6588 ASA Book.indb - American Surgical Association
AMERICAN SURGICAL ASSOCIATION Program of the 135th Annual Meeting Marriott Marquis San Diego, California Thursday, April 23rd Friday, April 24th Saturday, April 25th 2015 Table of Contents Officers and Council 2 Committees 3 Foundation Trustees 5 Representatives 6 Future Meetings 7 General Information 8 Continuing Medical Education Accreditation Information 10 Program Committee Disclosure List * 13 Faculty Disclosure List * 13 Author Disclosure List * 14 Discussant Disclosure List * 23 New Honorary Fellows 26 Schedule-at-a-Glance 29 Program Outline 31 Program Detail and Abstracts 45 Alphabetical Directory of Fellows * 105 Geographic Roster of Fellows * 281 Necrology 309 Medallion for Scientific Achievement Recipients 310 Medallion for Advancement of Surgical Care Recipients 312 Flance-Karl Award Recipients 313 Foundation Fellowship Award Recipients 315 Foundation Contributors * 317 Author Index 326 Record of Attendance * 337 Membership Update Form * 339 * These sections available on-site to professional attendees, or by logging into americansurgical.info/membersOnly.cgi. AMERICAN SURGICAL ASSOCIATION Program of the 135th Annual Meeting Marriott Marquis San Diego, California Thursday, April 23th Friday, April 24th Saturday, April 25th 2015 2 AMERICAN SURGICAL ASSOCIATION THE AMERICAN SURGICAL ASSOCIATION 2014–2015 OFFICERS President Anna M. Ledgerwood President-Elect James S. Economou Vice-President John M. Daly Secretary Ronald J. Weigel Treasurer Russell G. Postier Recorder Steven C. Stain AMERICAN SURGICAL ASSOCIATION 3 ADVISORY MEMBERSHIP COMMITTEE Robin S. McLeod, Chair................................................................2005–2016 Monica M. Bertagnolli ...................................................................2010–2015 William C. Chapman......................................................................2012–2017 Edward E. Cornwell, III .................................................................2014–2019 Diana L. Farmer .............................................................................2012–2017 David R. Flum................................................................................2014–2019 Anthony A. Meyer .........................................................................2010–2015 H. Leon Pachter .............................................................................2013–2018 Alec Patterson ................................................................................2011–2016 Grace S. Rozycki ...........................................................................2009–2016 Michael G. Sarr ..............................................................................2011–2016 Kenneth W. Sharp ..........................................................................2013–2018 Craig R. Smith ...............................................................................2012–2017 Mark A. Talamini ...........................................................................2013–2018 Michael T. Watkins ........................................................................2013–2018 Sharon M. Weber ...........................................................................2014–2019 ARRANGEMENTS COMMITTEE 135th Annual Meeting A. Brent Eastman, Chair COUNCIL L.D. Britt ........................................................................................2013–2016 Timothy J. Eberlein ........................................................................2012–2015 Layton F. Rikkers ...........................................................................2014–2017 AUDIT COMMITTEE Lynt B. Johnson, Chair ..................................................................2013–2015 Karen E. Deveney ..........................................................................2015–2017 David W. McFadden ......................................................................2014–2016 American Surgical Association Administrative Ofces 500 Cummings Center, Suite 4550 Beverly, MA 01915 Phone: (978) 927-8330 Fax: (978) 524-8890 Email: [email protected] Or visit: americansurgical.org ETHICS AND PROFESSIONALISM COMMITTEE L.D. Britt, Chair.............................................................................2014–2015 James S. Economou .......................................................................2014–2018 Anna M. Ledgerwood ....................................................................2014–2017 Mary H. McGrath...........................................................................2014–2016 Layton F. Rikkers ...........................................................................2014–2016 George C. Velmahos ......................................................................2014–2017 4 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 5 HONORARY FELLOWSHIPS COMMITTEE PROGRAM COMMITTEE Jay L. Grosfeld, Chair ...................................................................2007–2016 Yuman Fong ...................................................................................2013–2019 Keith D. Lillemoe ..........................................................................2014–2020 Marco G. Patti ................................................................................2015–2021 Courtney M. Townsend, Jr. ............................................................2011–2017 Donald D. Trunkey.........................................................................2011–2017 Valerie W. Rusch, Chair.................................................................2010–2016 Herbert Chen ..................................................................................2014–2019 Jeffrey A. Drebin ............................................................................2012–2017 Roger R. Perry ...............................................................................2013–2018 Loring W. Rue, III ..........................................................................2011–2015 FLANCE-KARL AWARD COMMITTEE Ronald P. DeMatteo, Chair ............................................................2010–2015 Timothy R. Billiar ..........................................................................2013–2018 Jeffrey A. Drebin ............................................................................2014–2019 Thomas F. Tracy, Jr. .......................................................................2011–2016 Ronald J. Weigel ............................................................................2012–2017 MEDALLION FOR THE ADVANCEMENT OF SURGICAL CARE AWARD COMMITTEE James S. Economou, Chair ............................................................2014–2017 Anna M. Ledgerwood ....................................................................2013–2016 Layton F. Rikkers ...........................................................................2012–2015 Steven C. Stain ...............................................................................2012–2015 Ronald J. Weigel ............................................................................2012–2015 Anthony D. Whittemore.................................................................2012–2015 NOMINATING COMMITTEE Timothy J. Eberlein, Chair ............................................................2012–2017 Kirby I. Bland ................................................................................2011–2016 L.D. Britt ........................................................................................2013–2018 Layton F. Rikkers ...........................................................................2014–2019 Donald D. Trunkey.........................................................................2010–2015 President, President-Elect, Secretary, and Recorder, ex ofcio with vote TRUSTEES OF THE AMERICAN SURGICAL ASSOCIATION FOUNDATION Chair Anthony D. Whittemore Vice Chair Donald D. Trunkey Secretary Ronald J. Weigel Treasurer Russell G. Postier Trustees Kirby I. Bland L.D. Britt Timothy J. Eberlein Ex-Ofcio Anna M. Ledgerwood 6 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION REPRESENTATIVES FUTURE MEETINGS OF THE AMERICAN SURGICAL ASSOCIATION AMERICAN BOARD OF SURGERY Karen J. Brasel ...............................................................................2012–2018 William C. Chapman......................................................................2013–2019 K. Craig Kent .................................................................................2013–2019 Selwyn M. Vickers .........................................................................2009–2015 AMERICAN BOARD OF THORACIC SURGERY Robert S. Higgins ...........................................................................2011–2017 Richard J. Shemin ..........................................................................2005–2015 AMERICAN COLLEGE OF SURGEONS, BOARD OF GOVERNORS Russell J. Nauta..............................................................................2013–2016 Bruce D. Schirmer .........................................................................2014–2017 AMERICAN COLLEGE OF SURGEONS, ADVISORY COUNCIL FOR GENERAL SURGERY W. Scott Melvin .............................................................................2012–2015 AMERICAN COLLEGE OF SURGEONS, SURGICAL RESEARCH COMMITTEE Jeffrey B. Matthews .......................................................................2013–2016 ASSOCIATION OF AMERICAN MEDICAL COLLEGES, COUNCIL OF FACULTY AND ACADEMIC SOCIETIES Susan Galandiuk ............................................................................2013–2016 Ajit K. Sachdeva ............................................................................2013–2016 NATIONAL ASSOCIATION FOR BIOMEDICAL RESEARCH Ronald M. Stewart .........................................................................2013–2015 April 14–16, 2016 Swissôtel Chicago Chicago, Illinois April 20–22, 2017 Philadelphia Marriott Downtown Philadelphia, Pennsylvania 7 8 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION GENERAL INFORMATION EMBARGO POLICY: The embargo on studies and their associated abstracts (including those posted online prior to the conference) scheduled for presentation at the American Surgical Association’s 135th Annual Meeting, April 23–25, 2015, San Diego, California, is the date and time of each individual scientic presentation (not the beginning of the overall session in which it has been scheduled). News media activities are restricted until the embargo lifts. Any news media activity about a study and its associated abstract must include the following: “The complete manuscript of this study and its presentation at the American Surgical Association’s 135th Annual Meeting, April 2015, in San Diego, California, is anticipated to be published in the Annals of Surgery pending editorial review.” The Marriott Marquis, San Diego, California, is the headquarters of the American Surgical Association for the 135th Annual Meeting, April 23–25, 2015. REGISTRATION: The Registration Desk for the 135th Annual Meeting is located outside the Marina Ballroom during the following hours: Wednesday, April 22nd Thursday, April 23rd Friday, April 24th Saturday, April 25th 2:00 p.m.