The laryngopharyngeal nerve: a comprehensive review.

The laryngopharyngeal nerve has received much less attention that the other contributions to the pharyngeal plexus i.e., glossopharyngeal and vagus nerves. Often, in descriptions and depictions, the nerve is simply labeled as the sympathetic contribution to the pharyngeal plexus. As there is such scant information available regarding this nerve, the present review was performed. Very little is found in the extant medical literature regarding the laryngopharyngeal nerve. However, based on available data, the nerve is a consistent contributory to the pharyngeal plexus and serves other adjacent areas e.g., carotid body. Therefore, a better understanding of this structure's anatomy is important for those who operate in this area. Further studies are necessary to better elucidate the true function of the laryngopharyngeal nerve.

Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage.

Background: Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows the placement of a hyperlordotic cage (HLC) to improve lumbar lordosis, but it is unclear if the amount of cage lordosis affects radiological outcomes in real-life patient conditions. Methods: Three patients were treated with ACR and 30° expandable HLC for positive sagittal imbalance secondary to single-level spondylolisthesis. Patients reported baseline and post-operative Oswestry Disability Index (ODI) and Numeric Pain Score (NRS). Radiographic parameters of sagittal balance included lumbar lordosis (LL), sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis mismatch (PI-LL). Results: Surgical indications were sagittal plane imbalance caused by L4-L5 degenerative spondylolisthesis (n = 2) and L3-L4 spondylolisthesis secondary to adjacent segmental degeneration (n = 1). Average post-operative length of stay was 3 days (range 2-4) and estimated blood loss was 266 mL (range 200-300). NRS and ODI improved in all patients. All experienced improvements in LL (x¯preop = 33°, x¯postop = 56°), SVA (x¯preop = 180 mm, x¯postop = 61 mm) and PI-LL (x¯preop = 26°, x¯postop = 5°). Conclusion: ACR with expandable HLC can restore sagittal plane balance associated with single-level spondylolisthesis. Failure to perform ACR with HLC placement during pre-psoas interbody fusion may result in under correction of lordosis and poorer outcome for these patients.

Spontaneous resolution of syringomyelia following pregnancy and parturition in a patient with type I chiari malformation: A case and systematic review.

BACKGROUND: Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and parturition. We review theories on syringomyelia development and spontaneous resolution to better understand the role pregnancy and parturition may play in both processes. METHODS: We present a 30-year-old female with MRI-confirmed spontaneous syrinx regression following caesarean delivery of a full-term pregnancy. We additionally review the literature to identify previously reported cases of spontaneous syrinx regression both independent of and associated with pregnancy. RESULTS: Including the present case, 39 cases describing spontaneous regression of syringomyelia have been reported in the literature, of which only four are associated with pregnancy and parturition. 75% of all reported cases were associated with type I Chiari malformation, though several disorders of the craniocervical junction and spinal canal were implicated. Complete syrinx regression was achieved in 33.3% of cases and 5% of cases described recurrence of syringomyelia following the spontaneous resolution. CONCLUSION: Syringomyelia likely develops due to disturbance of the physiologic flow of cerebrospinal fluid around the craniocervical junction and the obex. Several mechanisms including fissuring of the spinal cord parenchyma and reduction of subarachnoid scarring are likely involved in this process. In the setting of pregnancy, additional mechanisms surrounding the increased intraabdominal forces imparted by a growing fetus, Valsalva-like strain experienced during labor, and hemodynamic changes that occur to accommodate gestation are likely implicated. Nevertheless, patients should continue to be monitored periodically for syrinx recurrence.

Biomechanical Study of Cervical Endplate Removal on Subsidence and Migration in Multilevel Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: This study compares four cervical endplate removal procedures, validated by finite element models. PURPOSE: To characterize the effect of biomechanical strength and increased contact area on the maximum von Mises stress, migration, and subsidence between the cancellous bone, endplate, and implanted cage. OVERVIEW OF LITERATURE: Anterior cervical discectomy and fusion (ACDF) has been widely used for treating patients with degenerative spondylosis. However, no direct correlations have been drawn that incorporate the impact of the contact area between the cage and the vertebra/endplate. METHODS: Model 1 (M1) was an intact C2C6 model with a 0.5 mm endplate. In model 2 (M2), a cage was implanted after removal of the C4-C5 and C5-C6 discs with preservation of the osseous endplate. In model 3 (M3), 1 mm of the osseous endplate was removed at the upper endplate. Model 4 (M4) resembles M3, except that 3 mm of the osseous endplate was removed. RESULTS: The range of motion (ROM) at C2C6 in the M2-M4 models was reduced by at least 9º compared to the M1 model. The von Mises stress results in the C2C3 and C3C4 interbody discs were significantly smaller in the M1 model and slightly increased in the M2-M3 and M3-M4 models. Migration and subsidence decreased from the M2-M3 model, whereas further endplate removal increased the migration and subsidence as shown in the transition from M3 to M4. CONCLUSIONS: The M3 model had the least subsidence and migration. The ROM was higher in the M3 model than the M2 and M4 models. Endplate preparation created small stress differences in the healthy intervertebral discs above the ACDF site. A 1 mm embedding depth created the best balance of mechanical strength and contact area, resulting in the most favorable stability of the construct.

