2023 Research Day Abstract Assignments – Braithwaite

Thank you for your assistance in the 2023 Department of Surgery Research Day!  Below you will find your assigned abstracts for grading.

Please have reviews completed no later than May 8, 2023 to allow ample time to collate the scores, finalize the program, and notify authors.

Please go to the following site to score your assigned abstracts. You will complete one grading submission per abstract:

Research Day Abstract Grading

10196 Clinical Outcomes of the Over-the-Top Subscapularis Repair During Reverse Shoulder Arthroplasty 

Introduction: Benefit of subscapularis tendon repair during reverse shoulder arthroplasty (RSA) is debated. Previous biomechanical work demonstrated that when the upper two-thirds of the subscapularis tendon was repaired over-the-top of the center of rotation (OTTR), it functioned as an abductor through a greater range-of-motion (ROM). The purpose of this study was to assess the clinical outcomes of patients undergoing RSA with concomitant OTTR of subscapularis and compare them to patients undergoing no repair. Methods: Ninety-seven consecutive RSAs with either concomitant OTTR of the subscapularis (N=75) or no repair of the subscapularis (N=22) at a single institution were retrospectively reviewed. Patients with a preoperative diagnosis of cuff tear arthropathy, osteoarthritis, massive cuff tear, or inflammatory arthritis and minimum 2-year follow-up were included. Active ROM (forward elevation, abduction, external rotation, internal rotation) at preoperative and follow-up visits were recorded. Improvements in ROM were compared to the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for RSA. Clinical outcome scores were assessed at final follow-up. Additionally, complications and reoperations were evaluated. Results: RSAs were evaluated at a mean follow-up of 3.8±1.6 years. Demographics were similar between groups. Preoperatively, patients undergoing subscapularis repair had greater external rotation when compared to those without repair (15±16° vs. 5±12°, P=.003). Postoperatively, patients undergoing subscapularis repair had greater forward elevation (132±21° vs. 126±22°, P=.268) and abduction (114±26° vs. 106±23°, P=.193) with both exceeding the MCID (-2.9° and -1.9°, respectively); however, these differences were not statistically significant. Further, patients that underwent subscapularis repair had a significantly larger proportion of patients that were able to reach the small of their back postoperatively (65% vs. 21%, P=.006). Patients with subscapularis repair had less improvement in external rotation (13±20 vs. 24±20°, P=.028). Postoperative outcome scores were similar between the two groups. Neither the rate of complications nor reoperations significantly differed between patients with and without subscapularis repair (11.8%[n=9] vs. 13.6%[n=3], P=.729 and 3.9%[n=3] vs. 4.5%[n=1], P=1.000). Conclusions: The OTTR of the subscapularis tendon in RSA had similar ROM and outcome scores compared to no repair at mean 3.8-year follow-up, but a significantly larger proportion of patients with repair achieved functional internal rotation to the small of the back. Limitation of external rotation seen after conventional subscapularis repair techniques may also apply to our novel OTTR technique, but without a corresponding detrimental effect on forward flexion or abduction. Larger studies are needed to further evaluate the role of this repair technique. 

10292  Changes in Mental Health in Partners of Transgender Nonconforming Patients Post Gender Transition   

Introduction To date, no study has evaluated the psychosocial impact of gender transitioning on partners of transgender nonconforming (TGNC) individuals. Here, we assessed psychosocial distress, quality of life, and internal resilience of partners of TGNC individuals. Methods Anonymous surveys were administered via Amazon Mturk. Eligible participants were over 18 years with a partner who transitioned genders. Relationship satisfaction and mental health was assessed via the Self-Esteem and Relationship Questionnaire (SEAR), General Anxiety Disorder (GAD-7), and Personal Health Questionnaire Depression Scale (PHQ-8), Difficulties in Emotion Regulation Scale (DERS) and Resilience Scale. Multivariable linear regression assessed associations between relationship satisfaction and degree of partner transitioning. Results Among 337 participants who completed the study, 42.4% were male, with a mean age of 35.8. Nearly half (44.4%) had partners who transitioned from cis male to trans female (MTF), while a third (36.8%) had partners who transitioned from cis female to trans male (FTM). Most (72.4%) reported their partner underwent surgical transitioning (15.1% top surgery; 5.6% bottom; 51.6% top and bottom) versus 27.6% non-surgical transitioning. Sexual satisfaction and Resilience Scale scores were higher among respondents whose partners underwent non-surgical transitioning (p<0.001). Sexual satisfaction scores differed significantly among participants whose partners underwent top only versus bottom only surgery (p=0.004). Conclusion This is the first study to report the psychosocial impact of TGNC transitioning on their partners. Partner sexual satisfaction, depression, and anxiety scores were impacted by surgical transitioning of their TGNC partner. Supportive services for partners of TGNC individuals should be considered during the transition process to protect these romantic relationships for the benefit of both parties. 

