6588 ASA Book.indb - American Surgical Association

Transcription

AMERICAN
SURGICAL
ASSOCIATION
Program
of the
135th Annual Meeting
Marriott Marquis
San Diego, California
Thursday, April 23rd
Friday, April 24th
Saturday, April 25th
2015
Table of Contents
Officers and Council
2
Committees
3
Foundation Trustees
5
Representatives
6
Future Meetings
7
General Information
8
Continuing Medical Education Accreditation Information
10
Program Committee Disclosure List
*
13
Faculty Disclosure List
*
13
Author Disclosure List
*
14
Discussant Disclosure List
*
23
New Honorary Fellows
26
Schedule-at-a-Glance
29
Program Outline
31
Program Detail and Abstracts
45
Alphabetical Directory of Fellows
*
105
Geographic Roster of Fellows
*
281
Necrology
309
Medallion for Scientific Achievement Recipients
310
Medallion for Advancement of Surgical Care Recipients
312
Flance-Karl Award Recipients
313
Foundation Fellowship Award Recipients
315
Foundation Contributors
*
317
Author Index
326
Record of Attendance
*
337
Membership Update Form
*
339
* These sections available on-site to professional attendees,
or by logging into americansurgical.info/membersOnly.cgi.
AMERICAN
SURGICAL
ASSOCIATION
Program
of the
Marriott Marquis
San Diego, California
Thursday, April 23th
Friday, April 24th
2015
2
AMERICAN SURGICAL ASSOCIATION
THE AMERICAN SURGICAL ASSOCIATION
2014–2015
OFFICERS
President
Anna M. Ledgerwood
President-Elect
James S. Economou
Vice-President
John M. Daly
Secretary
Ronald J. Weigel
Treasurer
Russell G. Postier
Recorder
Steven C. Stain
3
ADVISORY MEMBERSHIP COMMITTEE
Robin S. McLeod, Chair................................................................2005–2016
Monica M. Bertagnolli ...................................................................2010–2015
William C. Chapman......................................................................2012–2017
Edward E. Cornwell, III .................................................................2014–2019
Diana L. Farmer .............................................................................2012–2017
David R. Flum................................................................................2014–2019
Anthony A. Meyer .........................................................................2010–2015
H. Leon Pachter .............................................................................2013–2018
Alec Patterson ................................................................................2011–2016
Grace S. Rozycki ...........................................................................2009–2016
Michael G. Sarr ..............................................................................2011–2016
Kenneth W. Sharp ..........................................................................2013–2018
Craig R. Smith ...............................................................................2012–2017
Mark A. Talamini ...........................................................................2013–2018
Michael T. Watkins ........................................................................2013–2018
Sharon M. Weber ...........................................................................2014–2019
ARRANGEMENTS COMMITTEE
A. Brent Eastman, Chair
COUNCIL
L.D. Britt ........................................................................................2013–2016
Timothy J. Eberlein ........................................................................2012–2015
Layton F. Rikkers ...........................................................................2014–2017
AUDIT COMMITTEE
Lynt B. Johnson, Chair ..................................................................2013–2015
Karen E. Deveney ..........................................................................2015–2017
David W. McFadden ......................................................................2014–2016
American Surgical Association
Administrative Ofces
500 Cummings Center, Suite 4550
Beverly, MA 01915
Phone: (978) 927-8330
Fax: (978) 524-8890
Email: [email protected]
Or visit: americansurgical.org
ETHICS AND PROFESSIONALISM COMMITTEE
L.D. Britt, Chair.............................................................................2014–2015
James S. Economou .......................................................................2014–2018
Anna M. Ledgerwood ....................................................................2014–2017
Mary H. McGrath...........................................................................2014–2016
Layton F. Rikkers ...........................................................................2014–2016
George C. Velmahos ......................................................................2014–2017
4
5
HONORARY FELLOWSHIPS COMMITTEE
PROGRAM COMMITTEE
Jay L. Grosfeld, Chair ...................................................................2007–2016
Yuman Fong ...................................................................................2013–2019
Keith D. Lillemoe ..........................................................................2014–2020
Marco G. Patti ................................................................................2015–2021
Courtney M. Townsend, Jr. ............................................................2011–2017
Donald D. Trunkey.........................................................................2011–2017
Valerie W. Rusch, Chair.................................................................2010–2016
Herbert Chen ..................................................................................2014–2019
Jeffrey A. Drebin ............................................................................2012–2017
Roger R. Perry ...............................................................................2013–2018
Loring W. Rue, III ..........................................................................2011–2015
FLANCE-KARL AWARD COMMITTEE
Ronald P. DeMatteo, Chair ............................................................2010–2015
Timothy R. Billiar ..........................................................................2013–2018
Jeffrey A. Drebin ............................................................................2014–2019
Thomas F. Tracy, Jr. .......................................................................2011–2016
Ronald J. Weigel ............................................................................2012–2017
MEDALLION FOR THE ADVANCEMENT OF
SURGICAL CARE AWARD COMMITTEE
James S. Economou, Chair ............................................................2014–2017
Anna M. Ledgerwood ....................................................................2013–2016
Layton F. Rikkers ...........................................................................2012–2015
Steven C. Stain ...............................................................................2012–2015
Ronald J. Weigel ............................................................................2012–2015
Anthony D. Whittemore.................................................................2012–2015
NOMINATING COMMITTEE
Timothy J. Eberlein, Chair ............................................................2012–2017
Kirby I. Bland ................................................................................2011–2016
L.D. Britt ........................................................................................2013–2018
Layton F. Rikkers ...........................................................................2014–2019
Donald D. Trunkey.........................................................................2010–2015
President, President-Elect, Secretary, and Recorder, ex ofcio with vote
TRUSTEES OF THE
FOUNDATION
Chair
Anthony D. Whittemore
Vice Chair
Donald D. Trunkey
Secretary
Ronald J. Weigel
Treasurer
Russell G. Postier
Trustees
Kirby I. Bland
L.D. Britt
Timothy J. Eberlein
Ex-Ofcio
Anna M. Ledgerwood
6
REPRESENTATIVES
FUTURE MEETINGS OF THE
AMERICAN BOARD OF SURGERY
Karen J. Brasel ...............................................................................2012–2018
William C. Chapman......................................................................2013–2019
K. Craig Kent .................................................................................2013–2019
Selwyn M. Vickers .........................................................................2009–2015
AMERICAN BOARD OF THORACIC SURGERY
Robert S. Higgins ...........................................................................2011–2017
Richard J. Shemin ..........................................................................2005–2015
AMERICAN COLLEGE OF SURGEONS,
BOARD OF GOVERNORS
Russell J. Nauta..............................................................................2013–2016
Bruce D. Schirmer .........................................................................2014–2017
ADVISORY COUNCIL FOR GENERAL SURGERY
W. Scott Melvin .............................................................................2012–2015
SURGICAL RESEARCH COMMITTEE
Jeffrey B. Matthews .......................................................................2013–2016
ASSOCIATION OF AMERICAN MEDICAL COLLEGES,
COUNCIL OF FACULTY AND ACADEMIC SOCIETIES
Susan Galandiuk ............................................................................2013–2016
Ajit K. Sachdeva ............................................................................2013–2016
NATIONAL ASSOCIATION FOR BIOMEDICAL RESEARCH
Ronald M. Stewart .........................................................................2013–2015
April 14–16, 2016
Swissôtel Chicago
Chicago, Illinois
April 20–22, 2017
Philadelphia Marriott Downtown
Philadelphia, Pennsylvania
7
8
GENERAL INFORMATION
EMBARGO POLICY: The embargo on studies and their associated abstracts (including those posted online prior to the conference) scheduled for
presentation at the American Surgical Association’s 135th Annual Meeting,
April 23–25, 2015, San Diego, California, is the date and time of each individual scientic presentation (not the beginning of the overall session in
which it has been scheduled). News media activities are restricted until the
embargo lifts. Any news media activity about a study and its associated abstract must include the following: “The complete manuscript of this study
and its presentation at the American Surgical Association’s 135th Annual
Meeting, April 2015, in San Diego, California, is anticipated to be published
in the Annals of Surgery pending editorial review.”
The Marriott Marquis, San Diego, California, is the headquarters of the
American Surgical Association for the 135th Annual Meeting, April 23–25,
2015.
REGISTRATION: The Registration Desk for the 135th Annual Meeting is
located outside the Marina Ballroom during the following hours:
Wednesday, April 22nd
Friday, April 24th
2:00 p.m.–6:00 p.m.
7:00 a.m.–5:15 p.m.
7:30 a.m.–5:00 p.m.
7:30 a.m.–11:00 a.m.
Fellows and guests who have pre-registered are required to sign the registration book and pick up registration materials at the ASA Registration Desk.
Registration is also available on-site.
SPEAKERS AND DISCUSSANTS: All manuscripts presented at the Scientic Sessions of the Annual Meeting must be submitted electronically to
The Annals of Surgery at www.editorialmanager.com/annsurg prior to the
presentation of the paper. The time allowed for each presentation is ten minutes. Following the presentation, the Primary Discussant will be allotted
three minutes for discussion. All additional discussants will be allotted two
minutes. The total amount of time provided for discussion is fteen minutes.
Please note the use of slides will NOT be permitted for discussants.
SPEAKER READY ROOM: The Speaker Ready Room is located in the Palomar Room. Authors are requested to submit their PowerPoint presentations on
USB memory drive or CD-ROM the day prior to their session to the technician
in the Speaker Ready Room. Speaker Ready Room hours are:
Wednesday, April 22nd
Friday, April 24th
2:00 p.m.–6:00 p.m.
7:00 a.m.–5:15 p.m.
7:30 a.m.–5:00 p.m.
7:30 a.m.–11:00 a.m.
9
BANQUET: The Annual Reception and Banquet is open to Fellows of the
Association and their registered spouses/partners, as well as Invited Guest
Physicians and Residents and their registered spouses/partners. The Reception and Banquet is scheduled for Friday, April 24th, with the reception taking place in the Marina Ballroom Foyer and dinner in the Marina Ballroom
(black tie preferred, but dark suits are acceptable).
SPECIAL EVENTS:
Address by the President
Forum Discussion
Thursday, April 23rd 10:50 a.m.
Friday, April 24th
10:30 a.m.
“Development of Surgical Scientists”
Executive Session (Fellows Only)
Friday, April 24th
Reception & Banquet
th
Friday, April 24
4:00 p.m.
7:00 p.m.
SPOUSE/GUEST HOSPITALITY: The Spouse/Guest Hospitality Suite is
located in the Catalina Room from 7:00 a.m. to 10:30 a.m., Thursday, April
23rd, and from 7:30 a.m. to 10:30 a.m. on Friday, April 24th and Saturday,
April 25th. The Local Arrangements Committee will have information on activities of interest and maps available in the room.
REGISTRANT BADGES: Badges are required for admittance to the ASA
Scientic Sessions. Badge colors represent the following designations:
Blue — Member/Fellow
Cream — Honorary Fellow
Green — Guest Physician
White — Spouse/Guest
10
CME MISSION/PURPOSE AND CONTENT
LEARNING OUTCOMES
The Continuing Medical Education Mission of the American Surgical Association is to provide a national forum for presenting the developing state-ofthe-art and science of general and sub-specialty surgery and the elevation
of the standards of the medical/surgical profession. This mission is accomplished primarily by conducting an annual scientic meeting consisting of
selected presentations containing the most current information available on
clinical and research topics related to surgery or surgical specialties, including studies on outcomes, practice and science of surgery and ethical and
other issues that affect its practice. In addition, the meeting features special
invited speakers who address a variety of topics directly or indirectly related
to the practice of surgery. The meeting is presented for the benet of those
physicians, surgeons and researchers involved in the study, treatment and
cure of diseases associated with the entire spectrum of human disease. The
meeting provides for a free exchange of information and serves the professional needs of the membership and invited guests. The Association’s mission is augmented by the publication of the scientic papers presented at the
annual meeting in the Annals of Surgery, a monthly scientic publication
distributed to subscribers throughout the world and by the publication of the
Proceedings of the Annual Meeting and the scientic papers in the Transactions of the American Surgical Association, an annual publication distributed
to the membership.
At the conclusion of the Annual Meeting, participants should have an
enhanced understanding of the latest techniques and current research specically related to the elds of clinical surgery, experimental surgery and related
sciences, surgical education and the socioeconomic aspects of surgical care.
Through the open discussion periods and the Forum Discussion, participants
will have the opportunity to hear the pros and cons of each paper presented
to gain an overall perspective of their current practices and to utilize results
presented in order to select appropriate surgical procedures and interventions
for their own patients and to integrate state-of-the-art knowledge into their
current practice and/or research.
LEARNING OBJECTIVES
The Annual Meeting of the American Surgical Association is designed to
provide two and one half days of comprehensive educational experiences
in the elds of clinical surgery, experimental surgery and related sciences,
surgical education and the socioeconomic aspects of surgical care. It is the
Association’s intent to bring together at this meeting the leading surgeons
and scientists from North America and other continents to freely and openly
discuss their latest clinical and research ndings.
11
EDUCATIONAL METHODS
Authored papers supported by audio/visual presentations, panel discussion,
and open group discussion.
ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical
Education through the joint providership of the American College of Surgeons
and the American Surgical Association. The American College of Surgeons
is accredited by the ACCME to provide continuing medical education for
physicians.
AMA PRA CATEGORY 1 CREDITS™
The American College of Surgeons designates this live activity for a maximum of 16.0 AMA PRA Category 1 Credits™. Physicians should claim only
the credit commensurate with the extent of their participation in the activity.
12
FACULTY DISCLOSURE INFORMATION
In accordance with the ACCME Accreditation Criteria, the American College of Surgeons, as the accredited provider of this activity, must ensure
that anyone in a position to control the content of the educational activity
has disclosed all relevant nancial relationships with any commercial interest. Therefore, it is mandatory that both the program planning committee
and speakers complete disclosure forms. Members of the program committee were required to disclose all nancial relationships and speakers were
required to disclose any nancial relationship as it pertains to the content
of the presentations. The ACCME denes a ‘commercial interest’ as “any
entity producing, marketing, re-selling, or distributing health care goods or
services consumed by, or used on, patients”. It does not consider providers of
clinical service directly to patients to be commercial interests. The ACCME
considers “relevant” nancial relationships as nancial transactions (in any
amount) that may create a conict of interest and occur within the 12 months
preceding the time that the individual is being asked to assume a role controlling content of the educational activity.
ACS is also required, through our joint providership partners, to manage any
reported conict and eliminate the potential for bias during the activity. All
program committee members and speakers were contacted and the conicts
listed below have been managed to our satisfaction. However, if you perceive
a bias during a session, please report the circumstances on the session evaluation form.
Please note we have advised the speakers that it is their responsibility to
disclose at the start of their presentation if they will be describing the use of
a device, product, or drug that is not FDA approved or the off-label use of an
approved device, product, or drug or unapproved usage.
The requirement for disclosure is not intended to imply any impropriety of
such relationships, but simply to identify such relationships through full disclosure and to allow the audience to form its own judgments regarding the
presentation.
26
New Honorary Fellows Introductions
Jiahong Dong, M.D.
Dr. Jiahong Dong is the new executive President of the Beijing Tsinghua Changgung
Hospital, a comprehensive hospital afliated
to Tsinghua University. He is one of the preeminent hepatobiliary surgeons in the world.
Professor Dong was educated at the Jiansu
Medical College, and did his surgical training at the Third Military Medical University in Chongquing. In 1996, he rose to be
the Surgeon-in-Chief of the Hepatobiliary
Surgery Center at the Third Military Medical University. In 2006, at age 46, he became
the Head of the Chinese People’s Liberation Army General Hospital (301)
in Beijing, a position he held until this year. This is the biggest and most
advanced hospital in China.
Professor Dong has received many honors, and has served as President of the
Chinese Society of Biliary Surgery since 2006, and Vice-president of the
Chinese Chapter of the International Hepato-pancreatico-biliary association
since 2007. He is on many editorial boards including serving as the editor-in
chief of the Chinese Journal of Digestive Surgery. He is famous for his technical surgical skills, and technical innovations in hepatic resections, in vascular reconstructions, and in robotic liver surgery. He is also famous for his
contributions to education and to international collaborations. For his works
in technical surgery, and for surgical education, he was made Honorary fellow of the French Academy of Surgery.
We welcome him to the American Surgical Association.
27
R. Ronan O’Connell, M.D.
Patrick Ronan O’Connell is a native of Dublin, Ireland. He graduated from Trinity College Dublin in 1979 with rst place and rst
class honours. His initial surgical training
was in Dublin with Professor Tom Hennessy
(also an Honorary Fellow of ASA). He subsequently gained an NIH Fogarty Scholarship to work as a research fellow with Dr
Keith Kelly at the Mayo Clinic, Rochester,
Minnesota. He continued his training with a
Fellowship in Colon and Rectal Surgery at
Mayo and returned as a senior registrar to
work in Cork and Dublin, Ireland. Following a year as a Senior Lecturer
working with Professor Sir Norman Williams at the London Hospital, Professor O’Connell returned to Dublin as consultant surgeon at the Mater
Misericordiae Hospital in 1990.
