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 e153 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 e154 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
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