10325  Impact of CYP3A4, CYP3A5, and ABCB1 genotypes on tacrolimus dosing and monitoring in liver transplant patients   

Introduction: Tacrolimus is a widely used immunosuppressant in liver transplantation. Its blood trough levels after transplantation must be closely controlled due to its narrow therapeutic range. It is a substrate for P-glycoprotein, a transmembrane efflux pump encoded by the ABCB1 gene, and for cytochrome P450 (CYP) 3A, an enzyme that oxidizes small organic molecules. ABCB1, CYP3A4, and CYP3A5 have single nucleotide polymorphisms (SNPs) that affect drug transport and drug metabolism. We aim to determine how single nucleotide polymorphisms (SNPs) in these genes affect tacrolimus blood trough level variability immediately after liver transplantation. We hypothesize that polymorphisms will impact the ease and predictability of short-term post-transplant immunosuppression dosing. Methods: Donor and recipient genotypes for CYP3A4, CYP3A5, and ABCB1 in 61 adult liver transplant recipients were analyzed. Outcomes compared included percentage of each patient’s hospital stay in which tacrolimus trough level was greater than 2 ng/ml out of range, average tacrolimus dose per kilogram, and tacrolimus dose and level at discharge. Results: Recipient ABCB1 SNPs significantly affected the percentage of each patient’s hospital stay in which tacrolimus trough level was greater than 2 ng/ml out of range. Donor ABCB1 SNPs affected the average tacrolimus dose per kilogram, as well as tacrolimus level at discharge. Recipient CYP3A4*1B SNPs affected average tacrolimus dose per kilogram and tacrolimus dose at discharge. Recipient CYP3A5*3 SNPs affected average tacrolimus dose per kilogram and tacrolimus dose at discharge. Conclusions: This study is the first demonstration that the feasibility of achieving and maintaining tacrolimus levels within therapeutic range in the immediate post-transplant period is influenced by genetic polymorphisms in drug metabolizing enzymes and drug transporters. These polymorphisms not only determine the ultimate immunosuppression dose, but they also impact the ease and predictability of post-transplant dosing, while the patient and the organs are recovering from the transplantation process. 

10328 Utilization of Visual Artificial Intelligence to Improve Intraoperative Identification of Biliary Anatomy 

Introduction: Misinterpretation of biliary anatomy due to errors in visual perception leads to adverse events such as common bile duct injury (BDI). Insufficient acquisition of the critical view of safety (CVS) is one of the causal factors of BDI during a laparoscopic cholecystectomy (LC). Artificial intelligence (AI) models trained on LC videos can provide real-time guidance on intraoperative interpretation of biliary anatomy and may reduce the incidence of BDI and therefore improve the safety of the operation. An objective method to identify biliary anatomy is the use of indocyanine green (ICG) and near-infrared fluorescence cholangiography (NIRFC) imaging. With the use of AI models, interpretation of biliary anatomy could be improved. We hypothesize that data obtained from NIRFC and visible light images during LC can be used to train AI models to interpret biliary anatomy without the use of NIRFC. Methods: NIRFC was routinely performed on adult patients undergoing LC. Intraoperative videos were used to train image-to-image (I2I) translation AI models using the pix2pix neural network architecture to identify biliary anatomy. We used 214 images from 26 LC operations. A random number generator assigned images into train/test/validation sets in a .6/.2/.2 distribution. Models were trained to produce simulations of NIRFC images from visible light images only, using paired white light and NIRFC images. Models were tested on an unseen subset of data. Accuracy was measured by calculating the mean squared error (MSE) of the test set NIRFC image and the corresponding synthetic NIRFC image generated by AI. Results: The model successfully produced a simulation of NIRFC and biliary anatomy, even when it was obscure to human visualization. The model located the common bile duct with sensitivity of 71% and specificity of 92%. Separate models were used for different timepoints of dissection in relation to obtaining the CVS. The MSE scaled to average brightness of the test set NIRFC image (sMSE) was significantly lower before dissection of the CVS compared to during dissection (5.6 vs 31.8, p=0.006) or after dissection (5.6 vs 85.3, p=0.005). Separate models were also used for different doses of ICG. The sMSE was lower for the low dose model compared to the combined dose model (9.3 vs 9.7, p=0.04). However, no significant differences were found between standard dose and combined dose, or between low dose and standard dose models. Conclusion: Visual AI can be developed to accurately and precisely identify the common bile duct during LC using only standard white light video, thus obviating the need for ICG administration and NIRFC imaging. Success in this study provides evidence that AI can be routinely integrated for real-time, accurate, and efficient identification of biliary anatomy during this operation. 

