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

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Circulating tumor DNA, more commonly referred to as ctDNA, has emerged as an attractive and potentially highly sensitive biomarker for patients with colorectal cancer. But what exactly is ctDNA, does it have any prognostic value for patients with colorectal liver metastasis, and how can it be incorporated into the management of said patients? In this episode from the HPB team at Behind the Knife, listen in on the discussion about ctDNA and its role in the perioperative management of colorectal liver metastasis.  



Hosts

Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.



Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. 



Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center



Learning Objectives:

-Develop an understanding of what circulating tumor DNA (ctDNA) is. 

-Develop an understanding of what makes ctDNA unique from other “tumor markers” like CEA.

-Develop an understanding of the prognostic value of ctDNA for colorectal liver metastasis (CRLM). 

-Develop an understanding of the current role of ctDNA in the perioperative treatment of patients with CRLM.

-Develop an understanding of how ctDNA can be incorporated into future treatment algorithms for patients undergoing hepatic resection for CRLM.



Papers Referenced (in the order they were mentioned in the episode):



1)    Newhook TE, Overman MJ, Chun YS, et al. Prospective Study of Perioperative Circulating Tumor DNA Dynamics in Patients Undergoing Hepatectomy for Colorectal Liver Metastases. Ann Surg. 2023;277(5):813-820.

https://pubmed.ncbi.nlm.nih.gov/35797554/



2)    Nishioka Y, Chun YS, Overman MJ, et al. Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases. J Am Coll Surg. 2022;234(4):474-483.

https://pubmed.ncbi.nlm.nih.gov/35290266/



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Journal Review in Hepatobiliary Surgery: ctDNA & Colorectal Liver Metastasis

Taking a lactating patient the OR? Prescribing antibiotics? What about a CT scan with IV contrast? Pump and dump, right? WRONG. It's time to get educated! Today, we review the finer points of caring for our lactating patients. 



In this episode Dr. Patrick Georgoff is joined by Dr. Austin Eckhoff, general surgery resident at Duke University, Dr. Annie Dotson, family medicine and breastfeeding medicine physician at Duke University, and Dr. Katrina Mitchell, breast surgeon at Ridley Tree Cancer Center in Santa Barbara, CA. 



Resources: 

https://www.bfmed.org/ 

https://www.e-lactancia.org/ 

https://physicianguidetobreastfeeding.org/



- - 



TRASH THE PUMP & DUMP: https://physicianguidetobreastfeeding.org/trash-the-pump-and-dump/trash-pump-dump/



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Is "Pump and Dump" Outdated?  An Update on Lactating Patients

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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Journal Review in Emergency General Surgery: Appendicitis

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