In 2007 he was appointed Professor of Surgery and Head of Surgical Specialties at the University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland. Professor O’Connell is currently Consultant Surgeon
and Director of the Centre for Colorectal Disease at St Vincent’s University
Hospital Dublin.
Professor O’Connell is a Council Member of the Royal College of Surgeons
in Ireland and is immediate past President of the European Society of Coloproctology, Secretary of the BJS Society and Vice President of the James’ IV
Society. He has served as editor of the British Journal of Surgery, associate
editor and Editor in Chief for the European Surgical Association, Associate
Editor of Diseases of the Colon and Rectum and is currently an Editorial
Board member of the Annals of Surgery.
Prof O’Connell is widely published in the areas of IBD, colorectal cancer and
pelvic oor physiology with over 225 peer-reviewed publications, book chapters, invited review articles/commentaries and editorials. He is joint editor of
Bailey and Love’s Short Practice of Surgery and Rob and Smith’s Operative
Surgery of the Colon Rectum and Anus. In addition he is joint editor of the
European Manual in Coloproctology. Within his chosen specialty of coloproctology, he has recognized by giving the Sir Alan Parks and John Goligher lectures in the UK, the ESR Hughes oration in Australia and the Harry E Bacon
Lecture to the American Society of Colon and Rectal Surgeons. In total he has
spoken nationally and internationally on over 400 occasions.
Prof O’Connell is married to Pauline, a new-born intensive care nurse specialist, who has accompanied him. They have three grown children, two of
whom have chosen medicine as a career.
28
John Thompson, M.D.
SCHEDULE-AT-A-GLANCE
John F. Thompson, M.D., is the Professor of
Melanoma and Surgical Oncology at the
University of Sydney, and since 2002 has
been the Executive director of the Melanoma
Institute Australia (formerly the Sydney Melanoma Unit). He has made enormous contributions to the eld of surgical oncology and
melanoma.
He received his Bachelors of Science from
the University of Sydney, and completed his
surgical training at the University of Sydney,
the Royal Prince Alfred Hospital, the Noga
Base Hospital in Papua New Guinea, as well as the University of Oxford.
Since his appointment as professor in 1999, no one has contributed more
to dening the standard of surgical care for melanoma, including optimal
margins, use of sentinel nodes, diagnosis and surveillance, limb perfusion,
and best reconstructions. The important ndings of his group have been published in over 600 peer reviewed publications, including journals such as the
Lancet and the New England Journal of Medicine.
In leadership positions, Professor Thompson was Chairman of the Working
Party which created the NHMRC-endorsed Clinical Practice Guidelines for
the Management of Cutaneous Melanoma in Australia and New Zealand,
Chairman of the Australia and New Zealand Melanoma Trials Group, and
President of the International Sentinel Node Society. In editorial positions,
he was Associate Editor of Annals of Surgical Oncology and Senior Editor
of Melanoma Management.
For his contributions to medicine, he was made an Ofcer in the Order of
Australia (AO), “for distinguished service to medicine in the eld of oncology research, particularly melanoma, to national and international professional organisations, and to medical education.” He received the Premier’s
Award for Outstanding Cancer Research, Cancer Institute NSW Annual
Awards, Sydney, August 2013. He was part of the group which received the
2009 Premier’s Award for Excellence in Translational Research: Sydney
Melanoma Unit.
For his contributions to treatment of melanoma, to surgical sciences, to international collaboration, and to surgical education, we welcome him to the
American Surgical Association.
29
THURSDAY, APRIL 23rd
8:15 AM Opening Session
Marina Ballroom E-G
President’s Opening Remarks
Secretary’s Welcome & Introduction of
New Fellows Elected In 2014
President’s Introduction of Honorary Fellows
Presentation of the Medallion for Scientic Achievement
Presentation of the Medallion for the Advancement of
Surgical Care
Eulogies of Past Presidents
Report of the Committee on Arrangements
9:10 AM Scientic Session I
Marina Ballroom E-G
Moderator: Anna M. Ledgerwood, M.D.
10:50 AM Presidential Address
Marina Ballroom E-G
Introduction: John M. Daly, M.D.
Address:
Anna M. Ledgerwood, M.D.
1:30 PM Scientic Session II
Marina Ballroom E-G
Moderator: James S. Economou, M.D., Ph.D.
30
FRIDAY, APRIL 24th
135th Annual Meeting April 23–25, 2015
Marriott Marquis San Diego, California
7:00 AM ASA Women in Surgery Breakfast
Mission Hills
8:00 AM Scientic Session III
Marina Ballroom E-G
10:30 AM Forum Discussion:
Marina Ballroom E-G
1:30 PM Scientic Session IV
Moderator: John M. Daly, M.D.
Marina Ballroom E-G
4:00 PM Executive Session (Fellows Only)
Presentation of the Flance-Karl Award
Marina Ballroom E-G
Marina Ballroom Foyer
8:00 PM Annual Banquet
(Black tie preferred, but dark
suits are acceptable.)
8:00 AM Scientic Session V
Moderator: New President-Elect
11:00 AM Adjourn
THURSDAY, APRIL 23, 2015
8:15 AM – 9:10 AM
OPENING SESSION
Marina Ballroom E-G
7:00 PM Annual Reception
SATURDAY, APRIL 25
PROGRAM OUTLINE
Marina Ballroom
Secretary’s Welcome & Introduction of New Fellows
Elected In 2014
Surgical Care
th
Marina Ballroom E-G
31
32
9:10 AM – 11:00 AM
SCIENTIFIC SESSION I
Marina Ballroom E-G
9:10 AM – 9:35 AM
1
Combined Preoperative Mechanical Bowel Preparation
with Oral Antibiotics Signicantly Reduces Surgical Site
Infection, Anastomotic Leak and Ileus After Colorectal
Surgery
Ravi P. Kiran*, A.C. Murray*, Cody Chiuzan*, David Estrada*,
Kenneth A. Forde
New York Presbyterian Hospital, Columbia University, New
York, NY
9:35 AM – 10:00 AM
2
Frozen Red Blood Cells Are Safe and Effective: A
Prospective Randomized Trial
Martin A. Schreiber1, John B. Holcomb2, Bryce Robinson*3,
Joseph Minei4, Ronald Stewart5, Laszlo Kiraly*1,
Belinda McCully*1, Bryan Cotton*6, Dina Gomaa*3,
Michael W. Cripps*4, Mark DeRosa*5, Samantha Underwood*1
1
Oregon Health & Science University, Portland, OR; 2University
of Texas at Houston, Houston, TX; 3University of Cincinnati,
Cincinnati, OH; 4University of Texas Southwestern, Dallas,
TX; 5University of Texas San Antonio, San Antonio, TX;
6
University of Texas at Houston, Houston, TX
10:00 AM – 10:25 AM
3
Impact of the Addition of Carboplatin and/or Bevacizumab
to Neoadjuvant Paclictaxel Followed by Doxorubicin and
Cyclophosphamide on Breast Conservation Rates in
Triple-Negative Breast Cancer: Surgical Results from
CALGB 40603 (Alliance)
Mehra Golshan*1, Constance T. Cirrincione*2, Donald T. Berry*3,
William M. Sikov*4, Sara Jasinski*2, Tracy F. Weisberg*5,
George Somlo*6, Eric P. Winer*7, Clifford Hudis*8,
David W. Ollila9
1
Brigham and Women’s Hospital, Boston, MA; 2Alliance
Statistics and Data Center; Duke University, Durham, NC;
3
Alliance Statistics and Data Center, MD Anderson, Houston,
TX; 4Women and Infants Hospital, Providence, RI; 5Maine
Center for Cancer Medicine, Scarborough, ME; 6City of Hope
Medical Center, Los Angeles, CA; 7Dana Farber Cancer
Institute, Boston, MA; 8Memorial Sloan-Kettering Cancer
Center, New York, NY; 9University of North Carolina, Chapel
Hill, NC
10:25 AM – 10:50 AM
4
Changing Paradigms in the Management of 2184
Traumatic Brain Injury Patients
Bellal Joseph*, Ansab A. Haider*, Viraj Pandit*, Andrew Tang*,
Narong Kulvatunyou*, Terence O’Keeffe*, Peter Rhee
The University of Arizona, Tucson, AZ
10:50 AM – 12:00 PM
PRESIDENTIAL ADDRESS
10:50 AM – 11:00 AM
Introduction of the President
John M. Daly, M.D.
11:00 AM – 12:00 PM
*By invitation
33
*By invitation
34
1:30 PM – 5:15 PM
SCIENTIFIC SESSION II
Marina Ballroom E-G
1:30 PM – 1:55 PM
5
Factors Inuencing the Decision of Surgery Residency
Graduates to Pursue General Surgery Practice or
Fellowship
Mary E. Klingensmith1, Thomas H. Cogbill2, Fred A. Luchette3,
Thomas A. Biester*4, Kelli Samonte*4, Andrew Jones*4,
Mark A. Malangoni4
1
Washington University in Saint Louis, Saint Louis, MO;
2
Gundersen Health System, LaCrosse, WI; 3Loyola University
Medical Center, Chicago, IL; 4American Board of Surgery,
Philadelphia, PA
1:55 PM – 2:20 PM
6
Genome-Wide Association Study of Post-Burn Scarring
Identies a Novel Protective Variant
Ravi F. Sood*, Anne M. Hocking*, Lara A. Mufey*,
Maricar Ga*, Shari Honari*, Alexander P. Reiner*,
Nicole S. Gibran
UW Medicine Regional Burn Center, Harborview Medical
Center, Seattle, WA
2:20 PM – 2:45 PM
7
Long-Term Outcomes of Helper Peptide Vaccination for
Metastatic Melanoma
Yinin Hu*, Helen Kim*, Christopher M. Blackwell*,
Mark E. Smolkin*, Craig L. Slingluff, Jr.
University of Virginia School of Medicine, Charlottesville, VA
2:45 PM – 3:10 PM
8
Dening 10 Year Outcomes with Living Donor Liver
Transplantation in North America
Kim M. Olthoff1, Abby Smith*2, Michael Abecassis3,
Talia Baker*3, Carl Berg*4, Charlotte Beil*2, Jean Emond5,
Gregory Everson*6, Chris Freise7, Brenda Gillespie*2,
Benjamin Samstein*5, Abraham Shaked1
1
University of Pennsylvania, Philadelphia, PA; 2Arbor
Research, Ann Arbor, MI; 3Northwestern University, Chicago,
IL; 4Duke University, Durham, NC; 5Columbia University, New
York, NY; 6University of Colorado, Denver, CO; 7University of
California San Francisco, San Francisco, CA
3:10 PM – 3:35 PM
9
Overall Survival and Renal Function of Patients with
Bilateral Wilms Tumor Undergoing Surgery at a Single
Institution
Andrew M. Davidoff1, Rodrigo B. Interiano*1, Lynn Wynn*1,
Noel Delos Santos*1, Jeffrey S. Dome*2, Rachel C. Brennan*1,
M. Elizabeth McCarville*1, Matthew J. Krasin*1,
Kathleen Kieran*3, Mark A. Williams*1
1
St. Jude Children’s Research Hospital, Memphis, TN;
2
Children’s National Medical Center, Washington, DC;
3
University of Iowa Children’s Hospital, Iowa City, IA
3:35 PM – 4:00 PM
10
Prophylactic Inferior Vena Cava Filter Placement Does Not
Result in a Survival Benet for Trauma Patients
Mark R. Hemmila*1, Nicholas H. Osborne*1, Peter K.
Henke1, John P. Kepros*2, Sujal G. Patel*3, Nancy J.
Birkmeyer*1
1
University of Michigan, Ann Arbor, MI; 2Michigan State
University, Lansing, MI; 3Covenant Medical Center, Saginaw, MI
*By invitation
*By invitation
35
36
4:00 PM – 4:25 PM
FRIDAY, APRIL 24, 2015
11
Autologous Reconstruction and Visceral Transplantation
for Gut Failure Following Bariatric Surgery: 20 Years of
Experience
Kareem M. Abu-Elmagd1, Guilherme Costa*2, Ruy J. Cruz*2,
Masato Fujiki*1, Koji Hashimoto*1, Neha Parekh*1,
Ajai Khanna*1, Abhinav Humar2, John Fung1
1
Cleveland Clinic, Cleveland, OH; 2University of Pittsburgh
Medical Center, Pittsburgh, PA
4:25 PM – 4:50 PM
12
Resection Margin and Survival in 2371 Patients
Undergoing Hepatic Resection for Metastatic Colorectal
Cancer: Surgical Technique or a Biologic Surrogate?
Eran Sadot*, Bas Groot Koerkamp*, Julie Leal*, Jinru Shia*,
Mithat Gonen*, Peter J. Allen, Ronald P. DeMatteo, T. Peter
Kingham*, William R. Jarnagin, Michael I. D’Angelica
Memorial Sloan Kettering Cancer Center, New York, NY
4:50 PM – 5:15 PM
13
Treatment of 200 Locally Advanced (Stage III)
Pancreatic Adenocarcinoma Patients with Irreversible
Electroporation: Safety and Efcacy
Robert C.G. Martin1, David Kwon*2, Sricharan Chalikonda*3,
Marty Sellars*4, Eric Kortz*5, Charles R. Scoggins*1,
Kevin T. Watkins*6, Kelly M. McMasters1
1
University of Louisville, Louisville, KY; 2Henry Ford Hospital
Department of Surgery, Detroit, MI; 3Cleveland Clinic Department
of Surgery, Cleveland, OH; 4Piedmont Hospital Department of
Surgery, Atlanta, GA; 5Swedish Medical Center Department
of Surgery, Denver, CO; 6Cancer Treatment Centers of
America, Atlanta, GA
*By invitation
37
7:00 AM – 8:00 AM
Mission Hills Room
ASA WOMEN IN SURGERY BREAKFAST
8:00 AM – 10:30 AM
SCIENTIFIC SESSION III
Marina Ballroom E-G
Moderator:Anna M. Ledgerwood, M.D.
8:00 AM – 8:25 AM
14
Prospective Randomized Double Blinded Trial Comparing
Two Anti-mrsa Agents with Supplemental Coverage to
Cefazolin Prior to Lower Extremity Revascularization
Patrick A. Stone*, Ali Abu Rahma, Stephen Hass*,
Albeir Mousa*, Asmita Modak*, Mary Emmett*,
James Campbell*,
Aravinda Nanjundappa*, Mohit Srivastiva*
WVU, Charleston, WV
8:25 AM – 8:50 AM
15
Early Versus Late Hospital Readmission After Major
Procedures Among Patients with Employer-Provided
Health Insurance
Yuhree Kim*, Gaya Spolverato*, Aslam Ejaz*, Joe Canner*,
Eric Schneider*, Timothy M. Pawlik
Johns Hopkins, Baltimore, MD
8:50 AM – 9:15 AM
16
Fast As a Predictor of Outcomes After Resuscitative
Thoracotomy: A Prospective Evaluation
Kenji Inaba*, Konstantinos Chouliaras*, Scott Zakaluzny*,
Pedro Teixeira*, Emre Sivrikoz*, Crystal Ives*,
Galinos Barmparas*, Nikos Koronakis*, Demetrios Demetriades
LAC+USC, University of Southern California, Los Angeles, CA
*By invitation
38
9:15 AM – 9:40 AM
39
10:30 AM – 12:00 PM
17
Tumor Genotype Determines Phenotype and DiseaseRelated Outcomes in Thyroid Cancer: A Study of 1,510
Patients
Linwah Yip*, Marina N. Nikiforova*, Jenny Yoo*,
Kelly L. McCoy*, Michael T. Stang*, Kristina J. Nicholson*,
Michaele J. Armstrong*, Steven P. Hodak*, Robert L. Ferris*,
Yuri E. Nikiforov*, Sally E. Carty
University of Pittsburgh, Pittsburgh, PA
FORUM DISCUSSION
Development of Surgical Scientists
“Sources of Funding”
Ronald J. Weigel, M.D.
University of Iowa, Iowa City, IA
“ACS Scholarships Generating Academic Leaders”
Gilbert R. Upchurch, Jr., M.D.
UVA Health System, Charlottesville, VA
9:40 AM – 10:05 AM
“Assuring Productivity: The Role of the Chair”
Timothy J. Eberlein, M.D.
Washington University School of Medicine, St. Louis, MO
18
Intraoperative Molecular Imaging Provides Rapid
and Accurate Diagnosis of Primary Pulmonary
Adenocarcinoma
Gregory T. Kennedy*1, Olugbenga T. Okusanya*1,
Daniel F. Heitjan*1, Charuhas Deshpande*1, Leslie A. Litzky*1,
Jane J. Keating*1, Steven M. Albelda*1, Shuming Nie*2,
Philip S. Low*3, Jeffrey A. Drebin1, Sunil Singhal*1
1
University of Pennsylvania School of Medicine, Philadelphia, PA;
2
Emory University, Atlanta, GA; 3Purdue University, West
Lafayette, IN
“My Grant Was Denied: What Now?”
