Surgical Capacity Building in Low- and Middle-Income Countries: Lessons for Thoracic Surgery
Koch R, Felsted AM, Virk S, Roy N, Jayaraman S
There is great need for intentional investment in capacity building for thoracic surgical conditions. This article provides a brief overview of thoracic surgical capacity building for low- and middle-income countries using the Lancet framework of infrastructure, workforce, financing, and information management. The authors highlight the needs, opportunities, and challenges that are relevant for the thoracic surgical community, as it aims to increase care for patients with these conditions globally
The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
Kateera F, Riviello R, Goodman A...Koch R, Hedt-Gauthier B
The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings.
This trial assesses whether CHW’s use of a mobile health (mHealth)–facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district.
Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda
Koch R, Nkurunziza T, Rudolfson N...Kateera F
The implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family’s financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE).
Rib Fractures and Delayed Pleural Space Complications
Presented at the Chest Wall Injury Society Research Symposium (Virtual) in October 2021.
Top presentation - awarded $1,000 research scholarship
Palliative care and the modern-day surgeon
Presented at the University of Utah's Department of Surgery Grand Rounds in Salt Lake City, Utah on June 9, 2021.
Age Is a Barrier to Surgical Stabilization of Rib Fracture in Patients with Flail Chest
Discussant of: Bachman LC, Ho VP, Moorman ML, Worrell SG, Argote-Greene LM, & Towe CW. Age Is a Barrier to Surgical Stabilization of Rib Fracture in Patients with Flail Chest. J Am Coll Surg. 2020; 231(4): S304 at the Chest Wall Injury Society Summit Meeting in Denver, Colorado in April 2021.
Stop flailing: The impact of bicortically displaced rib fractures on pulmonary outcomes in patients with chest trauma — an American Association for the Surgery of Trauma multi-institutional study
Senekjian L, Birkas Y, Buhavac M...Colonna A, Ennis T, McCrum M, Nunez J, Young J, Nirula R
Current evaluation of rib fractures focuses almost exclusively on flail chest with little attention on bicortically displaced fractures. Chest trauma that is severe enough to cause fractures leads to worse outcomes. An association between bicortically displaced rib fractures and pulmonary outcomes would potentially change patient care in the setting of trauma. We tested the hypothesis that bicortically displaced fractures were an important clinical marker for pulmonary outcomes in patients with nonflail rib fractures.
Novel Approach to Reduce Transmission of COVID-19 During Tracheostomy
Foster P, Cheung T, Craft P...Kryskow M...DiSiena M
Severe infection involving the novel coronavirus 2019 (COVID-19) has been associated with acute respiratory distress syndrome that subsequently requires patients to be intubated and dependent on mechanical ventilation. In the setting of the recent pandemic, there is a greater need to perform tracheostomy for these patients. With the high transmissibility of the virus, there has been an increasing concern for the development of techniques to perform surgical intervention while mitigating the risk for infecting hospital staff. As more data emerge pertaining to viral shedding in various bodily fluids, it has become more important to give special attention to precautions. In this article, we submit a novel approach for better protection and thus reduced transmission for tracheostomy in a COVID-19 positive patient. Importantly, this technique is functional, easy to set up, and can be used for additional operations that involve risk of aerosolization or droplet exposure to operating room staff.
Right Ventricular Involution: Big Changes in Small Hearts
Bowen ME, Selzman CH, McKellar SH
Before birth, the fetal right ventricle (RV) is the pump for the systemic circulation and is about as thick as the left ventricle (LV). After birth, the RV becomes the pump for the lower pressure pulmonary circulation, and the RV chamber elongates without change in its wall thickness. We hypothesize that the fetal RV may be a model of compensated RV hypertrophy, and understanding this process may aid in discovering therapeutic strategies for RV failure.
Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management
Chabot E, Nirula R
The term “open abdomen” refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic repercussions that must be recognized and managed during postoperative care. This review article describes these issues and provides guidelines for the critical care physician managing a patient with an open abdomen.
Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches
Cole CD, McCall TD, Schmidt MH, Dailey AT
The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw–rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.