j.jamcollsurg.2017.07.942

Vol. 225, No. 4S2, October 2017
polytrauma criteria, have been reviewed. One hundred and twenty
eight patients were excluded from statistical analysis (incomplete
folder, missed values of ISS or imagistic findings, unmentioned maneuvers in ICU or omitted autopsy protocol) and finally from 362
patients remained we retained 47 deaths (13% of patients included).
RESULTS: Twelve patients (3.3% admissions) had recognized errors in care that contributed to their death. Important errors patterns included: delayed control of abdominal and intra-thoracic
hemorrhage or inadequate recognition (6.3%), failure to secure
or protect airway (4.2%), inappropriate management of unstable
patients in 8.5% of deaths (long operative procedures, unstable patients sent to CT or to interhospital transfer), missed or delayed diagnoses (4.2%), and inadequate DVT prophylaxis (2.1%). By the
internal processing classification of causes, 25% were input errors,
41.7% were intentions errors and 33.3% were execution errors. By
phase of trauma management, 16.6% of errors occurred in the ED,
25% during the secondary survey and initial diagnostic, 33.3%
during surgery, 16.6% during transport to CT or interhospital
transfer, and 8.3% in the ICU stay.
CONCLUSIONS: This study combines contemporary understanding of error causation, classification and proposes their remediation
with a specific process and protocols.
Failure to Graduate from Surgical Residency:
A 10-Year Analysis
Charalampos Siotos, MD, Rachael M Payne,
Scott D Lifchez, MD, FACS, Damon Cooney, MD,
Gedge D Rosson, MD, Carisa M Cooney, MPH
Johns Hopkins University, Baltimore, MD
INTRODUCTION: General surgery and surgical subspecialty residents account for nearly 19% of residents overall; however, little
information exists regarding residents who are accepted for surgical
residency but never graduate. We sought to evaluate graduation
failure rates and associated factors for surgical residents.
METHODS: We evaluated information provided by the Accreditation Council for Graduate Medical Education on residents in surgery
and surgical subspecialties during the 2007 to 2016 academic years.
We extracted total number of graduating residents per year, total number of residents who failed to graduate per year, and reasons for discontinuation of residency. Ratios and proportions were calculated to
estimate potential differences among failure-to-graduate rates.
RESULTS: When assessing all residents and specialties, an average
of one out of every 14.3 residents will not graduate. The ratio is
lower for surgical specialties (1:9, range 7.6:1-11.2:1), indicating
that surgical residents are less likely to complete residency. From
2007-2015, the greatest decrease in ratio (47%) was shown in general surgery while the greatest increase was in otolaryngology
(158%). In cases when reason was known, more than 51% of surgical residents withdrew, 38% transferred to different programs,
and 9% were dismissed.
CONCLUSIONS: Our findings indicate that surgical residents are
more likely to discontinue training prior to completion than
Scientific Poster Presentations: 2017 Clinical Congress
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residents in medical specialties. General surgeons were the most
likely and otolaryngology residents the least likely to discontinue
training. Additional ratios among subspecialties vary, possibly
reflecting differences in residency duration and/or associated
burn-out rates. Further studies are required to investigate possible
barriers to completing surgical residencies.
Formal Didactic Training Improves Resident
Understanding and Communication of Brain
Death
Jeanette Zhang, MD, Andrea L Lubitz, MD,
Gweneth D O’Shaughnessy, Andrea Reynolds,
Amy J Goldberg, MD, FACS
Temple University Hospital, Gift of Life Donor Program,
Philadelphia, PA
INTRODUCTION: Understanding brain death is crucial in the organ donation process for families and physicians. This will become
more vital as the discrepancy between people awaiting transplantation and available donors continues to grow. We hypothesized that
formal didactic training will improve residents’ understanding of
and comfort in communicating brain death.
METHODS: A total of 722 residents in general surgery, internal
medicine, neurology, pediatrics and emergency medicine at 10 academic medical centers completed a didactic program followed by
simulation on communicating brain death. Resident knowledge
and comfort were evaluated in pre- and post-didactic assessments.
RESULTS: Sixty-nine percent of trainees had taken care of at least
one patient with traumatic brain injury leading to brain death prior
to the didactic program. However, 42 percent reported never
receiving instruction on how to explain brain death. Residents’
knowledge of the definition of brain death improved after the
educational session. More trainees indicated in the post-assessment
that conversations about donation should occur after pronouncement and after the family has achieved understanding of brain
death as death (94% vs 55%, p<0.05). Participants also reported
feeling more comfortable and confident discussing brain death after
the didactic. On subset analysis, the improvement in responses was
not significantly different between surgical and non-surgical
residents.
CONCLUSIONS: Residents across specialties reported improved
knowledge and comfort in communicating about brain death,
and better understanding of the organ donation process after
completing our didactic training. Standardized educational programs will become increasingly essential as the need for donors
continues to grow.
Hemangiomas and Vascular Malformation of
Head and Neck: When to Operate?
Andre´s C Limardo, Luis Blanco, Adrı´an Ortega, Rube´n Padı´n
Hospital Prof A Posadas, El Palomar, Argentina
INTRODUCTION: Hemangiomas and vascular malformations are
different congenital anomalies in pathogenesis, evolution and
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Scientific Poster Presentations: 2017 Clinical Congress
treatment, which often involve multiple anatomical spaces in the
head and neck region. All lesion are histological benignity. The
therapeutic possibilities include conservative medical treatment,
surgery, embolization followed by surgery or intralesional injection
of Sclerosing substances.