–6:00 p.m. 7:00 a.m.–5:15 p.m. 7:30 a.m.–5:00 p.m. 7:30 a.m.–11:00 a.m. Fellows and guests who have pre-registered are required to sign the registration book and pick up registration materials at the ASA Registration Desk. Registration is also available on-site. SPEAKERS AND DISCUSSANTS: All manuscripts presented at the Scientic Sessions of the Annual Meeting must be submitted electronically to The Annals of Surgery at www.editorialmanager.com/annsurg prior to the presentation of the paper. The time allowed for each presentation is ten minutes. Following the presentation, the Primary Discussant will be allotted three minutes for discussion. All additional discussants will be allotted two minutes. The total amount of time provided for discussion is fteen minutes. Please note the use of slides will NOT be permitted for discussants. SPEAKER READY ROOM: The Speaker Ready Room is located in the Palomar Room. Authors are requested to submit their PowerPoint presentations on USB memory drive or CD-ROM the day prior to their session to the technician in the Speaker Ready Room. Speaker Ready Room hours are: Wednesday, April 22nd Thursday, April 23rd Friday, April 24th Saturday, April 25th 2:00 p.m.–6:00 p.m. 7:00 a.m.–5:15 p.m. 7:30 a.m.–5:00 p.m. 7:30 a.m.–11:00 a.m. 9 BANQUET: The Annual Reception and Banquet is open to Fellows of the Association and their registered spouses/partners, as well as Invited Guest Physicians and Residents and their registered spouses/partners. The Reception and Banquet is scheduled for Friday, April 24th, with the reception taking place in the Marina Ballroom Foyer and dinner in the Marina Ballroom (black tie preferred, but dark suits are acceptable). SPECIAL EVENTS: Address by the President Forum Discussion Thursday, April 23rd 10:50 a.m. Friday, April 24th 10:30 a.m. “Development of Surgical Scientists” Executive Session (Fellows Only) Friday, April 24th Reception & Banquet th Friday, April 24 4:00 p.m. 7:00 p.m. SPOUSE/GUEST HOSPITALITY: The Spouse/Guest Hospitality Suite is located in the Catalina Room from 7:00 a.m. to 10:30 a.m., Thursday, April 23rd, and from 7:30 a.m. to 10:30 a.m. on Friday, April 24th and Saturday, April 25th. The Local Arrangements Committee will have information on activities of interest and maps available in the room. REGISTRANT BADGES: Badges are required for admittance to the ASA Scientic Sessions. Badge colors represent the following designations: Blue — Member/Fellow Cream — Honorary Fellow Green — Guest Physician White — Spouse/Guest 10 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION CME MISSION/PURPOSE AND CONTENT LEARNING OUTCOMES The Continuing Medical Education Mission of the American Surgical Association is to provide a national forum for presenting the developing state-ofthe-art and science of general and sub-specialty surgery and the elevation of the standards of the medical/surgical profession. This mission is accomplished primarily by conducting an annual scientic meeting consisting of selected presentations containing the most current information available on clinical and research topics related to surgery or surgical specialties, including studies on outcomes, practice and science of surgery and ethical and other issues that affect its practice. In addition, the meeting features special invited speakers who address a variety of topics directly or indirectly related to the practice of surgery. The meeting is presented for the benet of those physicians, surgeons and researchers involved in the study, treatment and cure of diseases associated with the entire spectrum of human disease. The meeting provides for a free exchange of information and serves the professional needs of the membership and invited guests. The Association’s mission is augmented by the publication of the scientic papers presented at the annual meeting in the Annals of Surgery, a monthly scientic publication distributed to subscribers throughout the world and by the publication of the Proceedings of the Annual Meeting and the scientic papers in the Transactions of the American Surgical Association, an annual publication distributed to the membership. At the conclusion of the Annual Meeting, participants should have an enhanced understanding of the latest techniques and current research specically related to the elds of clinical surgery, experimental surgery and related sciences, surgical education and the socioeconomic aspects of surgical care. Through the open discussion periods and the Forum Discussion, participants will have the opportunity to hear the pros and cons of each paper presented to gain an overall perspective of their current practices and to utilize results presented in order to select appropriate surgical procedures and interventions for their own patients and to integrate state-of-the-art knowledge into their current practice and/or research. LEARNING OBJECTIVES The Annual Meeting of the American Surgical Association is designed to provide two and one half days of comprehensive educational experiences in the elds of clinical surgery, experimental surgery and related sciences, surgical education and the socioeconomic aspects of surgical care. It is the Association’s intent to bring together at this meeting the leading surgeons and scientists from North America and other continents to freely and openly discuss their latest clinical and research ndings. 11 EDUCATIONAL METHODS Authored papers supported by audio/visual presentations, panel discussion, and open group discussion. ACCREDITATION STATEMENT This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Surgeons and the American Surgical Association. The American College of Surgeons is accredited by the ACCME to provide continuing medical education for physicians. AMA PRA CATEGORY 1 CREDITS™ The American College of Surgeons designates this live activity for a maximum of 16.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 12 AMERICAN SURGICAL ASSOCIATION FACULTY DISCLOSURE INFORMATION In accordance with the ACCME Accreditation Criteria, the American College of Surgeons, as the accredited provider of this activity, must ensure that anyone in a position to control the content of the educational activity has disclosed all relevant nancial relationships with any commercial interest. Therefore, it is mandatory that both the program planning committee and speakers complete disclosure forms. Members of the program committee were required to disclose all nancial relationships and speakers were required to disclose any nancial relationship as it pertains to the content of the presentations. The ACCME denes a ‘commercial interest’ as “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients”. It does not consider providers of clinical service directly to patients to be commercial interests. The ACCME considers “relevant” nancial relationships as nancial transactions (in any amount) that may create a conict of interest and occur within the 12 months preceding the time that the individual is being asked to assume a role controlling content of the educational activity. ACS is also required, through our joint providership partners, to manage any reported conict and eliminate the potential for bias during the activity. All program committee members and speakers were contacted and the conicts listed below have been managed to our satisfaction. However, if you perceive a bias during a session, please report the circumstances on the session evaluation form. Please note we have advised the speakers that it is their responsibility to disclose at the start of their presentation if they will be describing the use of a device, product, or drug that is not FDA approved or the off-label use of an approved device, product, or drug or unapproved usage. The requirement for disclosure is not intended to imply any impropriety of such relationships, but simply to identify such relationships through full disclosure and to allow the audience to form its own judgments regarding the presentation. 26 AMERICAN SURGICAL ASSOCIATION New Honorary Fellows Introductions Jiahong Dong, M.D. Dr. Jiahong Dong is the new executive President of the Beijing Tsinghua Changgung Hospital, a comprehensive hospital afliated to Tsinghua University. He is one of the preeminent hepatobiliary surgeons in the world. Professor Dong was educated at the Jiansu Medical College, and did his surgical training at the Third Military Medical University in Chongquing. In 1996, he rose to be the Surgeon-in-Chief of the Hepatobiliary Surgery Center at the Third Military Medical University. In 2006, at age 46, he became the Head of the Chinese People’s Liberation Army General Hospital (301) in Beijing, a position he held until this year. This is the biggest and most advanced hospital in China. Professor Dong has received many honors, and has served as President of the Chinese Society of Biliary Surgery since 2006, and Vice-president of the Chinese Chapter of the International Hepato-pancreatico-biliary association since 2007. He is on many editorial boards including serving as the editor-in chief of the Chinese Journal of Digestive Surgery. He is famous for his technical surgical skills, and technical innovations in hepatic resections, in vascular reconstructions, and in robotic liver surgery. He is also famous for his contributions to education and to international collaborations. For his works in technical surgery, and for surgical education, he was made Honorary fellow of the French Academy of Surgery. We welcome him to the American Surgical Association. AMERICAN SURGICAL ASSOCIATION 27 R. Ronan O’Connell, M.D. Patrick Ronan O’Connell is a native of Dublin, Ireland. He graduated from Trinity College Dublin in 1979 with rst place and rst class honours. His initial surgical training was in Dublin with Professor Tom Hennessy (also an Honorary Fellow of ASA). He subsequently gained an NIH Fogarty Scholarship to work as a research fellow with Dr Keith Kelly at the Mayo Clinic, Rochester, Minnesota. He continued his training with a Fellowship in Colon and Rectal Surgery at Mayo and returned as a senior registrar to work in Cork and Dublin, Ireland. Following a year as a Senior Lecturer working with Professor Sir Norman