Finite Element Analysis of the Effect of Dynamic Plating on Two-Level Anterior Cervical Discectomy Fusion Biomechanics.

BACKGROUND: The limitations of anterior cervical discectomy and fusion (ACDF) are related to mechanical failure of the construct after recurring subsidence and migration. In the present study, we evaluated the effect of the maximum rotation of variable angle screws on the range of motion (ROM), cage migration, and subsidence. METHODS: Five finite element models were developed from a C2-C7 cervical spine model. The first model was an intact C2-C7 spine model, and the second model was an altered C2-C7 model with C4-C6 cage insertion and a 2-level static plate. The other three models were altered C2-C7 models with the same C4-C6 cage insertion and a 2-level dynamic plate. RESULTS: The ROM of C4-C6 in the static plate model was reduced by ∼14° from the intact model but only reduced by ∼9° in the dynamic plate models. The maximum migration and subsidence at the cage-endplate interface in the dynamic plate models were lower than those in the static plate model for all moments. The von Mises stress of the C3-C4 and C6-C7 discs in the dynamic plate models was lower than that in the static plate model. CONCLUSIONS: Our results indicate that dynamic plating has promising potential (greater ROM and lower von Mises stress of discs) for stabilization in multilevel anterior cervical discectomy and fusion than static plating, although both dynamic and static plates showed lower ROM than the intact model. A lower screw rotational angle resulted in superior biomechanical performance (lower incidence of migration and subsidence) compared with a higher rotational angle in multilevel applications, regardless of loading.

Use of the NobleStitch™ EL for the treatment of patients with residual right-to-left shunt following device closure of PFO.

The unique design of the NobleStitch™ EL allows it to be used to close residual defects following failed device PFO closure without impacting the integrity of previously placed double-disk Gore occluders.

Cage-screw and anterior plating combination reduces the risk of micromotion and subsidence in multilevel anterior cervical discectomy and fusion-a finite element study.

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is widely used to treat patients with spinal disorders, where the cage is a critical component to achieve satisfactory fusion results. However, it is still not clear whether a cage with screws or without screws will be the best choice for long-term fusion as the micromotion (sliding distance) and subsidence (penetration) of the cage still take place repeatedly. PURPOSE: This study aims to examine the effect of cage-screws on the biomechanical characteristics of the human spine, implanted cage, and associate hardware by comparing the micromotion and subsidence. STUDY DESIGN: A finite element (FE) analysis study. METHODS: A FE model of a C3-C5 cervical spine with ACDF was developed. The spinal segment was modeled with the removal of the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and discectomy was then implanted with a cage-screw system. Three models were analyzed: the first was the original spine (S1 model), the second, S2, was implanted with cages and anterior plating, and the third, S3, was implanted with a cage-screw system in addition to the anterior plate. All investigations were under 1 N•m in flexion, extension, lateral bending, and axial rotation situations. RESULTS: Finite element analysis (FEA) demonstrated that range of motion (ROM) at C3-C4 in the S2 model was significantly reduced more than that in the S3 model, while the ROM at both C4-C5 in the S3 model was reduced more than that in the S2 model in all simulations. The ROM at C3-C5 in the S1 model was reduced by over 5° in the S2 and S3 models in all loading conditions. The micromotion and subsidence at all contacts of C3-C5 in the S3 model were lower than that in the S2 model in all flexion, extension, bending, and axial simulations. The subsidence and micromotion could be seen in the barrier area of the S2 model, while they occurred near the edge of the screw in the S3 model. CONCLUSIONS: These results showed that the cage-screw and anterior plating combination has promising potential to reduce the risk of micromotion and subsidence of implanted cages in two or more level ACDFs. CLINICAL SIGNIFICANCE: The use of double segmental fixation with cage-screw anterior plating combination constructs may increase the stiffness of the construct and reduce the incidence of clinical and radiographic pseudarthrosis following multilevel ACDF, which in turn, could decrease the need for revision surgeries or supplemental posterior fixation.