Charles E. Lucas, M.D.
Wayne State University, Detroit, MI
1:30 PM – 4:00 PM
SCIENTIFIC SESSION IV
Marina Ballroom E-G
10:05 AM – 10:30 AM
19
Factors Predicting Outcomes After Total Pancreatectomy
and Islet Auto Transplant – Lessons Learned from Over
500 Cases
Srinath Chinnakotla*, Gregory Beilman, Ty Dunn*,
Melena Bellin*, Martin Freeman*, Mustafa Arain*,
Sarah Jane Schwarzenberg*, David Radosevich*,
Alfred Clavel*, David Sutherland, Timothy Pruett
University of Minnesota, Minneapolis, MN
*By invitation
1:30 PM – 1:55 PM
20
The Relationship Between Margin Width and Local
Recurrence (LR) of Ductal Carcinoma In Situ (DCIS):
3001 Women Treated with Breast-Conserving Surgery
(BCS) Over 30 Years
Kimberly J. Van Zee, Preeti D. Subhedar*, Cristina Olcese*,
Sujata Patil*, Monica Morrow
*By invitation
40
1:55 PM – 2:20 PM
3:10 PM – 3:35 PM
21
Sarcoma Resection with and Without Vascular
Reconstruction: A Matched Case-Control Study
George A. Poultsides*, Thuy B. Tran*, David G. Mohler*,
Matthew W. Mell*, Raf S. Avedian*, Brendan C. Visser*,
Jason T. Lee*, Kristen Ganjoo*, E. John Harris*,
Jeffrey A. Norton
Stanford University Medical Center, Stanford, CA
24
Complete Pathologic Response to Pretransplant
Locoregional Therapy for Hepatocellular Carcinoma
Denes Cancer Cure After Liver Transplantation: Analysis
of 501 Consecutively Treated Patients
Vatche G. Agopian*, Maud Morshedi*, Michael HarlanderLocke*, Justin McWilliams*, Ali Zarrinpar*, Fady M. Kaldas*,
Douglas G. Farmer, Daniela Markovic*, Hasan Yersiz*,
Jonathan R. Hiatt, Ronald W. Busuttil
UCLA, Los Angeles, C
2:20 PM – 2:45 PM
22
Management of the Parathyroid Glands in Preventative
Thyroidectomy for Multiple Endocrine Neoplasia Type 2
Jeffrey F. Moley, Kathryn A. Rowland, Linda Jin*,
Amber L. Traugott, Michael A. Skinner*, Samuel A. Wells
3:35 PM – 4:00 PM
25
Use of a Bundle Checklist Combined with Provider
Conrmation Reduced Risk of Nosocomial Complications
and Death in Trauma Patients
Don Reiff*, Thomas Shoultz*, Russell Grifn*,
Benjamin Taylor*, Loring W. Rue, III
University of Alabama at Birmingham, Birmingham, AL
2:45 PM – 3:10 PM
23
The Society of Thoracic Surgeons Voluntary Public
Reporting Initiative: The First Four Years
David Shahian1, Frederick Grover2, Richard Prager3,
Fred Edwards*4, Giovanni Filardo*5, Sean O’Brien*6,
Xia He*6, Anthony Furnary*7, J. Scott Rankin*8,
Vinay Badhwar*9, Joseph Cleveland*2, Franco Fazzalari*3,
Mitchell Magee*10, Jane Han*11, Jeffrey Jacobs*12
1
Massachusetts General Hospital, Boston, MA; 2University
of Colorado Anschutz School of Medicine, Aurora, CO;
3
University of Michigan, Ann Arbor, MI; 4University of Florida,
Jacksonville, FL; 5Baylor Scott & White Health, Dallas, TX;
6
Duke Clinical Research Institute, Durham, NC; 7Starr-Wood
Cardiac Group, Portland, OR; 8Vanderbilt University,
Nashville, TN; 9University of Pittsburgh, Pittsburgh, PA;
1
0HCA Medical City Dallas Hospital, Dallas, TX; 11Society of
Thoracic Surgeons, Chicago, IL; 12Johns Hopkins All
Children’s Heart Institute, Saint Petersburg, FL
*By invitation
41
4:00 PM – 5:00 PM
EXECUTIVE SESSION
ASA Fellows Only
7:00 PM
ANNUAL RECEPTION
8:00 PM
ANNUAL BANQUET
Marina Ballroom
*By invitation
42
SATURDAY, APRIL 25, 2015
8:00 AM – 11:00 AM
SCIENTIFIC SESSION V
Marina Ballroom E-G
Moderator: New President- Elect
8:00 AM – 8:25 AM
26
Collected World Experience of the Snorkel/Chimney
Endovascular Technique in the Treatment of Complex
Aortic Aneurysms: The PERICLES Registry
Jason T. Lee*1, Konstantinos Donas*2, Mario Lachat*3,
Giovanni Torsello*2, Frank J. Veith4
1
Stanford University Medical Center, Stanford, CA; 2Muenster
University Hospital, Muenster, Germany; 3University Hospital
Zurich, Zurich, Switzerland; 4New York University – Langone
Medical Center, New York, NY
8:25 AM – 8:50 AM
27
How Well Does Renal Transplantation Cure
Hyperparathyroidism?
Irene Lou*, Scott Odorico*, David Foley*, David Schneider*,
Rebecca Sippel*, Herbert Chen
University of Wisconsin-Madison, Madison, WI
8:50 AM – 9:15 AM
28
A Quarter Century of Organ Protection in Open
Thoracoabdominal Repair
Anthony L. Estrera*, Harleen K. Sandhu*, Kristofer M.
Charlton-Ouw*, Rana O. A*, Ali Azizzadeh*,
Charles C. Miller, III*, Hazim J. Sa
University of Texas Health Science Center at Houston,
Houston, TX
*By invitation
43
9:15 AM – 9:40 AM
29
Racial Disparity in African American Renal Transplants: Is
Alemtuzumab Induction the Great Equalizer?
Alison A. Smith*, Mira John*, Isabelle Dortonne*,
Anil S. Paramesh*, Mary Killackey*, Rubin Zhang*,
Belinda Lee*, Bernard M. Jaffe, Joseph F. Buell*
Tulane University, New Orleans, LA
9:40 AM – 10:05 AM
30
Trans-Abdominal Redo Ileal Pouch Surgery for Failed
Restorative Proctocolectomy Lessons Learned Over 500
Patients
Feza H. Remzi*, Erman Aytac*, Jean Ashburn*, Jinyu Gu*,
Tracy L. Hull*, David W. Dietz*, Luca Stocchi*, James M.
Church, Bo Shen*
Cleveland Clinic, Cleveland, OH
10:05 AM – 10:30 AM
31
Components of Hospital Perioperative Infrastructure Can
Overcome the Weekend Effect in Urgent General Surgery
Procedures
Anai N. Kothari*1, Matthew A.C. Zapf*2, Robert Blackwell*3,
Victor Chang*2, Zhiyong Mi*1, Gopal N. Gupta*3, Paul C. Kuo1
1
Loyola University Chicago, Department of Surgery, Maywood,
IL; 2Stritch School of Medicine, Maywood, IL; 3Loyola
University Chicago, Department of Urology, Maywood, IL
*By invitation
44
10:30 AM – 10:55 AM
32
A Longitudinal Assessment of Outcomes, Cost, and
Healthcare Resource Utilization Following Immediate
Breast Reconstruction – Comparing Implant and
Autologous Reconstruction
John P. Fischer*, Justin P. Fox*, Liza C. Wu*,
Suhail K. Kanchwala*, Joshua Fosnot*,
Stephen J. Kovach*, Joseph M. Serletti
Hospital of the University of Pennsylvania, Philadelphia, PA
11:00 AM ADJOURN
PROGRAM DETAIL AND ABSTRACTS
THURSDAY, APRIL 23, 2015
8:15 AM – 9:10 AM
Marina Ballroom E-G
OPENING SESSION
Secretary’s Welcome & Introduction of New Fellows
Elected In 2014
Surgical Care
*By invitation
45
46
THURSDAY MORNING, APRIL 23rd, CONTINUED
On multivariable analysis, MBP with antibiotics, but not without, was independently associated with reduced anastomotic leak (OR = 0.50 (95% CI:
0.35–0.72), p = 0.0002), SSI (OR = 0.41, 95% CI: 0.33–0.51, p < 0.0001) and
post-operative ileus (OR = 0.65,95% CI: 0.54–0.79, p < 0.0001).
9:10 AM – 11:00 AM
Marina Ballroom E-G
Comparing No prep, MBP/ABX– and MBP/ABX+
No-Prep
(N = 2403)
MBP/ABX–
(N = 3700)
MBP/ABX+
(N = 2265)
p-Value
Age (years),
median (IQR)
62 (51–73)
62 (52–72)
62 (52–71)
0.6
Sex (male),
n (%)
1162 (48.4)
1783 (48.2)
1141 (50.4)
0.2
ASA class, n (%)
2
1140 (47.7)
1858 (50.5)
1270 (56.3)
<0.0001
Total operation
time (180 min),
n (%)
918 (38.2)
1512 (40.9)
929 (41.0)
0.07
Laparoscopic
surgery, n (%)
1470 (61.2)
2638 (71.3)
1674 (73.9)
<0.0001
SSI (supercial/
deep/organ space)
n (%)
344 (14.3)
446 (12.0)
139 (6.1)
<0.0001
Anastomotic leak,
n (%)
108 (4.5)
132 (3.6)
46 (2.0)
<0.0001
Post-operative
ileus, n (%)
360 (15.1)
445 (12.1)
206 (9.1)
<.0001
30-day mortality,
n (%)
36 (1.5)
23 (0.6)
8 (0.4)
0.001
Characteristics
SCIENTIFIC SESSION I
1
Combined Preoperative Mechanical Bowel Preparation
with Oral Antibiotics Signicantly Reduces Surgical Site
Infection, Anastomotic Leak and Ileus After Colorectal
Surgery
Ravi P. Kiran*, A.C. Murray*, Cody Chiuzan*, David Estrada*,
Kenneth A. Forde
New York Presbyterian Hospital, Columbia University, New
York, NY
OBJECTIVE: To clarify whether bowel preparation use, or its individual components (mechanical bowel preparation (MBP)/oral antibiotics)
impact specic outcomes after colorectal surgery.
METHODS: 2012 National Surgical Quality Improvement Program
targeted-colectomy data capture information on the use/type of bowel preparation and colorectal-specic complications. For patients undergoing elective
colorectal resection, the impact of preoperative MBP and antibiotics (MBP/
ABx+), MBP alone (MBP/ABx–) and no bowel preparation (no-prep) on
outcomes, particularly anastomotic leak, SSI and ileus was evaluated using
multivariable logistic regression analyses.
RESULTS: Of 8,368 patients, 2403 (28.7%) had no-prep, 3700
(44.2%) MBP/ABx– and 2265 (27.1%) MBP/ABx+. Baseline characteristics were similar except prior sepsis and steroid-use, both greater in no-prep
patients. MBP with or without antibiotics was associated with reduced ileus
(MBP/ABx+: OR = 0.57 (95% CI: 0.47–0.68), p < 0.0001; MBP/ABx–: OR
= 0.77 (95% CI: 0.67–0.90), p < 0.0001) and SSI (MBP/ABx+: OR = 0.39
(95% CI: 0.32–0.48), p < 0.0001; MBP/ABx–: OR = 0.82 (95% CI: 0.71–
0.96), p = 0.011) versus no-prep. MBP/Abx+ was also associated with lower
anastomotic leak than no-prep (OR = 0.44 (95% CI:0.31–0.62), p < 0.0001.
*By invitation
47
CONCLUSION: These data clarify the near 50-year debate whether
bowel preparation improves outcomes after colorectal resection. MBP with
oral antibiotics reduces by nearly half, SSI, anastomotic leak and ileus, the
most common and troublesome complications after colorectal surgery.
48
2
Frozen Red Blood Cells Are Safe and Effective: A
Prospective Randomized Trial
Martin A. Schreiber1, John B. Holcomb2, Bryce Robinson*3,
Joseph Minei4, Ronald Stewart5, Laszlo Kiraly*1,
Belinda McCully*1, Bryan Cotton*6, Dina Gomaa*3,
Michael W. Cripps*4, Mark DeRosa*5, Samantha Underwood*1
1
Oregon Health & Science University, Portland, OR; 2University
of Texas at Houston, Houston, TX; 3University of Cincinnati,
Cincinnati, OH; 4University of Texas Southwestern, Dallas,
TX; 5University of Texas San Antonio, San Antonio, TX;
6
University of Texas at Houston, Houston, TX
OBJECTIVES: The utility of standard red blood cells (RBCs) is
limited by an abbreviated shelf-life and worsening storage lesion with age.
Cryopreserved red blood cells (CRBCs) are frozen 2–6 days after donation,
stored up to 10 years and washed prior to use potentially providing a fresh
and puried RBC product. We hypothesized that CRBC transfusion would be
equivalent to RBC transfusion in stable trauma patients.
METHODS: We performed a prospective, randomized, double blind
study at 5 level 1 trauma centers. Stable trauma patients requiring transfusion
were randomized to young RBCs (14 storage days), old RBCs (>14 storage
days) or CRBCs. Tissue oxygenation (StO2), biochemical and inammatory
mediators were measured and clinical outcomes were determined.
RESULTS: 256 patients were randomized (84 young, 86 old and 86
CPRBCs). The patients were well-matched for injury severity and demographics (p > 0.2). Pre-transfusion and nal hematocrits were similar (p >
0.68). Patients randomized to CRBCs received 2 units compared to 4 in
the other groups (p < 0.001). Transfusion of old RBCs resulted in reduced
StO2 while transfusion of CRBCs increased it (p < 0.05). CRBCs contained
signicantly less 2-macrogobulin, haptoglobin, c-reactive protein, serum
amyloid P, and free hemoglobin than the other groups (p < 0.001). IL-2 was
elevated in patients who received CRBCs compared to old RBCs (p = 0.04).
There was no difference in organ failure, infection rate or mortality between
the groups (p > 0.22).
CONCLUSIONS: Transfusion of CRBCs is at least as safe and effective as transfusion of young and old RBCs and results in a 50% reduction in
transfused units and increased StO2.
*By invitation
49
3
Impact of the Addition of Carboplatin and/or Bevacizumab
to Neoadjuvant Paclictaxel Followed by Doxorubicin and
Cyclophosphamide on Breast Conservation Rates in
Triple-Negative Breast Cancer: Surgical Results from
CALGB 40603 (Alliance)
Mehra Golshan*1, Constance T. Cirrincione*2, Donald T. Berry*3,
William M. Sikov*4, Sara Jasinski*2, Tracy F. Weisberg*5,
George Somlo*6, Eric P. Winer*7, Clifford Hudis*8,
David W. Ollila9
1
Brigham and Women’s Hospital, Boston, MA; 2Alliance
Statistics and Data Center; Duke University, Durham, NC;
3
Alliance Statistics and Data Center, MD Anderson, Houston,
TX; 4Women and Infants Hospital, Providence, RI; 5Maine
Center for Cancer Medicine, Scarborough, ME; 6City of Hope
Medical Center, Los Angeles, CA; 7Dana Farber Cancer
Institute, Boston, MA; 8Memorial Sloan-Kettering Cancer
Center, New York, NY; 9University of North Carolina, Chapel
Hill, NC
OBJECTIVE: Neoadjuvant chemotherapy (NACT) improves breast
conserving therapy (BCT) rates, but the magnitude of this benet in different
tumor subtypes is unknown. To quantify this effect for triple-negative breast
cancer (TNBC), we reviewed surgical outcomes from CALGB (40603), a
randomized phase II trial of weekly paclitaxel (P) ± carboplatin (Cb) followed by doxorubicin plus cyclophosphamide (AC), ± bevacizumab (B).
METHODS: Patients with stage II-III TNBC were randomized to (1)
P- > AC, (2) P + B- > AC + B, (3) P + Cb- > AC, or (4) P + Cb + B- > AC +
B. The surgeon assessed BCT candidacy based on clinico-radiographic criteria, before and after NACT, though subsequent surgical management was
at surgeon and patient discretion. We recorded (1) the conversion rate from
BCT-ineligible to BCS-eligible; (2) the rate of successful BCT.
RESULTS: 406 of the 443 treated patients were assessable. Prior to
NACT, 230 (57%) were considered BCT candidates and 176 (43%) were
not. 190/230 (83%) remained BCT candidates after NACT; of 135 who chose
BCT, it was successful in 126 (93%). 88/176 (50%) patients initially considered non-candidates were converted to candidates, of who 55 chose BCT
with 49/44 (89%) success rate (Table 1). 278 patients who were BCT candidates post-NACT, 88 (32%) chose mastectomy.
