Surgical critical care: Is work-life expectancy increasing? An analysis of American Board of Surgery recertification rates across subspecialties.

The practice of surgical critical care (SCC) has traditionally necessitated additional in-house, extended night and weekend clinical commitments, which can be viewed as less desirable for many surgeons. Therefore, the authors have observed that some SCC surgeons elect to transition their practice to focus solely on general surgery (GS) rather than continuing practicing both SCC and GS. We hypothesized that surgeons with a practice focused on SCC are more likely to make the transition to a GS practice than those who have certification in other subspecialties that are certified through the American Board of Surgery.

Walking blood bank: a plan to ensure self-sufficiency in an era of blood shortage.

Mass casualty incidents and massive transfusion requirements continue to plague the USA with hemorrhage remaining the number one cause of death in trauma. The unfortunate reality of numerous mass shootings in Southwest Texas has led to the need for a way in which to provide blood during these events as rapidly as it is required. Multiple agencies within the Southwest Texas system have united to help provide this life-saving blood to people when they need it most. This effort began with the development of a system for safe, efficient, and now widespread use of whole blood in the region. After demonstrating the success of delivering large quantities of blood during the Uvalde shooting, we have begun to develop a walking blood bank that is similar to what the miliary uses on the battlefield. The concept behind this initiative is to have a cohort of whole blood donors who are preselected to join the program which is now dubbed 'Heroes in Arms'. These donors will be called upon to donate whole blood during a massive transfusion event. Their blood will be rapidly screened prior to transfusion to the patient. This blood will still undergo the normal rigorous testing and, should any potentially transmissible diseases by discovered post-transfusion, the individual who received that product will be treated accordingly. Given the low rate of transmissible disease among this preselected population, combined with rapid screening prior to transfusion, the risk of a person receiving a transmissible disease is insignificant in comparison to the benefit of having blood to transfuse during hemorrhage. This model is a promising collaborative effort to provide in a timely and sufficient blood product in cases of major need which will consequently minimize the number of traumatically injured civilian patients who die from hemorrhage.

TITAN CSR: a new self-retaining retractor for abdominal surgery.

Background: Self-retaining retractors provide hands-free exposure and allow surgeons to use their hands to perform surgery rather than manually retract tissues. Non-table-mounted retractors offer rapid assembly, but they have been traditionally limited in their ability to provide adequate exposure of the abdomen. Table-mounted retractors provide excellent exposure, but their cumbersome and time-intensive assembly often precludes their use in emergency settings. The TITAN CSR surgical retractor is a novel, lightweight, expandable, and modular system which offers the benefits of both designs by providing rapid assembly and effective abdominal exposure without a table attachment. We describe our experience with this new retractor system. Methods: Retrospective case series of selected trauma and emergency surgery laparotomies at an urban academic level 1 trauma center using the TITAN CSR surgical retractor during a 1-year period. Results: The TITAN CSR surgical retractor was used to provide exposure for trauma and emergency surgery laparotomies in both adult and pediatric patients in 89 cases from July 2021 to July 2022. Without requiring a table attachment, the TITAN CSR retractor provided hands-free surgical exposure during a variety of procedures including traumatic hysterectomy, gastrorrhaphy, enterorrhaphies and colectomy. With the added utility of attaching Bookwalter-compatible retractor blades, it provided effective exposure of retroperitoneal structures. These structures included the inferior vena cava, left femoral vessels, and duodenum. All laparotomies presented were successfully completed without setting up a post or a connection to the surgical table. Discussion: The TITAN CSR surgical retractor was successfully used in a number of difficult trauma and emergency surgery laparotomies, providing effective intra-abdominal and retroperitoneal exposure without necessitating an attachment to the surgical table. This retractor has the potential to replace current retractor systems in abdominal surgery, providing the benefits of table-mounted and non-table-mounted designs while removing their various disadvantages.