Intracranial Tubular Retractor Systems: A Comparison and Review of the Literature of the BrainPath, Vycor, and METRx Tubular Retractors in the Management of Deep Brain Lesions.

In neurosurgery, parenchymal injury resulting from focal exertion of pressure on retracted tissue is a common complication associated with the use of plate and self-sustaining retractors to access deep intraparenchymal lesions. Tubular retractors, including Vycor, BrainPath, and METRx, were developed to reduce retraction injuries via radial dispersion of force. Our study seeks to compare these retraction systems and assess their respective indications, benefits, and associated complications. A systematic review of PubMed MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and Cochrane Database of Systematic Reviews was performed. Twenty-nine articles (n = 289 patients) for BrainPath, 12 articles (n = 106 patients) for Vycor, and 3 articles for METRx (n = 31 patients) met the inclusion criteria. This report is the first formal comparison of the BrainPath, Vycor, and METRx tubular retraction systems. We found that all 3 retractors were effective in accessing intraparenchymal lesions. Although we found that the retractor systems were used more commonly in different locations and for different diseases, there was no significant difference in complications or mortality among the 3 retractors.

Association Between Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes.

Importance: Adults with comorbidity have less physiological reserve and an increased rate of postoperative mortality and readmission after the stress of a major surgical intervention. Objective: To assess postoperative mortality and readmission among individuals with diabetes with or without preoperative prescriptions for metformin. Design, Setting, and Participants: This cohort study obtained data from the electronic health record of a multicenter, single health care system in Pennsylvania. Included were adults with diabetes who underwent a major operation with hospital admission from January 1, 2010, to January 1, 2016, at 15 community and academic hospitals within the system. Individuals without a clinical indication for metformin therapy were excluded. Follow-up continued until December 18, 2018. Exposures: Preoperative metformin exposure was defined as 1 or more prescriptions for metformin in the 180 days before the surgical procedure. Main Outcomes and Measures: All-cause postoperative mortality, hospital readmission within 90 days of discharge, and preoperative inflammation measured by the neutrophil to leukocyte ratio were compared between those with and without preoperative prescriptions for metformin. The corresponding absolute risk reduction (ARR) and adjusted hazard ratio (HR) with 95% CI were calculated in a propensity score-matched cohort. Results: Among the 10 088 individuals with diabetes who underwent a major surgical intervention, 5962 (59%) had preoperative metformin prescriptions. A total of 5460 patients were propensity score-matched, among whom the mean (SD) age was 67.7 (12.2) years, and 2866 (53%) were women. In the propensity score-matched cohort, preoperative metformin prescriptions were associated with a reduced hazard for 90-day mortality (adjusted HR, 0.72 [95% CI, 0.55-0.95]; ARR, 1.28% [95% CI, 0.26-2.31]) and hazard of readmission, with mortality as a competing risk at both 30 days (ARR, 2.09% [95% CI, 0.35-3.82]; sub-HR, 0.84 [95% CI, 0.72-0.98]) and 90 days (ARR, 2.78% [95% CI, 0.62-4.95]; sub-HR, 0.86 [95% CI, 0.77-0.97]). Preoperative inflammation was reduced in those with metformin prescriptions compared with those without (mean neutrophil to leukocyte ratio, 4.5 [95% CI, 4.3-4.6] vs 5.0 [95% CI, 4.8-5.3]; P < .001). E-value analysis suggested robustness to unmeasured confounding. Conclusions and Relevance: This study found an association between metformin prescriptions provided to individuals with type 2 diabetes before a major surgical procedure and reduced risk-adjusted mortality and readmission after the operation. This association warrants further investigation.

Use of Vycor Tubular Retractors in the Management of Deep Brain Lesions: A Review of Current Studies.