*By invitation
50
51
4
Changing Paradigms in the Management of 2184 Traumatic
Brain Injury Patients
Bellal Joseph*, Ansab A. Haider*, Viraj Pandit*, Andrew Tang*,
Narong Kulvatunyou*, Terence O’Keeffe*, Peter Rhee
The University of Arizona, Tucson, AZ
CONCLUSIONS: This is the rst NACT trial to prospectively quantify a 50%-conversion rate from BCT-ineligible to eligible in TNBC. PostNACT: BCT was successful in 92% who chose this approach, however 32%
of BCT-eligible patients chose mastectomy.
OBJECTIVES: The management of traumatic brain injury (TBI)
has been evolving with trends towards management of minimally injured
patients with intracranial hemorrhage (ICH) exclusively by trauma surgeons.
The aim of this study was to assess safety and use of resources as a result of
this change in management.
METHODS: A prospective 5-year (2009–2014) database on all TBI
(skull fracture/ICH on head CT) patients presenting to a Level I trauma center was analyzed for patient demographics, injuries, admission physiology,
CT scan results, and hospital outcomes. These records were matched to the
institutional registry and hospital nancial database.
RESULTS: A total of 2,184 patients were included with mean age
43.4±26.1 years, median Glasgow Coma Scale (GCS) 13 [9–15], and median
head-abbreviated injury scale (h-AIS) 3 [2–3]. The distribution of types and
size of intracranial bleeds remained unchanged throughout the study period.
The proportion of TBI managed exclusively by trauma surgeons increased
signicantly over the years from 6.8% to 40.1%. (p < 0.001). Total number
of neurosurgical consultations, head CT scans, hospital length of stay and
costs decreased signicantly over time. The overall mortality rate (18.5%)
remained unchanged.
*By invitation
52
THURSDAY MORNING, APRIL 23rd, CONTINUED
11:00 AM – 12:00 PM
Marina Ballroom E-G
PRESIDENTIAL ADDRESS
Introduction of the President
John M. Daly, M.D.
Figure 1: Demonstrates the trends in outcomes.
CONCLUSION: TBI can be selectively managed without neurosurgeons safely and in a cost effective manner resulting in more effective use of
precious resources.
53
54
THURSDAY AFTERNOON, APRIL 23rd
as reasons to pursue SF. Both groups expressed a high degree of satisfaction
with their career choice (GS, 94%; SF, 90%).
CONCLUSIONS: Most graduates who pursue GS practice are condent and content. The decision to pursue GS is strongly inuenced by a GS
mentor. Lack of condence may be a more signicant factor for choosing
SF. These ndings suggest opportunity for improvements in condence and
mentorship during residency.
1:30 PM – 5:15 PM
Marina Ballroom E-G
SCIENTIFIC SESSION II
5
Factors Inuencing the Decision of Surgery Residency
Graduates to Pursue General Surgery Practice or Fellowship
Mary E. Klingensmith1, Thomas H. Cogbill2, Fred A. Luchette3,
Thomas A. Biester*4, Kelli Samonte*4, Andrew Jones*4,
Mark A. Malangoni4
1
Washington University in Saint Louis, Saint Louis, MO;
2
Gundersen Health System, LaCrosse, WI; 3Loyola University
Medical Center, Chicago, IL; 4American Board of Surgery,
Philadelphia, PA
OBJECTIVE: Surgery residency serves two purposes – prepare graduates for general surgery (GS) practice or post-residency surgical fellowship (SF). This study was undertaken to elucidate factors inuencing career
choice for these two groups.
METHODS: All U.S. allopathic surgery residency graduates 2009–
2013 (n = 5512) were surveyed by the American Board of Surgery regarding
condence, autonomy and reasons for career selection between GS and SF.
Surveys were distributed by mail in November 2013 with follow up mailings
to non-respondents.
RESULTS: 3354 graduates (68%) completed the survey; 26% pursued
GS and 74% SF. GS expressed greater levels of condence than SF across the
common surgical procedures queried. Condence improved with years after
completion of residency for GS but not SF. The decision to pursue GS or SF
was made during residency by 77% and 74%, respectively. 57% of those who
chose GS indicated a GS mentor signicantly inuenced their decision. GS
rated procedural variety, opportunity for practice autonomy, choice of practice location, and inuence of a mentor as reasons to pursue GS practice. SF
listed control over scope of practice, prestige, salary, and specialty interest
*By invitation
55
56
57
6
Genome-Wide Association Study of Post-Burn Scarring
Identies a Novel Protective Variant
Ravi F. Sood*, Anne M. Hocking*, Lara A. Mufey*,
Maricar Ga*, Shari Honari*, Alexander P. Reiner*,
Nicole S. Gibran
UW Medicine Regional Burn Center, Harborview Medical
Center, Seattle, WA
OBJECTIVE: Burn injuries and other partial-thickness wounds often
lead to hypertrophic scarring (HTS), a debilitating sequela with racial predisposition that suggests a genetic mechanism. We sought to identify singlenucleotide polymorphisms (SNPs) associated with HTS.
METHODS: We conducted a genome-wide association study in a prospective cohort of adults admitted with deep-partial-thickness burns. Scar
severity was assessed over time using the Vancouver Scar Scale (VSS), and
DNA was genotyped with a >500,000-marker array. We performed association testing of SNPs with minor allele frequency (MAF) >0.01 using linear
regression of VSS height score on genotype adjusted for patient- and injury
characteristics as well as population substructure. Genome-wide signicance
was based on Bonferroni correction for multiple testing.
RESULTS: Of 538 patients (median age 40 years, median burn size
6.0% body surface area), 71% were male and 76% were white. The mean
VSS height score was 1.2 (range: 0-3). Of 289,639 SNPs tested, a variant in
the “CUB and Sushi multiple domains 1” (CSMD1) gene (rs11136645; MAF
= 0.49), was signicantly associated with decreased scar height (regression
coefcient = -0.23, p = 7.9 × 10-8; Figure).
*By invitation
CONCLUSIONS: We report the rst SNP associated with reduced
severity of post-burn HTS. A common intron variant in the CSMD1 gene is
associated with decreased scar height, suggesting an anti-brogenic effect.
CSMD1 is a known tumor-suppressor implicated in colorectal cancer, underscoring the commonality of morphogenetic responses.
58
7
Long-Term Outcomes of Helper Peptide Vaccination for
Metastatic Melanoma
Yinin Hu*, Helen Kim*, Christopher M. Blackwell*,
Mark E. Smolkin*, Craig L. Slingluff, Jr.
University of Virginia School of Medicine, Charlottesville, VA
OBJECTIVES: A multipeptide vaccine designed to induce helper
T-cells against melanocytic and cancer-testis antigens (6MHP) induces
specic Th1-dominant CD4 + T-cell responses and CD8 + T-cell responses
through epitope spreading. We hypothesized that survival of patients with
stage IV melanoma vaccinated with 6MHP would exceed that of unvaccinated matched controls.
METHODS: The 6MHP vaccine was administered to patients
with metastatic melanoma on two clinical trials (NCT00089219 and
NCT00118274). Circulating CD4 + T-cell responses were measured by proliferation or direct IFN-gamma ELIspot assay. Overall survival of vaccinated
patients was compared to unvaccinated controls matched by age, metastatic
site, and resection status. Factors associated with survival were identied by
multivariable Cox proportional hazards analysis incorporating all variables
used for matching.
*By invitation
59
RESULTS: All 36 vaccinated patients were matched 1:1 by metastatic
site, resection, and age within 5 years. Median survival was signicantly
longer for vaccinated patients (5.4 vs 0.6 years, p < 0.001, Figure 1), among
which 67% (24/36) mounted a specic CD4 + T-cell response. In multivariable analysis, vaccination was the strongest predictor of survival (HR
0.176, p < 0.001). Among vaccinated patients, immune response (HR 0.29,
p = 0.021) and resection (HR 0.06, p < 0.001) were signicant predictors of
survival.
CONCLUSIONS: Helper peptide vaccination is associated with
favorable survival among patients with metastatic melanoma. These data
support a randomized prospective trial of the 6 MHP vaccine.
60
8
Dening 10 Year Outcomes with Living Donor Liver
Transplantation in North America
Kim M. Olthoff1, Abby Smith*2, Michael Abecassis3,
Talia Baker*3, Carl Berg*4, Charlotte Beil*2, Jean Emond5,
Gregory Everson*6, Chris Freise7, Brenda Gillespie*2,
Benjamin Samstein*5, Abraham Shaked1
1
University of Pennsylvania, Philadelphia, PA; 2Arbor
Research, Ann Arbor, MI; 3Northwestern University, Chicago,
IL; 4Duke University, Durham, NC; 5Columbia University, New
York, NY; 6University of Colorado, Denver, CO; 7University of
California San Francisco, San Francisco, CA
OBJECTIVES: Living donor liver transplantation (LDLT) provides
an important surgical option for end-stage liver disease. The Adult-to-Adult
Living Donor Liver Transplantation Cohort Study (A2ALL), the rst multicenter prospective NIH study for LDLT, compared survival benet between
LDLT and deceased donor liver transplant (DDLT) at experienced transplant
centers. Post-transplant outcomes up to 10 years were compared and key
variables impacting survival identied.
METHODS: Outcomes of 1428 liver recipients (964 LDLT) enrolled
in A2ALL transplanted between 1/1/1998 and 1/31/2014 at 12 North American centers with median follow-up 4.8 years were analyzed. Kaplan-Meier
and multivariable Cox models of time from transplant to death or graft failure were performed.
RESULTS: LDLT recipients had higher prevalence of white race, less
HCV/HCC, lower mean MELD (15.4 vs 20.4), and fewer were transplanted
from ICU, inpatient, on dialysis, ventilated, or with ascites. Post-transplant
ICU days were less for LDLT. Patient 10-yr survival was 70% (LDLT) and
66% (DDLT). Unadjusted survival was higher with LDLT (P = 0.05) but
attenuated after adjustment (P = 0.69). For all recipients, female gender and
PSC were associated with improved survival. Factors associated with worse
survival were dialysis, and older recipient/donor age. Era of transplantation
and type of donated lobe did not signicantly impact survival.
SUMMARY: Both LDLT and DDLT provide outstanding long-term
survival. LDLT provides signicant benet resulting in transplantation at a
lower MELD score, decreased death on waitlist, and excellent post-transplant outcomes. Recipient diagnosis, renal failure and ages of recipient and
donor should be considered in decision-making regarding timing of transplant and donor options.
*By invitation
61
9
Overall Survival and Renal Function of Patients with
Bilateral Wilms Tumor Undergoing Surgery at a Single
Institution
Andrew M. Davidoff1, Rodrigo B. Interiano*1, Lynn Wynn*1,
Noel Delos Santos*1, Jeffrey S. Dome*2, Rachel C. Brennan*1,
M. Elizabeth McCarville*1, Matthew J. Krasin*1,
Kathleen Kieran*3, Mark A. Williams*1
1
St. Jude Children’s Research Hospital, Memphis, TN;
2
Children’s National Medical Center, Washington, DC;
3
University of Iowa Children’s Hospital, Iowa City, IA
OBJECTIVE(S): Approximately 5% of children with Wilms tumor
present with bilateral disease, resulting in about 25 cases/year in the United
States. The treatment challenge is to achieve a high cure rate while maintaining long-term renal function. We retrospectively reviewed our institutional
experience with nephron-sparing surgery (NSS) in patients with bilateral
Wilms tumor (BWT) between 2001–2014.
METHODS: Imaging studies, surgical approach and pathology reports
were reviewed. Outcomes evaluated included surgical complications, tumor
recurrence, patient survival and renal function, as assessed by estimated glomerular ltration rate or radionuclide scans.
RESULTS: Forty-two patients with BWT were identied; 39 (92.9%)
patients underwent bilateral NSS and 3 underwent unilateral nephrectomy
with contralateral NSS. One additional patient with a solitary kidney underwent NSS on that kidney. Acute post-operative complications included prolonged urine leak (10), hospital-acquired infection (6), intussusception (1)
and transient renal insufciency (1). Five patients required early (within four
months) redo NSS for residual tumor. Overall survival was 88.4% (mean
follow-up, 3.8 years). Of the 5 patients who died, 4 had disease of anaplastic
histology (2 had focal anaplasia at initial resection, 2 had diffuse anaplasia
at recurrence). Long-term, seven patients had local tumor recurrence (managed with redo NSS in 6 and completion nephrectomy in 1) and four had an
episode of intestinal obstruction. All patients had GFR > 60mL/min/1.73m2
at last follow-up.
CONCLUSIONS: In patients with bilateral Wilms tumor, bilateral
nephron-sparing surgery is safe and almost always feasible, thereby saving
maximal renal parenchyma. With this approach, survival was excellent, as
was maintenance of long-term renal function.
*By invitation
62
10
Prophylactic Inferior Vena Cava Filter Placement Does Not
Result in a Survival Benet for Trauma Patients
Mark R. Hemmila*1, Nicholas H. Osborne*1, Peter K.
Henke1, John P. Kepros*2, Sujal G. Patel*3, Nancy J.
Birkmeyer*1
1
University of Michigan, Ann Arbor, MI; 2Michigan State
University, Lansing, MI; 3Covenant Medical Center, Saginaw, MI
OBJECTIVE(S): Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship
between prophylactic inferior vena cava (IVC) lter use, mortality, and VTE
complications.
METHODS: Trauma quality collaborative data (2010-2014) were
analyzed. Patients were excluded with no signs-of-life, injury severity score
<9, hospitalization <3 days, or who received IVC lter after occurrence of a
VTE event. Risk adjusted rates of IVC lter placement were calculated and
hospitals placed into quartiles of IVC lter use. Mortality rates by quartile
were compared. We determined the association of deep venous thrombosis
(DVT) with presence of an IVC lter accounting for type and timing of initiation of chemical VTE prophylaxis in addition to standard trauma patient
confounders.
*By invitation
63
RESULTS: A prophylactic IVC lter was placed in 799 (2%) of
39,114 patents. Hospitals exhibited signicant variability (0.7 to 9.9%) in
adjusted rates of IVC lter utilization (Figure-Left). Rates of IVC placement within quartiles were 0.8, 1.4, 2.3, and 4.3% respectively. IVC lter
use quartiles showed no variance in mortality (Figure-Right). Adjusting for
chemical prophylaxis and patient factors, prophylactic IVC lter placement
was associated with an increased incidence of DVT (Odds Ratio = 2.76; 95%
CI, 1.96–3.9).
CONCLUSIONS: High rates of prophylactic IVC lter placement
have no effect on reducing trauma patient mortality and are paradoxically
associated with an increase in DVT events.
64
11
Autologous Reconstruction and Visceral Transplantation for
Gut Failure Following Bariatric Surgery: 20 Years of
Experience
Kareem M. Abu-Elmagd1, Guilherme Costa*2, Ruy J. Cruz*2,
Masato Fujiki*1, Koji Hashimoto*1, Neha Parekh*1,
Ajai Khanna*1, Abhinav Humar2, John Fung1
1
Cleveland Clinic, Cleveland, OH; 2University of Pittsburgh
Medical Center, Pittsburgh, PA
OBJECTIVE(S): Bariatric surgery is currently the only long-lasting
treatment for morbid obesity. However, these weight loss procedures could
result in development of gut failure (GF) with need for total parenteral nutrition (TPN). This retrospective study is the rst to address the anatomic and
functional spectrum of bariatric surgery-associated GF with innovative surgical modalities to restore gut functions.
METHODS: Over a 20-year period, 1,200 patients were referred
with GF. Of these, 110 (9%) had prior bariatric surgery; 97 (88.3%) gastricbypass, 5 (4.5%) sleeve gastrectomy, 4 (3.6%) gastric banding and 4 (3.6%)
jejunoileal-bypass. Causes of gut failure were major surgical complications
(65%), dysmotility (25%), and malabsorption (10%). Catastrophic events
included technical failure with gastric/enteric stulae, internal herniation,
and vascular thrombosis due to hypercoagulability. TPN duration ranged
from 4 to 250 months. All patients were adults with 85% females. Multidisciplinary comprehensive medical and surgical rehabilitation was applied.
RESULTS: Foregut reconstruction was performed in all patients with
gastrogastric (77%), gastroesophageal (13%), jejunoesophageal (7%), and
colonic interposition (3%) anastomoses. Midgut reconstruction was required
in 76% of patients. Bowel lengthening was performed in 16%. Visceral transplantation was utilized as a rescue therapy in 22 (16%) patients with intestine
alone in 16 (73%) and composite visceral allograft in 6 (27%). With mean
follow-up of 52 + 34 months, 98% of surgically reconstructed patients and
73% of transplanted recipients were alive with achievement of full nutritional autonomy in 89%.
CONCLUSIONS: Gut failure is a potential complication of bariatric
surgery due to a technically awed operation and loss of gut homeostasis.
Successful outcome can be achieved with major restorative surgical procedures including visceral transplantation as a rescue therapy.
*By invitation
65
12
Resection Margin and Survival in 2371 Patients Undergoing
Hepatic Resection for Metastatic Colorectal Cancer: Surgical
Technique or a Biologic Surrogate?
