General Surgery Resident Operative Experiences in Solid Organ Injury: An Examination of Case Logs

2021 ◽  
pp. 000313482110475
Author(s):  
Andrew B. Nordin ◽  
Michael M. Wach ◽  
Kabir Jalal ◽  
Clairice A. Cooper ◽  
Jeffrey M. Jordan
Keyword(s):  
Operative Management ◽  
Significant Degree ◽  
Organ Injury ◽  
Solid Organ ◽  
Pancreatic Trauma ◽  
Solid Organ Injury ◽  
Operative Trauma ◽  
Case Logs ◽  
Surgery Resident ◽  
The Impact

Background Non-operative management (NOM) of traumatic solid organ injury (SOI) has become commonplace. This paradigm shift, along with reduced resident work hours, has significantly impacted surgical residents’ operative trauma experiences. We examined ongoing changes in residents’ operative SOI experience since duty hour restriction implementation, and assessed whether missed operative experiences were gained elsewhere in the resident experience. Methods We examined data from American College of Graduate Medical Education case log reports from 2003 to 2018. We collected mean case volumes in the categories of non-operative trauma, trauma laparotomy, and splenic, hepatic, and pancreatic trauma operations; case volumes for comparable non-traumatic solid organ operations were also collected. Solid organ injury operative volumes were compared against non-traumatic cases, and change over time was analyzed. Results Over the study period, both trauma laparotomies and non-operative traumas increased significantly ( P < .001). In contrast, operative volumes for splenic, hepatic, and pancreatic trauma all significantly decreased ( P < .001; P = .014; P < .001, respectively). Non-traumatic spleen cases also significantly decreased ( P < .001), but liver cases and distal pancreatectomies increased ( P < .001; P = .017). Pancreaticoduodenectomies increased, albeit not to a significant degree ( P = .052). Conclusions Continuing increases in NOM of SOI correlate with declining resident experience with operative solid organ trauma. These decreases can adversely affect residents’ technical skills and decision-making, although trends in specific non-traumatic areas may help to mitigate such losses. Further work should determine the impact of these trends on resident competence and autonomy.

scholarly journals Management of blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

2018 ◽  
Vol 5 (6) ◽  
pp. 2177
Author(s):  
Shashikumar H. B. ◽  
Madhu B. S. ◽  
Ajo Sebastian
Keyword(s):  
Blunt Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Tertiary Care ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Surgical Audit ◽  
Non Operative Management

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative management.

The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center

2017 ◽  
Vol 52 (2) ◽  
pp. 345-348 ◽  
Author(s):  
Nathan Vaughan ◽  
Jeff Tweed ◽  
Cynthia Greenwell ◽  
David M. Notrica ◽  
Crystal S. Langlais ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Trauma Center ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Level I ◽  
The Impact

scholarly journals Intra-Abdominal Solid Organ Injury Management in Pediatrics

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
K Subrumaniam ◽  
Sakti Sakti ◽  
Nur Daliza ◽  
YW Yan
Keyword(s):  
Chest Tube ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Pediatric Population ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Solid Organ ◽  
Significant Morbidity ◽  
Solid Organ Injury

Abdominal trauma is relatively uncommon in children but can leads to a significant morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children. We are reporting a case of a child with multiple solid organ injury that was successfully treated non-operatively at our center. We presented a previously healthy 9-month-old girl, presented with fluctuating GCS secondary to motor vehicle accident with borderline hemodynamic stability. She was intubated, blood transfusion commenced and a single inotrope support started. She subsequently diagnosed with grade III liver injury, grade II splenic injury, right grade IV renal injury with large perinephric and retroperitoneal hematoma and moderate hemoperitoneum, a non-displaced left superior pubic rami fracture and cerebral edema on computed tomography (CT). She was admitted to pediatric intensive care unit (PICU). Her intra-abdominal injury injuries were successfully treated conservatively. She required a right chest tube on post trauma day 2, for right hemothorax. The chest tube was removed 3 days later following adequate drainage. She eventually was weaned off from ventilator on post trauma day 11. Feeding was commenced on day 7 of post trauma. She was discharge home well after 3 weeks post trauma with periodical follow up. Conclusion: Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, which have shown successful rate more than 95%, although continued hemodynamic instability mandates operative intervention.

Selective non-operative management of solid organ injury following abdominal gunshot wounds

Injury ◽  
2007 ◽  
Vol 38 (9) ◽  
pp. 1084-1090 ◽  
Author(s):  
Joseph DuBose ◽  
Kenji Inaba ◽  
Pedro G.R. Teixeira ◽  
Antonio Pepe ◽  
Michael B. Dunham ◽  
...  
Keyword(s):  
Gunshot Wounds ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Non Operative Management ◽  
Abdominal Gunshot Wounds

BET 2: Is early chemical thromboprophylaxis safe in patients with blunt trauma solid organ injury (SOI) undergoing non-operative management (NOM)?

2018 ◽  
Vol 35 (2) ◽  
pp. 127-129 ◽  
Author(s):  
Craig Ferguson ◽  
Jonathan Lewin
Keyword(s):  
Blunt Trauma ◽  
Low Molecular Weight Heparin ◽  
Operative Management ◽  
Organ Injury ◽  
Low Molecular Weight ◽  
Solid Organ ◽  
Clinical Question ◽  
Solid Organ Injury ◽  
Study Type ◽  
Non Operative Management

A short cut review was carried out to establish whether chemical thromboprophylaxis was a safe early intervention in patients with solid organ injury that is being managed non-operatively. Eight papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is inadequate evidence assessing safety of low molecular weight heparin (LMWH) within 24 hours of trauma. The current available evidence does suggest that administration of LMWH within 48 hours is safe in non-operative management of patients who have sustained solid organ injury from blunt trauma.

scholarly journals A study of role of non-operative management in blunt abdominal trauma with solid organ injury

2018 ◽  
Vol 5 (9) ◽  
pp. 3043
Author(s):  
Atish N. Bansod ◽  
Rohan Umalkar ◽  
Ambrish T. Shyamkuwar ◽  
Amar Singade ◽  
Priyanka Tayade ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Operative Strategy ◽  
Non Operative Management

Background: The present study of role of non-operative management in blunt abdominal trauma with solid organ injury was done to assess the feasibility and safety of non-operative management in hemodynamically stable patients and identify the causes, predictive factors to delineate the rate of non-operative management failure.Methods: A longitudinal observational study was carried out from September 2013 to November 2015. All cases of blunt trauma abdomen with ultrasonological e/o solid organ injury and were hemodynamically stable were included in study.Results: Total 138 cases presented with a history of blunt trauma abdomen of which 56 cases had ultrasonological evidence of solid organ injury. 8 cases were excluded as 6 of these were hemodynamically unstable at presentation while 1 had bowel perforation and another had severe head injury all requiring operative management. Maximum cases were of age group 21-30 years (41.66%) and 31-40 years (31.25%). 42 (87.5%) cases were male and 6 (12.5%) cases of 48 were females.  28 (66.67%) cases presented as Road Traffic Accident. 28 (66.67%) cases had abdominal pain as the commonest symptom while tenderness in 38 (79.17%) cases and tachycardia in 30 (75%) cases was the predominant sign. Most injuries were seen in spleen 23 (47.92%) cases f/b Liver with 14 (29.12%). Conservative management was successful in 40 (83.33%) cases and failed in 8 (16.67%) cases. Mortality of the study was 1 (2.08%) case.Conclusions: Non-operative strategy is a successful approach in patients who are hemodynamically stable and authors strongly recommend it.

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