BACKGROUND: Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors, such as the ViewSite Brain Access System (VBAS), have been developed to reduce mechanical damage from retraction by dispersing the force of the retractor radially over the parenchyma. Therefore, we sought to review the current literature to accurately assess the indications, benefits, and complications associated with use of VBAS retractors. METHODS: A literature search for English articles published between 2005 and 2019 was performed using the MEDLINE database archive with the search terminology "Vycor OR ViewSite OR Brain-Access-System NOT glass." The VBAS website was also examined. Only articles detailing neurosurgical procedures using the VBAS tubular retractor system alone, or in combination with other retractors, were included. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twelve publications (106 patients) met the inclusion criteria. The VBAS retractor was used for tumor resections, hematoma evacuations, cyst removal, foreign body extractions, and lesion resection in toxoplasmosis and multiple sclerosis. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 63% of tumor excisions, and subtotal resection was achieved in 37%. Hematoma evacuation was successful in all cases. There were 3 short-term postoperative complications linked to the retractor, with an overall complication rate of 2.8%. CONCLUSIONS: This report is the first formal assessment of the VBAS, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe and efficacious tubular retraction system that can be used for tumor biopsy and resection, colloid cyst removal, hematoma evacuation, and removal of foreign bodies. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.

The Use of BrainPath Tubular Retractors in the Management of Deep Brain Lesions: A Review of Current Studies.

BACKGROUND: Traditional retraction to access deep intraparenchymal brain lesions results in vascular disruption. Tubular retractors such as the BrainPath tubular retractor system were developed to reduce retractor-related force injuries via radial dispersion of force. Our study seeks to assess the indications, benefits, and complications associated with BrainPath retractors. METHODS: A literature search of PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Cochrane Database of Systematic Reviews was performed. The search terminology used was "BrainPath OR Brain-Path." The BrainPath Web site was also examined. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twenty-nine articles (n = 289 patients) met the inclusion criteria. BrainPath was used primarily for tumor resections and hematoma evacuations. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 79% of tumor excisions and subtotal resection in 21%. Hematoma evacuation >90% of original hematoma volume was achieved in 65.1% of cases, 75%-90% of original volume in 21.7%, and <75% in the remaining 13.2%. The complication rate attributed to retractor use was 8.3%. CONCLUSIONS: This report is the first formal assessment of the BrainPath tubular retraction system, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe, efficacious system that can be used for tumor resection or biopsy and hematoma evacuation. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.

Cochlear Implantation and Facial Nerve Synkinesis in an Infant with Hypoplastic Internal Auditory Canals - A Case Report.

Sensorineural hearing loss (SNHL) is a common finding in cases of the congenital internal acoustic canal (IAC) stenosis. Previous reports reveal a relationship between IAC stenosis and facial palsy as well as vestibular dysfunction. This case identifies a patient with bilateral profound SNHL, bilateral IAC stenosis, and temporary unilateral facial palsy who went on to receive bilateral cochlear implants (CI). The facial nerve synkinesis that was found in this patient with hypoplastic IACs occurred after a cochlear implant activation. The synkinesis was ipsilateral to prior transient facial palsy after salmonella infection. Patients with IAC stenosis and cochlear nerve hypoplasia may respond well to cochlear implantation, but caution should be used when considering CI with an emphasis on counseling for possible facial nerve complications.

Reduction of surgical site infections in colorectal surgery: A 10-year experience from an independent academic medical center.

BACKGROUND: Surgical site infections (SSI) are a source of patient morbidity and increased cost. In 2007, our organization discovered an SSI rate of 18% after colorectal surgery (CRS), corresponding to an ACS NSQIP benchmarked high outlier. METHODS: From 2007 to 2016, surgeons championed a stepwise, multidisciplinary improvement pathway for SSI reduction. NSQIP was used to track SSI rates and estimate cost savings. RESULTS: From 2007 to 2016, 1508 patients underwent CRS at our facility. In 2007, our SSI rate was 18%. In 2016, the SSI rate was 7%, corresponding to a NSQIP benchmarked exemplary performance. 54 patients avoided the morbidity of a SSI. The expense of SSI reduction implementation was $180,000. Cost savings was estimated at $1.3 million. CONCLUSIONS: Our approach reduced SSI rates by 58% over ten years. We observed a significant morbidity reduction and cost savings. Our strategy could be adopted within other medical centers focused on CRS SSI improvement.

The effect of mupirocin dressings on postoperative surgical site infections in elective colorectal surgery: A prospective, randomized controlled trial.

