Adam Dugan

Characterization and Management of Patients with Heroin versus Nonheroin Opioid Overdoses: Experience at an Academic Medical Center

To characterize the differences between patients who had heroin and nonheroin opioid overdoses and to determine whether there were any significant differences in their management with regard to the naloxone use.

Does the Podcast Video Playback Speed Affect Comprehension for Novel Curriculum Delivery? A Randomized Trial

Introduction Medical education is a rapidly evolving field that has been using new technology to improve how medical students learn. One of the recent implementations in medical education is the recording of lectures for the purpose of playback at various speeds. Though previous studies done via surveys have shown a subjective increase in the rate of knowledge acquisition when learning from sped-up lectures, no quantitative studies have measured information retention. The purpose of this study was to compare mean test scores on written assessments to objectively determine if watching a video of a recorded lecture at 1.5× speed was significantly different than 1.0× speed for the immediate retention of novel material. Methods Fifty-four University of Kentucky medical students volunteered to participate in this study. The subjects were divided into two separate groups: Group A and Group B. Each group watched two separate videos, the first at 1.5× speed and the second at 1.0× speed, then completed assessments following each. The topics of the two videos were ultrasonography artifacts and transducers. Group A watched the artifacts video first at 1.5× speed followed by the transducers video at 1.0× speed. Group B watched the transducers video first at 1.5× speed followed by the artifacts video at 1.0× speed. The percentage correct on the written assessment were calculated for each subject at each video speed. The mean and standard deviation were also calculated using a t-test to determine if there was a significant difference in assessment scores between 1.5× and 1.0× speeds. Results There was a significant (p=0.0188) detriment in performance on the artifacts quiz at 1.5× speed (mean 61.4; 95% confidence interval [CI]-53.9, 68.9) compared to the control group at normal speed (mean 72.7; 95% CI−66.8, 78.6). On the transducers assessment, there was not a significant (p=0.1365) difference in performance in the 1.5× speed group (mean 66.9; CI− 59.8, 74.0) compared to the control group (mean 73.8; CI− 67.7, 79.8). Conclusion These findings suggest that, unlike previously published studies that showed subjective improvement in performance with sped-up video-recorded lectures compared to normal speed, objective performance may be worse.

Short-term Complication Rates Following Anterior Urethroplasty: An Analysis of National Surgical Quality Improvement Program Data

Objective: To determine the characteristics and predictors of perioperative complications after male anterior urethroplasty. Materials and Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) is a validated outcomes-based program comprising academic and community hospitals in the United States and Canada. Data from 2007-2015 were queried for single-stage anterior urethroplasty using Current Procedure Terminology (CPT) codes. The primary outcome was frequency of complications within the 30-day postoperative period. Preoperative and intraoperative parameters were correlated with morbidity measures and univariate and multivariate regression analyses were used. Results: 556 patients underwent anterior urethroplasty, of whom 180 (32.4%) had graft/flap placement. 127 patients (22.9%) went home the same day after surgery, 255 patients (45.9 %) stayed 1 night, and 173 (31.2%) stayed for 2 or more nights. No deaths, cardiovascular complications, or sepsis were noted. 47 (8.5%) patients had complications in the 30-day period. The most common complications were infection (57.4%), readmission (42.9%) and return to the operating room (17%). On univariate analysis, patients who had substitution urethroplasty (p=0.04) and longer operative times (p=0.002) were more likely to have complications, but only longer operative time showed significance on multivariate analysis (p=0.006). Age, American Society of Anesthesiologists (ASA) score and length of stay were not predictive of complication frequency. Conclusions: Anterior urethroplasty has low postoperative morbidity. Longer operative times were associated with increased rate of complications. Longer hospital stay after surgery is not protective against perioperative complications.OBJECTIVE To determine the characteristics and predictors of perioperative complications after male anterior urethroplasty. MATERIALS AND METHODS The American College of Surgeons-National Surgical Quality Improvement Program is a validated outcomes-based program comprising academic and community hospitals in the United States and Canada. Data from 2007 to 2015 were queried for single-stage anterior urethroplasty using Current Procedure Terminology codes. The primary outcome was frequency of complications within the 30-day postoperative period. Preoperative and intraoperative parameters were correlated with morbidity measures, and univariate and multivariate regression analyses were used. RESULTS A total of 555 patients underwent anterior urethroplasty, of whom 180 (32.4%) had graft or flap placement. Of the patients, 127 (22.9%) went home the same day after surgery, 255 (45.9%) stayed for 1 night, and 173 (31.2%) stayed for 2 or more nights. No deaths, cardiovascular complications, or sepsis were noted. Forty-seven patients (8.5%) had complications in the 30-day period. The most common complications were infection (57.4%), readmission (42.9%), and return to the operating room (17%). On univariate analysis, patients who had substitution urethroplasty (P = .04) and longer operative times (P = .002) were more likely to have complications, but only longer operative time showed significance on multivariate analysis (P = .006). Age, American Society of Anesthesiologists score, and length of stay were not predictive of complication frequency. CONCLUSION Anterior urethroplasty has low postoperative morbidity. Longer operative times were associated with increased rate of complications. Longer hospital stay after surgery is not protective against perioperative complications.