10400 Implementation of Ergonomic Training in Surgical Simulation at the University of Florida

Introduction Ergonomic awareness and the development of surgical tools adhering to ergonomic principles are critical to a surgeon’s health (Barrios,…Gravina. Surgery. In press). Work-related musculoskeletal disorders affect a majority of surgeons, and various operative modalities (i.e. open, laparoscopic, and robotic surgery) stress the musculoskeletal system in unique ways. SoterTask (SoterAnalytics, Wilmington, DE) uses video capture and artificial intelligence to measure the injury risk of movements and provides individualized feedback to implement changes to reduce risk to an individual. We hypothesize that SoterTask can improve ergonomic practices in the surgical simulation laboratory with core Fundamentals of Laparoscopic Surgery (FLS) skill sets. Methods We will implement an Institutional Review Board-approved study in which general surgery residents (n=6-8) will perform FLS skill sets in a simulation center. Using SoterTask, we will measure low, medium, and high-risk positioning for neck, arms, back, and legs of individuals. The recorded videos provide a layover image of real-time risk, so users can see how their positioning affects risk. First, we will collect baseline data using the software while residents perform FLS skill sets. Next, we will intervene by showing participants their video with the risk layover. Subsequently, the user will perform the tasks again. We will evaluate their performance using single-subject multiple baseline design across participants, which demonstrate experimental control when performance changes only after the intervention is implemented. We will also analyze the change in performance using statistical analysis. These preliminary data will provide information to inform a larger scale intervention study aimed at improving surgeon ergonomics. Results Preliminary data has revealed that the program can alter user behavior. Starting with a simple seated task, we measured baseline posture data on two participants using SoterTask. On subsequent tasks, their neutral posture improved and risk decreased. A third participant did not improve with verbal feedback alone. However, they improved after being shown a video with the SoterTask layover. Conclusions Sotertask, along with targeted educational training, could potentially improve awareness of proper ergonomic principles and allow the implementation of better practices in the operating room. Our collaborative research group intends to conduct this study through the University of Florida Department of Psychology and Surgery and has already applied for potential NIH funding (Grant Number R21OH012566-01). With successful pilot studies, we intend to work with Department of Surgery Education leadership to engender transformative change in general surgery resident training. 

10439  Oncologic efficacy and feasibility of robotic compared to open total pancreatectomy for pancreatic cancer   \

Introduction: The use of robotic surgery for pancreatic cancer resections is increasing over time. There are multiple studies comparing this approach to open surgery, specifically for Whipple and distal pancreatectomies. But there is limited data on its feasibility and oncologic efficacy in patients requiring total pancreatectomy. Methods: This is a retrospective study from the 2010-2019 National Cancer Database comparing the postoperative, pathological, and long-term oncologic outcomes between robotic total pancreatectomy (RTP) and open total pancreatectomy (OTP) for pancreatic adenocarcinoma. Results: 188 (5%) RTP and 3447 (95%) OTP patients were identified. The number of RTP increased from 4 in 2010 to 32 in 2019. There were no major differences in patient demographics and treatment characteristics, except that RTP patients were more likely to be performed at non-academic centers and less likely to get radiation. After adjustment, there was similar yield of examined lymph nodes, 90-day mortality and receipt of adjuvant therapy between both groups. The RTP did have a statistically significant shorter length of stay. There was no difference in median overall survival between RTP and OTP (22.3 months vs 23.3 months add p value). The 1-, 3-, and 5-year overall survival rates for RTP were 78%, 31%, and 34% and for OTP were 75%, 38%, and 30%. After adjustment, the use of robotic surgery was associated with similar overall survival to the open approach (HR 0.939, 95% confidence interval (CI) 0.760-1.161). Conclusions: Following neoadjuvant chemotherapy, RTP is associated with similar short- and long-term mortality without sacrificing oncologic outcomes including adequate lymphadenectomy and neoadjuvant chemotherapy receipt with the advantage of shorter length of stay. 