Williams at the London Hospital, Professor O’Connell returned to Dublin as consultant surgeon at the Mater Misericordiae Hospital in 1990. In 2007 he was appointed Professor of Surgery and Head of Surgical Specialties at the University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland. Professor O’Connell is currently Consultant Surgeon and Director of the Centre for Colorectal Disease at St Vincent’s University Hospital Dublin. Professor O’Connell is a Council Member of the Royal College of Surgeons in Ireland and is immediate past President of the European Society of Coloproctology, Secretary of the BJS Society and Vice President of the James’ IV Society. He has served as editor of the British Journal of Surgery, associate editor and Editor in Chief for the European Surgical Association, Associate Editor of Diseases of the Colon and Rectum and is currently an Editorial Board member of the Annals of Surgery. Prof O’Connell is widely published in the areas of IBD, colorectal cancer and pelvic oor physiology with over 225 peer-reviewed publications, book chapters, invited review articles/commentaries and editorials. He is joint editor of Bailey and Love’s Short Practice of Surgery and Rob and Smith’s Operative Surgery of the Colon Rectum and Anus. In addition he is joint editor of the European Manual in Coloproctology. Within his chosen specialty of coloproctology, he has recognized by giving the Sir Alan Parks and John Goligher lectures in the UK, the ESR Hughes oration in Australia and the Harry E Bacon Lecture to the American Society of Colon and Rectal Surgeons. In total he has spoken nationally and internationally on over 400 occasions. Prof O’Connell is married to Pauline, a new-born intensive care nurse specialist, who has accompanied him. They have three grown children, two of whom have chosen medicine as a career. 28 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION John Thompson, M.D. SCHEDULE-AT-A-GLANCE John F. Thompson, M.D., is the Professor of Melanoma and Surgical Oncology at the University of Sydney, and since 2002 has been the Executive director of the Melanoma Institute Australia (formerly the Sydney Melanoma Unit). He has made enormous contributions to the eld of surgical oncology and melanoma. He received his Bachelors of Science from the University of Sydney, and completed his surgical training at the University of Sydney, the Royal Prince Alfred Hospital, the Noga Base Hospital in Papua New Guinea, as well as the University of Oxford. Since his appointment as professor in 1999, no one has contributed more to dening the standard of surgical care for melanoma, including optimal margins, use of sentinel nodes, diagnosis and surveillance, limb perfusion, and best reconstructions. The important ndings of his group have been published in over 600 peer reviewed publications, including journals such as the Lancet and the New England Journal of Medicine. In leadership positions, Professor Thompson was Chairman of the Working Party which created the NHMRC-endorsed Clinical Practice Guidelines for the Management of Cutaneous Melanoma in Australia and New Zealand, Chairman of the Australia and New Zealand Melanoma Trials Group, and President of the International Sentinel Node Society. In editorial positions, he was Associate Editor of Annals of Surgical Oncology and Senior Editor of Melanoma Management. For his contributions to medicine, he was made an Ofcer in the Order of Australia (AO), “for distinguished service to medicine in the eld of oncology research, particularly melanoma, to national and international professional organisations, and to medical education.” He received the Premier’s Award for Outstanding Cancer Research, Cancer Institute NSW Annual Awards, Sydney, August 2013. He was part of the group which received the 2009 Premier’s Award for Excellence in Translational Research: Sydney Melanoma Unit. For his contributions to treatment of melanoma, to surgical sciences, to international collaboration, and to surgical education, we welcome him to the American Surgical Association. 29 THURSDAY, APRIL 23rd 8:15 AM Opening Session Marina Ballroom E-G President’s Opening Remarks Secretary’s Welcome & Introduction of New Fellows Elected In 2014 President’s Introduction of Honorary Fellows Presentation of the Medallion for Scientic Achievement Presentation of the Medallion for the Advancement of Surgical Care Eulogies of Past Presidents Report of the Committee on Arrangements 9:10 AM Scientic Session I Marina Ballroom E-G Moderator: Anna M. Ledgerwood, M.D. 10:50 AM Presidential Address Marina Ballroom E-G Introduction: John M. Daly, M.D. Address: Anna M. Ledgerwood, M.D. 1:30 PM Scientic Session II Marina Ballroom E-G Moderator: James S. Economou, M.D., Ph.D. 30 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION FRIDAY, APRIL 24th AMERICAN SURGICAL ASSOCIATION 135th Annual Meeting April 23–25, 2015 Marriott Marquis San Diego, California 7:00 AM ASA Women in Surgery Breakfast Mission Hills 8:00 AM Scientic Session III Marina Ballroom E-G Moderator: Anna M. Ledgerwood, M.D. 10:30 AM Forum Discussion: Marina Ballroom E-G “Development of Surgical Scientists” Moderator: Anna M. Ledgerwood, M.D. 1:30 PM Scientic Session IV Moderator: John M. Daly, M.D. Marina Ballroom E-G 4:00 PM Executive Session (Fellows Only) Presentation of the Flance-Karl Award Marina Ballroom E-G Marina Ballroom Foyer 8:00 PM Annual Banquet (Black tie preferred, but dark suits are acceptable.) 8:00 AM Scientic Session V Moderator: New President-Elect 11:00 AM Adjourn THURSDAY, APRIL 23, 2015 8:15 AM – 9:10 AM OPENING SESSION Marina Ballroom E-G President’s Opening Remarks 7:00 PM Annual Reception SATURDAY, APRIL 25 PROGRAM OUTLINE Marina Ballroom Secretary’s Welcome & Introduction of New Fellows Elected In 2014 President’s Introduction of Honorary Fellows Presentation of the Medallion for Scientic Achievement Presentation of the Medallion for the Advancement of Surgical Care th Marina Ballroom E-G Eulogies of Past Presidents Report of the Committee on Arrangements 31 32 AMERICAN SURGICAL ASSOCIATION 9:10 AM – 11:00 AM SCIENTIFIC SESSION I Marina Ballroom E-G Moderator: Anna M. Ledgerwood, M.D. 9:10 AM – 9:35 AM 1 Combined Preoperative Mechanical Bowel Preparation with Oral Antibiotics Signicantly Reduces Surgical Site Infection, Anastomotic Leak and Ileus After Colorectal Surgery Ravi P. Kiran*, A.C. Murray*, Cody Chiuzan*, David Estrada*, Kenneth A. Forde New York Presbyterian Hospital, Columbia University, New York, NY 9:35 AM – 10:00 AM 2 Frozen Red Blood Cells Are Safe and Effective: A Prospective Randomized Trial Martin A. Schreiber1, John B. Holcomb2, Bryce Robinson*3, Joseph Minei4, Ronald Stewart5, Laszlo Kiraly*1, Belinda McCully*1, Bryan Cotton*6, Dina Gomaa*3, Michael W. Cripps*4, Mark DeRosa*5, Samantha Underwood*1 1 Oregon Health & Science University, Portland, OR; 2University of Texas at Houston, Houston, TX; 3University of Cincinnati, Cincinnati, OH; 4University of Texas Southwestern, Dallas, TX; 5University of Texas San Antonio, San Antonio, TX; 6 University of Texas at Houston, Houston, TX AMERICAN SURGICAL ASSOCIATION 10:00 AM – 10:25 AM 3 Impact of the Addition of Carboplatin and/or Bevacizumab to Neoadjuvant Paclictaxel Followed by Doxorubicin and Cyclophosphamide on Breast Conservation Rates in Triple-Negative Breast Cancer: Surgical Results from CALGB 40603 (Alliance) Mehra Golshan*1, Constance T. Cirrincione*2, Donald T. Berry*3, William M. Sikov*4, Sara Jasinski*2, Tracy F. Weisberg*5, George Somlo*6, Eric P. Winer*7, Clifford Hudis*8, David W. Ollila9 1 Brigham and Women’s Hospital, Boston, MA; 2Alliance Statistics and Data Center; Duke University, Durham, NC; 3 Alliance Statistics and Data Center, MD Anderson, Houston, TX; 4Women and Infants Hospital, Providence, RI; 5Maine Center for Cancer Medicine, Scarborough, ME; 6City of Hope Medical Center, Los Angeles, CA; 7Dana Farber Cancer Institute, Boston, MA; 8Memorial Sloan-Kettering Cancer Center, New York, NY; 9University of North Carolina, Chapel Hill, NC 10:25 AM – 10:50 AM 4 Changing Paradigms in the Management of 2184 Traumatic Brain Injury Patients Bellal Joseph*, Ansab A. Haider*, Viraj Pandit*, Andrew Tang*, Narong Kulvatunyou*, Terence O’Keeffe*, Peter Rhee The University of Arizona, Tucson, AZ 10:50 AM – 12:00 PM PRESIDENTIAL ADDRESS 10:50 AM – 11:00 AM Introduction of the President John M. Daly, M.D. 11:00 AM – 12:00 PM Address by the President Anna M. Ledgerwood, M.D. *By invitation 33 *By invitation 34 AMERICAN SURGICAL ASSOCIATION 1:30 PM – 5:15 PM SCIENTIFIC SESSION II Marina Ballroom E-G Moderator: James S. Economou, M.D., Ph.D. 1:30 PM – 1:55 PM 5 Factors Inuencing the Decision of Surgery Residency Graduates to Pursue General Surgery Practice or Fellowship Mary E. Klingensmith1, Thomas H. Cogbill2, Fred A. Luchette3, Thomas A. Biester*4, Kelli Samonte*4, Andrew Jones*4, Mark A. Malangoni4 1 Washington University in Saint Louis, Saint Louis, MO; 2 Gundersen Health System, LaCrosse, WI; 3Loyola University Medical Center, Chicago, IL; 4American Board of Surgery, Philadelphia, PA 1:55 PM – 2:20 PM 6 Genome-Wide Association Study of Post-Burn Scarring Identies a Novel Protective Variant Ravi F. Sood*, Anne M. Hocking*, Lara A. Mufey*, Maricar Ga*, Shari Honari*, Alexander P. Reiner*, Nicole S. Gibran UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA 2:20 PM – 2:45 PM 7 Long-Term Outcomes of Helper Peptide Vaccination for Metastatic Melanoma Yinin Hu*, Helen Kim*, Christopher M. Blackwell*, Mark E. Smolkin*, Craig L. Slingluff, Jr. University of Virginia School of Medicine, Charlottesville, VA AMERICAN SURGICAL ASSOCIATION 2:45 PM – 3:10 PM 8 Dening 10 Year Outcomes with Living Donor Liver Transplantation in North America Kim M. Olthoff1, Abby Smith*2, Michael Abecassis3, Talia Baker*3, Carl Berg*4, Charlotte Beil*2, Jean Emond5, Gregory Everson*6, Chris Freise7, Brenda Gillespie*2, Benjamin Samstein*5, Abraham Shaked1 1 University of Pennsylvania, Philadelphia, PA; 2Arbor Research, Ann Arbor, MI; 3Northwestern University, Chicago, IL; 4Duke University, Durham, NC; 5Columbia University, New York, NY; 6University of Colorado, Denver, CO; 7University of California San Francisco, San Francisco, CA 3:10 PM – 3:35 PM 9 Overall Survival and Renal Function of Patients with Bilateral Wilms Tumor Undergoing Surgery at a Single Institution Andrew M. Davidoff1, Rodrigo B. Interiano*1, Lynn Wynn*1, Noel Delos Santos*1, Jeffrey S. Dome*2, Rachel C. Brennan*1, M. Elizabeth McCarville*1, Matthew J. Krasin*1, Kathleen Kieran*3, Mark A. Williams*1 1 St. Jude Children’s Research Hospital, Memphis, TN; 2 Children’s National Medical Center, Washington, DC; 3 University of Iowa