Outpatient Surgical Management for Acquired Buried Penis

OBJECTIVE To demonstrate the safety and feasibility of outpatient surgical management for patients with acquired buried penis (ABP). METHODS We conducted an Institutional Review Board approved review of patients who underwent surgical repair of ABP at a single institution from September 2014 to August 2017. Patient characteristics, operative details, and 30- and 90-day complications were assessed. RESULTS Sixteen patients underwent surgical repair of ABP at the University of Kentucky during the study period. Mean age was 54 years (range 44-62). Median body mass index (BMI) was 47.7 (range 25.5-53.3). Patients largely underwent penile liberation, escutcheonectomy, and split thickness skin grafting. Concurrent scrotoplasty and urethroplasty were performed in select cases. The majority of patients 10/16 (62.5%) were discharged on the same day of surgery, while the remaining 6/16 (37.5%) were outpatient extended stay-and were discharged on postoperative day 1. The 30- and 90-day complications were 19% and 25% respectively, all were Clavien II. Split thickness skin graft take was 100%, and technical success was achieved in all patients. Patients with complications had higher BMIs, higher rates of diabetes, and higher rates of tobacco use, though only BMI reached statistical significance (P = .0150, P = .5846, and P = .0632) respectively. CONCLUSION Multi component repair of adult ABP can be safely done on an outpatient basis without need for routine inpatient admission and complex algorithms. The most common complication is surgical site infection, which arose in the first 30 days postoperatively. Higher BMI was a significant risk factor for complications.

Does the Addition of M-Mode to B-Mode Ultrasound Increase the Accuracy of Identification of Lung Sliding in Traumatic Pneumothoraces?: M-Mode Versus B-Mode Ultrasound in Evaluation of Pneumothoraces

It is unknown whether the addition of M‐mode to B‐mode ultrasound (US) has any effect on the overall accuracy of interpretation of lung sliding in the evaluation of a pneumothorax by emergency physicians. This study aimed to determine what effect, if any, this addition has on US interpretation by emergency physicians of varying training levels.

Blood transfusion is a critical determinant of resource utilization and total hospital cost in liver transplantation

The aim of this study is to identify factors associated with increased resource use and total hospital cost (THC) after liver transplantation (LT).