10451  National Adoption of Neoadjuvant Chemotherapy: Paradigm Shift in the Treatment of Pancreatic Cancer   

Introduction: The historical standard of care in treating operable pancreatic cancer via upfront surgery followed by adjuvant chemotherapy has been challenged recently using a neoadjuvant approach. There is limited contemporary data on the widespread use of this approach at the national level. The aim of this study was to examine national practice patterns in the management of pancreatic cancer with an emphasis on the trends of neoadjuvant systemic therapy use. Methods: This is a cross-sectional time-series study using the National Cancer Database (NCDB) from 2006-2019. Patients who underwent resection for stage I-II pancreatic adenocarcinoma were selected. The trend of using neoadjuvant systemic therapy, its predictors, the use of radiation therapy, the resection rate and overall survival were analyzed over time. Results: 45,020 resections were selected. Overall, 20% of patients had neoadjuvant chemotherapy followed by surgery, 51% had surgery followed by adjuvant chemotherapy and 29% had surgery alone. The rate of neoadjuvant systemic therapy has steadily increased from 6% in 2006 to 41% in 2019. This was accompanied over the same period by a decrease in the rate of surgery followed by systemic chemotherapy from 50% to 39%, and a decrease in the rate of surgery alone from 44% to 20%. The predictors of receiving of neoadjuvant systemic therapy were being non-Hispanic, having fewer comorbidities, having higher income, private insurance, younger age and treatment at academic centers in recent years. On the other hand, the rate of radiation therapy use has decreased over time, as has the resection rate, while median overall survival has steadily improved over the years. Conclusions: In 2019, the rate of using neoadjuvant systemic therapy overtook the rate of surgery first followed by adjuvant systemic therapy, marking a pragmatic national shift in the clinical management of pancreatic cancer. There is still a high percentage of patients receiving upfront surgery especially of those receiving surgery alone. While survival has improved over time, there is still room to improve and ensure delivery of multimodal therapy to the largest proportion of patients possible. 

10753 Patient Reported Outcome Measures after Endoscopic Cubital Tunnel Release with at least One-Year Postoperative Follow-Up

Introduction: The primary objective of this study was to investigate mid-term outcomes following endoscopic cubital tunnel release (ECuTR) with the Seg-Way system using patient-reported outcome measures (PROM). A secondary aim was to evaluate symptom resolution as assessed through Dellon stage, McGowan grade and Messina’s criteria and recurrence following ECuTR.
Methods: Functional outcomes were assessed in 38 patients who underwent 43 surgeries. Details on baseline characteristics as well as preoperative and postoperative symptoms were collected. PROMs were administered with at least 1-year follow-up in all patients.
Results: Mean age of patients was 50.2 ± 16.1 years with 20 (52.6%) males and 18 (47.4%) females. Postoperatively, pain completely resolved in 21 (72.4%), while sensory and motor deficits improved completely in 22 (56.4%) and 11 (64.7%) of patients. Meantime interval between ECuTR and PROMs was 26.3 (13-63) months. Median Michigan Hand Outcomes
Questionnaire (MHQ) score was 73.2 (48-91). Median Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale (NRS) scores were 12.9 (7-35) and 2.5 (0-5), respectively. The majority of patients were satisfied postoperatively with a median satisfaction score of 4 (3-5). There was a significant difference in median DASH and NRS scores between
patients with and without concomitant proximal nerve disease.
Conclusion: ECuTR is a safe and effective option for surgical management of CuTS. The presence of other proximal nerve disease is associated with poorer outcomes, less symptom resolution and higher recurrence rates. One-year postoperative PROMs show equivalence to those reported in other studies following OCuTR.