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Abstract Background Laparoscopic sleeve gastrectomy (SG) continues to grow in popularity as a primary bariatric procedure. The purpose of this study is to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital.MethodsA retrospective review was conducted between January 1, 2016, and December 31, 2018, on SG patients. All cases performed in 2018 were completed with a closed suction calibration system. Patient demographics, comorbidities, operative variables, and outcomes were collected. Descriptive statistics and chi-squared test were used to compare the two groups. Logistic regression models were adjusted for patient- and procedure-specific factors.ResultsFour hundred ninety cases were performed before and 195 after institution of the CSCS. Groups were similar in most characteristics, including median body mass index (BMI) (46.4 vs 45.8 kg/m2, p = 0.79). Those in the closed suction cohort were more likely to have OSA requiring therapy (32.4% vs 46.6%, p < 0.01) and to have their cases performed robotically (55.4% vs 39.6%, p = 0.02). Post introduction of the CSCS, the overall leak rate was 0% (1.4% vs 0%, p = 0.09); overall need for postoperative interventions decreased (9.6% vs 2.6%, p = 0.009). After adjustment, a 69% decrease was observed in need for related additional intervention [aOR 0.31 (0.12–0.81), p = 0.017].ConclusionThe use of a standardized closed suction calibration system resulted in overall decreased leak rates, which was associated with a clinically significant decrease in additional interventions.

Gun violence is a health crisis that disparately affects non-Hispanic black males, where victims get stuck in a cycle of recurrent violence perpetuated by systemic inequities. Hospital-based violence intervention programs (HVIPs) decrease violent reinjury by addressing social drivers/determinants of health. Many HVIPs solely focus on inpatient interventions. We designed a novel three-pronged continuum of care model: the Bedside, Clinic, Community (BCC) model as a longitudinal approach for equitable service delivery.Our HVIP, Interrupting Violence in Youth and Young Adults (IVYY), serves victims of community violence. The first pillar provides ‘Bedside’ care for inpatients; the second uses a multidisciplinary ‘Clinic’ to address medical and social concerns; and the third ‘Community’ pillar consists of partnerships with local grassroots organizations. Throughout the intervention, IVYY provides pathways for education, mental health, housing, employment, financial, and legal aid. In the first year of service, IVYY enrolled 299 patients who received 1168 inpatient visits. 26.1% were considered high risk and were seen in the IVYY clinic. Community partners provided innumerable resources to IVYY participants. By implementing the BCC model, we provide longitudinal care that addresses patient needs at every stage of their journey.

Surgical training relies on subjective feedback on resident technical performance by attending surgeons. A novel data recorder connected to a robotic-assisted surgical platform captures synchronized kinematic and video data during an operation to calculate quantitative, objective performance indicators (OPIs). The aim of this study was to determine if OPIs during initial task of a resident’s robotic-assisted lobectomy (RL) correlated with bleeding during the procedure. Forty-six residents from the 2019 Thoracic Surgery Directors Association Resident Boot Camp completed RL on an ex vivo perfused porcine model while continuous video and kinematic data were recorded. For this pilot study, RL was segmented into 12 tasks and OPIs were calculated for the initial major task. Cases were reviewed for major bleeding events and OPIs of bleeding cases were compared to those who did not. Data from 42 residents were complete and included in the analysis. 10/42 residents (23.8%) encountered bleeding: 10/40 residents who started with superior pulmonary vein exposure and 0/2 residents who started with pulmonary artery exposure. Twenty OPIs for both hands were assessed during the initial task. Six OPIs related to instrument usage or smoothness of motion were significant for bleeding. Differences were statistically significant for both hands ( p  < 0.05). OPIs showing bimanual asymmetry indicated lower proficiency. This study demonstrates that kinematic and video analytics can establish a correlation between objective performance metrics and bleeding events in an ex vivo perfused lobectomy. Further study could assist in the development of focused exercises and simulation on objective domains to help improve overall performance and reducing complications during RL.