Eran Sadot*, Bas Groot Koerkamp*, Julie Leal*, Jinru Shia*,
Mithat Gonen*, Peter J. Allen, Ronald P. DeMatteo, T. Peter
Kingham*, William R. Jarnagin, Michael I. D’Angelica
OBJECTIVE(S): The impact of margin width on overall survival
(OS) in the context of other prognostic factors after resection for colorectal
liver metastases (CRLM) is unclear. We evaluated the relationship between
resection margin and OS utilizing high-resolution distance measurements.
METHODS: A single-institution prospectively collected database
was queried for all patients who underwent an initial complete resection of
CRLM between 1991–2012. R1 resection was dened as tumor cells at the
resection margin (0 mm). R0 resection was further divided into 3 groups:
0.1–0.9 mm, 1–9 mm, 10 mm. Multivariate analysis used stepwise Cox
regression.
RESULTS: 2371 patients were included. Half of the patients presented
with synchronous disease, 43% had solitary metastasis, and the median size
was 3.4cm. With a median follow-up for survivors of 55 months, the median
OS of the R1, 0.1–0.9 mm, 1–9 mm, and 10 mm groups were 32, 40, 53,
and 56 months, respectively. Predictors of OS are described in Table 1, which
demonstrates that even submillimeter margins correlate with improved OS
compared to R1 resection (p = 0.02). The association between the margin and
OS remained signicant regardless of chemotherapy and clinicopathologic
prognostic factors.
CONCLUSIONS: Resection margin width is an independent predictor
of OS. The improved outcome observed with margin width up to submillimeter clearance is likely a microscopic surrogate of an undened biologic
confounder rather than the result of surgical technique.
*By invitation
66
67
13
Treatment of 200 Locally Advanced (Stage III) Pancreatic
Adenocarcinoma Patients with Irreversible Electroporation:
Safety and Efcacy
Robert C.G. Martin1, David Kwon*2, Sricharan Chalikonda*3,
Marty Sellars*4, Eric Kortz*5, Charles R. Scoggins*1,
Kevin T. Watkins*6, Kelly M. McMasters1
1
University of Louisville, Louisville, KY; 2Henry Ford Hospital
Department of Surgery, Detroit, MI; 3Cleveland Clinic Department
of Surgery, Cleveland, OH; 4Piedmont Hospital Department of
Surgery, Atlanta, GA; 5Swedish Medical Center Department
of Surgery, Denver, CO; 6Cancer Treatment Centers of
America, Atlanta, GA
OBJECTIVES: Ablative therapies have been increasingly utilized in
treatment of locally advanced pancreatic cancer (LAPC). Irreversible Electroporation (IRE) is an energy delivery system, effective in ablating tumors
by inducing irreversible cell membrane destruction of cells. We aimed to
demonstrate efcacy of treatment with IRE as part of multimodal treatment
of LAPC.
METHODS: From July 2010 to October 2014, patients with radiographic stage III LAPC were treated with IRE and monitored under a multicenter, prospective IRB-approved registry. Perioperative 90-day outcomes,
local failure, and overall survival were recorded and compared to standard of
care data for stage III LAPC.
RESULTS: 200 patients with LAPC underwent IRE of tumor (In-Situ,
n = 150) or IRE with pancreatic ±arterial resection (Margin, n = 50). All
patients underwent induction chemotherapy, with an additional 52% receiving chemo-radiation, for a median of 7 months (range, 5–13) prior to IRE
(Figure). IRE was successfully administered to all patients. 19% sustained
complications with a median grade of 2 (range, 1–3). Median length of stay
was 6 days (range, 4–58). With a median follow up of 25 months, 6 (3%)
had local recurrence. Median overall survival (OS) in both groups was 23.5
months (Figure).
*By invitation
68
69
FRIDAY MORNING, APRIL 24th
7:00 AM – 8:00 AM
Mission Hills Room
ASA WOMEN IN SURGERY BREAKFAST
8:00 AM – 10:30 AM
Marina Ballroom E-G
CONCLUSION: In stage II LAPC, the addition of IRE with established chemotherapy and/or radiation therapy can provide a signicant survival advantage. These early outcome metrics and overall survival begin to
establish the minimal standards in which to establish future comparative
studies.
SCIENTIFIC SESSION III
14
Prospective Randomized Double Blinded Trial Comparing
Two Anti-mrsa Agents with Supplemental Coverage to
Cefazolin Prior to Lower Extremity Revascularization
Patrick A. Stone*, Ali Abu Rahma, Stephen Hass*,
Albeir Mousa*, Asmita Modak*, Mary Emmett*,
James Campbell*,
Aravinda Nanjundappa*, Mohit Srivastiva*
WVU, Charleston, WV
Current antibiotic prophylaxis for vascular procedures includes a rst
generation cephalosporin No changes in recommendations have occurred
despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a signicant reduction in gram + or MRSA infections?.
METHODS: Single center prospective double blinded randomized
study of patients undergoing lower extremity vascular procedures from
2010-2014. 178 patients evaluable at 90 days for surgical site infection.
Infections were categorized as early infections <90 days of the index procedure and late after 90 days.
*By invitation
70
RESULTS: Early vascular Surgical site infection occurred in 6 (7.06%)
of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm.
(p = .27). Gram positive related infections and MRSA infections occurred
in 0%/0% of Vancomycin patients and 2 (2.15%)/7 (7.53%) of Daptomycin
patients respectively (p < 0.01 & p = 0.49). Readmissions related to surgical site infections occurred in 4 (4.71%) in the Vancomycin group and 11
(11.8%) in the Daptomycin group (p = 0.083). Patients undergoing operative
exploration occurred in 4 (4.71%) in the Vancomycin group and 10 (10.75%)
of the Daptomycin group (p = .128). Late infections occurred in 2 patients in
both arms. Median hospital charges related to readmissions related to surgical site infections were in the Vancomycin supplemented and Daptomycin
supplemented patients was 45,450 dollars and 51,182 dollars respectively.
(p = 0.79)
CONCLUSION: Vancomycin supplemental prophylaxis appears to
reduce the incidence of gram positive infection compared to adding supplemental Daptomycin prophylaxis. The Incidence of MRSA related surgical
site infection is low with the addition of either anti-MRSA agents compared
to historical incidence of MRSA related infection.
71
15
Early Versus Late Hospital Readmission After Major
Procedures Among Patients with Employer-Provided
Health Insurance
Yuhree Kim*, Gaya Spolverato*, Aslam Ejaz*, Joe Canner*,
Eric Schneider*, Timothy M. Pawlik
Johns Hopkins, Baltimore, MD
INTRODUCTION: Most studies report only data on readmission
within 30-days of discharge from the same hospital. These data may underestimate readmission, as patients may be readmitted beyond 30-days and/
or at other hospitals. We sought to dene the incidence of early versus late
hospital readmission among surgical patients.
METHODS: Patients discharged after ten major surgical procedures
(CABG, AAA, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, lobectomy, hepatectomy, colectomy, and cystectomy)
between 2010–2012 were identied from a large employer-sponsored health
plan.
RESULTS: 228,144 patients were identied; mean patient age was 52.6
years, 58.2% were male, and 40.7% had Charlson Comorbidity Index of 2.
Median (IQR) length-of-stay was 5 (3, 8) days. Among the 73,498 (32.2%)
patients who experienced readmission, 27,523 (37.5%) had a readmission
within 30-days while 16,208 (22.1%) were readmitted within 31–90 days.
In-hospital mortality was higher among patients re-admitted early (2.7% vs.
1.9%, P < 0.001). Among patients readmitted, 45.7% were re-admitted to a
different hospital than where the index procedures had been performed. Both
early (index hospital:63.0% vs. non-index hospital:37.0%) and late (index
hospital:60.0% vs. non-index hospital:40.0%) readmissions were more likely
to occur at the index hospital (P = 0.007). In-hospital mortality at index vs.
non-index hospitals either among patients with early readmission (index hospital: 3.0% vs. non-index hospital: 2.7%) or late readmission (index hospital:1.3% vs. non-index hospital:2.2%) was comparable (both P > 0.05).
CONCLUSIONS: Most readmissions occurred beyond 30-days, with
approximately half of them occurring at non-index hospitals after major
surgical procedures. Assessment of only 30-day same hospital readmissions
underestimates the true incidence of re-hospitalization.
*By invitation
72
16
Fast As a Predictor of Outcomes After Resuscitative
Thoracotomy: A Prospective Evaluation
Kenji Inaba*, Konstantinos Chouliaras*, Scott Zakaluzny*,
Pedro Teixeira*, Emre Sivrikoz*, Crystal Ives*,
Galinos Barmparas*, Nikos Koronakis*, Demetrios Demetriades
LAC+USC, University of Southern California, Los Angeles, CA
OBJECTIVE(S): Resuscitative thoracotomy (RT) is a high-risk, lowsalvage procedure performed in arresting trauma patients. The indications for
performing this emergent procedure are poorly dened and are based on low
quality primarily retrospective data. The purpose of this study was to examine the ability of FAST to discriminate between survivors and non-survivors
undergoing RT after traumatic arrest.
METHODS: All patients undergoing RT from 10/2010–05/2014 were
prospectively enrolled. A bedside parasternal/subxiphoid cardiac ultrasound
was performed prior to or concurrent with RT. The FAST was captured as
equivocal or adequate with the presence/absence of pericardial uid and/or
wall motion. A sensitivity analysis utilizing the primary outcome measure of
survival to discharge or organ donation was performed.
RESULTS: Overall, 187 patients arrived in traumatic arrest and underwent FAST. Mean age 35.0 (1–84), 84.5% male, 51.3% penetrating. Loss
of vitals occurred in the eld in 48.1%, en-route in 24.6% and in the ED in
27.3%. 77.5% underwent emergent left thoracotomy and 22.5% a clamshell.
Sustained cardiac activity was regained in 49.7% however overall survival
was only 3.2% with 1.6% proceeding to organ donation. FAST was equivocal in 3.7%, 28.9% demonstrated wall motion and 9.1% pericardial uid.
FAST was 100% sensitive and 62% specic for the identication of survivors
and potential donors.
CONCLUSIONS: With 100% sensitivity for the detection of survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of resuscitative
thoracotomy from potential survivors. Prospective multicenter validation is
warranted.
*By invitation
73
17
Tumor Genotype Determines Phenotype and Disease-Related
Outcomes in Thyroid Cancer: A Study of 1,510 Patients
Linwah Yip*, Marina N. Nikiforova*, Jenny Yoo*,
Kelly L. McCoy*, Michael T. Stang*, Kristina J. Nicholson*,
Michaele J. Armstrong*, Steven P. Hodak*, Robert L. Ferris*,
Yuri E. Nikiforov*, Sally E. Carty
University of Pittsburgh, Pittsburgh, PA
OBJECTIVE(S): The prognostic signicance of molecular signature
in thyroid cancer (TC) is undened but is expected to markedly change surgical management. Our aim is to correlate TC genotype to histology and
outcomes.
METHODS: We reviewed a consecutive series of 1,510 patients
who had initial thyroidectomy for TC from 2/07–6/13 with routine testing
for BRAF, RAS, RET/PTC, and PAX8/PPARg genetic alterations. Histologic metastatic or recurrent TC was tracked 6 months after oncologic
thyroidectomy.
RESULTS: Papillary thyroid cancer (PTC) was diagnosed in 97%,
and poorly-differentiated/anaplastic TC in 0.9%. Genetic alterations were
detected in 1,039 (70%); the most common mutations were BRAFV600E
(644/1039, 62%) and RAS isoforms (323/1039, 31%). BRAFV600E-positive PTC was often conventional or tall-cell variant (58%), with frequent
extrathyroidal extension (ETE, 51%) and lymph node metastasis (LNM,
46%). Conversely, RAS-positive PTC was commonly follicular-variant
(87%), with infrequent ETE (4.6%) and LNM (5.6%). BRAFV600E- and
RET/PTC-positive PTCs were histologically similar. Analogously, RAS- and
PAX8/PPARg-positive PTCs were histologically similar. Compared to RASor PAX8/PPARg-positive TC, the TC expressing BRAFV600E or RET/PTC
were more often associated with TNM stage III/IV at presentation (40% v.
15%, p < .001) and early recurrence (10% v. 0.7%, p < .001; mean followup
33±21months). Distant metastasis was highest in patients with RET/PTCpositive TC (10.8%, p = .02).
CONCLUSIONS: In this unique, large study of prospective mutation testing in unselected patients with thyroid cancer, molecular signature
predicted distinctive tumor phenotypes including TC with higher risks of
both distant metastasis and early recurrence. Preoperative genotype provides
valuable prognostic data to appropriately inform surgical care.
*By invitation
74
75
18
Intraoperative Molecular Imaging Provides Rapid and
Accurate Diagnosis of Primary Pulmonary Adenocarcinoma
Gregory T. Kennedy*1, Olugbenga T. Okusanya*1,
Daniel F. Heitjan*1, Charuhas Deshpande*1, Leslie A. Litzky*1,
Jane J. Keating*1, Steven M. Albelda*1, Shuming Nie*2,
Philip S. Low*3, Jeffrey A. Drebin1, Sunil Singhal*1
1
University of Pennsylvania School of Medicine, Philadelphia, PA;
2
Emory University, Atlanta, GA; 3Purdue University, West
Lafayette, IN
OBJECTIVE: To compare molecular imaging to frozen section analysis for intraoperative diagnosis of solitary pulmonary nodules (SPNs).
BACKGROUND: Intraoperative frozen section analysis of indeterminate SPNs guides the extent of pulmonary resection. Frozen sectioning is time consuming and susceptible to error, and alternative diagnostic
modalities have been unsuccessfully pursued for decades. We report a novel
molecular imaging technology that rapidly and accurately diagnoses primary
pulmonary adenocarcinomas, which are the most common SPNs.
METHODS: Thirty consecutive patients with an indeterminate SPN
were preoperatively administered a contrast agent specic for primary pulmonary adenocarcinomas. During surgery, SPNs were removed and molecular imaging was used to identify primary adenocarcinomas. Frozen section
analysis was performed, and immunohistochemical diagnosis served as the
gold standard to compare the diagnostic techniques.
RESULTS: Molecular imaging identied 19 of 19 primary adenocarcinomas and correctly predicted those patients that should undergo a
lobectomy. There were no false positive diagnoses despite two metastatic
adenocarcinomas. Frozen section identied 13 (68%) primary adenocarcinomas, and a false negative diagnosis incorrectly altered the management
in one patient. Molecular imaging required 2.4 minutes compared to 26.5
minutes for frozen section (p < 0.001).
*By invitation
CONCLUSIONS: This proof-of-principle study demonstrates that
molecular imaging has superior positive predictive value for primary adenocarcinomas and is signicantly faster than frozen section. Targeted contrast
agents can be developed for other tumors, and this technology can be broadly
applied in surgical oncology.
76
77
19
Factors Predicting Outcomes After Total Pancreatectomy
and Islet Auto Transplant – Lessons Learned from Over
500 Cases
Srinath Chinnakotla*, Gregory Beilman, Ty Dunn*,
Melena Bellin*, Martin Freeman*, Mustafa Arain*,
Sarah Jane Schwarzenberg*, David Radosevich*,
Alfred Clavel*, David Sutherland, Timothy Pruett
University of Minnesota, Minneapolis, MN
OBJECTIVE(S): Total-Pancreatectomy and islet-cell-auto transplantation (TP/IAT) is being increasingly utilized for the management of chronicpancreatitis (CP). However, the outcome predictors of this operation remain
unclear.
METHODS: 581 patients (including 91 children) undergoing TP/
IAT for the treatment of CP at a single-center were analyzed. End points
included persistent “Pancreatic pain” similar to pre-surgery, narcotic use for
any reason and insulin dependence (multiple daily doses/C peptide negative) at 1 year follow up. Forward and backward step-wise regression models
were used to create the 3 best tting multivariate-logistic-regression models.
Potential risk factors included: patient characteristics, surgery related factors
(e.g., pancreas brosis and islet yield) and previous surgeries and procedures.
RESULTS: Patients had a mean ± SD 6.94 ± 6.6 years duration of
pancreatitis and 3 ± 2.6 years of narcotic use prior to TP-IAT. Pediatric
patients (OR 0.3,LCL 0.88, UCL 0.58,p = 0.001) performed better in all
three outcomes. Among the adults, for persistent “pancreatic-pain” at 1 year,
increasing body mass, familial etiology, pancreas divisum, prior Whipple,
and ERCP/>3 stents were independent risk factors. Previous ERCP/>3 stents
were associated with increase in narcotic use. Prior Puestow/distal pancreatecotmy were associated with lower narcotic use. With adjustment for islet
yield, an alcohol etiology and previous Puestow were independent risk factors for insulin dependence (all stats listed in Figure1).
*By invitation
CONCLUSIONS: This represents the largest series examining risk
factors, outcomes after TP/IAT. The identied patient groups warrant further
attention prior to TP-IAT.
