Jad Abdelsattar

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• Abdelsattar, J. M., Afridi, F. G., Dai, Z., Yousaf, N., Seldomridge, A., Battin, A. O., Wen, S., Gray, D., Marsh, J. W., Cowher, M. S., Partin, J. F., Hazard-Jenkins, H., & Lupinacci, K. (2023). The Effect of Lumpectomy and Cavity Shave Margin Status on Recurrence and Survival in Breast-Conserving Surgery. The American surgeon, 89(3), 424-433.
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  Cavity shave margins (CSMs) decrease rate of positive margins and need for re-excision. Recurrence data following breast-conserving surgery (BCS) are not always available in large cancer registries. We sought to define our recurrence and survival data in BCS with routine excision of CSMs.
• Abdelsattar, J., Afridi, F., Dai, Z., Yousaf, N., Seldomridge, A., Battin, A., Wen, S., Gray, D., Marsh, J., Cowher, M., Partin, J., Lupinacci, K., & Hazard‐Jenkins, H. (2023). The Effect of Lumpectomy and Cavity Shave Margin Status on Recurrence and Survival in Breast-Conserving Surgery. American Surgeon, 89(3). doi:10.1177/00031348211030464
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  Background/Objective: Cavity shave margins (CSMs) decrease rate of positive margins and need for re-excision. Recurrence data following breast-conserving surgery (BCS) are not always available in large cancer registries. We sought to define our recurrence and survival data in BCS with routine excision of CSMs. Methods: A single institution, 10-year retrospective review of breast cancer patients who underwent BCS with routine CSMs was conducted. Cavity shave margin technique was standard. Cox proportional hazard analyses and the Kaplan-Meier method were used to estimate recurrence and survival. Results: Breast-conserving surgery with CSM was performed in 839 patients. Re-excision rate to achieve negative margins was 8.5%. Fifty-two patients (75%) underwent margin re-excision vs 18 patients (25%) underwent salvage mastectomy. Positive margin rate stratified by tumor histology was highest for invasive lobular carcinoma followed by mixed invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS), followed by pure DCIS and lowest for IDC. Length of follow-up was (4.7 ± 2.6, years). Overall recurrence rate (locoregional and systemic) was 4.3%: highest in patients with negative lumpectomy margin but positive CSM (L−S+ = 15%) followed by positive lumpectomy and CSMs (L+S+ = 14%), followed by patients with positive lumpectomy margin but negative CSMs (L+S− = 13%) and lowest for negative lumpectomy and CSM (L−S− = 5%), (P =.0008). There was no difference in 5-year breast cancer–specific survival between the 4 subgroups: 96% for L−S−, 86.7% L−S+, 94.7% L+S+ and 90% L+S− (P =.094). Conclusions: Recurrence following BCS with CSMs can be stratified based on both lumpectomy and cavity shave margin positivity. Routine excision of CSMs allows identification of these patient subsets.
• Coleman, J. R., Abdelsattar, J. M., Dent, D., & Turner, P. L. (2022). Implications of lack of available personal protective equipment on surgical trainees: Lessons learned from the COVID-19 pandemic. American journal of surgery, 224(6), 1492-1493.
• Coleman, J., Abdelsattar, J., Dent, D., & Turner, P. (2022). Implications of lack of available personal protective equipment on surgical trainees: Lessons learned from the COVID-19 pandemic. American Journal of Surgery, 224(6). doi:10.1016/j.amjsurg.2022.08.014
• Joshi, A., Abdelsattar, J., Castro-Varela, A., Wehrle, C. J., Cullen, C., Pei, K., Arora, T. K., Dechert, T. A., & Kauffmann, R. (2022). Incorporating mass casualty incidents training in surgical education program. Global surgical education : journal of the Association for Surgical Education, 1(1), 17.
• Abdelsattar, J. M., Coleman, J. R., Nagler, A., Shabahang, M., Ellison, E. C., Baker, Y., Stain, S. C., Matthews, J. B., Dent, D., Blair, P., Britt, L. D., Sachdeva, A. K., & Spanknebel, K. (2021). Lived Experiences of Surgical Residents During the COVID-19 Pandemic: A Qualitative Assessment. Journal of surgical education, 78(6), 1851-1862.
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  As the COVID-19 pandemic dynamically changes our society, it is important to consider how the pandemic has affected the training and wellness of surgical residents. Using a qualitative study of national focus groups with general surgery residents, we aim to identify common themes surrounding their personal, clinical, and educational experiences that could be used to inform practice and policy for future pandemics and disasters.
• Abdelsattar, J., Coleman, J., Nagler, A., Shabahang, M., Ellison, E., Baker, Y., Stain, S., Matthews, J., Dent, D., Blair, P., Britt, L., Sachdeva, A., & Spanknebel, K. (2021). Lived Experiences of Surgical Residents During the COVID-19 Pandemic: A Qualitative Assessment. Journal of Surgical Education, 78(6). doi:10.1016/j.jsurg.2021.04.020
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  OBJECTIVE: As the COVID-19 pandemic dynamically changes our society, it is important to consider how the pandemic has affected the training and wellness of surgical residents. Using a qualitative study of national focus groups with general surgery residents, we aim to identify common themes surrounding their personal, clinical, and educational experiences that could be used to inform practice and policy for future pandemics and disasters. DESIGN: Six 90-minute focus groups were conducted by a trained qualitative researcher who elicited responses on six predetermined topics. De-identified transcripts and audio recordings were later analyzed by two independent researchers who organized responses to each topic into themes. SETTING: Focus groups were conducted virtually and anonymously. PARTICIPANTS: General surgery residents were recruited from across the country. Demographic information of potential participants was coded, and subjects were randomly selected to ensure a diverse group of participants. RESULTS: The impact of the COVID-19 pandemic on residents’ clinical, educational, and personal experiences varied depending on the institutional response of the program and the burden of COVID-19 cases geographically. Many successes were identified: the use of telehealth and virtual didactics, an increased sense of camaraderie amongst residents, and flexibility in scheduling. Many challenges were also identified: uncertainty at work regarding personal protective equipment and scheduling, decreased case volume and educational opportunities, and emotional trauma and burnout associated with the pandemic. CONCLUSIONS: These data gathered from our qualitative study highlight a clear, urgent need for thoughtful institutional planning and policies for the remainder of this and future pandemics. Residency programs must ensure a balanced training program for surgical residents as they attempt to master the skills of their craft while also serving as employed health care providers in a pandemic. Furthermore, a focus on wellness, in addition to clinical competency and education, is vital to resident resilience and success in a pandemic setting.
