Recent Publications | Department of Surgery

Donation after circulatory death donors in lung transplantation

Lead Author: Thomas Egan, MD | Journal of Thoracic Disease

Transplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria.

The effect of traditional healer intervention prior to allopathic care on pediatric burn mortality in Malawi

Lead Author: Jared Gallagher, MD | Journal: Burns

Burn injury is a significant contributor to mortality, especially in low and middle-income countries (LMICs). Patients in many communities throughout sub-Saharan Africa use traditional health practitioners for burn care prior to seeking evaluation at an allopathic burn center. The World Health Organization defines a traditional health practitioner as “a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal and mineral substances and other methods based on social, cultural and religious practices based on indigenous knowledge and belief system.” The aim of this study is to determine the prevalence of prior traditional health practitioner treatment and assess its effect on burn injury mortality.

Pediatric Burn Infection

Lead Author: Felicia N. Williams | Journal: Surgical Infections

Severe burns lead to a profound hypermetabolic, hypercatabolic, hyper-inflammatory state. Pediatric burn patients are at significantly increased risk for infection and sepsis secondary to loss of the skin barrier and subsequent immunosuppression. Infection is the most common cause of morbidity and death in pediatric burn patients, and the mortality rate from sepsis remains high.

The effect of neighborhood Area Deprivation Index on residential burn injury severity

Lead Author: Lauren Purcell, MD | Journal: Burns

Residential fires account for the majority of burn-related injuries and fatalities. Established risk factors for burn injury include male gender, racial minority, children and elderly individuals, poverty, and substandard housing characteristics. In North Carolina, the rate of residential fire injuries and deaths is higher than the national average. Therefore, we sought to describe residential fire hospitalizations at a large regional burn center and describe the neighborhoods in which they live. We hypothesized that patients living in areas with higher Area Deprivation Index (ADI) are more likely to have major residential burns.

The effect of burn mechanism on pediatric mortality in Malawi: A propensity weighted analysis

Resident Authors: Laura N. Purcell, MD | Faculty Authors: Bruce Cairns, MD, Michael R. Phillips, MD, Jared R. Gallaher, MD, Anthony Charles, MD | Journal: Burns

The burden of global trauma disproportionately affects low- and middle-income countries, with a high incidence in children. Thermal injury represents one of the most severe forms of trauma and is associated with remarkable morbidity and mortality. The predictors of burn mortality have been well described (age, % total body surface area burn [TBSA], and presence of inhalation injury). However, the contribution of the burn mechanism as a predictor of burn mortality is not well delineated.

Isoforms of MUC16 activate oncogenic signaling through EGF receptors to enhance the progression of pancreatic cancer

Lead Author: Jen Jen Yeh, MD | Journal: Molecular Theory

Aberrant expression of CA125/MUC16 is associated with pancreatic ductal adenocarcinoma (PDAC) progression and metastasis. However, knowledge of the contribution of MUC16 to pancreatic tumorigenesis is limited. Here, we show that MUC16 expression is associated with disease progression, basal-like and squamous tumor subtypes, increased tumor metastasis, and short-term survival of PDAC patients.

Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients

Lead Author: Trista Reid, MD | Journal: Surgery

While ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates.

What Survivorship Means to Liver Transplant Recipients: Qualitative Groundwork for a Survivorship Conceptual Model

Author: Chirag Desai, MD | Journal: Liver Transplantation

Survivorship is a well-established concept in the cancer care continuum with a focus on disease recurrence, quality of life, and the minimization of competing risks for mortality; however, survivorship has not been well studied in liver transplantation (LT). We investigated what survivorship means to LT patients and identified motivations and coping strategies for overcoming challenges after LT.

The Role of Intraoperative Radiation in Early-stage Breast Cancer

Lead Author: David Ollila, MD | Journal: Clinical Breast Cancer

Intraoperative radiation therapy (IORT) is a specialized form of accelerated partial breast irradiation in which a single dose of radiation is delivered to the tumor bed at the time of breast conserving surgery.

Perceived Versus Objective Change in Walking Ability in Peripheral Artery Disease: Results from 3 Randomized Clinical Trials of Exercise Therapy

Author: Melina R. Kibbe, MD | Journal of American Heart Association

Background In people with lower-extremity peripheral artery disease, the effects of exercise on patient-reported outcomes remain unclear.

Randomized Phase II Study of PET Response-Adapted Combined Modality Therapy for Esophageal Cancer: Mature Results of the CALGB 80803 (Alliance) Trial

Author: Michael O. Meyers | Journal of Clinical Oncology

To evaluate the use of early assessment of chemotherapy responsiveness by positron emission tomography (PET) imaging to tailor therapy in patients with esophageal and esophagogastric junction adenocarcinoma.

Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population

Resident Author: Josh Herb, MD | Faculty Author: Lawrence Kim, MD | Journal: Surgery

Few studies assess use of parathyroidectomy among older adults with symptomatic primary hyperparathyroidism. Our objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults.

Male sex, ostomy, infection, and intravenous fluids are associated with increased risk of postoperative ileus in elective colorectal surgery

Surgery Author: Muneera R. Kapadia, MD | Surgery Journal

Postoperative ileus is a common and costly complication after elective colorectal surgery. Effects of intravenous fluid administration remain controversial, and the effect of ostomy construction has not been fully evaluated. Various restrictive intravenous fluid protocols may adversely affect renal function. We aimed to investigate the impact of intestinal reconstruction and intravenous fluid on ileus and renal function after colorectal resection under an enhanced recovery protocol.