78
FRIDAY MORNING, APRIL 24th, CONTINUED
FRIDAY AFTERNOON, APRIL 24th
10:30 AM – 12:00 PM
Marina Ballroom E-G
1:30 PM – 4:00 PM
Marina Ballroom E-G
FORUM DISCUSSION
SCIENTIFIC SESSION IV
79
Development of Surgical Scientists
“Sources of Funding”
Ronald J. Weigel, M.D.
University of Iowa, Iowa City, IA
“ACS Scholarships Generating Academic Leaders”
UVA Health System, Charlottesville, VA
“Assuring Productivity: The Role of the Chair”
Timothy J. Eberlein, M.D.
“My Grant Was Denied: What Now?”
Charles E. Lucas, M.D.
Wayne State University, Detroit, MI
20
The Relationship Between Margin Width and Local
Recurrence (LR) of Ductal Carcinoma In Situ (DCIS):
3001 Women Treated with Breast-Conserving Surgery
(BCS) Over 30 Years
Kimberly J. Van Zee, Preeti D. Subhedar*, Cristina Olcese*,
Sujata Patil*, Monica Morrow
OBJECTIVE: While DCIS has minimal mortality, LR rates after BCS
remain signicant, and half of LR are invasive. Positive margins are associated with increased risk of LR, but there is no consensus regarding optimal
margin width. Our goal was to investigate the relationship between margin
width and LR in a large population of women with long follow-up.
METHODS: We retrospectively reviewed a prospective database of
DCIS patients undergoing BCS from 1978–2010. Cox proportional hazard
models were used to investigate the association between margin width and
LR.
RESULTS: 3001 women were identied; 2713 had complete data. 324
recurred. Median follow-up for women without LR was 74 mo (range 0-30
years); 680 were followed for 10 yrs. Controlling for age (p < 0.001), family history (p = 0.02), clinical vs. radiologic presentation (p = 0.02), number
of excisions (p = 0.006), radiotherapy (RT) (p < 0.0001), endocrine therapy
(p < 0.0001), and year of surgery (p = 0.002), margin width was signicantly
associated with LR (p = 0.0004) in the entire population. Larger negative
margins were associated with lower hazard ratio (HR) compared to positive
margins (Table). An interaction between RT and margin width was signicant (p < 0.02); the association of LR with margin width was signicant in
those without RT (p < 0.0001)(Table), but not in those with RT (p = 0.9).
*By invitation
80
Relationship of Margin Width and LR in Cox Proportional
Hazards Models Controlling for Other Factors
Population in Model
Margin Width
Hazard Ratio
P
Entire population
(N = 2713)
Positive
1
0.0004
2 mm
0.81
No radiotherapy
population (N = 1229)
2–10 mm
0.73
>10 mm
0.46
Positive
1
< = 2 mm
0.76
>2–10 mm
0.59
>10 mm
0.31
<0.0001
CONCLUSIONS: In women not receiving RT, margin width was signicantly associated with LR, with wider margins resulting in a signicantly
lower rate of LR. Obtaining wider negative margins may be important in
reducing the risk of LR in women who choose not to undergo RT.
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21
Sarcoma Resection with and Without Vascular
Reconstruction: A Matched Case-Control Study
George A. Poultsides*, Thuy B. Tran*, David G. Mohler*,
Matthew W. Mell*, Raf S. Avedian*, Brendan C. Visser*,
Jason T. Lee*, Kristen Ganjoo*, E. John Harris*,
Jeffrey A. Norton
Stanford University Medical Center, Stanford, CA
OBJECTIVE: En bloc resection and reconstruction of involved major
vessels is being increasingly performed during sarcoma surgery, however the
outcomes of this strategy are not well described.
METHODS: Patients undergoing sarcoma resection with (VASC)
and without (NO-VASC) vascular reconstruction were 1:2 matched on site,
histology, grade, size, synchronous metastasis, and primary (vs. repeat)
resection. R2 resections were excluded. Endpoints included perioperative
morbidity, mortality, recurrence, and survival.
RESULTS: From 2000 to 2014, 53 sarcoma patients underwent VASC
resection. These were matched with 106 NO-VASC patients having similar clinicopathologic characteristics (Table). Perioperative complications
(74% vs. 43%, P < 0.001), grade 3/4 complications (36% vs. 19%, P = 0.02),
transfusion (68% vs. 34%, P < 0.001), and reoperation (26% vs. 10%, P =
0.018) were all more common in the VASC group. Thirty-day (2% vs. 0%,
P = 0.33) or 90-day mortality (6% vs. 2%, P = 0.19) were not signicantly
higher. Local recurrence (25% vs. 36%, P = 0.19) and survival after resection
(5-year, 58% vs. 51%, P = 0.56) were similar between the two groups. Within
the VASC group, survival after venous only (n = 18), arterial and venous (n
= 19), or arterial only (n = 16) reconstruction was comparable (5-year, 72%,
61%, 51%, P = 0.33).
CONCLUSIONS: This is the rst matched case-control study examining the impact of concomitant vascular reconstruction on sarcoma resection
outcomes. These operations are associated with considerable morbidity and
require meticulous multidisciplinary planning. However, the oncologic outcome appears equivalent to cases without vascular involvement.
*By invitation
82
VASC*
Cases
(n = 53)
NO-VASC
Controls
(n = 106)
P
Age (yrs)
57
57
0.69
Female Gender
55%
54%
0.91
Resection Type
1
Synchronous
Metastasis
Site
Retroperitoneum
51%
51%
Extremity
36%
36%
Trunk
7%
7%
Mediastinum
6%
6%
10.1
10.1
Tumor Size (cm)
VASC*
Cases
(n = 53)
Grade
0.93
NO-VASC
Controls
(n = 106)
83
P
Primary
81%
81%
Repeat (for
Recurrence)
19%
19%
1
23%
21%
0.78
28%
28%
0.83
Low
Intermediate
21%
17%
High
51%
55%
26%
28%
Leiomyosarcoma
26%
26%
R1 Margin
Dediff
Liposarcoma
13%
13%
UPS, Undifferentiated Pleomorphic Sarcoma; ESS, Endometrial Stromal Sarcoma; PNST,
Peripheral Nerve Sheath Tumor
UPS
9%
9%
Synovial Sarcoma
9%
9%
Desmoid
9%
9%
Angiosarcoma
8%
8%
Myxoid
Liposarcoma
6%
6%
Well-diff
Liposarcoma
4%
4%
Osteosarcoma
4%
4%
Fibromyxoid
Sarcoma
4%
4%
Carcinosarcoma
2%
2%
ESS
2%
2%
Chondrosarcoma
2%
2%
PNST
2%
2%
Histologic Type
0.61
* Overall, 72 vessels were reconstructed in 53 patients: aorta (n = 6), vena cava (n = 16),
iliac artery (n = 5), iliac vein (n = 5), lower extremity artery (n = 17), lower extremity
vein (n = 13), upper extremity artery (n = 4), upper extremity vein (n = 2), pulmonary
artery (n = 2), superior mesenteric artery (n = 1), and portal vein (n = 1).
1
84
22
Management of the Parathyroid Glands in Preventative
Thyroidectomy for Multiple Endocrine Neoplasia Type 2
Jeffrey F. Moley, Kathryn A. Rowland, Linda Jin*,
Amber L. Traugott, Michael A. Skinner*, Samuel A. Wells
OBJECTIVES: Multiple endocrine neoplasia type 2 is characterized
by a near 100% risk of medullary thyroid carcinoma (MTC). Genetic testing identies gene carriers in affected families and allows performance of
preventative thyroidectomy. Management of the parathyroids in these operations is controversial, with some experts advocating total parathyroidectomy
with autotransplantation, and others leaving the parathyroids in situ.
METHODS: Between 1993 and 2003 we performed 50 preventative thyroidectomies. All patients had central neck dissection (CND), total
parathyroidectomy and autotransplantation to the non-dominant forearm,
regardless of preoperative calcitonin level (Group A). Between 2003 and the
present, the lead author performed 95 preventative thyroidectomies, leaving
the parathyroids in situ with an intact vascular pedicle (group B). Individual
parathyroids were autotransplanted only if they appeared non-viable. CND
was done only if calcitonin was greater than 40pg/ml.
RESULTS: Permanent hypoparathyroidism occurred in 3/50 patients
in group A, vs 1/95 in group B (p = 0.1184). There were no permanent recurrent laryngeal nerve injuries in either group. No patient developed subsequent
hyperparathyroidism. Recurrence/persistence of MTC requiring re-operation
occurred in 2 patients in group A, and in 1 patient in group B (though followup is longer in group A, and several group B patients currently have elevated
calcitonin). No patients have died.
CONCLUSIONS: Routine total parathyroidectomy with autotransplantation and CND during preventative thyroidectomy has excellent longterm results. Preservation of the parathyroids in situ during preventative
thyroidectomy, and selective central neck dissection based upon calcitonin
level in MEN 2 gene carriers is an effective and safe alternative.
*By invitation
85
23
The Society of Thoracic Surgeons Voluntary Public
Reporting Initiative: The First Four Years
David Shahian1, Frederick Grover2, Richard Prager3,
Fred Edwards*4, Giovanni Filardo*5, Sean O’Brien*6,
Xia He*6, Anthony Furnary*7, J. Scott Rankin*8,
Vinay Badhwar*9, Joseph Cleveland*2, Franco Fazzalari*3,
Mitchell Magee*10, Jane Han*11, Jeffrey Jacobs*12
1
Massachusetts General Hospital, Boston, MA; 2University
of Colorado Anschutz School of Medicine, Aurora, CO;
3
University of Michigan, Ann Arbor, MI; 4University of Florida,
Jacksonville, FL; 5Baylor Scott & White Health, Dallas, TX;
6
Duke Clinical Research Institute, Durham, NC; 7Starr-Wood
Cardiac Group, Portland, OR; 8Vanderbilt University,
Nashville, TN; 9University of Pittsburgh, Pittsburgh, PA;
1
0HCA Medical City Dallas Hospital, Dallas, TX; 11Society of
Thoracic Surgeons, Chicago, IL; 12Johns Hopkins All
Children’s Heart Institute, Saint Petersburg, FL
OBJECTIVE: We report initial ndings of a voluntary national public
reporting program using Society of Thoracic Surgeons (STS) clinical data
and quality metrics for index procedures.
METHODS: In 9 consecutive semi-annual STS performance rating
periods (2010–2014), we studied public reporting participation rates as well
as the distributions of risk-adjusted mortality rates, composite performance
scores (risk-adjusted morbidity and mortality for each cardiac operation, plus
two process measures for CABG), star ratings, and volumes for reporting
versus non-reporting sites.
RESULTS: Among 8,929 unique STS Database participant rating
opportunities (generally hospital/program level), sites were classied as low
performing in 916 (10.3%) instances, average in 6,801 (76.2%), and high
performing in 1,212 (13.6%). Overall public reporting participation rates
ranged from 23.8% in 2010 to 41.8% in October 2014. Risk-adjusted mortality rates for isolated CABG were consistently lower in public reporting
sites than in non-reporting sites (e.g., 2.1% versus 2.4%, P = 0.03, in the rst
rating period of 2014). Composite performance scores and star ratings were
also superior in the former (4.5% low performing and 23.2% high performing, versus 13.8% low performing and 7.6% high performing, respectively).
STS public reporting sites had higher mean annualized CABG volumes than
non-reporting sites (169 versus 145, p < 0.0001), and high performing programs had higher mean CABG volumes (n = 241) than average (n = 139) or
low performing (n = 153) sites.
*By invitation
86
CONCLUSIONS: Participation in the STS voluntary public reporting
program has nearly doubled over 4 years. Reporting programs have signicantly higher volumes and performance.
87
24
Complete Pathologic Response to Pretransplant
Locoregional Therapy for Hepatocellular Carcinoma Denes
Cancer Cure After Liver Transplantation: Analysis of 501
Consecutively Treated Patients
Vatche G. Agopian*, Maud Morshedi*, Michael HarlanderLocke*, Justin McWilliams*, Ali Zarrinpar*, Fady M. Kaldas*,
Douglas G. Farmer, Daniela Markovic*, Hasan Yersiz*,
Jonathan R. Hiatt, Ronald W. Busuttil
UCLA, Los Angeles, CA
OBJECTIVE: Patients with hepatocellular carcinoma (HCC) awaiting
liver transplantation (LT) have variable risks of tumor progression, waitlist
dropout, and post-transplant recurrence. Pretransplant locoregional therapies
(LRT; percutaneous ablations, transarterial embolizations) mitigate these
risks by inducing tumor necrosis. We evaluated the rate of complete pathological response (cPR) in patients undergoing LRT, the effect of LRT on
post-LT HCC recurrence and survival, and factors associated with cPR.
METHODS: Comparisons were made among HCC recipients with
and without cPR who received pre-LT LRT from 1994 to 2013. Multivariate
logistic regression identied predictors of achieving cPR.
RESULTS: Of 501 patients, 272, 148, and 81 received 1, 2, and 3 or
more LRT. Post-LT HCC recurrence developed in 57 of 375 patients (15.2%)
without cPR compared to 3 of 126 patients (2.4%) with cPR (P < 0.001).
Recipients with cPR had signicantly superior 1-, 3-, and 5-year disease-specic and recurrence-free survival, and only 1 disease-specic death (Figure).
Multivariate predictors accurately identied recipients with cPR (c-statistic
0.75, Table).
CONCLUSIONS: Achieving cPR in HCC patients receiving LRT
strongly predicts tumor free survival with a negligible risk of HCC recurrence. We identify important factors predicting cPR, allowing for differential prioritization of HCC recipients based on their variable risks of post-LT
recurrence.
*By invitation
88
89
Multivariate Predictors of cPR after LRT for HCC
Odds Ratio
95% CI
P-Value
— No recurrent/residual tumor
1.00
ref
ref
— Possible recurrent/residual tumor
0.45
0.26–0.78
0.004
— Denite recurrent/residual tumor
0.23
0.11–0.45
< 0.001
Post LRT AFP prior to LT = Max pre-LT
AFP
0.23
0.06–0.84
0.027
Radiologic Assessment prior to LT
Lab MELD, per SD decrease
1.35
1.04–1.75
0.024
Radiological max tumor diameter, per log
SD decrease
1.25
0.98–1.59
0.074
Time from last LRT to LT (days),
per SD increase
1.24
1.11–1.39
< 0.001
90
25
Use of a Bundle Checklist Combined with Provider
Conrmation Reduced Risk of Nosocomial Complications
and Death in Trauma Patients
Don Reiff*, Thomas Shoultz*, Russell Grifn*,
Benjamin Taylor*, Loring W. Rue, III
University of Alabama at Birmingham, Birmingham, AL
OBJECTIVES: Bundle checklists are increasingly utilized in patient
care, but data is inconsistent regarding their efcacy in reducing nosocomial
complication rates. We examined whether checklist usage was associated
with nosocomial complications when documented elements were veried by
provider bedside rounds.
METHODS: We performed a retrospective cohort study of trauma
patients admitted to our hospital during a three-phase implementation of a
quality improvement project. For this analysis, patients were categorized as
pre-documentation (PD), documentation only (DO), or documentation with
provider review (PR) cohort based on temporal designations. Logistic regression was used to estimate odds ratios (ORs) and 95% condence intervals
(CIs) for the association between documentation cohorts and nosocomial
complications.
RESULTS: No difference in mean hospital stay, ICU days, or ventilator days was observed. The DO cohort showed no signicant differences in
the risk of complications. Among ICU patients, when compared to the PD
cohort, the PR cohort demonstrated a decreased risk of all complications
OR 0.72 (95% CI 0.55–0.93), pulmonary embolus OR 0.29 (95% CI 0.11–
0.73), pneumonia OR 0.66 (95% CI 0.50-0.88), and death OR 0.50 (95% CI
0.31–0.79).
CONCLUSION: Bedside conrmation of bundle checklists during
physician extender rounds reduces the risk of pulmonary embolus, pneumonia, and death when compared to chart documentation alone. This study
underscores the importance of the team approach to the bundle checklist and
it’s ability to reduce morbidity and mortality.
*By invitation
91
Odds Ratios* (ORs) and Associated 95% Condence Intervals (CI)
for the Association Between FASTHUGS
Pre-Documentation
Cohort (n = 1,136)
Documentation
Only Cohort
(n = 1,160)
Documentation
and Physician
Extender
Check Cohort
(n = 1,185)
OR (95% CI)
OR (95% CI)
OR (95% CI)
ALL PATIENTS
Any event
Ref
0.93 (0.72–1.19)
0.72 (0.56–0.92)
DVT
Ref
1.01 (0.64–1.59)
0.77 (0.48–1.24)
Pulmonary
embolism
Ref
0.74 (0.37–1.45)
0.31 (0.13–0.73)
Pneumonia
Ref
0.89 (0.67–1.17)
0.68 (0.51–0.89)
Bacteremia
Ref
0.94 (0.61–1.44)
0.94 (0.61–1.43)
Death
Ref
0.90 (0.59–1.36)
0.50 (0.31–0.79)
* Estimated from logistic regression and adjusted for injury severity score and race
92
FRIDAY AFTERNOON, APRIL 24th, CONTINUED
FRIDAY EVENING, APRIL 24th
4:00 PM – 5:00 PM
Marina Ballroom E-G
7:00 PM – 8:00 PM
EXECUTIVE SESSION
ASA Fellows Only
ANNUAL RECEPTION
8:00 PM – 10:30 PM
Marina Ballroom
ANNUAL BANQUET
93
94
SATURDAY MORNING, APRIL 25th
patency was 94%, with secondary patency of 95.3%. Type Ia endoleak was
present in 5.7% with secondary intervention rates of 37.9%. Overall survival
of patients in this high-risk cohort for open repair at latest follow-up was
79%.