• Coleman, J. R., Abdelsattar, J. M., Glocker, R. J., & , R. C. (2021). COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons. Journal of the American College of Surgeons, 232(2), 119-135.e20.
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  To better understand how the COVID-19 pandemic has affected surgical trainees' and early-career surgeons' professional and personal experiences, a survey of the membership of the American College of Surgeons (ACS) Resident and Associate Society (RAS) and Young Fellows Association (YFA) was performed.
• Coleman, J., Abdelsattar, J., Glocker, R., Vigneshwar, N., Ryan, R., Qiu, Q., Nayyar, A., Visenio, M., Sonntag, C., Chotai, P., Nikolian, V., Ochoa, J., & Turner, P. (2021). COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons. Journal of the American College of Surgeons, 232(2). doi:10.1016/j.jamcollsurg.2020.09.026
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  Background: To better understand how the COVID-19 pandemic has affected surgical trainees' and early-career surgeons' professional and personal experiences, a survey of the membership of the American College of Surgeons (ACS) Resident and Associate Society (RAS) and Young Fellows Association (YFA) was performed. Study Design: An anonymous online survey was disseminated to members of RAS and YFA. Descriptive analyses were performed and factors associated with depression and burnout were examined with univariate and multivariable stepwise logistic regression. Results: Of the RAS/YFA membership of 21,385, there were 1,160 respondents. The majority of respondents (96%) reported the COVID-19 pandemic having a negative impact on their clinical experience, with 84% of residents reporting a > 50% reduction in operative volume and inability to meet minimum case requirements. Respondents also reported negative impacts on personal wellness. Nearly one-third reported inadequate access to personal protective equipment, and depression and burnout were pervasive (≥21% of respondents reported yes to every screening symptom). On multivariable analysis, female sex (odds ratio [OR] 1.54 for depression, OR 1.47 for burnout) and lack of wellness resources (OR 1.55 for depression, OR 1.44 for burnout) predicted depression and burnout. Access to adequate personal protective equipment was protective against burnout (OR 0.52). Conclusions: These data demonstrate a significant impact of the COVID-19 pandemic on the lives of residents and early-career surgeons. Actionable items from these data include mitigation of burnout and depression through increasing personal protective equipment access and provision of wellness programs, with a particular focus on high-risk groups.
• Abdelsattar, J. M., McClain, K., Afridi, F. G., Wen, S., Cai, Y., Musgrove, K. A., Bailey, K., Shaikh, P. M., Jacobson, G. M., Marsh, W., Lupinacci, K., Cowher, M. S., & Jenkins, H. H. (2020). Intraoperative Radiation Therapy Versus Whole Breast Radiation for Early-Stage Breast Cancer Treatment in Rural Appalachia. The American surgeon, 86(12), 1666-1671.
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  Intraoperative radiation therapy (IORT) is an alternate accelerated form of radiation following breast-conserving surgery (BCS). Lack of data regarding long-term outcomes has limited adoption. We report our experience with IORT in patients undergoing BCS versus whole breast radiation therapy (WBRT).
• Abdelsattar, J. M., McCulloch, I. L., & Abunnaja, S. (2020). Emergency laparoscopic partial resection of the excluded stomach and gastric pouch in a gastric bypass patient with acute gastrogastric fistula bleeding. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 16(3), 445-446.
• Abdelsattar, J. M., Mourany, J., Afridi, F. G., Musgrove, K., Shaffer, L., Khan, U., Marsh, J. W., & Borgstrom, D. C. (2020). Enhancing the Educational Value and Faculty Attendance of a Morbidity and Mortality Conference. Journal of surgical education, 77(4), 905-910.
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  There exists significant variation in the approach to and execution of morbidity and mortality conference (M&MC). Faculty attendance remains a working challenge. We sought to change our department's M&MC and hypothesized improved educational value and attendance.
• Abdelsattar, J., McClain, K., Afridi, F., Wen, S., Cai, Y., Musgrove, K., Bailey, K., Shaikh, P., Jacobson, G., Marsh, W., Lupinacci, K., Cowher, M., & Jenkins, H. (2020). Intraoperative Radiation Therapy Versus Whole Breast Radiation for Early-Stage Breast Cancer Treatment in Rural Appalachia. American Surgeon, 86(12). doi:10.1177/0003134820940735
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  Background: Intraoperative radiation therapy (IORT) is an alternate accelerated form of radiation following breast-conserving surgery (BCS). Lack of data regarding long-term outcomes has limited adoption. We report our experience with IORT in patients undergoing BCS versus whole breast radiation therapy (WBRT). Methods: Retrospective review of patients undergoing BCS with IORT versus WBRT (2012-2017). Inclusion: low grade, T1-2N0M0, estrogen receptor/progesterone receptor positive, and Her2-negative infiltrating ductal carcinomas. IORT was delivered as a single fraction of radiation (20 Gy) intraoperatively. Outcomes were compared using Fisher’s test for discrete variables or Wilcoxon signed-rank test for continuous variables. Kaplan-Meier method was used to estimate disease-free survival (DFS). Results: Fifty-one patients (44%) received IORT, and 66 (56%) received WBRT. There was no difference in age, tumor size, receptor status, or in-breast recurrence (1.9% vs 0%, all P >.05). Length of follow-up was longer in the WBRT group due to time to inception of IORT (mean ± SD: 44 ± 8.1 vs 73 ± 13 months, P
• Musgrove, K. A., Abdelsattar, J. M., LeMaster, S. J., Ballou, M. C., Kappel, D. A., & Borgstrom, D. C. (2020). Optimal Resources for Rural Surgery. The American surgeon, 86(9), 1057-1061.