Socioeconomic factors in timing of esophagectomy and association with outcomes

Residency Author: Kevin A. Chen, MD | Faculty Author: Michael O Meyers | Journal of Surgical Oncology

Disparities in esophageal cancer are well-established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes.

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample

Authors: Gita N. Mody, MD, John S. Ikonomidis, MD, Jason M. Long | Journal: PLoS One

The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use.

Pathology and Molecular Characteristics of Pancreatic Cancer

Residency Author: Joseph F Kearney, MD | Faculty Author: Jen Jen Yeh, MD | Journal: Surgical Oncology Clinics of North America

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer. However, it should be kept in mind that there are other pancreatic cancers that are classified by their cellular lineage: acinar cell carcinomas (acinar differentiation), neuroendocrine neoplasms (arising from the islets), solid-pseudopapillary neoplasms (showing no discernible cell lineage), and pancreatoblastomas (characterized by multiphenotypic differentiation, including acinar endocrine and ductal). This article focuses on the molecular and pathology alterations in PDAC.

Patch grafting, strategies for transplantation of organoids into solid organs such as liver

Author: Yi Xianwen, PhD | Journal: Biomaterials

Epithelial cell therapies have been at an impasse because of inefficient methods of transplantation to solid organs. Patch grafting strategies were established enabling transplantation of ≥107th organoids/patch of porcine GFP+ biliary tree stem/progenitors into livers of wild type hosts.

Burn Injury Induces Proinflammatory Plasma Extracellular Vesicles That Associate with Length of Hospital Stay in Women: CRP and SAA1 as Potential Prognostic Indicators

Leader Author: Robert Maile, PhD | International Journal of Molecular Sciences

Severe burn injury is a devastating form of trauma that results in persistent immune dysfunction with associated morbidity and mortality. The underlying drivers of this immune dysfunction remain elusive, and there are no prognostic markers to identify at-risk patients.

Causes of death following discharge after trauma in North Carolina

Residency Author: Mary K Bryant, MD | Faculty Authors: Sharon Schiro, PhD, Lauren Raff, MD, Arielle J. Perez, MD, Trista Reid, MD | The Journal of Trauma and Acute Care Surgery

While a “fourth peak” of delayed trauma mortality has been described, limited data describe the causes of death (COD) for patients in the years following an injury. This study investigates the difference in COD statewide for patients with and without a recent trauma admission.

ACR Appropriateness Criteria® Parathyroid Adenoma

UNC Surgery Author: Lawrence Kim, MD | Journal of the American College of Radiology

Hyperparathyroidism is defined as excessive parathyroid hormone production. The diagnosis is made through biochemical testing, in which imaging has no role. However, imaging is appropriate for preoperative parathyroid gland localization with the intent of surgical cure. Imaging is particularly useful in the setting of primary hyperparathyroidism whereby accurate localization of a single parathyroid adenoma can facilitate minimally invasive parathyroidectomy.

Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery

Authors: Aman Kumar, MD, Alex Zendel, MD, Michael Batres, MD, David A. Gerber, MD, Chirag S. Desai, MD | The American Journal of Surgery

Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist’s differential diagnosis in cases of SHC will often include “rule out biliary cystadenoma.”

The Sociotechnical Factors Associated With Burnout in Residents in Surgical Specialties: A Qualitative Systematic Review

Surgery Authors: Ian Kratzke, MD, and Muneera Kapadia, MD, MEE | Journal of Surgical Education

The consequences of burnout remain prevalent within general surgery training programs, yet there is no comprehensive description of the factors associated with burnout. Using sociotechnical systems theory, this review aims to qualitatively evaluate the factors associated with burnout in surgical residents.

Adenosine, Lidocaine, and Magnesium for Attenuating Ischemia Reperfusion Injury from Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in a Porcine Model

Lead Author: Matthew J Eckert | Journal of Trauma and Acute Care Surgery

Minimally invasive REBOA following non-compressible hemorrhage results in significant ischemia reperfusion injury (IRI). Adverse outcomes from IRI include organ dysfunction and can result in profound hemodynamic and molecular compromise. We hypothesized that ALM attenuates organ injury and inflammation responses following REBOA IRI in a porcine model of hemorrhage.

ASTS Cellular Transplantation Committee. Challenges, highlights, and opportunities in cellular transplantation: A white paper of the current landscape

Lead Author: Chirag Desai, MD | American Journal of Transplantation

Although cellular transplantation remains a relatively small field compared to solid organ transplantation, the prospects for advancement in basic science and clinical care remain bountiful. In this review, notable historical events and the current landscape of the field of cellular transplantation are reviewed with an emphasis on islets (allo- and xeno-), hepatocytes

Dynamic α-Fetoprotein Response-Are We Ready to Change the Dynamics of Hepatocellular Carcinoma Liver Transplant Practice?

Lead Author: Chirag Desai, MD | Journal: JAMA Surgery

There is an important unmet need for better measures of liver tumor biologic and objective criteria that may be used to select patients who will benefit most from the limited pool of life-saving liver grafts. This study advances our understanding of AFP-R, and such data may eventually be used in organ allocation practice and policy. However, before considering