Children’s Hospital, Iowa City, IA 3:35 PM – 4:00 PM 10 Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benet for Trauma Patients Mark R. Hemmila*1, Nicholas H. Osborne*1, Peter K. Henke1, John P. Kepros*2, Sujal G. Patel*3, Nancy J. Birkmeyer*1 1 University of Michigan, Ann Arbor, MI; 2Michigan State University, Lansing, MI; 3Covenant Medical Center, Saginaw, MI *By invitation *By invitation 35 36 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 4:00 PM – 4:25 PM FRIDAY, APRIL 24, 2015 11 Autologous Reconstruction and Visceral Transplantation for Gut Failure Following Bariatric Surgery: 20 Years of Experience Kareem M. Abu-Elmagd1, Guilherme Costa*2, Ruy J. Cruz*2, Masato Fujiki*1, Koji Hashimoto*1, Neha Parekh*1, Ajai Khanna*1, Abhinav Humar2, John Fung1 1 Cleveland Clinic, Cleveland, OH; 2University of Pittsburgh Medical Center, Pittsburgh, PA 4:25 PM – 4:50 PM 12 Resection Margin and Survival in 2371 Patients Undergoing Hepatic Resection for Metastatic Colorectal Cancer: Surgical Technique or a Biologic Surrogate? Eran Sadot*, Bas Groot Koerkamp*, Julie Leal*, Jinru Shia*, Mithat Gonen*, Peter J. Allen, Ronald P. DeMatteo, T. Peter Kingham*, William R. Jarnagin, Michael I. D’Angelica Memorial Sloan Kettering Cancer Center, New York, NY 4:50 PM – 5:15 PM 13 Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients with Irreversible Electroporation: Safety and Efcacy Robert C.G. Martin1, David Kwon*2, Sricharan Chalikonda*3, Marty Sellars*4, Eric Kortz*5, Charles R. Scoggins*1, Kevin T. Watkins*6, Kelly M. McMasters1 1 University of Louisville, Louisville, KY; 2Henry Ford Hospital Department of Surgery, Detroit, MI; 3Cleveland Clinic Department of Surgery, Cleveland, OH; 4Piedmont Hospital Department of Surgery, Atlanta, GA; 5Swedish Medical Center Department of Surgery, Denver, CO; 6Cancer Treatment Centers of America, Atlanta, GA *By invitation 37 7:00 AM – 8:00 AM Mission Hills Room ASA WOMEN IN SURGERY BREAKFAST 8:00 AM – 10:30 AM SCIENTIFIC SESSION III Marina Ballroom E-G Moderator:Anna M. Ledgerwood, M.D. 8:00 AM – 8:25 AM 14 Prospective Randomized Double Blinded Trial Comparing Two Anti-mrsa Agents with Supplemental Coverage to Cefazolin Prior to Lower Extremity Revascularization Patrick A. Stone*, Ali Abu Rahma, Stephen Hass*, Albeir Mousa*, Asmita Modak*, Mary Emmett*, James Campbell*, Aravinda Nanjundappa*, Mohit Srivastiva* WVU, Charleston, WV 8:25 AM – 8:50 AM 15 Early Versus Late Hospital Readmission After Major Procedures Among Patients with Employer-Provided Health Insurance Yuhree Kim*, Gaya Spolverato*, Aslam Ejaz*, Joe Canner*, Eric Schneider*, Timothy M. Pawlik Johns Hopkins, Baltimore, MD 8:50 AM – 9:15 AM 16 Fast As a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation Kenji Inaba*, Konstantinos Chouliaras*, Scott Zakaluzny*, Pedro Teixeira*, Emre Sivrikoz*, Crystal Ives*, Galinos Barmparas*, Nikos Koronakis*, Demetrios Demetriades LAC+USC, University of Southern California, Los Angeles, CA *By invitation 38 AMERICAN SURGICAL ASSOCIATION 9:15 AM – 9:40 AM AMERICAN SURGICAL ASSOCIATION 39 10:30 AM – 12:00 PM 17 Tumor Genotype Determines Phenotype and DiseaseRelated Outcomes in Thyroid Cancer: A Study of 1,510 Patients Linwah Yip*, Marina N. Nikiforova*, Jenny Yoo*, Kelly L. McCoy*, Michael T. Stang*, Kristina J. Nicholson*, Michaele J. Armstrong*, Steven P. Hodak*, Robert L. Ferris*, Yuri E. Nikiforov*, Sally E. Carty University of Pittsburgh, Pittsburgh, PA FORUM DISCUSSION Development of Surgical Scientists Moderator: Anna M. Ledgerwood, M.D. “Sources of Funding” Ronald J. Weigel, M.D. University of Iowa, Iowa City, IA “ACS Scholarships Generating Academic Leaders” Gilbert R. Upchurch, Jr., M.D. UVA Health System, Charlottesville, VA 9:40 AM – 10:05 AM “Assuring Productivity: The Role of the Chair” Timothy J. Eberlein, M.D. Washington University School of Medicine, St. Louis, MO 18 Intraoperative Molecular Imaging Provides Rapid and Accurate Diagnosis of Primary Pulmonary Adenocarcinoma Gregory T. Kennedy*1, Olugbenga T. Okusanya*1, Daniel F. Heitjan*1, Charuhas Deshpande*1, Leslie A. Litzky*1, Jane J. Keating*1, Steven M. Albelda*1, Shuming Nie*2, Philip S. Low*3, Jeffrey A. Drebin1, Sunil Singhal*1 1 University of Pennsylvania School of Medicine, Philadelphia, PA; 2 Emory University, Atlanta, GA; 3Purdue University, West Lafayette, IN “My Grant Was Denied: What Now?” Charles E. Lucas, M.D. Wayne State University, Detroit, MI 1:30 PM – 4:00 PM SCIENTIFIC SESSION IV Marina Ballroom E-G Moderator: John M. Daly, M.D. 10:05 AM – 10:30 AM 19 Factors Predicting Outcomes After Total Pancreatectomy and Islet Auto Transplant – Lessons Learned from Over 500 Cases Srinath Chinnakotla*, Gregory Beilman, Ty Dunn*, Melena Bellin*, Martin Freeman*, Mustafa Arain*, Sarah Jane Schwarzenberg*, David Radosevich*, Alfred Clavel*, David Sutherland, Timothy Pruett University of Minnesota, Minneapolis, MN *By invitation 1:30 PM – 1:55 PM 20 The Relationship Between Margin Width and Local Recurrence (LR) of Ductal Carcinoma In Situ (DCIS): 3001 Women Treated with Breast-Conserving Surgery (BCS) Over 30 Years Kimberly J. Van Zee, Preeti D. Subhedar*, Cristina Olcese*, Sujata Patil*, Monica Morrow Memorial Sloan Kettering Cancer Center, New York, NY *By invitation 40 AMERICAN SURGICAL ASSOCIATION 1:55 PM – 2:20 PM AMERICAN SURGICAL ASSOCIATION 3:10 PM – 3:35 PM 21 Sarcoma Resection with and Without Vascular Reconstruction: A Matched Case-Control Study George A. Poultsides*, Thuy B. Tran*, David G. Mohler*, Matthew W. Mell*, Raf S. Avedian*, Brendan C. Visser*, Jason T. Lee*, Kristen Ganjoo*, E. John Harris*, Jeffrey A. Norton Stanford University Medical Center, Stanford, CA 24 Complete Pathologic Response to Pretransplant Locoregional Therapy for Hepatocellular Carcinoma Denes Cancer Cure After Liver Transplantation: Analysis of 501 Consecutively Treated Patients Vatche G. Agopian*, Maud Morshedi*, Michael HarlanderLocke*, Justin McWilliams*, Ali Zarrinpar*, Fady M. Kaldas*, Douglas G. Farmer, Daniela Markovic*, Hasan Yersiz*, Jonathan R. Hiatt, Ronald W. Busuttil UCLA, Los Angeles, C 2:20 PM – 2:45 PM 22 Management of the Parathyroid Glands in Preventative Thyroidectomy for Multiple Endocrine Neoplasia Type 2 Jeffrey F. Moley, Kathryn A. Rowland, Linda Jin*, Amber L. Traugott, Michael A. Skinner*, Samuel A. Wells Washington University School of Medicine, St. Louis, MO 3:35 PM – 4:00 PM 25 Use of a Bundle Checklist Combined with Provider Conrmation Reduced Risk of Nosocomial Complications and Death in Trauma Patients Don Reiff*, Thomas Shoultz*, Russell Grifn*, Benjamin Taylor*, Loring W. Rue, III University of Alabama at Birmingham, Birmingham, AL 2:45 PM – 3:10 PM 23 The Society of Thoracic Surgeons Voluntary Public Reporting Initiative: The First Four Years David Shahian1, Frederick Grover2, Richard Prager3, Fred Edwards*4, Giovanni Filardo*5, Sean O’Brien*6, Xia He*6, Anthony Furnary*7, J. Scott Rankin*8, Vinay Badhwar*9, Joseph Cleveland*2, Franco Fazzalari*3, Mitchell Magee*10, Jane Han*11, Jeffrey Jacobs*12 1 Massachusetts General Hospital, Boston, MA; 2University of Colorado Anschutz School of Medicine, Aurora, CO; 3 University of Michigan, Ann Arbor, MI; 4University of Florida, Jacksonville, FL; 5Baylor Scott & White Health, Dallas, TX; 6 Duke Clinical Research Institute, Durham, NC; 7Starr-Wood Cardiac Group, Portland, OR; 8Vanderbilt University, Nashville, TN; 9University of Pittsburgh, Pittsburgh, PA; 1 0HCA Medical City Dallas Hospital, Dallas, TX; 11Society of Thoracic Surgeons, Chicago, IL; 12Johns Hopkins All Children’s Heart Institute, Saint Petersburg, FL *By invitation 41 4:00 PM – 5:00 PM EXECUTIVE SESSION ASA Fellows Only Presentation of the Flance-Karl Award 7:00 PM ANNUAL RECEPTION Marina Ballroom Foyer 8:00 PM ANNUAL BANQUET Marina Ballroom *By invitation 42 AMERICAN SURGICAL ASSOCIATION SATURDAY, APRIL 25, 2015 8:00 AM – 11:00 AM SCIENTIFIC SESSION V Marina Ballroom E-G Moderator: New President- Elect 8:00 AM – 8:25 AM 26 Collected World Experience of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Aneurysms: The PERICLES Registry Jason T. Lee*1, Konstantinos Donas*2, Mario Lachat*3, Giovanni Torsello*2, Frank J. Veith4 1 Stanford University Medical Center, Stanford, CA; 2Muenster University Hospital, Muenster, Germany; 3University Hospital Zurich, Zurich, Switzerland; 4New York University – Langone Medical Center, New York, NY 8:25 AM – 8:50 AM 27 How Well Does Renal Transplantation Cure Hyperparathyroidism? Irene Lou*, Scott Odorico*, David Foley*, David Schneider*, Rebecca Sippel*, Herbert Chen University of Wisconsin-Madison, Madison, WI 8:50 AM – 9:15 AM 28 A Quarter Century of Organ Protection in Open Thoracoabdominal Repair Anthony L. Estrera*, Harleen K. Sandhu*, Kristofer M. Charlton-Ouw*, Rana O. A*, Ali Azizzadeh*, Charles C. Miller, III*, Hazim J. Sa University of Texas Health Science Center at Houston, Houston, TX *By invitation AMERICAN SURGICAL ASSOCIATION 43 9:15 AM – 9:40 AM 29 Racial Disparity in African American Renal Transplants: Is Alemtuzumab Induction the Great Equalizer? Alison A. Smith*, Mira John*, Isabelle Dortonne*, Anil S. Paramesh*, Mary Killackey*, Rubin Zhang*, Belinda Lee*, Bernard M. Jaffe, Joseph F. Buell* Tulane University, New Orleans, LA 9:40 AM – 10:05 AM 30 Trans-Abdominal Redo Ileal Pouch Surgery for Failed Restorative Proctocolectomy Lessons Learned Over 500 Patients Feza H. Remzi*, Erman Aytac*, Jean Ashburn*, Jinyu Gu*, Tracy L. Hull*, David W. Dietz*, Luca Stocchi*, James M. Church, Bo Shen* Cleveland Clinic, Cleveland, OH 10:05 AM – 10:30 AM 31 Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures Anai N. Kothari*1, Matthew A.C. Zapf*2, Robert Blackwell*3, Victor Chang*2, Zhiyong Mi*1, Gopal N. Gupta*3, Paul C. Kuo1 1 Loyola University Chicago, Department of Surgery, Maywood, IL; 2Stritch School of Medicine, Maywood, IL; 3Loyola University Chicago, Department of Urology, Maywood, IL *By invitation 44 AMERICAN SURGICAL ASSOCIATION 10:30 AM – 10:55 AM 32 A Longitudinal Assessment of Outcomes, Cost, and Healthcare Resource Utilization Following Immediate Breast Reconstruction – Comparing Implant and Autologous Reconstruction John P. Fischer*, Justin P. Fox*, Liza C. Wu*, Suhail K. Kanchwala*, Joshua Fosnot*, Stephen J. Kovach*, Joseph M. Serletti Hospital of the University of Pennsylvania, Philadelphia, PA 11:00 AM ADJOURN AMERICAN SURGICAL ASSOCIATION PROGRAM DETAIL AND ABSTRACTS THURSDAY, APRIL 23, 2015 8:15 AM – 9:10 AM Marina Ballroom E-G OPENING SESSION President’s Opening Remarks Secretary’s Welcome & Introduction of New Fellows Elected In 2014 President’s Introduction of Honorary Fellows Presentation of the Medallion for Scientic Achievement Presentation of the Medallion for the Advancement of Surgical Care Eulogies of Past Presidents Report of the Committee on Arrangements *By invitation 45 46 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION THURSDAY MORNING, APRIL 23rd, CONTINUED On multivariable analysis, MBP with antibiotics, but not without, was independently associated with reduced anastomotic leak (OR = 0.50 (95% CI: 0.35–0.72), p = 0.0002), SSI (OR = 0.41, 95% CI: 0.33–0.51, p < 0.0001) and post-operative ileus (OR = 0.65,95% CI: 0.54–0.79, p < 0.0001). 