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  Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care.
• Musgrove, K., Abdelsattar, J., LeMaster, S., Ballou, M., Kappel, D., & Borgstrom, D. (2020). Optimal Resources for Rural Surgery. American Surgeon, 86(9). doi:10.1177/0003134820942142
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  Background: Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care. Methods: Forty-five nonteaching hospitals in West Virginia were divided into large community hospitals with multiple specialties (LCHs), small community hospitals with fewer specialties (SCHs), and critical access hospitals (CAHs). A 58-question survey on optimal resources for surgery was completed by 1 representative surgeon at each hospital. There were 8 LCHs, 18 SCHs, and 19 CAHs with survey response rates of 100%, 83%, and 89%, respectively. Results: One hundred percent of hospitals surveyed had respiratory therapy and ventilator support, computerized tomography (CT) scanner and ultrasound, certified operating rooms, lab support, packed red blood cells (PRBC), and FFP accessible 24/7. Availability of cryoprecipitate, platelets, tranexamic acid (TXA), and prothrombin complexconcentrate (PCC) decreased from LCHs to CAHs. The majority had board-certified general surgeons; however, only 86% LCHs, 53% SCHs, and 50% CAHs had advanced trauma lifesupport (ATLS) certification. One hundred percent of LCHs had operating room (OR) crew on call within 30 minutes, emergency cardiovascular equipment, critical care nursing, on-site pathologist, and biologic/synthetic mesh, whereas fewer SCHs and CAHs had these resources. One hundred percent of LCHs and SCHs had anesthesia availability 24/7 compared to 78% of CAHs. Discussion: Improving access to the aforementioned resources is of utmost importance to patient outcomes. This will enhance rural surgical care and decrease emergency surgical transfers. Further education and research are necessary to support and improve rural trauma systems.
• Musgrove, K., Abdelsattar, J., Spear, C., Sharma, N., Toker, A., & Abbas, G. (2020). Superiorities of robotic segmentectomy: A review. Video-Assisted Thoracic Surgery, 5(september). doi:10.21037/vats-20-20
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  Several approaches to the resection of lung cancer are now available within the armamentarium of the thoracic surgeon. Robotic-assisted surgery has emerged as a comparable alternative to both the open and video-assisted thoracoscopic (VATS) approaches. Numerous studies have confirmed equivalent oncologic outcomes and superior postoperative outcomes with robotic resections compared to both the open and VATS approaches. In particular, due to the meticulous anatomical dissection required during segmentectomy, there is heightened interest in outcomes research comparing the 3 approaches. The aim of this review is to study the available data on robotic vs. VATS and open segmentectomy and present a thorough comparative analysis including oncologic, postoperative and patient outcomes for and against robotic segmentectomy. In our review, we find robotic segmentectomies to be cost effective and offer improved dexterity resulting in decreased complications and hospital length of stay (LOS). There is promise for this approach especially within the elderly frail patients, and data suggest that the reduction in LOS offsets the higher cost of establishing a robotic program. Ultimately, long-term outcomes from well-designed prospective studied are needed but initial results are promising and have set the acquisition of robotic programs in motion.
• Abdelsattar, J. M., AlJamal, Y. N., Ruparel, R. K., Rowse, P. G., Heller, S. F., & Farley, D. R. (2018). Correlation of Objective Assessment Data With General Surgery Resident In-Training Evaluation Reports and Operative Volumes. Journal of surgical education, 75(6), 1430-1436.
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  Faculty evaluations, ABSITE scores, and operative case volumes often tell little about true resident performance. We developed an objective structured clinical examination called the Surgical X-Games (5 rooms, 15 minutes each, 12-15 tests total, different for each postgraduate [PGY] level). We hypothesized that performance in X-Games will prove more useful in identifying areas of strength or weakness among general surgery (GS) residents than faculty evaluations, ABSITE scores, or operative cases volumes.
• Abdelsattar, J., AlJamal, Y., Ruparel, R., Rowse, P., Heller, S., & Farley, D. (2018). Correlation of Objective Assessment Data With General Surgery Resident In-Training Evaluation Reports and Operative Volumes. Journal of Surgical Education, 75(6). doi:10.1016/j.jsurg.2018.04.016
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  Objective: Faculty evaluations, ABSITE scores, and operative case volumes often tell little about true resident performance. We developed an objective structured clinical examination called the Surgical X-Games (5 rooms, 15 minutes each, 12-15 tests total, different for each postgraduate [PGY] level). We hypothesized that performance in X-Games will prove more useful in identifying areas of strength or weakness among general surgery (GS) residents than faculty evaluations, ABSITE scores, or operative cases volumes. Design: PGY 2 to 5 GS residents (n = 35) were tested in a semiannual X-Games assessment using multiple simulation tasks: laparoscopic skills, bowel anastomosis, CT/CXR analysis, chest tube placement, etc. over 1 academic year. Resident scores were compared to their ABSITE, in-training evaluation reports, and operating room case numbers. Setting: Academic medical center. Participants: PGY-2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. Results: Results varied greatly within each class except for staff evaluations: in-training evaluation reports medians for PGY-2s were 5.3 (range: 5.0-6.0), PGY-3s 5.9 (5.5-6.3), PGY-4s 5.6 (5.0-6.0), and PGY-5s were 6.1 (5.6-6.9). Although ABSITE and operating room case volumes fluctated greatly with each PGY class, only X-Games scores (median: PGY-2 = 82, PGY-3 = 61, PGY-4 = 76, and PGY-5 = 60) correlated positively (p < 0.05) with operative case volume and negatively (p < 0.05) with staff evaluations. Conclusions: X-Games assessment generated wide differentiation of resident performance quickly, inexpensively, and objectively. Although “Minnesota-nice” surgical staff may feel all GS trainees are “above average,” objective assessment tells us otherwise.
