Sleep, Nutrition, and Health Maintenance in Cardiothoracic Surgery.

Cardiothoracic surgeons work in high-intensity environments starting in surgical training and throughout their careers. They deal with critical patients. Their routine procedures are delicate, require extensive attention to detail, and can have detrimental effects on patients' lives. Cardiothoracic surgeons are required to perform at their best capacity incessantly. To do this, they must safeguard their mental and physical well-being. Preserving health through sleep, nutrition, exercise, and routine medical checkups ensures a cardiothoracic surgeon's well-being. Great personal effort and discipline is required to maintain health in a busy schedule. We offer our best recommendations from expert peers in the field.

Robotic hiatal hernia repair without mesh.

Background: Newer minimally invasive techniques have supplanted laparotomy and thoracotomy for management of hiatal hernias. Limited data exists on outcomes after robotic hiatal hernia repair without mesh despite the increasing popularity of this approach. We report our high-volume experience with durable robotic hiatal hernia repair with gastric fundoplication without mesh. Methods: A retrospective review was conducted on patients with type I-IV hiatal hernias who underwent an elective robotic-assisted repair from 2016 to 2019 using a novel technique of approximating the hiatus with running barbed absorbable (V-locTM) suture and securing it with interrupted silk sutures. Main outcomes included length of stay, readmission rate, and recurrence rate. Results: A total of 144 patients were reviewed. The average age of the patient was 61 years. Most of the patients were female [95 females (66%) to 49 males], and the average body mass index (BMI) was 29.96 kg/m2. The average operating time was 173 minutes (standard deviation 62 minutes). The average length of stay in the hospital was 2 days, and 89% of patients went home within the first 3 days. Ten patients (6.9%) were readmitted within 30 days, there were no mortalities in 30 days, and there were 6 (4.2%) recurrences on follow up requiring reoperation. Conclusions: Elective robotic hiatal hernia repair with fundoplication and primary closure of the hiatus with V-locTM and nonabsorbable suture without mesh is safe and effective. The robotic approach has similar operative times, lengths of stay, and complications compared to nationally published data on laparoscopic hiatal hernia repairs.

Learning to SuRRF: Sustained Engagement and Increased Academic Productivity Over Two Years of a Resident-Led Virtual Laboratory.

OBJECTIVE: To determine if implementation of a resident-led virtual laboratory can sustain increased engagement and academic productivity in residents and faculty. DESIGN: We developed and introduced a multimodal virtual Surgery Resident Research Forum (SuRRF) in July 2019. SuRRF utilizes monthly virtual lab meetings, weekly newsletters, a centralized database of projects, project tracking tools, and a shared calendar of deadlines to facilitate research among surgical residents. Data on number of participating residents, faculty, and projects across SuRRF meetings at 1-year (7/2020) and 2-years post-implementation (9/2021) were collected to evaluate engagement. Institutional ACGME Resident Scholarly Activity and Faculty Scholarly Activity reports were evaluated for the pre-SuRRF implementation (2018-2019) and post-implementation (2020-2021) academic years to assess productivity pre- and post-implementation. SETTING: Three tertiary academic hospitals of a single health system in New York. PARTICIPANTS: All residents in our general surgery program during the study period, including research residents, were eligible to participate in our study. RESULTS: At 1-year, there were 2 attendings, 13 residents, and 23 projects, compared to 12 attendings, 25 residents, and 42 projects at 2-years post-implementation. Post-SuRRF implementation, residents had significantly more publications (0.56 ± 0.15 vs. 1.10 ± 0.15, p = 0.005), textbook chapters (0.00 vs. 0.010 ± 0.044, p = 0.014), research participation (p < 0.01), and scholarly activity (p = 0.02). Post-SuRRF, faculty had significantly more publications (0.74 ± 0.15 vs. 2.20 ± 0.33, p < 0.001) and scholarly activity (p = 0.006). CONCLUSIONS: SuRRF promotes exposure to projects and resources and increases collaboration and peer-to-peer mentorship. Our experience with SuRRF suggests that resident-led virtual laboratories may increase peer-reviewed publications and improve resident and faculty engagement in scholarly activity, thus supporting academic growth.

Pre-hospital caloric deficits in surgical patients.

BACKGROUND: The timing, route, and amount of nutrition for surgical patients with substantial caloric deficits remain active areas of study. Current guidelines are based on in-hospital days NPO after admission to the hospital. This historic process neglects the multiple days of caloric deficit patients experience prior to hospital admission. AIM: To determine the impact of pre-hospital caloric deficit (PHCD) for surgical patients on their outcomes. METHODS: 313 patients admitted with a diagnosis of small bowel obstruction, pancreatitis, or diverticulitis were analyzed for their PHCD's. PHCD's were estimated using patient-reported days with significant emesis, and absent oral intake. Patients with PHCD's were compared to patients with no PHCD for length of stay, status on discharge, disposition, and 30-day readmission rate. RESULTS: There were 313 patients and 42% of the patients were male. The median age was 65 years. Median number of days sick prior to hospital admission was 1 (IQR: 1 to 2). Median PHCD was 1882 kcal (IQR: 1355 to 3650). Median number of days NPO while in-hospital was 3 (IQR: 2 to 5). Median in-hospital caloric deficit was 4268 kcal (IQR: 2825 to 6610). No significant association was observed between discharge disposition, complication rate, ambulatory status, 30-day readmission rate and PHCD. In-hospital caloric deficit was associated with complications after surgery (p < 0.0001). CONCLUSION: Small PHCD's in patients with SBO's, pancreatitis, or diverticulitis do not negatively affect their outcomes. Further research of patients with large PHCD's is needed to best treat surgical patients at risk for malnutrition.

Epiglottic hematoma after carotid endarterectomy with cervical block.

There are few trials assessing the risks and benefits of performing a cervical plexus block (CPB) in urgent carotid endarterectomies (CEA). We describe a case of a patient who underwent urgent CEA under CPB and suffered a complication of postoperative epiglottic hematoma. There were clinical findings that helped to distinguish the hematoma from other, more common postoperative complications. The mainstay of treatment was steroids and observation. Epiglottic hematomas after cervical blocks for CEAs are rare but potentially lethal complications. More research is needed investigating complications related to CPBs performed for CEAs.