Does the adult thymus have a purpose and function? Are there any long-term health effects of thymectomy? Tune in to another Swedish Thoracic surgery journal review where we discuss the recent paper out of the NEJM which reports on the health consequences of thymus removal in adults. This paper has been widely picked up by the media and our patients frequently bring it into the office. Listen as we discuss the study population, methods, and potential applications of this paper. Learning Objectives: - Review the purpose and function of the thymus. - Discuss the population, methods, and results of this trial. - Discuss the application of this paper and how it may or may not impact clinical practice for thoracic surgeons.  Hosts: Chloe E. Hanson, MD, PGY-3 Kelly Daus MD, PGY-4 Peter White, MD, Thoracic Surgery Attending Brian Louie, MD, Thoracic Surgery Attending Reference Material: Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023;389(5):406-417. https://pubmed.ncbi.nlm.nih.gov/37530823/ Lin TM, Chang YS, Hou TY, et al. Risk of incident autoimmune diseases in patients with thymectomy. Ann Clin Transl Neurol. 2020;7(7):1072-1082. https://pubmed.ncbi.nlm.nih.gov/32478484/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Did you know that 13% of trauma patients who go home with an opioid prescription will develop opioid dependence?  Multimodal pain regimens not only reduce opioid consumption, but also improve pain control.  On this episode of the BIG T TRAUMA series, we explore a multimodal approach to pain management...and tackle some surgical dogma along the way.   Hosts: Patrick Georgoff, MD, Trauma Surgeon, Duke University, @georgoff Teddy Puzio, MD, Trauma Surgeon, University of Texas Houston Gabby Hatton, MD, Trauma Surgery fellow, University of Texas Houston  References: 1.     Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767637 2.     Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. Injury Prevention 2017: https://pubmed.ncbi.nlm.nih.gov/27597400/ 3.     Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial. J Trauma 2024: https://pubmed.ncbi.nlm.nih.gov/38689402/ 4.     EAST PMG: Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma (2023): https://www.east.org/education-resources/practice-management-guidelines/details/efficacy-and-safety-of-nonsteroidal-antiinflammatory-drugs-nsaids-for-the-treatment-of-acute-pain-af 5.     Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period. JACS 2021: https://pubmed.ncbi.nlm.nih.gov/33515678/ 6.     Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe? J Trauma 2023: https://pubmed.ncbi.nlm.nih.gov/36728125/ 7.     University of Texas at Houston Multimodal Pain Guideline: https://med.uth.edu/surgery/acute-trauma-pain-multimodal-therapy/ 8.     ACS TRAUMA QUALITY PROGRAMS BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT IN TRAUMA PATIENTS: https://www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

A 70 year old healthy female is referred to you with a 5.7 cm abdominal aortic aneurysm. As an astute clinician you are aware that current guidelines support surgical repair for her AAA. What if there was new data to suggest this patient may not benefit from repair? What would be the optimal size threshold that she would benefit from AAA repair? Tune into this episode of Behind the Knife, where the vascular surgery subspecialty team discusses a paper that challenges current size threshold guidelines for AAA repair.  Hosts:  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan. Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives - Review the current size threshold guidelines for surgical repair of abdominal aortic aneurysms - Understand the limitations of the aforementioned guidelines - Understand the methodology, findings, limitations, and clinical applications of the manuscript “Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration.” References 1.    Columbo JA, Scali ST, Jacobs BN, et al. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. Journal of Vascular Surgery. 2024;79(5):1069-1078.e8. doi:10.1016/j.jvs.2024.01.017 https://pubmed.ncbi.nlm.nih.gov/38262565/ 2.    Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044 https://pubmed.ncbi.nlm.nih.gov/29268916/ 3.    Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery. 2024;67(2):192-331. doi:10.1016/j.ejvs.2023.11.002 https://pubmed.ncbi.nlm.nih.gov/38307694/ 4.    The UK Small Aneurysm Trial Participants, Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms.  Lancet 1998;352 (9141) 1649- 1655 https://pubmed.ncbi.nlm.nih.gov/9853436/ 5.    Lederle  FAWilson  SEJohnson  GR  et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group, Immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med 2002;346 (19) 1437- 1444 https://pubmed.ncbi.nlm.nih.gov/12000813/ 6.    United Kingdom EVAR Trial Investigators; Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11. PMID: 20382982. https://pubmed.ncbi.nlm.nih.gov/20382982/ 7.    Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, Littooy FN, Freischlag JA, Bandyk D, Rapp JH, Salam AA; Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002 Jun 12;287(22):2968-72. doi: 10.1001/jama.287.22.2968. PMID: 12052126. 8.    