CONCLUSIONS: This global experience is the largest series in the
literature of ch-EVAR and demonstrates comparable outcomes to published
branched/fenestrated devices and is independent of the type of abdominal
device or selected chimney graft, suggesting it’s broad applicability to most
surgeons. These results support ch-EVAR as a valid off-the-shelf alternative
in the treatment of complex EVAR and give impetus for the standardization
of the technique in the future.
8:00 AM - 11:00 AM
Marina Ballroom E-G
SCIENTIFIC SESSION V
26
Collected World Experience of the Snorkel/Chimney
Endovascular Technique in the Treatment of Complex
Aortic Aneurysms: The PERICLES Registry
Jason T. Lee*1, Konstantinos Donas*2, Mario Lachat*3,
Giovanni Torsello*2, Frank J. Veith4
1
Stanford University Medical Center, Stanford, CA; 2Muenster
University Hospital, Muenster, Germany; 3University Hospital
Zurich, Zurich, Switzerland; 4New York University – Langone
Medical Center, New York, NY
OBJECTIVE(S): Endovascular aneurysm repair (EVAR) has largely
replaced open surgery worldwide for anatomically suitable aortic aneurysms.
Lack of availability of fenestrated devices and off the shelf solutions have
encouraged an alternative strategy utilizing parallel, or snokel/chimney
grafts (ch-EVAR). We sought to examine the collected worldwide experience with use of ch-EVAR for complex aneurysm treatment.
METHODS: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from
2008–2014 by pre-arranged dened and documented protocols.
RESULTS: 119 patients in US centers and 398 in European centers
were treated during the study period. US centers preferentially used Zenith
stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%).
Overall 898 chimney grafts (49% vs 51% balloon-expandable vs selfexpandable covered stents) were placed into 692 renal arteries, 156 SMAs,
and 50 celiacs. At a mean follow up of 17.1 months (1–70 months), primary
*By invitation
95
96
27
How Well Does Renal Transplantation Cure
Hyperparathyroidism?
Irene Lou*, Scott Odorico*, David Foley*, David Schneider*,
Rebecca Sippel*, Herbert Chen
University of Wisconsin-Madison, Madison, WI
BACKGROUND: Most patients with end-stage kidney disease will
develop renal hyperparathyroidism. Transplantation reportedly resolves secondary hyperparathyroidism in 95% of cases. Therefore, current practice
guidelines recommend a watchful waiting approach to hyperparathyroidism
the rst 12 months after transplantation to allow maximal allograft function.
The purpose of our study is to examine the incidence of hyperparathyroidism, dened as an elevated parathyroid hormone (PTH) level, after renal
transplantation in a contemporary cohort.
METHOD: A total of 2,039 patients underwent kidney transplantation
from 1/1/2004–6/30/2012 with a minimum of 24 months of follow-up. Oneway analysis of variance was used to compare group means. A multivariate
logistic regression model was constructed, with signicance at p < 0.05.
RESULTS: 603 (30%) of patients achieved normal PTH within the
rst year. 659 (32%) attained normal PTH after one year, with the remaining 777 (38%) having recurrent or persistent hyperparathyroidism (RPH).
Patients normalizing PTH within 12 months had a longer mean graft-survival
(6.9 ± 0.1 years) compared to those with delayed PTH normalization (5.35
± 0.08 years) and those with RPH (5.08 ± 0.07 years), p < 0.001. There
was no statistically signicant difference in graft-survival between those
with delayed normalization of PTH and those with RPH (p = 0.054). Factors
predictive of RPH include age at transplant (p = 0.025), obesity (p < 0.001),
time on dialysis pre-transplant (p < 0.001) and delayed graft failure (p = 0.02)
dened as requiring dialysis within 7 days of transplantation.
CONCLUSION: Renal transplant resolves hyperparathyroidism in
only 62% of patients. Resolution within the rst year portends longer graftsurvival, therefore consideration of earlier intervention for hyperparathyroidism is warranted.
*By invitation
97
28
A Quarter Century of Organ Protection in Open
Thoracoabdominal Repair
Anthony L. Estrera*, Harleen K. Sandhu*, Kristofer M.
Charlton-Ouw*, Rana O. A*, Ali Azizzadeh*,
Charles C. Miller, III*, Hazim J. Sa
University of Texas Health Science Center at Houston,
Houston, TX
OBJECTIVE(S): Thoracoabdominal aortic aneurysm (TAAA)
remains a challenging problem. We describe our experience with open TAAA
and descending thoracic (DTAA) aortic aneurysm repair.
METHODS: Between 1991 and 2014, we repaired 1904 DTAA or
TAAA in 1815 patients. Mean age was 64.5±13.6 with 680/1815 (37.5%)
women. Of 1904 operations, 664 (35%) were DTAA, 312 (16%) TAAA1,
308 (16%) TAAA2, 186 (9%) TAAA3, 341 (18%) TAAA4, and 111 (6%)
TAAA5. 229 (12%) were redo procedures. Adjunct (cerebrospinal uid
drainage + distal aortic perfusion) was used in 75%.
RESULTS: 653/1904 (34%) had aortic dissection and 141 (7.4%) had
rupture. Preoperative glomerular ltration rate (GFR) was 67 ml/min/1.73m2
(interquartile range (IQR) 48–95). Renal failure requiring dialysis occurred
in 316 (16.6%). Immediate neurological-decit (ND) occurred in 89 (4.7%)
and delayed in 105 (5.5%). Of these, 47/194 (24.2%) recovered by the time
of discharge. Postoperative stroke was 90/1904 (4.7%). 30-day mortality was 261/1904 (13.7%). Mortality with GFR > 95 was 25/459 (5.45%),
and 112/427 (26.2%) with GFR < 48 (p < 0.0001). In multivariable analysis, immediate ND was greater in females (p < 0.02) and TAAA2 or 3 (p <
0.0001); it was signicantly reduced by higher GFR (p < 0.0001) and use
of adjunct (p < 0.02), particularly in TAAA2 or 3 (interaction p < 0.0016).
Adjunct is the only signicant predictor of recovery after ND (p < 0.035).
Predictors of 30-day mortality were age (p < 0.02), GFR (p < 0.0001),
TAAA2 (p < 0.03), TAAA3 (p < 0.002), and emergency (p < 0.0001).
CONCLUSIONS: Open thoracoabdominal repair demonstrates
acceptable mortality and morbidity and provides a benchmark for endovascular repair. Adjunct is protective against ND in TAAA2 and 3, and improves
recovery.
*By invitation
98
29
Racial Disparity in African American Renal Transplants: Is
Alemtuzumab Induction the Great Equalizer?
Alison A. Smith*, Mira John*, Isabelle Dortonne*,
Anil S. Paramesh*, Mary Killackey*, Rubin Zhang*,
Belinda Lee*, Bernard M. Jaffe, Joseph F. Buell*
Tulane University, New Orleans, LA
OBJECTIVE: African Americans (AA) renal transplant recipients
experience inferior outcomes compared to Caucasians (CA). Numerous
unsuccessful attempts have been made to identify specic immunologic
and socioeconomic factors contributing to this discrepancy. Our objective
was to examine the effect of induction therapy on racial outcomes for renal
transplantation.
METHODS: Retrospective analysis of outcomes in consecutive adult
renal transplant recipients from 2006–2014 was performed. Patients were
separated by race and further stratied by induction therapy, alemtuzumab
(AL) vs. no alemtuzumab (nAL). Kaplan Meier curves, log rank tests, and
hazard ratios (HR) were generated for mortality and allograft survival. Multiple linear regression modeling measured the effect of independent variables
(nAL, rejection, delayed graft function, CMV infection) on AA allograft
survival.
RESULTS: 433 patients (172 CA and 261 AA) were identied. Mortality was equivalent between CA and AA (23.2% vs. 17.2%, p = 0.1068, HR
= 0.6970) while the incidence of allograft failure was lower for CA vs. AA
(9.3% vs. 21.8%, p = 0.0037*, HR = 2.079). Stratication by induction agent
(267 AL vs. 166 nAL induction) found no difference in allograft survival
between CA vs. AA with AL induction (5.9% vs. 9.7%, p = 0.2364, HR =
1.728) compared to nAL induction (14.2% vs. 42.7%, p = 0.0058*, HR =
2.296). Multiple linear regression conrmed the strongest predictor for AA
allograft failure was nAL induction (p < 0.05*).
CONCLUSIONS: This is the rst study to suggest that a modern
induction agent can eliminate the historic racial disparity previously ascribed
to AA renal transplant recipients. The results of this study should stimulate
further investigations on optimizing healthcare outcomes for AA.
*By invitation
99
30
Trans-Abdominal Redo Ileal Pouch Surgery for Failed
Restorative Proctocolectomy Lessons Learned Over 500
Patients
Feza H. Remzi*, Erman Aytac*, Jean Ashburn*, Jinyu Gu*,
Tracy L. Hull*, David W. Dietz*, Luca Stocchi*, James M.
Church, Bo Shen*
Cleveland Clinic, Cleveland, OH
OBJECTIVE(S): Reported ileal pouch-anal anastomosis (IPAA) failure rate ranged from 3 to 15%, mainly due technical or inammatory conditions. Surgical revision is the only option for patients with a failed IPAA to
avoid permanent stoma. Data regarding surgical, functional and quality of
life (QOL) outcomes of redo surgery for failed IPAA are limited. We aimed
to evaluate single center experience on trans-abdominal redo surgery for
failed IPAA.
METHODS: Patients undergoing trans-abdominal redo surgery for
failed IPAA between 1983 and 2014 were evaluated based on prospectively
maintained institutional registry.
RESULTS: There were 502 (43% male) patients with a mean age of 38
and body mass index 30 kg/m2 at the time of revision surgery. 407 patients
(81%) were referred from outside institutions. Operative indications are
listed in the table. Prior pouch types were J (81%), S (18%) and W (0.3%).
The new pouch was created in 40% of patients. Of these patients with neoIPAA, there were J (87%) and S (13%) pouches. Short-term anastomotic leak
was 8%. The mean postoperative length of stay was 10 days. Failure rate
after redo ileal pouch surgery was 19% within a mean of 9 years follow-up.
Overall functional outcomes and QOL scores were similar to that in patients
who had had the rst time IPAA. Patients with nal diagnosis of Crohn’s
disease,pouch vaginal stula had high failure rates where septic complication
as primary indication had higher success rates.
*By invitation
100
Indications of Redo Surgery
n = 502
Septic complications
Anastomotic leak/stula/anastomotic sinus/
pelvicor perianal abscess
305 (61%)
Obstruction/prolapse
125 (25%)
Dysfunction/chronic pouchitis
60 (12%)
Neoplasia
12 (2%)
CONCLUSIONS: Redo ileal pouch surgery provides high salvage
sates, avoids permanent stoma with acceptable functional outcome and QOL.
101
31
Components of Hospital Perioperative Infrastructure Can
Overcome the Weekend Effect in Urgent General Surgery
Procedures
Anai N. Kothari*1, Matthew A.C. Zapf*2, Robert Blackwell*3,
Victor Chang*2, Zhiyong Mi*1, Gopal N. Gupta*3, Paul C. Kuo1
1
Loyola University Chicago, Department of Surgery, Maywood,
IL; 2Stritch School of Medicine, Maywood, IL; 3Loyola
University Chicago, Department of Urology, Maywood, IL
OBJECTIVE(S): The “weekend effect” (WE) is the observation that
surgeon-independent patient outcomes are worse on the weekend compared
to weekdays. We hypothesized that perioperative hospital resources could
overcome the WE in patients undergoing emergent/urgent surgeries.
METHODS: Emergent/urgent surgeries were identied using the
Healthcare Cost and Utilization Project State Inpatient Database (Florida)
from 2007–2011 and were linked to the American Hospital Association
Annual Survey database to determine hospital level characteristics. Extended
median length of stay on the weekend compared to the weekday (after controlling for hospital, year, and procedure type) was selected as a surrogate
for WE.
RESULTS: Included were 127,221 patients at 166 hospitals. A total of
17 hospitals overcame the WE during the study period. Logistic regression,
controlling for patient characteristics, identied high resolution CT scanner
(OR 1.33)*, home health program (OR 1.88)*, social work program (OR
1.37)*, full adoption of electronic medical records (OR 1.62)*, and increased
nurse-to-bed ratio (OR 2.55)* as hospital resources that overcame the WE
following implementation. The prevalence of these factors in hospitals
exhibiting the WE for all 5 years of the study period were compared to those
hospitals which overcame the WE. (*p < 0.0001).
CONCLUSIONS: Specic hospital resources can overcome the WE
seen in urgent general surgery procedures. Improved hospital perioperative
infrastructure represents an important target for overcoming disparities in
surgical care.
*By invitation
102
Comparing Hospitals With and Without WE
Hospital Factor
Hospitals That
Overcame WE
(n = 17)
Hospitals with
Persistent WE
(n = 40)
p-Value
Nurse to Bed Ratio
1.46
1.22
0.0001
Home Health Program (%)
27.3%
29.6%
0.8609
Patient Controlled Analgesia (%)
93.8%
83.3%
0.2896
Electronic Medical Records (%)
55.6%
13.1%
0.0008
Social Work (%)
98.7%
82.3%
0.0091
High Resolution CT Scanner (%)
61.4%
50.4%
0.4461
103
32
A Longitudinal Assessment of Outcomes, Cost, and
Healthcare Resource Utilization Following Immediate Breast
Reconstruction – Comparing Implant and Autologous
Reconstruction
John P. Fischer*, Justin P. Fox*, Liza C. Wu*,
Suhail K. Kanchwala*, Joshua Fosnot*,
Stephen J. Kovach*, Joseph M. Serletti
Hospital of the University of Pennsylvania, Philadelphia, PA
OBJECTIVES: Immediate breast reconstruction (IBR) has increased
in recent years, yet long-term comparative data on complication and cost
proles are lacking. We perform a comparison of cumulative healthcare
resource utilization and outcomes following implant- and autologous-based
breast reconstruction.
METHODS: 2007–2011 CA, FL, NE, and NY inpatient and ambulatory surgery databases were used (AHRQ HCUP) encompassing 25% of
all-payer 2010 population. Discharges for women 18 years who underwent
mastectomy with breast reconstruction (10/1/2008–10/31/2009), excluding
those with metastatic disease. Outcomes included: 90-day surgical complications, 3-year breast surgery procedures, and cumulative healthcare costs.
RESULTS: 11,493 patients underwent IBR generating costs of $273
million, of which $101 million was for secondary procedures. Adjusted
90-day complication proles favored expander reconstruction (6.5%) relative to direct implant (6.6%) and autologous (13.2%). However, \ adjusted
rate of breast procedures within 3 years was highest in expander reconstruction (2,018 per 1,000 discharges) compared to direct implant (1,427 per
1,000 discharges) and autologous (944 per 1,000) (P < 0.001). Cumulative
adjusted healthcare costs across procedures differed between autologous
($51,948), expander ($57,366), and direct implant ($56,784) modalities
(P < .001) (Figure 1).
*By invitation
104
IN MEMORIAM
CONCLUSION: This analysis provides 3-year data on healthcare
resource utilization across common reconstructive modalities from a cohort
comprising 25% of the all-payer US population and demonstrates the signicant and differing costs of breast reconstruction surgery including revision surgery and the long-term performance of autologous tissue relative to
implants.
11:00 AM ADJOURN
R. Peter Altman, M.D., New York City, NY
Jay L. Ankeney, M.D., Chagrin Falls, OH
Robert E. Condon, M.D., Clyde Hill, WA
Richard E. Edlich, M.D., Brush Prairie, WA
Robert L. Goodale, Jr., M.D., Minneapolis, MN
Raymond Heimbecker, M.D., Collingwood, ON, Canada
Anthony L. Imbembo, M.D., Cockeysville, MD
Adib D. Jatene, M.D., Sao Paulo, Brazil
Gerard A. Kaiser, M.D., Miami, FL
Henry L. Laws, M.D., Clanton, AL
Robert S. Litwak, M.D., Concord, MA
John B. Lynch, M.D., Nashville, TN
Robert A. Macbeth, M.D., Toronto, ON, Canada
Lloyd D. MacLean, M.D., Verdun, QC, Canada
James V. Maloney, Jr., M.D., Los Angeles, CA
Frank T. Padberg, M.D., Little Rock, AR
William W Pfaff, M.D., Gainesville, FL
Peter Randall, M.D., Gwynedd, PA
Raymond C. Read, M.D., Little Rock, AR
Thomas R. Russell, M.D., San Francisco, CA
Robert B. Rutherford, M.D., Boerne, TX
Keiji Sano, M.D., Tokyo, Japan
Erwin R. Thal, M.D., Dallas, TX
Colin G. Thomas, Jr., M.D., Chapel Hill, NC
Stephen L. Wangensteen, M.D., Rembert, SC
David I. Williams, M.D., London, England
309
310
MEDALLION FOR
SCIENTIFIC ACHIEVEMENT (Continued)
MEDALLION FOR
SCIENTIFIC ACHIEVEMENT
2000
BERNARD FISHER, M.D.