BACKGROUND: Surgical site infections (SSIs) are the most common nosocomial infection among surgical patients. We hypothesized that mupirocin ointment would decrease SSI rates compared to standard surgical dressings in patients undergoing colorectal surgery. METHODS: A prospective randomized controlled trial was performed, including patients undergoing elective open and minimally invasive colorectal surgery. Patients were randomized 1:1 to receive standard gauze dressings or mupirocin ointment (2%) dressings. The primary outcome was incisional SSI at 30 days postoperative. RESULTS: A total of 192 patients were enrolled; 150 underwent randomization: 75 to the mupirocin arm, and 75 to the standard gauze dressing arm. Three SSIs occurred; one (1%) in the mupirocin group, and two (3%) in the standard gauze group (P = 0.560). There was no significant difference between standard gauze dressings and mupirocin dressings. CONCLUSION: Mupirocin (2%) ointment failed to show a benefit compared to standard dressings for postoperative SSI.

Injection laryngoplasty in neonates and young children with unilateral vocal fold immobility.

INTRODUCTION: Although injection laryngoplasty (IL) is a well-accepted treatment strategy in older children and adults with unilateral vocal fold immobility (UVFI), its efficacy and safety have not been well studied in neonates and young children. OBJECTIVES: The main objective of this study was to evaluate the clinical and radiographic effects of IL on aspiration & dysphagia in neonates and young children with UVFI. METHODS: This was a retrospective chart review of infants and children who underwent IL at a tertiary children's hospital. The primary endpoints were improved aspiration and avoidance of gastrostomy tube placement. Additional endpoints included adverse airway and swallowing effects of IL. RESULTS: Eight patients were included in this case series. A total of 10 injection laryngoplasties were performed. Average corrected age of patients undergoing IL was 1.22 years(range 0.5-3.6 y). Seven out of 8 patients had preoperative modified barium swallow (MBS). Five out of seven showed improvement in aspiration. Three out of six (50%) patients who did not have gastrostomy tube preoperatively, were able to avoid gastrostomy tube. No adverse effects were noted following IL. One patient with severe tracheomalacia ultimately required tracheostomy 5 months after IL. CONCLUSION: Injection laryngoplasty appears to be a safe and effective therapeutic option in neonates and young children with unilateral vocal cord immobility and associated aspiration. It may be an effective treatment to improve aspiration and avoid gastrostomy tube placement. Further investigation is warranted. LEVEL OF EVIDENCE: 4.

Evolution of Characteristics From Letters of Recommendation in General Surgery Residency Applications.

OBJECTIVE: Letters of recommendation (LOR) describe applicants being considered for Surgery Residencies. Although objective measures have been studied, the descriptive language of LOR and changes over time has yet to be evaluated. The objective of this study was to evaluate the descriptions of autonomy, teamwork, and ACGME core competencies in the LOR of applicants over time. DESIGN: After IRB approval, LOR of residents who matriculated into our Surgery Residency were evaluated. Residents were grouped into early (1973-1999) vs. late (2000-2016) applications, and generational groups (baby boomers: 1943-1960, generation X: 1961-1980, millennial: 1981-1999), to identify the following themes: autonomy, teamwork, ACGME core competencies, and technical skills. Content analysis was performed using Nvivo 11. SETTING: Independent academic medical center. PARTICIPANTS: LOR from 76 of 77 residents who matriculated into our Surgery Residency from 1973-2016. RESULTS: 255 LOR were available. Autonomy was described 175 times in 43 residents, and teamwork was described 263 times in 51 residents. Teamwork was more common in late vs. early applications (82% vs 53%; p = 0.007), and autonomy was present in 53% vs 61% of early vs late applications (p = 0.490). Teamwork was more commonly noted among millennial versus generation X and baby boomer applicants (92% vs 59% vs 47%; p = 0.006). Core competencies were detected 1445 times, with an increase in systems-based practice, and practice-based learning and improvement in early versus late applications (0 vs 16%, p = 0.001; 37% vs 74%, p = 0.025). Professionalism (68% vs 79%) and medical knowledge (74% vs 79%) were described consistently in early and late applications. Technical skills were described in 58% of early and 71% of late applications (p = 0.230). CONCLUSIONS: LOR for surgery residency applicants has evolved over time with increased teamwork concepts. Descriptions of practice-based learning, system-based practice, research, and volunteerism have increased, while professionalism, medical knowledge, and technical skills were consistently described over time.

Daily Fantasy Football and Self-Reported Problem Behavior in the United States.