Lancaster EM, Gologorsky R, Hull MM, Okuhn S, Solomon MD, Avins AL, Adams JL, Chang RW. The natural history of large abdominal aortic aneurysms in patients without timely repair. J Vasc Surg. 2022 Jan;75(1):109-117. doi: 10.1016/j.jvs.2021.07.125. Epub 2021 Jul 26. PMID: 34324972. https://pubmed.ncbi.nlm.nih.gov/34324972/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Take a listen into the wild and fascinating world of lung transplantation! One of the biggest challenges for any transplant is organ preservation to provide the best possible recovery and outcome for recipients. That’s especially important for lung transplant, which remains one of the most complex and challenging areas in the field of transplantation. This episode takes a deep dive into the lung transplant landscape and discusses new technologies and innovations that are revolutionizing the field. Jon Williams is joined by Dr. Elliot Wakeam, MD, a thoracic surgeon and lung transplant expert from University of Toronto to discuss the advent of ex-vivo lung perfusion (EVLP) systems and how that and other preservation techniques may impact the future of lung transplantation. Also, Dr. Wakeam provides unique perspectives as faculty from one of the best lung transplant programs in the world.  If you have any questions or comments, or find the episode interesting and want to learn more, feel free to reach out to us at hello@behindtheknife.org. Dominate the Day! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

As we move towards a model of Competency-Based Surgical Education, individualization of training may be needed. How can we get the right education to the right trainee at the right time? How can we link education to actual patient outcomes? Precision education aims to do just that, while leveraging technology, data, and analytics to decrease burden on assessors. While this approach offers a lot of promise to advance surgical education, it can be difficult to conceptualize how this would be implemented in practice. We’re joined by an expert in the field of precision medical education, Dr. Jesse Burk-Rafel, to break down what precision education is and how it might integrate into our current system of surgical education Join hosts Nicole Brooks MD, Judith French PhD, and Jeremy Lipman MD, MHPE for this exciting conversation with Jesse Burk-Rafel MD. Learning Objectives 1.     Listeners will define precision education. 2.     Listeners will describe examples of how precision medical or surgical education is being used currently.  3.     Listeners will explain barriers that must be addressed with the implementation of precision surgical education, including bias and issues with data sharing.  4.     Listeners will consider how precision surgical education will evolve, including possible use within their own institution to completement competency-based surgical education. References Desai SV, Burk-Rafel J, Lomis KD, et al. Precision Education: The Future of Lifelong Learning in Medicine. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38277444/ Richardson J, Santen SA, Mejicano GC, et al. Learner Assessment and Program Evaluation: Supporting Precision Education. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38166211/ Perrone KH, Abdelaal AE, Pugh CM, Okamura AM. Haptics: The Science of Touch As a Foundational Pathway to Precision Education and Assessment. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38109654/ Sukhera J. Precision Education and Equity: A Participatory Framework to Advance Equitable Assessment. Academic Medicine. 2024;99(4).  https://pubmed.ncbi.nlm.nih.gov/38109658/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In this Journal Review episode, the Hernia Content Team from Carolinas Medical Center reviews the definition and meaning of a hernia center. In a subspecialty field that is in its relative infancy, the specialization of care at hernia centers is a relatively new concept. The team reviews two relevant publications on hernia centers that help to provide guidance on this topic for the hernia community. Hosts: - Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center (Charlotte, NC), @SAyusoMD (Twitter) - Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center (Charlotte, NC), @THeniford (Twitter) - Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center (Charlotte, NC), @VedraAugenstein (Twitter) - Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL), No Twitter handle - Dr. Brittany Mead, GI & MIS Fellow, Carolinas Medical Center (Charlotte, NC), No Twitter handle References:  -Shulkin et al, Characterizing Hernia Centers in the United States: What Defines a Hernia Center?, Hernia, 2022 https://pubmed.ncbi.nlm.nih.gov/33871743/  -Köckerling et al, Accreditation and Certification Requirements for Hernia Centers and Surgeons: the ACCESS Project, Hernia, 2019  https://pubmed.ncbi.nlm.nih.gov/33871743/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