Pittsburgh, Pennsylvania
1970
LESTER R. DRAGSTEDT, M.D.
Gainesville, Florida
2001
JOHN W. KIRKLIN, M.D.
Birmingham, Alabama
1973
ROBERT E. GROSS, M.D.
Boston, Massachusetts
2002
ROBERT H. BARTLETT, M.D.
Ann Arbor, Michigan
1976
OWEN H. WANGENSTEEN, M.D.
Minneapolis, Minnesota
2003
CLYDE F. BARKER, M.D.
1977
ROBERT M. ZOLLINGER, SR., M.D.
Columbus, Ohio
2004
SAMUEL A. WELLS, JR., M.D.
Durham, North Carolina
1978
FRANCIS D. MOORE, SR., M.D.
2006
STEVEN A, ROSENBERG, M.D.
Bethesda, Maryland
1979
JONATHAN E. RHOADS, M.D.
2007
RONALD W. BUSUTTIL, M.D.
Los Angeles, California
1981
MICHAEL E. DEBAKEY, M.D.
Houston, Texas
2008
JOSEF E. FISCHER, M.D.
1987
RICHARD L. VARCO, M.D.
Minneapolis, Minnesota
2009
STANLEY J. DUDRICK, M.D.
Waterbury, Connecticut
1990
THOMAS E. STARZL, M.D.
2010
DENTON A. COOLEY, M.D.
Houston, Texas
1991
JOSEPH E. MURRAY, M.D.
2012
PATRICIA K. DONAHOE, M.D.
1992
NORMAN E. SHUMWAY, M.D.
Stanford, California
2014
DAVID N. HERNDON, M.D.
Galveston, Texas
1995
FOLKERT O. BELZER, M.D.
Madison, Wisconsin
1997
M. JUDAH FOLKMAN, M.D.
1998
BASIL A. PRUITT, JR., M.D.
San Antonio, Texas
311
312
MEDALLION FOR THE
ADVANCEMENT OF SURGICAL CARE
313
FLANCE-KARL AWARD RECIPIENTS
2012
TOM R. DEMEESTER, M.D.
San Marino, California
2013
EDWARD E. MASON, M.D.
Iowa City, Iowa
2014
DONALD L. MORTON, M.D.
Santa Monica, California
The Flance-Karl Award was established in 1996 by Samuel A. Wells, Jr., M.D.,
who was then President of the Association. The primary endowment for
the award was a gift from Mr. David Farrell, Chief Executive Ofcer of the
May Corporation, and the Barnes-Jewish-Christian Health Care System,
both of St. Louis, Missouri. The award recognizes I. Jerome Flance, M.D.,
and Michael M. Karl, M.D., two physicians in St. Louis, who cared for
Mr. Farrell and his family. The Flance-Karl Award is presented to a surgeon
in the United States of America who has made a seminal contribution in
basic laboratory research which has application to clinical surgery. The
recipient should be active in clinical or laboratory research and preferably is
less than 60 years of age. Prior recipients of the Association’s Medallion for
Scientic Achievement are not eligible for the Flance-Karl Award.
1997
STANLEY J. DUDRICK, M.D.
Waterbury, Connecticut
&
JONATHAN E. RHOADS, M.D.
1998
M. JUDAH FOLKMAN, M.D.
1999
NORMAN E. SHUMWAY, M.D.
2000
FRANCIS D. MOORE, SR., M.D.
2001
BERNARD FISHER, M.D.
2002
STEVEN A. ROSENBERG, M.D.
Bethesda, Maryland
2003
STEVEN F. LOWRY, M.D.
New Brunswick, New Jersey
314
FLANCE-KARL AWARD RECIPIENTS (Continued)
FOUNDATION FELLOWSHIP AWARD RECIPIENTS
2004
PATRICIA K. DONAHOE, M.D.
2005
ALEXANDER W. CLOWES, M.D.
Seattle, Washington
2006
DAVID N. HERNDON, M.D.
Galveston, Texas
2007
RONALD V. MAIER, M.D.
Seattle, Washington
2008
TIMOTHY R. BILLIAR, M.D.
2009
JOSEPH P. VACANTI
2010
B. MARK EVERS, M.D.
Lexington, Kentucky
2011
MICHAEL T. LONGAKER, M.D.
2012
JEFFREY A. NORTON, M.D.
2013
JAMES S. ECONOMOU, M.D.
Los Angeles, California
2014
CHRISTIAN P. LARSEN, M.D.
Atlanta, Georgia
Dana K. Andersen, M.D.
Michael E. Shapiro, M.D.
Ronald G. Tompkins, M.D.
Lawrence Rosenberg, M.D.
B. Mark Evers, M.D.
Jonathan S. Bromberg, M.D., Ph.D.
Ronald J. Weigel, M.D., Ph.D.
Bruce R. Rosengard, M.D.
Michael S. Conte, M.D.
John A. Goss, M.D.
Vivian Gahtan, M.D.
Robert C. Gorman, M.D.
James S. Allan, M.D.
Michael S. Mulligan, M.D.
Herbert Chen, M.D.
Christopher R. Mantyh, M.D.
James C.Y. Dunn, M.D.
Daniel A. Saltzman, M.D.
Shahab A. Akhter, M.D.
John R. Renz, M.D.
Nita Ahuja, M.D.
Christopher K. Breuer, M.D.
Marc G. Jeschke, M.D.
Christopher E. Touloukian, M.D.
Michael J. Englesbe, M.D.
Robert W. O’Rourke, M.D.
Christopher L. Wolfgang, M.D.
Andrew M. Cameron, M.D.
Rebecca A. Gladdy, M.D.
Jennifer F. Tseng, M.D.
Caprice Greenberg, M.D.
James O. Park, M.D.
Jen Jen Yeh, M.D.
Eric Chien-Wei Liao, M.D.
Tippi C. MacKenzie, M.D.
Genevieve Melton-Meaux, M.D.
Vishal Bansal, M.D.
David Rabkin, M.D.
315
1982–1984
1984–1986
1986–1988
1988–1990
1990–1992
1992–1994
1994–1996
1996–1998
1997–1999
1998–2000
1999–2001
2000–2002
2000–2001
2001–2003
2001–2003
2002–2004
2002–2004
2003–2005
2003–2005
2004–2006
2004–2006
2005–2007
2005–2007
2006–2008
2006–2008
2007–2009
2007–2009
2007–2009
2008–2010
2008–2010
2008–2010
2009–2011
2009–2011
2009–2011
2010–2012
2010–2012
2010–2012
2011–2013
2011–2013
316
Bryan Tillman, M.D.
Ryan C. Fields, M.D.
James J. Mezhir, M.D.
Sunil Singhal, M.D.
Bao-Ngoc H. Nguyen, M.D.
Kimberly J. Riehle, M.D.
Joseph J. Skitzki, M.D.
Daniel S. Eiferman, M.D.
Karin M. Hardiman, M.D., Ph.D.
Shirling Tsai, M.D.
Todd W. Costantini, M.D.
Paige Porrett, M.D., Ph.D.
Brian R. Untch, M.D.
2011–2013
2012–2014
2012–2014
2012–2014
2013–2015
2013–2015
2013–2015
2014–2016
2014–2016
2014–2016
2015–2017
2015–2017
2015–2017
326
AUTHOR INDEX
Program #
Author
8
Michael Abecassis
11
Kareem M. Abu-Elmagd
14
Ali AbuRahma
28
Rana O. A
24
Vatche G. Agopian
18
Steven M. Albelda
12
Peter J. Allen
19
Mustafa Arain
17
Michaele J. Armstrong
30
Jean Ashburn
21
Raf S. Avedian
30
Erman Aytac
28
Ali Azizzadeh
23
Vinay Badhwar
8
Talia Baker
16
Galinos Barmparas
8
Charlotte Beil
19
Gregory Beilman
19
Melena Bellin
8
Carl Berg
3
Donald T. Berry
5
Thomas A. Biester
10
Nancy J. Birkmeyer
7
Christopher M. Blackwell
31
Robert Blackwell
9
Rachel C. Brennan
Program #
Author
29
Joseph F. Buell
24
Ronald W. Busuttil
14
James Campbell
15
Joe Canner
17
Sally E. Carty
13
Sricharan Chalikonda
31
Victor Chang
28
Kristofer M. Charlton-Ouw
27
Herbert Chen
19
Srinath Chinnakotla
1
Cody Chiuzan
16
Konstantinos Chouliaras
30
James M. Church
3
Constance T. Cirrincione
19
Alfred Clavel
23
Joseph Cleveland
5
Thomas H. Cogbill
11
Guilherme Costa
2
Bryan Cotton
2
Michael W. Cripps
11
Ruy J. Cruz
12
Michael I. D’Angelica
9
Andrew M. Davidoff
9
Noel Delos Santos
12
Ronald P. DeMatteo
16
Demetrios Demetriades
2
Mark DeRosa
18
Charuhas Deshpande
327
328
Program #
Author
Program #
Author
30
David W. Dietz
21
Kristen Ganjoo
9
Jeffrey S. Dome
6
Nicole S. Gibran
26
Konstantinos Donas
8
Brenda Gillespie
29
Isabelle Dortonne
3
Mehra Golshan
18
Jeffrey A. Drebin
2
Dina Gomaa
19
Ty Dunn
12
Mithat Gonen
23
Fred Edwards
25
Russell Grifn
15
Aslam Ejaz
12
Bas Groot Koerkamp
14
Mary Emmett
23
Frederick Grover
8
Jean Emond
30
Jinyu Gu
1
David Estrada
31
Gopal N. Gupta
28
Anthony L. Estrera
4
Ansab A. Haider
8
Gregory Everson
23
Jane Han
24
Douglas G. Farmer
24
Michael Harlander-Locke
23
Franco Fazzalari
21
E. John Harris
17
Robert L. Ferris
11
Koji Hashimoto
23
Giovanni Filardo
14
Stephen Hass
32
John P. Fischer
23
Xia He
27
David Foley
18
Daniel F. Heitjan
1
Kenneth A. Forde
10
Mark R. Hemmila
32
Joshua Fosnot
10
Peter K. Henke
32
Justin P. Fox
24
Jonathan R. Hiatt
19
Martin Freeman
6
Anne M. Hocking
8
Chris Freise
17
Steven P. Hodak
11
Masato Fujiki
2
John B. Holcomb
11
John Fung
6
Shari Honari
23
Anthony Furnary
7
Yinin Hu
6
Maricar Ga
3
Clifford Hudis
329
330
Program #
Author
Program #
Author
30
Tracy L. Hull
13
Eric Kortz
11
Abhinav Humar
31
Anai N. Kothari
16
Kenji Inaba
32
Stephen J. Kovach
9
Rodrigo B. Interiano
9
Matthew J. Krasin
16
Crystal Ives
4
Narong Kulvatumyou
23
Jeffrey Jacobs
31
Paul C. Kuo
29
Bernard M. Jaffe
13
David Kwon
12
William R. Jarnagin
26
Mario Lachat
3
Sara Jasinski
12
Julie Leal
22
Linda Jin
21, 26
Jason T. Lee
29
Mira John
29
Belinda Lee
5
Andrew Jones
18
Leslie A. Litzky
4
Bellal Joseph
27
Irene Lou
24
Fady M. Kaldas
18
Philip S. Low
32
Suhail K. Kanchwala
5
Fred A. Luchette
18
Jane J. Keating
23
Mitchell Magee
18
Gregory T. Kennedy
5
Mark A. Malangoni
10
John P. Kepros
24
Daniela Markovic
11
Ajai Khanna
13
Robert C.G. Martin
9
Kathleen Kieran
9
M. Elizabeth McCarville
29
Mary Killackey
17
Kelly L. McCoy
7
Helen Kim
2
Belinda McCully
15
Yuhree Kim
13
Kelly M. McMasters
12
T. Peter Kingham
24
Justin McWilliams
2
Laszlo Kiraly
21
Matthew W. Mell
1
Ravi P. Kiran
31
Zhiyong Mi
5
Mary E. Klingensmith
28
Charles C. Miller
16
Nikos Koronakis
2
Joseph Minei
331
332
Program #
Author
Program #
Author
14
Asmita Modak
21
George A. Poultsides
21
David G. Mohler
23
Richard Prager
22
Jeffrey F. Moley
19
Timothy Pruett
20
Monica Morrow
19
David Radosevich
24
Maud Morshedi
23
J. Scott Rankin
14
Albeir Mousa
25
Don Reiff
6
Lara A. Mufey
6
Alexander P. Reiner
1
A.C. Murray
30
Feza H. Remzi
14
Aravinda Nanjundappa
4
Peter Rhee
17
Kristina J. Nicholson
2
Bryce Robinson
18
Shuming Nie
22
Kathryn A. Rowland
17
Yuri E. Nikiforov
25
Loring W. Rue
17
Marina N. Nikiforova
12
Eran Sadot
21
Jeffrey A. Norton
28
Hazim J. Sa
23
Sean O’Brien
5
Kelli Samonte
27
Scott Odorico
8
Benjamin Samstein
4
Terence O’Keeffe
28
Harleen K. Sandhu
18
Olugbenga T. Okusanya
15
Eric Schneider
20
Cristina Olcese
27
David Schneider
3
David W. Ollila
2
Martin A. Schreiber
8
Kim M. Olthoff
19
Sarah Jane Schwarzenberg
10
Nicholas H. Osborne
13
Charles R. Scoggins
4
Viraj Pandit
13
Marty Sellars
29
Anil S. Paramesh
32
Joseph M. Serletti
11
Neha Parekh
23
David Shahian
10
Sujal G. Patel
8
Abraham Shaked
20
Sujata Patil
30
Bo Shen
15
Timothy M. Pawlik
12
Jinru Shia
333
334
Program #
Author
Program #
Author
25
Thomas Shoultz
26
Frank J. Veith
3
William M. Sikov
21
Brendan C. Visser
18
Sunil Singhal
13
Kevin T. Watkins
27
Rebecca Sippel
3
Tracy F. Weisberg
16
Emre Sivrikoz
22
Samuel A. Wells
22
Michael Skinner
9
Mark A. Williams
7
Craig L. Slingluff
3
Eric P. Winer
8
Abby Smith
32
Liza C. Wu
29
Alison A. Smith
9
Lynn Wynn
7
Mark E. Smolkin
24
Hasan Yersiz
3
George Somlo
17
Linwah Yip
6
Ravi F. Sood
17
Jenny Yoo
15
Gaya Spolverato
16
Scott Zakaluzny
14
Mohit Srivastiva
31
Matthew A.C. Zapf
17
Michael T. Stang
24
Ali Zarrinpar
2
Ronald Stewart
29
Rubin Zhang
30
Luca Stocchi
14
patrick A. stone
20
Preeti D. Subhedar
19
David Sutherland
4
Andrew Tang
25
Benjamin Taylor
16
Pedro Teixeira
26
Giovanni Torsello
21
Thuy B. Tran
22
Amber L. Traugott
2
Samantha Underwood
20
Kimberly J. Van Zee
335
SCHEDULE-AT-A-GLANCE
THURSDAY, APRIL 23rd
8:15 AM
Opening Session
Marina Ballroom E-G
President's Opening Remarks
Secretary's Welcome and Introduction of New Fellows
Elected in 2014
Presentation of the Medallion for Scientific Achievement
Presentation of the Medallion for the Advancement of Surgical Care
9:10 AM Scientific Session I
Marina Ballroom E-G
10:50 AM Presidential Address
Marina Ballroom E-G
Introduction: John M. Daly, M.D.
Address: Anna M. Ledgerwood, M.D.
1:30 PM Scientific Session II
Marina Ballroom E-G
FRIDAY, APRIL 24th
7:00 AM
8:00 AM
ASA Women in Surgery Breakfast
Mission Hills
Scientific Session III
Marina Ballroom E-G
10:30 AM Forum Discussion:
Marina Ballroom E-G
1:30 PM Scientific Session IV
Marina Ballroom E-G
4:00 PM Executive Session (Fellows Only)
Marina Ballroom E-G
7:00 PM Annual Reception
8:00 PM Annual Banquet
Marina Ballroom E-G
(Black tie preferred, but dark suits are acceptable.)
SATURDAY, APRIL 25th
8:00 AM
Scientific Session V
11:00 AM Adjourn
Marina Ballroom E-G

6588 ASA Book.indb - American Surgical Association

Transcription

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