• Abdelsattar, J. M., Al-Hilli, Z., Hoskin, T. L., Heins, C. N., & Boughey, J. C. (2016). Validation of the CPS + EG Staging System for Disease-Specific Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Annals of surgical oncology, 23(10), 3206-11.
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  CPS + EG staging, which incorporates estrogen receptor (ER) status and tumor grade with pretreatment clinical stage (CS) and post-treatment pathologic stage (PS), has been reported to have better correlation with outcome than classic TNM staging for patients treated with neoadjuvant chemotherapy (NAC). Our goal was to evaluate the performance of CPS + EG staging system in an external cohort treated with NAC.
• Abdelsattar, J. M., Boughey, J. C., Fahy, A. S., Jakub, J. W., Farley, D. R., Hieken, T. J., Degnim, A. C., Goede, W., Mohan, A. T., Harmsen, W. S., Niesen, A. D., Tran, N. V., Bakri, K., Jacobson, S. R., Lemaine, V., & Saint-Cyr, M. (2016). Comparative Study of Liposomal Bupivacaine Versus Paravertebral Block for Pain Control Following Mastectomy with Immediate Tissue Expander Reconstruction. Annals of surgical oncology, 23(2), 465-70.
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  Several approaches to minimize postoperative pain, nausea, and enhance recovery are available for patients undergoing mastectomy with immediate tissue expander (TE) reconstruction. We compared the effectiveness of intraoperative local infiltration of liposomal bupivacaine (LB) to preoperative paravertebral block (PVB).
• Abdelsattar, J., Al-Hilli, Z., Hoskin, T., Heins, C., & Boughey, J. (2016). Validation of the CPS + EG Staging System for Disease-Specific Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Annals of Surgical Oncology, 23(10). doi:10.1245/s10434-016-5324-y
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  Background: CPS + EG staging, which incorporates estrogen receptor (ER) status and tumor grade with pretreatment clinical stage (CS) and post-treatment pathologic stage (PS), has been reported to have better correlation with outcome than classic TNM staging for patients treated with neoadjuvant chemotherapy (NAC). Our goal was to evaluate the performance of CPS + EG staging system in an external cohort treated with NAC. Methods: We reviewed patients with stages I–IIIC breast cancer treated with NAC and surgery at our institution between 1988 and 2014. ER status, Nottingham grade, treatment, American Joint Committee on Cancer (AJCC) CS before NAC and PS after NAC, and follow-up data were collected. The discrimination of CPS + EG and pathologic AJCC stage were assessed using area under the curve (AUC) for survival data. Results: A total of 769 patients were analyzed with a median follow-up of 2.6 (range 0.0–19.4) years; 103 patients died of breast cancer. Overall, the 5-year breast cancer cause-specific survival was 81.5 % [95 % confidence interval (CI) 77.6–85.5]. The 5-year, cause-specific survival by CPS + EG score was 93.8 % score 0, 89.9 % score 1, 90.7 % score 2, 84.8 % score 3, 67.7 % score 4, and 43.4 % score 5/6. CPS + EG score was significantly associated with cause-specific survival (p < 0.001) with an AUC of 0.69 (95 % CI 0.62–0.77) at 5 years. This was higher than the AUC of 0.63 (95 % CI 0.56–0.70) for AJCC PS (p = 0.10). Conclusions: This study validates the CPS + EG staging system using Nottingham grade in an external cohort. Addition of tumor biology and treatment response shows promise in improving survival estimates for patients treated with NAC.
• Abdelsattar, J., Boughey, J., Fahy, A., Jakub, J., Farley, D., Hieken, T., Degnim, A., Goede, W., Mohan, A., Harmsen, W., Niesen, A., Tran, N., Bakri, K., Jacobson, S., Lemaine, V., & Saint-Cyr, M. (2016). Comparative Study of Liposomal Bupivacaine Versus Paravertebral Block for Pain Control Following Mastectomy with Immediate Tissue Expander Reconstruction. Annals of Surgical Oncology, 23(2). doi:10.1245/s10434-015-4833-4
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  Background: Several approaches to minimize postoperative pain, nausea, and enhance recovery are available for patients undergoing mastectomy with immediate tissue expander (TE) reconstruction. We compared the effectiveness of intraoperative local infiltration of liposomal bupivacaine (LB) to preoperative paravertebral block (PVB). Methods: We retrospectively reviewed patients who underwent mastectomy with immediate TE reconstruction between May 2012 and October 2014 and compared patients with preoperative ultrasound-guided PVB to those with intraoperative LB infiltration. Results: Fifty-three patients (54.6 %) received LB and 44 received PVB. LB was associated with less opioid use in the recovery room (p < 0.001), fewer patients requiring antiemetics (p = 0.03), and lower day of surgery pain scores (p = 0.008). LB also was associated with longer time to first opioid use (p = 0.04). On multivariable analysis controlling for expander placement location, year of surgery, and axillary lymph node dissection (ALND), the only variable that remained statistically significant was lower opioid use in the recovery room for patients with LB (p = 0.03) and day of surgery pain scores approached significance (p = 0.05). There was no difference in the proportion of patients discharged within 36 h of surgery between the groups. Focusing on first cases of the day (where PVBs are performed in the OR) showed average time to skin incision was 15 min shorter in the LB group (p = 0.004). Conclusions: Local infiltration of LB in patients undergoing mastectomy with immediate TE reconstruction decreases narcotic requirements in the recovery room, shortens preoperative anesthesiology time, and provides similar, if not better, perioperative pain control compared with PVB.
• Buckarma, E. L., Gas, B. L., Pandian, T. K., Abdelsattar, J. M., El Khatib, M. M., Mohan, M., Naik, N. D., & Farley, D. R. (2016). Catch me if you can…early simulation efforts affect fundamental surgical skill assessment scores. American journal of surgery, 211(3), 583-8.
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  We evaluated whether early exposure to a simulation curriculum enhances acquired surgical skills.