Traditional, season-long fantasy sport participation has grown considerably since the late 1990s, and in an attempt to capitalize on this growing demand, daily fantasy sports (DFS) providers have created a new game where money changes hands instantly. This change has led some legal commentators and state agencies to believe the game is a form of Internet gambling similar to online poker, blackjack, and sports wagering, and thus, it requires increased regulation or even prohibition. Little is known, however, about the gambling behavior associated with DFS participation. Thus, the purpose of the current study was to examine problem gambling severity in conjunction with DFS participant motives, perceptions, and consumption behavior. Over 500 DFS participants were surveyed, and the results suggest DFS participants behave similarly with participants in other forms of gambling activities. In addition, the findings suggest additional consumer protections may be needed to prevent further problem behavior such as chasing.

Implementation of an Enhanced Recovery After Surgery Program for Colorectal Surgery at a Community Teaching Hospital.

INTRODUCTION: Perioperative programs aimed at decreasing surgical stress to colorectal patients can reduce hospital length of stay and morbidity while improving the patient's perception of the surgical experience. Our goal was to transform patient care from a perioperative platform based on individual physician and nurse choice to a standardized evidence-based Enhanced Recovery After Surgery (ERAS) protocol for all patients undergoing elective colorectal resections. METHODS: An institutional review board-approved retrospective review was performed for the first 12 months of ERAS protocol-driven patient care in 2014 and compared to the prior 12 months (2013) of individual choice managed care. RESULTS: Ninety-nine patients and 92 patients underwent elective colorectal surgery in the post- ERAS and pre-ERAS period, respectively. The post-ERAS group experienced a shorter length of stay (4.9±2.7 vs 6.2±4.0 days, P=0.001), were more likely to advance to a general diet on postoperative day 1 (72% vs 9%, P<0.001), and had quicker return of bowel function (2.3±1.8 vs 2.8±1.1 days, P<0.0001) compared to the pre-ERAS group. Thirty-day complications were similar between the post-ERAS and pre-ERAS groups and included anastomotic leak (4% vs 0%, P=0.120), surgical site infections (4% vs 8%, P=0.990), and abscess (3% vs 3%, P=0.990). Eleven (11%) post-ERAS patients and 7 (8%) pre-ERAS patients were readmitted within 30 days postoperative (P=0.410). CONCLUSION: We implemented change through a new system of care based upon standardized evidence-based ERAS protocols through the preoperative, intraoperative, and postoperative patient experience. In the first year of the ERAS program, patients experienced a reduced length of stay without a significant difference in morbidity or mortality.

An Analysis of Future Publications, Career Choices, and Practice Characteristics of Research Presenters at an American College of Surgeons State Conference: A 15-Year Review.

OBJECTIVES: The Accreditation Council for Graduate Medical Education requires scholarly activity within general surgery residency programs. The association between in-training research presentations and postgraduation publications is unknown. We hypothesized that surgical trainee presentations at an American College of Surgeons (ACS) state chapter meeting resulted in peer-reviewed publications and future scholarly activity. DESIGN: The ACS Wisconsin state chapter meeting agendas from 2000 to 2014 were reviewed to identify all trainees who delivered podium presentations. A literature search was completed for subsequent publications. Program coordinators were queried and an electronic search was performed to determine practice location and type for each residency graduate. SETTING: Wisconsin state chapter ACS meeting. PARTICIPANTS: General surgery residents, fellows, and medical students in Wisconsin. RESULTS: There were 288 podium presentations by trainees (76% residents, 20% medical students, and 4% fellows). Presentations were clinical (79.5%) and basic science (20.5%). There were 204 unique presenters; 25% presented at subsequent meetings. Of these unique presenters, 46% published their research and 31% published additional research after residency. Among presenters who completed residency or fellowship (N = 119), 34% practiced in a university setting, and 61% practiced in a community setting; 31% practiced in Wisconsin. When comparing clinical vs basic science presenters, there was no difference in fellowship completion (37% vs 44%; p = 0.190) or practice type (38% vs 46% in a university setting; p = 0.397). Repeat presenters were more likely to pursue a fellowship vs those presenting once (76% vs 37%; p = 0.001). CONCLUSIONS: Research presentations by surgical trainees at an ACS state chapter meeting frequently led to peer-reviewed publications. Presenters were likely to pursue research opportunities after residency. Repeat presenters were more likely to pursue a fellowship. ACS Wisconsin chapter meetings provide an excellent opportunity for scholarly activity. These outcomes should encourage ACS chapters and ACS members to support trainee research.