9:10 AM – 11:00 AM Marina Ballroom E-G Comparing No prep, MBP/ABX– and MBP/ABX+ No-Prep (N = 2403) MBP/ABX– (N = 3700) MBP/ABX+ (N = 2265) p-Value Age (years), median (IQR) 62 (51–73) 62 (52–72) 62 (52–71) 0.6 Sex (male), n (%) 1162 (48.4) 1783 (48.2) 1141 (50.4) 0.2 ASA class, n (%) 2 1140 (47.7) 1858 (50.5) 1270 (56.3) <0.0001 Total operation time (180 min), n (%) 918 (38.2) 1512 (40.9) 929 (41.0) 0.07 Laparoscopic surgery, n (%) 1470 (61.2) 2638 (71.3) 1674 (73.9) <0.0001 SSI (supercial/ deep/organ space) n (%) 344 (14.3) 446 (12.0) 139 (6.1) <0.0001 Anastomotic leak, n (%) 108 (4.5) 132 (3.6) 46 (2.0) <0.0001 Post-operative ileus, n (%) 360 (15.1) 445 (12.1) 206 (9.1) <.0001 30-day mortality, n (%) 36 (1.5) 23 (0.6) 8 (0.4) 0.001 Characteristics SCIENTIFIC SESSION I Moderator: Anna M. Ledgerwood, M.D. 1 Combined Preoperative Mechanical Bowel Preparation with Oral Antibiotics Signicantly Reduces Surgical Site Infection, Anastomotic Leak and Ileus After Colorectal Surgery Ravi P. Kiran*, A.C. Murray*, Cody Chiuzan*, David Estrada*, Kenneth A. Forde New York Presbyterian Hospital, Columbia University, New York, NY OBJECTIVE: To clarify whether bowel preparation use, or its individual components (mechanical bowel preparation (MBP)/oral antibiotics) impact specic outcomes after colorectal surgery. METHODS: 2012 National Surgical Quality Improvement Program targeted-colectomy data capture information on the use/type of bowel preparation and colorectal-specic complications. For patients undergoing elective colorectal resection, the impact of preoperative MBP and antibiotics (MBP/ ABx+), MBP alone (MBP/ABx–) and no bowel preparation (no-prep) on outcomes, particularly anastomotic leak, SSI and ileus was evaluated using multivariable logistic regression analyses. RESULTS: Of 8,368 patients, 2403 (28.7%) had no-prep, 3700 (44.2%) MBP/ABx– and 2265 (27.1%) MBP/ABx+. Baseline characteristics were similar except prior sepsis and steroid-use, both greater in no-prep patients. MBP with or without antibiotics was associated with reduced ileus (MBP/ABx+: OR = 0.57 (95% CI: 0.47–0.68), p < 0.0001; MBP/ABx–: OR = 0.77 (95% CI: 0.67–0.90), p < 0.0001) and SSI (MBP/ABx+: OR = 0.39 (95% CI: 0.32–0.48), p < 0.0001; MBP/ABx–: OR = 0.82 (95% CI: 0.71– 0.96), p = 0.011) versus no-prep. MBP/Abx+ was also associated with lower anastomotic leak than no-prep (OR = 0.44 (95% CI:0.31–0.62), p < 0.0001. *By invitation 47 CONCLUSION: These data clarify the near 50-year debate whether bowel preparation improves outcomes after colorectal resection. MBP with oral antibiotics reduces by nearly half, SSI, anastomotic leak and ileus, the most common and troublesome complications after colorectal surgery. 48 AMERICAN SURGICAL ASSOCIATION 2 Frozen Red Blood Cells Are Safe and Effective: A Prospective Randomized Trial Martin A. Schreiber1, John B. Holcomb2, Bryce Robinson*3, Joseph Minei4, Ronald Stewart5, Laszlo Kiraly*1, Belinda McCully*1, Bryan Cotton*6, Dina Gomaa*3, Michael W. Cripps*4, Mark DeRosa*5, Samantha Underwood*1 1 Oregon Health & Science University, Portland, OR; 2University of Texas at Houston, Houston, TX; 3University of Cincinnati, Cincinnati, OH; 4University of Texas Southwestern, Dallas, TX; 5University of Texas San Antonio, San Antonio, TX; 6 University of Texas at Houston, Houston, TX OBJECTIVES: The utility of standard red blood cells (RBCs) is limited by an abbreviated shelf-life and worsening storage lesion with age. Cryopreserved red blood cells (CRBCs) are frozen 2–6 days after donation, stored up to 10 years and washed prior to use potentially providing a fresh and puried RBC product. We hypothesized that CRBC transfusion would be equivalent to RBC transfusion in stable trauma patients. METHODS: We performed a prospective, randomized, double blind study at 5 level 1 trauma centers. Stable trauma patients requiring transfusion were randomized to young RBCs (14 storage days), old RBCs (>14 storage days) or CRBCs. Tissue oxygenation (StO2), biochemical and inammatory mediators were measured and clinical outcomes were determined. RESULTS: 256 patients were randomized (84 young, 86 old and 86 CPRBCs). The patients were well-matched for injury severity and demographics (p > 0.2). Pre-transfusion and nal hematocrits were similar (p > 0.68). Patients randomized to CRBCs received 2 units compared to 4 in the other groups (p < 0.001). Transfusion of old RBCs resulted in reduced StO2 while transfusion of CRBCs increased it (p < 0.05). CRBCs contained signicantly less 2-macrogobulin, haptoglobin, c-reactive protein, serum amyloid P, and free hemoglobin than the other groups (p < 0.001). IL-2 was elevated in patients who received CRBCs compared to old RBCs (p = 0.04). There was no difference in organ failure, infection rate or mortality between the groups (p > 0.22). CONCLUSIONS: Transfusion of CRBCs is at least as safe and effective as transfusion of young and old RBCs and results in a 50% reduction in transfused units and increased StO2. *By invitation AMERICAN SURGICAL ASSOCIATION 49 3 Impact of the Addition of Carboplatin and/or Bevacizumab to Neoadjuvant Paclictaxel Followed by Doxorubicin and Cyclophosphamide on Breast Conservation Rates in Triple-Negative Breast Cancer: Surgical Results from CALGB 40603 (Alliance) Mehra Golshan*1, Constance T. Cirrincione*2, Donald T. Berry*3, William M. Sikov*4, Sara Jasinski*2, Tracy F. Weisberg*5, George Somlo*6, Eric P. Winer*7, Clifford Hudis*8, David W. Ollila9 1 Brigham and Women’s Hospital, Boston, MA; 2Alliance Statistics and Data Center; Duke University, Durham, NC; 3 Alliance Statistics and Data Center, MD Anderson, Houston, TX; 4Women and Infants Hospital, Providence, RI; 5Maine Center for Cancer Medicine, Scarborough, ME; 6City of Hope Medical Center, Los Angeles, CA; 7Dana Farber Cancer Institute, Boston, MA; 8Memorial Sloan-Kettering Cancer Center, New York, NY; 9University of North Carolina, Chapel Hill, NC OBJECTIVE: Neoadjuvant chemotherapy (NACT) improves breast conserving therapy (BCT) rates, but the magnitude of this benet in different tumor subtypes is unknown. To quantify this effect for triple-negative breast cancer (TNBC), we reviewed surgical outcomes from CALGB (40603), a randomized phase II trial of weekly paclitaxel (P) ± carboplatin (Cb) followed by doxorubicin plus cyclophosphamide (AC), ± bevacizumab (B). METHODS: Patients with stage II-III TNBC were randomized to (1) P- > AC, (2) P + B- > AC + B, (3) P + Cb- > AC, or (4) P + Cb + B- > AC + B. The surgeon assessed BCT candidacy based on clinico-radiographic criteria, before and after NACT, though subsequent surgical management was at surgeon and patient discretion. We recorded (1) the conversion rate from BCT-ineligible to BCS-eligible; (2) the rate of successful BCT. RESULTS: 406 of the 443 treated patients were assessable. Prior to NACT, 230 (57%) were considered BCT candidates and 176 (43%) were not. 190/230 (83%) remained BCT candidates after NACT; of 135 who chose BCT, it was successful in 126 (93%). 88/176 (50%) patients initially considered non-candidates were converted to candidates, of who 55 chose BCT with 49/44 (89%) success rate (Table 1). 278 patients who were BCT candidates post-NACT, 88 (32%) chose mastectomy. *By invitation 50 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 51 4 Changing Paradigms in the Management of 2184 Traumatic Brain Injury Patients Bellal Joseph*, Ansab A. Haider*, Viraj Pandit*, Andrew Tang*, Narong Kulvatunyou*, Terence O’Keeffe*, Peter Rhee The University of Arizona, Tucson, AZ CONCLUSIONS: This is the rst NACT trial to prospectively quantify a 50%-conversion rate from BCT-ineligible to eligible in TNBC. PostNACT: BCT was successful in 92% who chose this approach, however 32% of BCT-eligible patients chose mastectomy. OBJECTIVES: The management of traumatic brain injury (TBI) has been evolving with trends towards management of minimally injured patients with intracranial hemorrhage (ICH) exclusively by trauma surgeons. The aim of this study was to assess safety and use of resources as a result of this change in management. METHODS: A prospective 5-year (2009–2014) database on all TBI (skull fracture/ICH on head CT) patients presenting to a Level I trauma center was analyzed for patient demographics, injuries, admission physiology, CT scan results, and hospital outcomes. These records were matched to the institutional registry and hospital nancial database. RESULTS: A total of 2,184 patients were included with mean age 43.4±26.1 years, median Glasgow Coma Scale (GCS) 13 [9–15], and median head-abbreviated injury scale (h-AIS) 3 [2–3]. The distribution of types and size of intracranial bleeds remained unchanged throughout the study period. The proportion of TBI managed exclusively by trauma surgeons increased signicantly over the years from 6.8% to 40.1%. (p < 0.001). Total number of neurosurgical consultations, head CT scans, hospital length of stay and costs decreased signicantly over time. The overall mortality rate (18.5%) remained unchanged. *By invitation 52 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION THURSDAY MORNING, APRIL 23rd, CONTINUED 11:00 AM – 12:00 PM Marina Ballroom E-G PRESIDENTIAL ADDRESS Introduction of the President John M. Daly, M.D. Figure 1: Demonstrates the trends in outcomes. Address by the President CONCLUSION: TBI can be selectively managed without neurosurgeons safely and in a cost effective manner resulting in more effective use of precious resources. Anna M. Ledgerwood, M.D. 53 54 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION THURSDAY AFTERNOON, APRIL 23rd as reasons to pursue SF. Both groups expressed a high degree of satisfaction with their career choice (GS, 94%; SF, 90%). CONCLUSIONS: Most graduates who pursue GS practice are condent and content. The decision to pursue GS is strongly inuenced by a GS mentor. Lack of condence may be a more signicant factor for choosing SF. These ndings suggest opportunity for improvements in condence and mentorship during residency. 