• Buckarma, E., Gas, B., Pandian, T., Abdelsattar, J., El Khatib, M., Mohan, M., Naik, N., & Farley, D. (2016). Catch me if you can⋯early simulation efforts affect fundamental surgical skill assessment scores. American Journal of Surgery, 211(3). doi:10.1016/j.amjsurg.2015.11.007
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  Background We evaluated whether early exposure to a simulation curriculum enhances acquired surgical skills. Methods The "Surgical Olympics" evaluates interns on basic surgical skills and knowledge. After the Summer Olympics (July), interns were randomly divided into groups: "A" participated in a 7-week curriculum once a week, whereas "B" attended 7 weeks of lectures once a week. All interns then participated in the October Olympics. The 2 groups then switched. Finally, all interns completed a January Olympics. Results Scores were tabulated for the July, October, and January Olympics. Mean scores (A = 182 ± 42, Group B = 188 ± 34; P =.70) were similar in July; in October, group A (mean score = 237 ± 31) outperformed group B (mean score = 200 ± 32; P =.01). Mean total scores in January (A = 290 ± 34, B = 276 ± 34; P =.32) were similar. Conclusions Early exposure to a surgical simulation curriculum enhances surgical intern performance in our Surgical Olympics. Subsequent simulation experience helps learners close this gap.
• Rowse, P. G., Ruparel, R. K., Abdelsattar, J. M., AlJamal, Y. N., Dy, B. M., & Farley, D. R. (2016). TEP and Lichtenstein anatomy: does simulation accelerate acquisition among interns?. Hernia : the journal of hernias and abdominal wall surgery, 20(3), 411-6.
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  The anatomy of the inguinal region is notoriously challenging to master. We sought to teach open inguinal hernia (OIH) and totally extraperitoneal (TEP) anatomy with simulation models among general surgery (GS) interns.
• Rowse, P., Ruparel, R., Abdelsattar, J., AlJamal, Y., Dy, B., & Farley, D. (2016). TEP and Lichtenstein anatomy: does simulation accelerate acquisition among interns?. Hernia, 20(3). doi:10.1007/s10029-015-1409-y
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  Purpose: The anatomy of the inguinal region is notoriously challenging to master. We sought to teach open inguinal hernia (OIH) and totally extraperitoneal (TEP) anatomy with simulation models among general surgery (GS) interns. Methods: Low-fidelity OIH and TEP models were constructed out of cardboard, plastic bins, fabric, and yarn. GS interns (n = 30) participated in a 3-h hernia session including a pretest, anatomy lecture, simulated OIH and TEP hernia repair, and posttest. Pre- and posttest scores were based on a difficult 30-point exam which included didactic questions (10 points), drawing relevant TEP (10 points), and OIH (10 points) anatomy. Participants were surveyed following the session. Results: Median pretest scores were 13 % (range 0–60 %). Median posttest scores improved to 47 % (range 20–93 %, p < 0.001). Median number of structures drawn in the TEP image improved from 2 (range 0–14) to 11 (range 1–21, p < 0.001). Median number of structures drawn in the OIH image improved from 3 (range 0–15) to 7 (range 1–19, p < 0.001). 67 % (12/18) demonstrated improvement in knowledge of abdominal wall layers. 23 % (7/30) knew the triangles of pain/doom on the pretest vs. 77 % (23/30) on the posttest. Mean Likert scores favored session enjoyability (4.5), not a waste of training time (4.4), and improved understanding of OIH and TEP anatomy (4.4, 4.2). Conclusions: Low-fidelity simulators can be used to teach and assess knowledge of TEP and OIH anatomy. While enjoyable and useful, one 3-h session does not create master hernia surgeons or expert anatomists out of novice trainees.
• Sun, P., Pandian, T. K., Abdelsattar, J. M., & Farley, D. R. (2016). Reoperation for groin pain after inguinal herniorrhaphy: does it really work?. American journal of surgery, 211(3), 637-43.
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  Chronic groin pain after inguinal hernia repair (IHR) is a vexing problem. Reoperation for groin pain (R4GP) has varied outcomes.
• Zhu, L., Mohan, A. T., Abdelsattar, J. M., Wang, Z., Vijayasekaran, A., Hwang, S. M., Tran, N. V., & Saint-Cyr, M. (2016). Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 69(4), e77-86.
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  Tissue expander-based two-stage reconstruction remains the most commonly used technique in immediate breast reconstruction. This study compares the subcutaneous expander placement to the traditional submuscular placement and describes our early experience with the expander insertion plane-choosing algorithm.
• Zhu, L., Mohan, A., Abdelsattar, J., Wang, Z., Vijayasekaran, A., Hwang, S., Tran, N., & Saint-Cyr, M. (2016). Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction. Journal of Plastic, Reconstructive and Aesthetic Surgery, 69(4). doi:10.1016/j.bjps.2016.01.006
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  Background and Aim Tissue expander-based two-stage reconstruction remains the most commonly used technique in immediate breast reconstruction. This study compares the subcutaneous expander placement to the traditional submuscular placement and describes our early experience with the expander insertion plane-choosing algorithm. Methods A retrospective study of patients who underwent two-stage immediate breast reconstruction from May 2012 to October 2014 was conducted. All expander insertion planes were chosen using the same algorithm. Expansion, pain, and complications were compared between two groups. Results The study included 88 patients (158 expanders; 50 subcutaneous and 108 submuscular). The subcutaneous group had a higher intraoperative expansion ratio (p < 0.001), high first postoperative expansion ratio (p < 0.001), shorter duration of expansion (p = 0.02), less number of expansion visits (p = 0.002), and less average pain during admission (p = 0.004). Significant differences in the intraoperative and first postoperative expansion ratios in patients with postmastectomy radiation therapy were also found between the two groups (p = 0.005 and 0.01, respectively). Complications during expansion and after second-stage autologous flap reconstruction were comparable between two groups. Conclusion The subcutaneous expander placement was associated with greater intraoperative and first postoperative expansion, shorter expansion duration, less expansion visits, and less pain. With the expander insertion plane-choosing algorithm, subcutaneous expander placement could be performed with comparable complications rates with the submuscular placement during expansion and after second-stage autologous flap reconstruction. Further studies can be performed due to the lack of long-term complications following second-stage implant reconstruction in the subcutaneous approach.