VTE prophylaxis is more than just some squeezy leg socks and a one-size fits all dose of enoxaparin!  Ever wonder how VTE prophylaxis is similar to constipation?  Have you or a loved one been hurt by a hospital administrator telling you that VTE is a never event?  Come with us, and our special guest Dr. Bryan Cotton, on this journey to the frontier of research attempting to debunk this myth and improve patient care by reducing VTE rates in trauma patients.   Hosts: - Michael Cobler-Lichter, MD, PGY4/R2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (X/twitter) - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow University of Pennsylvania Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency @urrechisme (X/twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending: Loma Linda University Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship - Brandon Parker, DO, Assistant Professor of Surgery, 5 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @BrandonParkerDO (X/twitter) - Bryan Cotton, MD, MPH, FACS, Professor of Surgery, 20 years in practice  University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Herman Hospital @bryanacotton1 (X/twitter) Learning Objectives: - Describe the rationale for the addition of aspirin to chemoprophylactic regimens for VTE -  Identify appropriate screening systems for trauma patients at high risk for VTE -  Describe the rationale for monitoring anti factor Xa levels in the trauma population receiving VTE chemoprophylaxis - List the major conclusions of the two studies discussed regarding the addition of aspirin to VTE chemoprophylaxis regimens in trauma patients, and the change in antithrombin activity levels over time in relation to enoxaparin responsiveness in polytrauma patients Quick Hits: 1.     On adjusted analysis, the standard VTE PPX plus aspirin group had a lower OR of developing VTE, though limitations of this study highlight need for future prospective work 2.     Trauma patients often suffer from decreased activity of antithrombin 3, which may mediate the relatively higher rates of VTE in this population. 3.     Trauma patients who went on to develop VTE were more likely to not achieve satisfactory anti Xa levels, with a VTE rate of 30% in the never-responder group, the group for which Xa levels were never higher than 0.2 4.     Ex vivo supplementation of antithrombin seems to improve enoxaparin responsiveness.  Remember, enoxaparin and heparin are HELPING AT3, not the other way around References 1.     Lammers D, Scerbo M, Davidson A, et al. Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients. Trauma Surg Acute Care Open. 2023;8(1):e001140. doi:10.1136/tsaco-2023-001140 https://pubmed.ncbi.nlm.nih.gov/37936904/ 2.     Vincent LE, Talanker MM, Butler DD, et al. Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism. JAMA Surg. 2022;157(8):713-721. doi:10.1001/jamasurg.2022.2214 https://pubmed.ncbi.nlm.nih.gov/35731524/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Most surgeons know about malpractice lawsuits, but did you know that residents and even medical students can be involved in them? Join us for a discussion of what happens when patients sue their treatment teams -- and what happens when those teams involve trainees. Host: Nina Clark, MD, MS Guests: Cindy Hamra, JD, MA is an associate dean in the GME Office at the University of Washington School of Medicine, where she leads the operational, administrative and finance functions.  UW School of Medicine is sponsors clinical training for over 1600 medical and dental residents in fellows in over 200 programs.  UW Medicine, through the School of Medicine, is the largest sponsor of GME programs in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho). Lisa Hammel, JD is the senior director of clinical risk management for UW medicine. Prior to that, she spent over 20 years as a defense attorney primarily working in medical malpractice and professional liability defense.  References: American College of Surgeons: https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/litigation-overview/  AMA: https://www.ama-assn.org/medical-residents/residency-life/resident-medical-liability-lawsuits-why-and-how-often-they-happen JAMA Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833625/ & https://jamanetwork.com/journals/jamasurgery/article-abstract/2670456 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Join Drs. Scott Steele and Dan Scheese as they engage in an in-depth conversation with Dr. Michael Valente about the intricate world of appendiceal masses, including carcinoid, adenocarcinoma, and mucinous neoplasms. Despite the complexity of the subject, this episode skillfully deconstructs the topic through the analysis of three distinct cases, illuminating the latest terminology, diagnostic approaches, and management strategies.  Hosts:  Scott Steele, MD (@ScottRSteeleMD) Dan Scheese, MD (@DanScheese13) Guest: Michael Valente, MD (@DrMikeValente) is an Associate Professor of Surgery at the Cleveland Clinic and Program Director of the colon and rectal residency program. Dr. Valente's specialty and research interests include cancer of the appendix, peritoneum, colon, rectum and anus, cytoreductive surgery/HIPEC, complex re-operative surgery, inflammatory bowel disease, advanced endoscopic techniques, laparoscopic and minimally invasive colorectal surgery, and surgical education. Dr. Valente has published numerous peer-reviewed journal articles and book chapters and has presented his research interests both nationally and internationally. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Two surgical experts, Keith Lillemoe and Luise Pernar, discuss improving morbidity and mortality conferences in surgery to enhance education and quality improvement. They explore the historical evolution of these conferences, challenges in connecting them with quality improvement initiatives, creating a supportive culture, and the importance of cultural factors in analyzing surgical complications.