1:30 PM – 5:15 PM Marina Ballroom E-G SCIENTIFIC SESSION II Moderator: James S. Economou, M.D., Ph.D. 5 Factors Inuencing the Decision of Surgery Residency Graduates to Pursue General Surgery Practice or Fellowship Mary E. Klingensmith1, Thomas H. Cogbill2, Fred A. Luchette3, Thomas A. Biester*4, Kelli Samonte*4, Andrew Jones*4, Mark A. Malangoni4 1 Washington University in Saint Louis, Saint Louis, MO; 2 Gundersen Health System, LaCrosse, WI; 3Loyola University Medical Center, Chicago, IL; 4American Board of Surgery, Philadelphia, PA OBJECTIVE: Surgery residency serves two purposes – prepare graduates for general surgery (GS) practice or post-residency surgical fellowship (SF). This study was undertaken to elucidate factors inuencing career choice for these two groups. METHODS: All U.S. allopathic surgery residency graduates 2009– 2013 (n = 5512) were surveyed by the American Board of Surgery regarding condence, autonomy and reasons for career selection between GS and SF. Surveys were distributed by mail in November 2013 with follow up mailings to non-respondents. RESULTS: 3354 graduates (68%) completed the survey; 26% pursued GS and 74% SF. GS expressed greater levels of condence than SF across the common surgical procedures queried. Condence improved with years after completion of residency for GS but not SF. The decision to pursue GS or SF was made during residency by 77% and 74%, respectively. 57% of those who chose GS indicated a GS mentor signicantly inuenced their decision. GS rated procedural variety, opportunity for practice autonomy, choice of practice location, and inuence of a mentor as reasons to pursue GS practice. SF listed control over scope of practice, prestige, salary, and specialty interest *By invitation 55 56 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 57 6 Genome-Wide Association Study of Post-Burn Scarring Identies a Novel Protective Variant Ravi F. Sood*, Anne M. Hocking*, Lara A. Mufey*, Maricar Ga*, Shari Honari*, Alexander P. Reiner*, Nicole S. Gibran UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA OBJECTIVE: Burn injuries and other partial-thickness wounds often lead to hypertrophic scarring (HTS), a debilitating sequela with racial predisposition that suggests a genetic mechanism. We sought to identify singlenucleotide polymorphisms (SNPs) associated with HTS. METHODS: We conducted a genome-wide association study in a prospective cohort of adults admitted with deep-partial-thickness burns. Scar severity was assessed over time using the Vancouver Scar Scale (VSS), and DNA was genotyped with a >500,000-marker array. We performed association testing of SNPs with minor allele frequency (MAF) >0.01 using linear regression of VSS height score on genotype adjusted for patient- and injury characteristics as well as population substructure. Genome-wide signicance was based on Bonferroni correction for multiple testing. RESULTS: Of 538 patients (median age 40 years, median burn size 6.0% body surface area), 71% were male and 76% were white. The mean VSS height score was 1.2 (range: 0-3). Of 289,639 SNPs tested, a variant in the “CUB and Sushi multiple domains 1” (CSMD1) gene (rs11136645; MAF = 0.49), was signicantly associated with decreased scar height (regression coefcient = -0.23, p = 7.9 × 10-8; Figure). *By invitation CONCLUSIONS: We report the rst SNP associated with reduced severity of post-burn HTS. A common intron variant in the CSMD1 gene is associated with decreased scar height, suggesting an anti-brogenic effect. CSMD1 is a known tumor-suppressor implicated in colorectal cancer, underscoring the commonality of morphogenetic responses. 58 AMERICAN SURGICAL ASSOCIATION 7 Long-Term Outcomes of Helper Peptide Vaccination for Metastatic Melanoma Yinin Hu*, Helen Kim*, Christopher M. Blackwell*, Mark E. Smolkin*, Craig L. Slingluff, Jr. University of Virginia School of Medicine, Charlottesville, VA OBJECTIVES: A multipeptide vaccine designed to induce helper T-cells against melanocytic and cancer-testis antigens (6MHP) induces specic Th1-dominant CD4 + T-cell responses and CD8 + T-cell responses through epitope spreading. We hypothesized that survival of patients with stage IV melanoma vaccinated with 6MHP would exceed that of unvaccinated matched controls. METHODS: The 6MHP vaccine was administered to patients with metastatic melanoma on two clinical trials (NCT00089219 and NCT00118274). Circulating CD4 + T-cell responses were measured by proliferation or direct IFN-gamma ELIspot assay. Overall survival of vaccinated patients was compared to unvaccinated controls matched by age, metastatic site, and resection status. Factors associated with survival were identied by multivariable Cox proportional hazards analysis incorporating all variables used for matching. *By invitation AMERICAN SURGICAL ASSOCIATION 59 RESULTS: All 36 vaccinated patients were matched 1:1 by metastatic site, resection, and age within 5 years. Median survival was signicantly longer for vaccinated patients (5.4 vs 0.6 years, p < 0.001, Figure 1), among which 67% (24/36) mounted a specic CD4 + T-cell response. In multivariable analysis, vaccination was the strongest predictor of survival (HR 0.176, p < 0.001). Among vaccinated patients, immune response (HR 0.29, p = 0.021) and resection (HR 0.06, p < 0.001) were signicant predictors of survival. CONCLUSIONS: Helper peptide vaccination is associated with favorable survival among patients with metastatic melanoma. These data support a randomized prospective trial of the 6 MHP vaccine. 60 AMERICAN SURGICAL ASSOCIATION 8 Dening 10 Year Outcomes with Living Donor Liver Transplantation in North America Kim M. Olthoff1, Abby Smith*2, Michael Abecassis3, Talia Baker*3, Carl Berg*4, Charlotte Beil*2, Jean Emond5, Gregory Everson*6, Chris Freise7, Brenda Gillespie*2, Benjamin Samstein*5, Abraham Shaked1 1 University of Pennsylvania, Philadelphia, PA; 2Arbor Research, Ann Arbor, MI; 3Northwestern University, Chicago, IL; 4Duke University, Durham, NC; 5Columbia University, New York, NY; 6University of Colorado, Denver, CO; 7University of California San Francisco, San Francisco, CA OBJECTIVES: Living donor liver transplantation (LDLT) provides an important surgical option for end-stage liver disease. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL), the rst multicenter prospective NIH study for LDLT, compared survival benet between LDLT and deceased donor liver transplant (DDLT) at experienced transplant centers. Post-transplant outcomes up to 10 years were compared and key variables impacting survival identied. METHODS: Outcomes of 1428 liver recipients (964 LDLT) enrolled in A2ALL transplanted between 1/1/1998 and 1/31/2014 at 12 North American centers with median follow-up 4.8 years were analyzed. Kaplan-Meier and multivariable Cox models of time from transplant to death or graft failure were performed. RESULTS: LDLT recipients had higher prevalence of white race, less HCV/HCC, lower mean MELD (15.4 vs 20.4), and fewer were transplanted from ICU, inpatient, on dialysis, ventilated, or with ascites. Post-transplant ICU days were less for LDLT. Patient 10-yr survival was 70% (LDLT) and 66% (DDLT). Unadjusted survival was higher with LDLT (P = 0.05) but attenuated after adjustment (P = 0.69). For all recipients, female gender and PSC were associated with improved survival. Factors associated with worse survival were dialysis, and older recipient/donor age. Era of transplantation and type of donated lobe did not signicantly impact survival. SUMMARY: Both LDLT and DDLT provide outstanding long-term survival. LDLT provides signicant benet resulting in transplantation at a lower MELD score, decreased death on waitlist, and excellent post-transplant outcomes. Recipient diagnosis, renal failure and ages of recipient and donor should be considered in decision-making regarding timing of transplant and donor options. *By invitation AMERICAN SURGICAL ASSOCIATION 61 9 Overall Survival and Renal Function of Patients with Bilateral Wilms Tumor Undergoing Surgery at a Single Institution Andrew M. Davidoff1, Rodrigo B. Interiano*1, Lynn Wynn*1, Noel Delos Santos*1, Jeffrey S. Dome*2, Rachel C. Brennan*1, M. Elizabeth McCarville*1, Matthew J. Krasin*1, Kathleen Kieran*3, Mark A. Williams*1 1 St. Jude Children’s Research Hospital, Memphis, TN; 2 Children’s National Medical Center, Washington, DC; 3 University of Iowa Children’s Hospital, Iowa City, IA OBJECTIVE(S): Approximately 5% of children with Wilms tumor present with bilateral disease, resulting in about 25 cases/year in the United States. The treatment challenge is to achieve a high cure rate while maintaining long-term renal function. We retrospectively reviewed our institutional experience with nephron-sparing surgery (NSS) in patients with bilateral Wilms tumor (BWT) between 2001–2014. METHODS: Imaging studies, surgical approach and pathology reports were reviewed. Outcomes evaluated included surgical complications, tumor recurrence, patient survival and renal function, as assessed by estimated glomerular ltration rate or radionuclide scans. RESULTS: Forty-two patients with BWT were identied; 39 (92.9%) patients underwent bilateral NSS and 3 underwent unilateral nephrectomy with contralateral NSS. One additional patient with a solitary kidney underwent NSS on that kidney. Acute post-operative complications included prolonged urine leak (10), hospital-acquired infection (6), intussusception (1) and transient renal insufciency (1). Five patients required early (within four months) redo NSS for residual tumor. Overall survival was 88.4% (mean follow-up, 3.8 years). Of the 5 patients who died, 4 had disease of anaplastic histology (2 had focal anaplasia at initial resection, 2 had diffuse anaplasia at recurrence). Long-term, seven patients had local tumor recurrence (managed with redo NSS in 6 and completion nephrectomy in 1) and four had an episode of intestinal obstruction. All patients had GFR > 60mL/min/1.73m2 at last follow-up. CONCLUSIONS: In patients with bilateral Wilms tumor, bilateral nephron-sparing surgery is safe and almost always feasible, thereby saving maximal renal parenchyma. With this approach, survival was excellent, as was maintenance of long-term renal function. *By invitation 62 AMERICAN SURGICAL ASSOCIATION 10 Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benet for Trauma Patients Mark R. Hemmila*1, Nicholas H. Osborne*1, Peter K. Henke1, John P. Kepros*2, Sujal G. Patel*3, Nancy J. Birkmeyer*1 1 University of Michigan, Ann Arbor, MI; 2Michigan State University, Lansing, MI; 3Covenant Medical Center, Saginaw, MI OBJECTIVE(S): Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) lter use, mortality, and VTE complications. METHODS: Trauma quality collaborative data (2010-2014) were analyzed. Patients were excluded with no signs-of-life, injury severity score <9, hospitalization <3 days, or who received IVC lter after occurrence of a VTE event. Risk adjusted rates of IVC lter placement were calculated and hospitals placed into quartiles of IVC lter use. Mortality rates by quartile were compared. We determined the association of deep venous thrombosis (DVT) with presence of an IVC lter accounting for type and timing of initiation of chemical VTE prophylaxis in addition to standard trauma patient confounders. *By invitation AMERICAN SURGICAL ASSOCIATION 63 RESULTS: A prophylactic IVC lter was placed in 799 (2%) of 39,114 patents. Hospitals exhibited signicant variability (0.7 to 9.9%) in adjusted rates of IVC lter utilization (Figure-Left). Rates of IVC placement within quartiles were 0.8, 1.4, 2.3, and 4.3% respectively. IVC lter use quartiles showed no variance in mortality (Figure-Right). Adjusting for chemical prophylaxis and patient factors, prophylactic IVC lter placement was associated with an increased incidence of DVT (Odds Ratio = 2.76; 95% CI, 1.96–3.9). CONCLUSIONS: High rates of prophylactic IVC lter placement have no effect on reducing trauma patient mortality and are paradoxically associated with an increase in DVT events. 