• Abdelsattar, J. M., Degnim, A. C., Hieken, T. J., Saint-Cyr, M., & Boughey, J. C. (2015). Local Infiltration of Liposomal Bupivacaine for Pain Control in Patients Undergoing Mastectomy with Immediate Tissue Expander Reconstruction. Annals of surgical oncology, 22(10), 3402-3.
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  Mastectomy with immediate tissue expander reconstruction is associated with postoperative pain, nausea, and vomiting. Various techniques of perioperative and postoperative pain control have been described. Our standard of care for postsurgical pain management in patients undergoing mastectomy with immediate tissue expander reconstruction has been preoperative ultrasound-guided paravertebral block. Recent literature demonstrating the opioid-sparing benefits of liposomal bupivacaine has directed two of our plastic surgeons to pilot its use in immediate tissue expander reconstruction. In the accompanying video, we present our technique of intraoperative local infiltration of liposomal bupivacaine into the base of mastectomy skin flaps, serratus fascia, and periaxillary tissue after completion of the mastectomy and before tissue expander placement into the reconstruction pocket.
• Abdelsattar, J. M., Pandian, T. K., Finnesgard, E. J., El Khatib, M. M., Rowse, P. G., Buckarma, E. N., Gas, B. L., Heller, S. F., & Farley, D. R. (2015). Do You See What I See? How We Use Video as an Adjunct to General Surgery Resident Education. Journal of surgical education, 72(6), e145-50.
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  Preparation of learners for surgical operations varies by institution, surgeon staff, and the trainees themselves. Often the operative environment is overwhelming for surgical trainees and the educational experience is substandard due to inadequate preparation. We sought to develop a simple, quick, and interactive tool that might assess each individual trainee's knowledge baseline before participating in minimally invasive surgery (MIS).
• Abdelsattar, J., Degnim, A., Hieken, T., Saint-Cyr, M., & Boughey, J. (2015). Local Infiltration of Liposomal Bupivacaine for Pain Control in Patients Undergoing Mastectomy with Immediate Tissue Expander Reconstruction. Annals of Surgical Oncology, 22(10). doi:10.1245/s10434-015-4670-5
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  Mastectomy with immediate tissue expander reconstruction is associated with postoperative pain, nausea, and vomiting. Various techniques of perioperative and postoperative pain control have been described. Our standard of care for postsurgical pain management in patients undergoing mastectomy with immediate tissue expander reconstruction has been preoperative ultrasound-guided paravertebral block. Recent literature demonstrating the opioid-sparing benefits of liposomal bupivacaine has directed two of our plastic surgeons to pilot its use in immediate tissue expander reconstruction. In the accompanying video, we present our technique of intraoperative local infiltration of liposomal bupivacaine into the base of mastectomy skin flaps, serratus fascia, and periaxillary tissue after completion of the mastectomy and before tissue expander placement into the reconstruction pocket.
• LeBlanc, K., Misra, D., Zacherl, J., Petrella, G., Khan, F., Negro, P., Roll, S., Hope, W., Campanelli, G., Van Lander, A., Muysoms, F., Kyle-Leinhase, I., Ceulemans, R., Pletinckx, P., Jacobs, I., Michiels, M., Berrevoet, F., Blair, L., Huntington, C., , Cox, T., et al. (2015). Quality of Life after Hernia Surgery. Hernia : the journal of hernias and abdominal wall surgery, 19 Suppl 1, S127-31.
• Rowse, P. G., Ruparel, R. K., AlJamal, Y. N., Abdelsattar, J. M., & Farley, D. R. (2015). Video Skills Curricula and Simulation: A Synergistic Way to Teach 2-Layered, Hand-Sewn Small Bowel Anastomosis. Journal of surgical education, 72(5), 1057-63.
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  We sought to determine if general surgery (GS) interns could learn a side-to-side, 2-layered, hand-sewn small bowel anastomosis (HSBA) using an online instructional video and low-fidelity simulation model.
• Rowse, P. G., Ruparel, R. K., Brahmbhatt, R. D., Dy, B. M., AlJamal, Y. N., Abdelsattar, J., & Farley, D. R. (2015). Assimilating endocrine anatomy through simulation: a pre-emptive strike!. American journal of surgery, 209(3), 542-6.
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  We sought to determine if endocrine anatomy could be learned with the aid of a hands-on, low-cost, low-fidelity surgical simulation curriculum and pre-emptive 60-second YouTube video clip.
• Rowse, P., Ruparel, R., Brahmbhatt, R., Dy, B., Aljamal, Y., Abdelsattar, J., & Farley, D. (2015). Assimilating endocrine anatomy through simulation: A pre-emptive strike!. American Journal of Surgery, 209(3). doi:10.1016/j.amjsurg.2014.12.004
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  Background We sought to determine if endocrine anatomy could be learned with the aid of a hands-on, low-cost, low-fidelity surgical simulation curriculum and pre-emptive 60-second YouTube video clip. Methods A 3-hour endocrine surgery simulation session was held on back-to-back Fridays. A video clip was made available to the 2nd group of learners. A comprehensive 40-point test was administered before (pre-test) and after (post-test) the sessions. Results General surgery interns (n = 26) participated. The video was viewed 19 times by 80% (12 of 15) of interns with access. Viewers outperformed nonviewers on subsequent post-testing (mean [SD], 29.7 [1.3] vs 24.4 [1.6]; P =.015). Mean scores on the anatomy section of the post-test were higher among viewers than nonviewers (mean [SD] 14.2 [.9] vs 10.3 [1.0]; P =.012). Conclusions Low-cost simulation models can be used to teach endocrine anatomy. Pre-emptive viewing of a 60-second video may have been a key factor resulting in higher post-test scores compared with controls, suggesting that the video intervention improved the educational effectiveness of the session.
