listen as we debate the pros and cons of surgical management of this disease with extrapleural pneumonectomy versus pleural decortication and discuss the nuances of choosing the right approach for the right patient.



Learning Objectives

- Describe the workup and staging of a patient with malignant pleural mesothelioma

- List the subtypes of malignant pleural mesothelioma, characteristics of resectable disease, and patient factors which impact surgical candidacy 

- Describe the approach to an extrapleural pneumonectomy and pleural decortication

- Analyze which surgical approach is best for various subsets of patients

- Describe the adjuvant treatment for malignant pleural mesothelioma



Hosts

Kelly Daus MD, Adam Bograd MD, Peter White MD, Brian Louie MD



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Clinical Challenges in Thoracic Surgery: Malignant Pleural Mesothelioma

Can appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning.



Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93.

https://pubmed.ncbi.nlm.nih.gov/37436871/



-Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following a decision to operate versus the immediate appendectomy group with surgery taking place between 8pm and 4am and within 6 hours of a decision to operate



-A priori non-inferiority margin of 15% for 30-day complications



-Intention-to-treat analysis with risk difference -12% in favor of the delayed group (p < 0.001)



-Superiority as on per protocol analysis



-Underpowered at 91% due to early closure of study due to loss of reliable day time emergency triage operating time



Paper 2: Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, Leppäniemi A, Mentula P. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023 Oct 28;402(10412):1552-1561.

https://pubmed.ncbi.nlm.nih.gov/37717589/



-Non-inferiority randomized controlled trial comparing appendectomy within 8 hours versus 24 hours



-No difference in rate of perforation on intention-to-treat or per protocol analyses



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Journal Review in Emergency General Surgery: Appendicitis

Before 1952, open heart surgery was considered science fiction. The heart was off limits to surgeons despite more than half a million Americans dying annually from heart disease. Doing nothing was the strategy. However, the status quo would soon change thanks to a few brave and imaginative surgeons who dared to break the most rigid of medical taboos: Do not touch the human heart. We sat down with Dr. Gerald Imber, author of the new book “Cardiac Cowboys: The Heroic Invention of Heart Surgery” to discuss how five men raced to invent an entirely new field of surgery. 



Guests:

Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife 

 Nick Teman, MD- Associate Professor of Cardiac Surgery and Critical Care- University of Virginia 

Gerald Imber- Assistant Clinical Professor of Plastic surgery at the Weill-Cornell Medical Center, Attending Surgeon at New York-Presbyterian Hospital, and Director of a private clinic in New York City, NY; Author of “Wendell Black, MD”, “Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted”, and “Cardiac Cowboys: The Heroic Invention of Heart Surgery”. 



Want to hear more from Dr. Imber- be sure to check out his podcast series, Cardiac Cowboys, based on Dr. Imber’s book. You can listen to an introduction of the Cardiac Cowboys series here: https://shorturl.at/rKLM8



Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  



If you liked this episode, check out more recent episodes: https://app.behindtheknife.org/listen


Clinical Challenges in Emergency General Surgery: Complicated Pancreatitis

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