METHODS: Retrospective and observational study. The aim is
define criteria for surgery valuing the aesthetic and functional alteration of the affected organs. We presents 37 adult patients with
vascular anomalies in the cervicofacial region, treated in a period
from January 2006 to December 2016. Vascular anomalies were
categorized based on histopathology, dividing in hemangiomas
and vascular anomalies.
RESULTS: Of 37 patients, 20 had hemangiomas and 17 vascular
anomalies. Cervicofacial vascular abnormalities were most
frequently located in lip. Six patients had observation and 31 patients were performed surgery by present symptoms, disorders cosmetics or by the presence of bulky tumor. The embolization prior
to the resection was used in the malformation arteriovenous.
CONCLUSIONS: We perform surgery by symptomatic and/or
deforming lesions with low possibility of injured vital structures
in the area, avoiding also submit to the patient to risk vital by complications hemodynamic. The surgery should never be mutilating.
In the stage pre-teenager is prefer a criterion conservative. The
feature benign of these injuries allows a conduct expectant until
the patient complete their stage of growth.
Incorporating NSQIP into Surgical Morbidity
and Mortality Conference Promotes an
Environment of Education, Transparency, and
Accountability
Kendal M Endicott, MD, Sara L Zettervall, MD, MPH,
R Luke Rettig, Neerav Patel, MD, Lauri Buckley,
Stanley M Knoll, MD, Khashayar Vaziri, MD, FACS
George Washington University, Washington, DC
INTRODUCTION: Surgical Morbidity and Mortality Conference
(M&M) nationwide lacks a standardized structure. We compared
implementation of NSQIP definitions to structure our M&M vs
our current system of self-identification and review.
METHODS: A prospective study was performed to compare the
identification of adverse events and the educational value of our
M&M conference before and after implementation of NSQIP definitions over 10 weeks. Chart review was performed of all cases to
identify NSQIP defined M&Ms. Surveys were administered before
and after intervention to assess educational value. All presented
M&Ms were evaluated for adequate reporting of adverse events
and areas for improvement. Survey and presentation data were
compared using Student’s T or Mann-Whitney testing as appropriate. P-values <.05 were considered significant.
RESULTS: Pre-intervention, 15% of occurrences were identified
compared to 81% post-intervention. One of three deaths pre-intervention was identified vs four of four identified post-intervention.
Faculty, residents, and students found improved clarity and
J Am Coll Surg
education content in cases presented as well as improved identification of etiology, learning points, and prevention of future adverse
events (all p<.01). Residents and faculty found the post-intervention model better identified and communicated adverse events
(p¼.02), opportunities for prevention (p¼.04), and promoted
improved transparency (p<.01) and inclusion of all adverse events
(p<.01). 85% of participants supported the changes in M&M
conference.
CONCLUSIONS: Incorporation of NSQIP into M&M standardizes identification and discussion of adverse events thus identifying
opportunities for improvement and augmenting educational content. Consideration of the use of NSQIP should be given to other
surgical departmental M&Ms.
Laparoscopic Radical Left Hemicolectomy: A
Bursa Omentalis Approach Makes Splenic
Flexure Mobilization Easy
Wei Wang, MD, Wenjun Xiong, Jin Wan
Guangdong Provincial Hospital of Chinese Medicine,
Guangzhou, Guangdong, China
INTRODUCTION: This study was aimed to explore the safety and
feasibility of laparoscopic radical left hemicoletomy using a bursa
omentalis approach.
METHODS: First, the left part of gastrocolic ligament was
dissected to enter bursa omentalis. The anterior lobe of mesentery
of transverse colon was dissected at the inferior border of pancreas
from right to left and a piece of gauze was placed at the inferior
border of pancreas for introduction. Second, the left Toldt’s fascia
was dissected at the level of the sacral promontory. The left Toldt’s
space was expanded cephalad and pancreas was identified clearly
with the introduction of the gauze. It was easy to combine left
Toldt’s space and bursa omentalis. Third, the lateral attachments
of the descending colon were separated.
RESULTS: A total of 32 patients with splenic flexure cancer underwent laparoscopic left hemicoletomy using a bursa omentalis
approach. No intra-operative complication was recorded. The
mean operative time was 134.227.6 min containing a mean laparoscopic manipulation time of 65.714.5 min. The mean estimated blood loss was 50.720.8 mL. The mean first time of
flatus was 41.512.1 hours. One patient developed a wound infection and was cured with percutaneous drainage discharged on 15
days after surgery. The mean hospital stay was 6.42.0 days.
CONCLUSIONS: This apparoach for laparoscopic radical left
hemicoletomy can be safe and feasible. The advantages of present
approach contain easy to identify pancreas when expanding the
left Told’s space and simple to mobilize the splenic flexure.
Leaders are Made, Not Born: A Leadership
Development Curriculum for General Surgery
Residents
Tejal Pandya, MD, Rachel Dirks, PhD, Amy Kwok, MD, FACS
University of California, San Francisco-Fresno, Fresno, CA