• Rowse, P. G., Ruparel, R. K., AlJamal, Y. N., Abdelsattar, J. M., Heller, S. F., & Farley, D. R. (2014). Catering to millennial learners: assessing and improving fine-needle aspiration performance. Journal of surgical education, 71(6), e53-8.
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  Fine-needle aspiration (FNA) of a palpable cervical lymph node is a straightforward procedure that should be safely performed by educated general surgery (GS) trainees. Retention of technical skill is suspect, unless sequential learning experiences are provided. However, voluntary learning experiences are no guarantee that trainees will actually use the resource.

Proceedings Publications

• Abdelsattar, J., McCulloch, I., & Abunnaja, S. (2020). Emergency laparoscopic partial resection of the excluded stomach and gastric pouch in a gastric bypass patient with acute gastrogastric fistula bleeding. In Surg Obes Relat Dis.
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  PMID 31932206
• Abdelsattar, J., Mourany, J., Afridi, F., Musgrove, K., Shaffer, L., Khan, U., Marsh, J., & Borgstrom, D. (2020). Enhancing the Educational Value and Faculty Attendance of a Morbidity and Mortality Conference. In J Surg Educ 2020.
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  Objective: There exists significant variation in the approach to and execution of morbidity and mortality conference (M&MC). Faculty attendance remains a working challenge. We sought to change our department's M&MC and hypothesized improved educational value and attendance. Design: Complications were submitted in Clavien-Dindo format. A designated M&MC moderator facilitated discussion. A teaching point (TP) was assigned to each complication intended to be the focus of discussion. Presentations followed a structured 6-slide PowerPoint template. A web-based tool using Google Forms was developed and distributed as an “App” for tracking of attendance. An anonymous online survey was distributed to participants to elucidate perception of M&MC following the intervention. Setting: Academic medical center. Participants: Postgraduate year-1 to 5 surgery residents and faculty at West Virginia University, Morgantown. Results: Forty-eight of sixty-three surveys were returned (response rate 76%). Twenty-five faculty (70%) and 23 residents (82%) responded. A predetermined TP was viewed as the most favorable change made by both faculty and residents. 65% of faculty and residents acknowledged improved educational value, 58% found a single moderator to help streamline Morbidity and Mortality (M&M) presentations and 71% felt that a standard PowerPoint template improved quality of presentations. Both residents (96%) and faculty (68%) believed a predetermined TP improved the educational value of the conference and medical knowledge during preparation. More residents (43%) than faculty (16%) believed that changes to the department's M&MC format allowed better identification of quality improvement issues. Furthermore, the majority of residents (83%) believed that changes to the department's M&M format allowed better identification of system factors compared to faculty (32%), p = 0.003. Faculty participation increased from 60% to 80% after changes (p = 0.03). Conclusions: The educational value of M&MC and attendance can be improved with simple changes, but faculty and residents may have different expectations and perceptions.
• Sun, P., Pandian, T., Abdelsattar, J., & Farley, D. (2016). Reoperation for groin pain after inguinal herniorrhaphy: Does it really work?. In Am J Surg PMID: 26792272.
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  Background Chronic groin pain after inguinal hernia repair (IHR) is a vexing problem. Reoperation for groin pain (R4GP) has varied outcomes. Methods A retrospective review and telephone survey of adults who presented with groin pain after IHR from 1995 to 2014. Results Forty-four patients underwent R4GP; 23% had greater than 1 R4GP. Twenty-three (52%) had hernia recurrence at the time of R4GP. Twenty (45%) underwent nerve resection, and 13 (30%) had mesh removed. Twenty-eight patients completed a telephone survey. Of these, 26 (93%) respondents indicated they experienced pain after their last R4GP for a median duration of 12.5 months. At study completion, 5 patients continued to have debilitating chronic groin pain, 5 had moderate pain, 6 had minimal discomfort, and 12 were pain-free. Twenty-four respondents (86%) would proceed with reoperation(s) again if they could go back in time. Conclusions Although most patients do not experience immediate relief with R4GP, the majority receive some benefit in long-term follow-up.
• Abdelsattar, J., Pandian, T., Finnesgard, E., El Khatib, M., Rowse, P., Buckarma, E., Gas, B., Heller, S., & Farley, D. (2015). Do You See What i See? How We Use Video as an Adjunct to General Surgery Resident Education. In J Surg Educ.
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  Objective Preparation of learners for surgical operations varies by institution, surgeon staff, and the trainees themselves. Often the operative environment is overwhelming for surgical trainees and the educational experience is substandard due to inadequate preparation. We sought to develop a simple, quick, and interactive tool that might assess each individual trainee's knowledge baseline before participating in minimally invasive surgery (MIS). Design A 4-minute video with 5 separate muted clips from laparoscopic procedures (splenectomy, gastric band removal, cholecystectomy, adrenalectomy, and inguinal hernia repair) was created and shown to medical students (MS), general surgery residents, and staff surgeons. Participants were asked to watch the video and commentate (provide facts) on the operation, body region, instruments, anatomy, pathology, and surgical technique. Comments were scored using a 100-point grading scale (100 facts agreed upon by 8 surgical staff and trainees) with points deducted for incorrect answers. All participants were video recorded. Performance was scored by 2 separate raters. Setting An academic medical center. Participants MS = 10, interns (n = 8), postgraduate year 2 residents (PGY)2s (n = 11), PGY3s (n = 10), PGY4s (n = 9), PGY5s (n = 7), and general surgery staff surgeons (n = 5). Results Scores ranged from -5 to 76 total facts offered during the 4-minute video examination. MS scored the lowest (mean, range; 5, -5 to 8); interns were better (17, 4-29), followed by PGY2s (31, 21-34), PGY3s (33, 10-44), PGY4s (44, 19-47), PGY5s (48, 28-49), and staff (48, 17-76), p < 0.001. Rater concordance was 0.98 - measured using a concordance correlation coefficient (95% CI: 0.96-0.99). Only 2 of 8 interns acknowledged the critical view during the laparoscopic cholecystectomy video clip vs 10 of 11 PGY2 residents (p < 0.003). Of 8 interns, 7 misperceived the spleen as the liver in the splenectomy clip vs 2 of 7 chief residents (p = 0.02). Conclusions Not surprisingly, more experienced surgeons were able to relay a larger number of laparoscopic facts during a 4-minute video clip of 5 MIS operations than inexperienced trainees. However, even tenured staff surgeons relayed very few facts on procedures they were unfamiliar with. The potential differentiating capabilities of such a quick and inexpensive effort has pushed us to generate better online learning tools (operative modules) and hands-on simulation resources for our learners. We aim to repeat this and other studies to see if our learners are better prepared for video assessment and ultimately, MIS operations.