64 AMERICAN SURGICAL ASSOCIATION 11 Autologous Reconstruction and Visceral Transplantation for Gut Failure Following Bariatric Surgery: 20 Years of Experience Kareem M. Abu-Elmagd1, Guilherme Costa*2, Ruy J. Cruz*2, Masato Fujiki*1, Koji Hashimoto*1, Neha Parekh*1, Ajai Khanna*1, Abhinav Humar2, John Fung1 1 Cleveland Clinic, Cleveland, OH; 2University of Pittsburgh Medical Center, Pittsburgh, PA OBJECTIVE(S): Bariatric surgery is currently the only long-lasting treatment for morbid obesity. However, these weight loss procedures could result in development of gut failure (GF) with need for total parenteral nutrition (TPN). This retrospective study is the rst to address the anatomic and functional spectrum of bariatric surgery-associated GF with innovative surgical modalities to restore gut functions. METHODS: Over a 20-year period, 1,200 patients were referred with GF. Of these, 110 (9%) had prior bariatric surgery; 97 (88.3%) gastricbypass, 5 (4.5%) sleeve gastrectomy, 4 (3.6%) gastric banding and 4 (3.6%) jejunoileal-bypass. Causes of gut failure were major surgical complications (65%), dysmotility (25%), and malabsorption (10%). Catastrophic events included technical failure with gastric/enteric stulae, internal herniation, and vascular thrombosis due to hypercoagulability. TPN duration ranged from 4 to 250 months. All patients were adults with 85% females. Multidisciplinary comprehensive medical and surgical rehabilitation was applied. RESULTS: Foregut reconstruction was performed in all patients with gastrogastric (77%), gastroesophageal (13%), jejunoesophageal (7%), and colonic interposition (3%) anastomoses. Midgut reconstruction was required in 76% of patients. Bowel lengthening was performed in 16%. Visceral transplantation was utilized as a rescue therapy in 22 (16%) patients with intestine alone in 16 (73%) and composite visceral allograft in 6 (27%). With mean follow-up of 52 + 34 months, 98% of surgically reconstructed patients and 73% of transplanted recipients were alive with achievement of full nutritional autonomy in 89%. CONCLUSIONS: Gut failure is a potential complication of bariatric surgery due to a technically awed operation and loss of gut homeostasis. Successful outcome can be achieved with major restorative surgical procedures including visceral transplantation as a rescue therapy. *By invitation AMERICAN SURGICAL ASSOCIATION 65 12 Resection Margin and Survival in 2371 Patients Undergoing Hepatic Resection for Metastatic Colorectal Cancer: Surgical Technique or a Biologic Surrogate? Eran Sadot*, Bas Groot Koerkamp*, Julie Leal*, Jinru Shia*, Mithat Gonen*, Peter J. Allen, Ronald P. DeMatteo, T. Peter Kingham*, William R. Jarnagin, Michael I. D’Angelica Memorial Sloan Kettering Cancer Center, New York, NY OBJECTIVE(S): The impact of margin width on overall survival (OS) in the context of other prognostic factors after resection for colorectal liver metastases (CRLM) is unclear. We evaluated the relationship between resection margin and OS utilizing high-resolution distance measurements. METHODS: A single-institution prospectively collected database was queried for all patients who underwent an initial complete resection of CRLM between 1991–2012. R1 resection was dened as tumor cells at the resection margin (0 mm). R0 resection was further divided into 3 groups: 0.1–0.9 mm, 1–9 mm, 10 mm. Multivariate analysis used stepwise Cox regression. RESULTS: 2371 patients were included. Half of the patients presented with synchronous disease, 43% had solitary metastasis, and the median size was 3.4cm. With a median follow-up for survivors of 55 months, the median OS of the R1, 0.1–0.9 mm, 1–9 mm, and 10 mm groups were 32, 40, 53, and 56 months, respectively. Predictors of OS are described in Table 1, which demonstrates that even submillimeter margins correlate with improved OS compared to R1 resection (p = 0.02). The association between the margin and OS remained signicant regardless of chemotherapy and clinicopathologic prognostic factors. CONCLUSIONS: Resection margin width is an independent predictor of OS. The improved outcome observed with margin width up to submillimeter clearance is likely a microscopic surrogate of an undened biologic confounder rather than the result of surgical technique. *By invitation 66 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 67 13 Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients with Irreversible Electroporation: Safety and Efcacy Robert C.G. Martin1, David Kwon*2, Sricharan Chalikonda*3, Marty Sellars*4, Eric Kortz*5, Charles R. Scoggins*1, Kevin T. Watkins*6, Kelly M. McMasters1 1 University of Louisville, Louisville, KY; 2Henry Ford Hospital Department of Surgery, Detroit, MI; 3Cleveland Clinic Department of Surgery, Cleveland, OH; 4Piedmont Hospital Department of Surgery, Atlanta, GA; 5Swedish Medical Center Department of Surgery, Denver, CO; 6Cancer Treatment Centers of America, Atlanta, GA OBJECTIVES: Ablative therapies have been increasingly utilized in treatment of locally advanced pancreatic cancer (LAPC). Irreversible Electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible cell membrane destruction of cells. We aimed to demonstrate efcacy of treatment with IRE as part of multimodal treatment of LAPC. METHODS: From July 2010 to October 2014, patients with radiographic stage III LAPC were treated with IRE and monitored under a multicenter, prospective IRB-approved registry. Perioperative 90-day outcomes, local failure, and overall survival were recorded and compared to standard of care data for stage III LAPC. RESULTS: 200 patients with LAPC underwent IRE of tumor (In-Situ, n = 150) or IRE with pancreatic ±arterial resection (Margin, n = 50). All patients underwent induction chemotherapy, with an additional 52% receiving chemo-radiation, for a median of 7 months (range, 5–13) prior to IRE (Figure). IRE was successfully administered to all patients. 19% sustained complications with a median grade of 2 (range, 1–3). Median length of stay was 6 days (range, 4–58). With a median follow up of 25 months, 6 (3%) had local recurrence. Median overall survival (OS) in both groups was 23.5 months (Figure). *By invitation 68 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 69 FRIDAY MORNING, APRIL 24th 7:00 AM – 8:00 AM Mission Hills Room ASA WOMEN IN SURGERY BREAKFAST 8:00 AM – 10:30 AM Marina Ballroom E-G CONCLUSION: In stage II LAPC, the addition of IRE with established chemotherapy and/or radiation therapy can provide a signicant survival advantage. These early outcome metrics and overall survival begin to establish the minimal standards in which to establish future comparative studies. SCIENTIFIC SESSION III Moderator: Anna M. Ledgerwood, M.D. 14 Prospective Randomized Double Blinded Trial Comparing Two Anti-mrsa Agents with Supplemental Coverage to Cefazolin Prior to Lower Extremity Revascularization Patrick A. Stone*, Ali Abu Rahma, Stephen Hass*, Albeir Mousa*, Asmita Modak*, Mary Emmett*, James Campbell*, Aravinda Nanjundappa*, Mohit Srivastiva* WVU, Charleston, WV Current antibiotic prophylaxis for vascular procedures includes a rst generation cephalosporin No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a signicant reduction in gram + or MRSA infections?. METHODS: Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2010-2014. 178 patients evaluable at 90 days for surgical site infection. Infections were categorized as early infections <90 days of the index procedure and late after 90 days. *By invitation 70 AMERICAN SURGICAL ASSOCIATION RESULTS: Early vascular Surgical site infection occurred in 6 (7.06%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm. (p = .27). Gram positive related infections and MRSA infections occurred in 0%/0% of Vancomycin patients and 2 (2.15%)/7 (7.53%) of Daptomycin patients respectively (p < 0.01 & p = 0.49). Readmissions related to surgical site infections occurred in 4 (4.71%) in the Vancomycin group and 11 (11.8%) in the Daptomycin group (p = 0.083). Patients undergoing operative exploration occurred in 4 (4.71%) in the Vancomycin group and 10 (10.75%) of the Daptomycin group (p = .128). Late infections occurred in 2 patients in both arms. Median hospital charges related to readmissions related to surgical site infections were in the Vancomycin supplemented and Daptomycin supplemented patients was 45,450 dollars and 51,182 dollars respectively. (p = 0.79) CONCLUSION: Vancomycin supplemental prophylaxis appears to reduce the incidence of gram positive infection compared to adding supplemental Daptomycin prophylaxis. The Incidence of MRSA related surgical site infection is low with the addition of either anti-MRSA agents compared to historical incidence of MRSA related infection. AMERICAN SURGICAL ASSOCIATION 71 15 Early Versus Late Hospital Readmission After Major Procedures Among Patients with Employer-Provided Health Insurance Yuhree Kim*, Gaya Spolverato*, Aslam Ejaz*, Joe Canner*, Eric Schneider*, Timothy M. Pawlik Johns Hopkins, Baltimore, MD INTRODUCTION: Most studies report only data on readmission within 30-days of discharge from the same hospital. These data may underestimate readmission, as patients may be readmitted beyond 30-days and/ or at other hospitals. We sought to dene the incidence of early versus late hospital readmission among surgical patients. METHODS: Patients discharged after ten major surgical procedures (CABG, AAA, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, lobectomy, hepatectomy, colectomy, and cystectomy) between 2010–2012 were identied from a large employer-sponsored health