Urethroplasty Practice Patterns of Genitourinary Reconstructive Surgeons

Introduction: To our knowledge there are no studies evaluating urethroplasty practice patterns among genitourinary reconstructive surgeons. Methods: An electronic survey was sent to members of the Society of Genitourinary Reconstructive Surgeons. Respondents were queried regarding approach to bulbar urethral reconstruction in 6 index cases. Results: A total of 91 society members who regularly treated men with urethral strictures responded to the survey. For a 1.5 cm stricture excision and primary anastomosis was the preferred treatment, although less unanimously than expected (only 83% in older men and 67% in younger men). For 2.5 cm strictures urethroplasty with buccal mucosal graft was the preferred treatment for a 35‐year‐old man, and excision and primary anastomosis for a 65‐year‐old man. Excision and primary anastomosis was preferred less frequently in younger patients and in patients with longer strictures (Cochran Q test, p <0.001). No other variables were independently associated with use of excision and primary anastomosis, but there were trends toward increased use of excision and primary anastomosis in higher volume surgeons and surgeons who trained fellows. Of the respondents 90% harvest their own buccal grafts, with 46% leaving harvest sites open and 36% closing them. Of the respondents 48% use stricture location to determine graft placement, while 33% use dorsal onlay and 19% use ventral onlay when substitution urethroplasty is chosen. Conclusions: Urethroplasty consisting of excision and primary anastomosis is performed less commonly than expected among genitourinary reconstructive surgeons. Considerable variation exists regarding operative technique, management of buccal mucosal graft harvest site and substitution onlay site.

PD38-06 CYSTECTOMY AND URINARY DIVERSION FOR BENIGN DISEASE: PATIENT CHARACTERISTICS AND PREDICTORS OF POST-OPERATIVE OUTCOMES FROM A CONTEMPORARY NATIONAL COHORT

analysis was performed for potential predictors of catheterization and urinary retention. Retention was defined as 3 or more catheterizations per day or self-reported inability to void without catheterizing. RESULTS: The need to catheterize at all was noted in 33 of 265 (12.4%) patients. Of these, 11 (4.2% of the total) were determined to be in retention or required catheterization to void. Data regarding the number of catheterizations per day was available in 32 of these patients (Table 1). Univariate analysis showed that increasing BMI significantly predicted the need for catheterization (p 1⁄4 0.009, coefficient 1⁄4 0.097). Diabetes and moderate-to-severe renal disease approached significance (p-value 1⁄4 0.075 and 0.09, respectively), but there were otherwise no significant predictors of the need to catheterize. Additionally, no significant predictors of urinary retention were found (Table 2). CONCLUSIONS: In males undergoing radical cystectomy with NB, retention requiring catheterization to void is uncommon. In this large cohort, the rate of any catheterization at all was 12.4%, of which a small fraction (4.2%) had complete urinary retention. BMI was found to significantly correlate with the need to catheterize, but age, medical comorbidities, pathologic stage, and receiving neoadjuvant chemotherapy did not have significant correlations with urinary retention. Larger power studies are required to further evaluate these predictors.

Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk

Background. We evaluated perioperative outcomes in super obese patients (body mass index >50 kg/m2) undergoing liver resection using the American College of Surgeons National Surgical Quality Improvement Program. Methods. Patients undergoing hepatectomy recorded in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2015 were analyzed. Out of 21,228 hepatectomies in the National Surgical Quality Improvement Program dataset, 146 were performed on super obese patients. Results. Seventy‐two percent of the super obese patients were female with a median age of 50.6 years, and 10% were classified as American College of Surgeons Class ≥III. In this group, 69.2% were hypertensive, 38.4% were diabetics, and 17.8% had dyspnea. The median operation time was 248 minutes in the super obese group, greater than any other body mass index class. Twenty‐two percent of these patients required perioperative transfusion, although 74% underwent partial hepatectomies. Body mass index >50 kg/m2 significantly increased morbidity in patients undergoing hepatectomies, almost 2‐fold. Infectious complications increased by 86%, and the risk of developing critical care complications increased by 63%. Conclusion. Our data show that super obesity (body mass index >50 kg/m2) is the strongest independent predictor of perioperative morbidity. These patients also are at much greater risk of infectious complications and critical care complications. Future studies should be conducted using weight loss strategies in extreme obese patients to reduce their risk of life‐threatening complications after hepatectomy.