• Rowse, P., Ruparel, R., Aljamal, Y., Abdelsattar, J., & Farley, D. (2015). Video skills curricula and simulation: A synergistic way to teach 2-layered, hand-sewn small bowel anastomosis. In Journal of Surgical Education.
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  Background We sought to determine if general surgery (GS) interns could learn a side-to-side, 2-layered, hand-sewn small bowel anastomosis (HSBA) using an online instructional video and low-fidelity simulation model. Methods A 3-hour HSBA technical skills training session was held among GS interns. Participants were asked to write down the steps for performing a side-to-side, 2-layered HSBA (pretest). An online 13-minute instructional video on HSBA was then viewed. Low-fidelity bowel simulators were then provided for deliberate practice under staff supervision. A posttest (identical to pretest) concluded the session. The maximum test score was 20 points. At 4 months later, a retention test was administered. Trainees were anonymously surveyed to determine the session's educational value. Pretest, posttest, and retention test scores were compared. Results Participants were 25 GS interns. The mean pretest score was 5 (range: 0-11). Posttest scores improved (mean = 15; range: 11-19, p = 0.016), whereas retention test scores were stable (mean = 14; range: 8-18). Of those who participated in retention testing (24/25), 7 had now performed a 2-layered HSBA, 11 had witnessed HSBA, and 6 had neither performed nor witnessed an HSBA since the educational session. Retention test scores were higher among those who had performed HSBA (mean = 16; range: 13-18) vs those who had not performed nor witnessed an HSBA (mean = 14; range: 8-18, p = 0.04). Mean Likert scores supported the educational value of the session. Conclusion Initial intern performance of HSBA was abysmal. A contemporary online video skills curriculum coupled with low-fidelity bowel simulators improved trainee knowledge of how to perform a 2-layered HSBA. This effect remained stable over 4 months.
• Yu, D., Abdelrahman, A., Buckarma, E., Lowndes, B., Gas, B., Finnesgard, E., Abdelsattar, J., Pandian, T., El Khatib, M., Farley, D., & Hallbeck, S. (2015). Mental and physical workloads in a competitive laparoscopic skills training environment: A pilot study. In Proceedings of the Human Factors and Ergonomics Society 59th Annual Meeting, 508-512.
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  Surgical trainees undergo demanding training to achieve high surgical task proficiency. Abounding clinical and educational responsibilities mandate efficient and effective training. This research measured resident workload during laparoscopic skills training to identify excessive workload and how workload impacted task performance. Twenty-eight surgical trainees performed a standardized surgical training task and completed a workload questionnaire while observers measured physiological stress, posture risk assessment, and task performance. Participants self-reported mental demands, physical demands, temporal demands, performance, effort, and frustration. Effort (12±4) and frustration (12±5) were the highest subscales while physical demand (8±4) was the lowest. All participants were observed performing the task in at-risk postures, with 21% exhibiting risk levels requiring immediate intervention. Physical demand was associated with posture risk assessment scores (p
• Rowse, P., Ruparel, R., Aljamal, Y., Abdelsattar, J., Heller, S., & Farley, D. (2014). Catering to millennial learners: Assessing and improving fine-needle aspiration performance. In Journal of Surgical Education.
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  Objectives Fine-needle aspiration (FNA) of a palpable cervical lymph node is a straightforward procedure that should be safely performed by educated general surgery (GS) trainees. Retention of technical skill is suspect, unless sequential learning experiences are provided. However, voluntary learning experiences are no guarantee that trainees will actually use the resource. Design A 3-minute objective structured assessment of technical skill-type station was created to assess GS trainee performance using FNA. Objective criteria were developed and a checklist was generated (perfect score = 24). Following abysmal performance of 11 postgraduate year (PGY)-4 trainees on the FNA station of our semiannual surgical skills assessment ("X-Games"), we provided all GS residents with electronic access to a 90-second YouTube video clip demonstrating proper FNA technique. PGY-2 (n = 11) and PGY-3 (n = 10) residents subsequently were tested on FNA technique 5 and 12 days later, respectively. Results All 32 trainees completed the station in less than 3 minutes. Overall scores ranged from 4 to 24 (mean = 14.9). PGY-4 residents assessed before the creation of the video clip scored lowest (range: 4-18, mean = 11.4). PGY-3 residents (range: 10-22, mean = 17.8) and PGY-2 residents (range: 10-24, mean = 15.8) subsequently scored higher (p < 0.05). Ten residents admitted watching the 90-second FNA video clip and scored higher (mean = 21.7) than the 11 residents that admitted they did not watch the clip (mean = 13.1, p < 0.001). Of the 11 trainees who did not watch the video, 6 claimed they did not have time, and 5 felt it would not be useful to them. Conclusions Overall performance of FNA was poor in 32 midlevel GS residents. However, a 90-second video clip demonstrating proper FNA technique viewed less than 2 weeks before the examination significantly elevated scores. Half of trainees given the chance to learn online did not take the opportunity to view the video clip. Although preemptive learning is effective, future efforts should attempt to improve self-directed learning habits of trainees and evaluate actual long-term skill retention.