plan. RESULTS: 228,144 patients were identied; mean patient age was 52.6 years, 58.2% were male, and 40.7% had Charlson Comorbidity Index of 2. Median (IQR) length-of-stay was 5 (3, 8) days. Among the 73,498 (32.2%) patients who experienced readmission, 27,523 (37.5%) had a readmission within 30-days while 16,208 (22.1%) were readmitted within 31–90 days. In-hospital mortality was higher among patients re-admitted early (2.7% vs. 1.9%, P < 0.001). Among patients readmitted, 45.7% were re-admitted to a different hospital than where the index procedures had been performed. Both early (index hospital:63.0% vs. non-index hospital:37.0%) and late (index hospital:60.0% vs. non-index hospital:40.0%) readmissions were more likely to occur at the index hospital (P = 0.007). In-hospital mortality at index vs. non-index hospitals either among patients with early readmission (index hospital: 3.0% vs. non-index hospital: 2.7%) or late readmission (index hospital:1.3% vs. non-index hospital:2.2%) was comparable (both P > 0.05). CONCLUSIONS: Most readmissions occurred beyond 30-days, with approximately half of them occurring at non-index hospitals after major surgical procedures. Assessment of only 30-day same hospital readmissions underestimates the true incidence of re-hospitalization. *By invitation 72 AMERICAN SURGICAL ASSOCIATION 16 Fast As a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation Kenji Inaba*, Konstantinos Chouliaras*, Scott Zakaluzny*, Pedro Teixeira*, Emre Sivrikoz*, Crystal Ives*, Galinos Barmparas*, Nikos Koronakis*, Demetrios Demetriades LAC+USC, University of Southern California, Los Angeles, CA OBJECTIVE(S): Resuscitative thoracotomy (RT) is a high-risk, lowsalvage procedure performed in arresting trauma patients. The indications for performing this emergent procedure are poorly dened and are based on low quality primarily retrospective data. The purpose of this study was to examine the ability of FAST to discriminate between survivors and non-survivors undergoing RT after traumatic arrest. METHODS: All patients undergoing RT from 10/2010–05/2014 were prospectively enrolled. A bedside parasternal/subxiphoid cardiac ultrasound was performed prior to or concurrent with RT. The FAST was captured as equivocal or adequate with the presence/absence of pericardial uid and/or wall motion. A sensitivity analysis utilizing the primary outcome measure of survival to discharge or organ donation was performed. RESULTS: Overall, 187 patients arrived in traumatic arrest and underwent FAST. Mean age 35.0 (1–84), 84.5% male, 51.3% penetrating. Loss of vitals occurred in the eld in 48.1%, en-route in 24.6% and in the ED in 27.3%. 77.5% underwent emergent left thoracotomy and 22.5% a clamshell. Sustained cardiac activity was regained in 49.7% however overall survival was only 3.2% with 1.6% proceeding to organ donation. FAST was equivocal in 3.7%, 28.9% demonstrated wall motion and 9.1% pericardial uid. FAST was 100% sensitive and 62% specic for the identication of survivors and potential donors. CONCLUSIONS: With 100% sensitivity for the detection of survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of resuscitative thoracotomy from potential survivors. Prospective multicenter validation is warranted. *By invitation AMERICAN SURGICAL ASSOCIATION 73 17 Tumor Genotype Determines Phenotype and Disease-Related Outcomes in Thyroid Cancer: A Study of 1,510 Patients Linwah Yip*, Marina N. Nikiforova*, Jenny Yoo*, Kelly L. McCoy*, Michael T. Stang*, Kristina J. Nicholson*, Michaele J. Armstrong*, Steven P. Hodak*, Robert L. Ferris*, Yuri E. Nikiforov*, Sally E. Carty University of Pittsburgh, Pittsburgh, PA OBJECTIVE(S): The prognostic signicance of molecular signature in thyroid cancer (TC) is undened but is expected to markedly change surgical management. Our aim is to correlate TC genotype to histology and outcomes. METHODS: We reviewed a consecutive series of 1,510 patients who had initial thyroidectomy for TC from 2/07–6/13 with routine testing for BRAF, RAS, RET/PTC, and PAX8/PPARg genetic alterations. Histologic metastatic or recurrent TC was tracked 6 months after oncologic thyroidectomy. RESULTS: Papillary thyroid cancer (PTC) was diagnosed in 97%, and poorly-differentiated/anaplastic TC in 0.9%. Genetic alterations were detected in 1,039 (70%); the most common mutations were BRAFV600E (644/1039, 62%) and RAS isoforms (323/1039, 31%). BRAFV600E-positive PTC was often conventional or tall-cell variant (58%), with frequent extrathyroidal extension (ETE, 51%) and lymph node metastasis (LNM, 46%). Conversely, RAS-positive PTC was commonly follicular-variant (87%), with infrequent ETE (4.6%) and LNM (5.6%). BRAFV600E- and RET/PTC-positive PTCs were histologically similar. Analogously, RAS- and PAX8/PPARg-positive PTCs were histologically similar. Compared to RASor PAX8/PPARg-positive TC, the TC expressing BRAFV600E or RET/PTC were more often associated with TNM stage III/IV at presentation (40% v. 15%, p < .001) and early recurrence (10% v. 0.7%, p < .001; mean followup 33±21months). Distant metastasis was highest in patients with RET/PTCpositive TC (10.8%, p = .02). CONCLUSIONS: In this unique, large study of prospective mutation testing in unselected patients with thyroid cancer, molecular signature predicted distinctive tumor phenotypes including TC with higher risks of both distant metastasis and early recurrence. Preoperative genotype provides valuable prognostic data to appropriately inform surgical care. *By invitation 74 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 75 18 Intraoperative Molecular Imaging Provides Rapid and Accurate Diagnosis of Primary Pulmonary Adenocarcinoma Gregory T. Kennedy*1, Olugbenga T. Okusanya*1, Daniel F. Heitjan*1, Charuhas Deshpande*1, Leslie A. Litzky*1, Jane J. Keating*1, Steven M. Albelda*1, Shuming Nie*2, Philip S. Low*3, Jeffrey A. Drebin1, Sunil Singhal*1 1 University of Pennsylvania School of Medicine, Philadelphia, PA; 2 Emory University, Atlanta, GA; 3Purdue University, West Lafayette, IN OBJECTIVE: To compare molecular imaging to frozen section analysis for intraoperative diagnosis of solitary pulmonary nodules (SPNs). BACKGROUND: Intraoperative frozen section analysis of indeterminate SPNs guides the extent of pulmonary resection. Frozen sectioning is time consuming and susceptible to error, and alternative diagnostic modalities have been unsuccessfully pursued for decades. We report a novel molecular imaging technology that rapidly and accurately diagnoses primary pulmonary adenocarcinomas, which are the most common SPNs. METHODS: Thirty consecutive patients with an indeterminate SPN were preoperatively administered a contrast agent specic for primary pulmonary adenocarcinomas. During surgery, SPNs were removed and molecular imaging was used to identify primary adenocarcinomas. Frozen section analysis was performed, and immunohistochemical diagnosis served as the gold standard to compare the diagnostic techniques. RESULTS: Molecular imaging identied 19 of 19 primary adenocarcinomas and correctly predicted those patients that should undergo a lobectomy. There were no false positive diagnoses despite two metastatic adenocarcinomas. Frozen section identied 13 (68%) primary adenocarcinomas, and a false negative diagnosis incorrectly altered the management in one patient. Molecular imaging required 2.4 minutes compared to 26.5 minutes for frozen section (p < 0.001). *By invitation CONCLUSIONS: This proof-of-principle study demonstrates that molecular imaging has superior positive predictive value for primary adenocarcinomas and is signicantly faster than frozen section. Targeted contrast agents can be developed for other tumors, and this technology can be broadly applied in surgical oncology. 76 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 77 19 Factors Predicting Outcomes After Total Pancreatectomy and Islet Auto Transplant – Lessons Learned from Over 500 Cases Srinath Chinnakotla*, Gregory Beilman, Ty Dunn*, Melena Bellin*, Martin Freeman*, Mustafa Arain*, Sarah Jane Schwarzenberg*, David Radosevich*, Alfred Clavel*, David Sutherland, Timothy Pruett University of Minnesota, Minneapolis, MN OBJECTIVE(S): Total-Pancreatectomy and islet-cell-auto transplantation (TP/IAT) is being increasingly utilized for the management of chronicpancreatitis (CP). However, the outcome predictors of this operation remain unclear. METHODS: 581 patients (including 91 children) undergoing TP/ IAT for the treatment of CP at a single-center were analyzed. End points included persistent “Pancreatic pain” similar to pre-surgery, narcotic use for any reason and insulin dependence (multiple daily doses/C peptide negative) at 1 year follow up. Forward and backward step-wise regression models were used to create the 3 best tting multivariate-logistic-regression models. Potential risk factors included: patient characteristics, surgery related factors (e.g., pancreas brosis and islet yield) and previous surgeries and procedures. RESULTS: Patients had a mean ± SD 6.94 ± 6.6 years duration of pancreatitis and 3 ± 2.6 years of narcotic use prior to TP-IAT. Pediatric patients (OR 0.3,LCL 0.88, UCL 0.58,p = 0.001) performed better in all three outcomes. Among the adults, for persistent “pancreatic-pain” at 1 year, increasing body mass, familial etiology, pancreas divisum, prior Whipple, and ERCP/>3 stents were independent risk factors. Previous ERCP/>3 stents were associated with increase in narcotic use. Prior Puestow/distal pancreatecotmy were associated with lower narcotic use. With adjustment for islet yield, an alcohol etiology and previous Puestow were independent risk factors for insulin dependence (all stats listed in Figure1). *By invitation CONCLUSIONS: This represents the largest series examining risk factors, outcomes after TP/IAT. The identied patient groups warrant further attention prior to TP-IAT. 78 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION FRIDAY MORNING, APRIL 24th, CONTINUED FRIDAY AFTERNOON, APRIL 24th 10:30 AM – 12:00 PM Marina Ballroom E-G 1:30 PM – 4:00 PM Marina Ballroom E-G FORUM DISCUSSION SCIENTIFIC SESSION IV 79 Moderator: John M. Daly, M.D. Development of Surgical Scientists Moderator: Anna M. Ledgerwood, M.D. “Sources of Funding” Ronald J. Weigel, M.D. University of Iowa, Iowa City, IA “ACS Scholarships Generating Academic Leaders” Gilbert R. Upchurch, Jr., M.D. UVA Health System, Charlottesville, VA “Assuring Productivity: The Role of the Chair” Timothy J. Eberlein, M.D. Washington University School of Medicine, St. Louis, MO “My Grant Was Denied: What Now?” Charles E. Lucas, M.D. Wayne State University, Detroit, MI 20 The Relationship Between Margin Width and Local Recurrence (LR) of Ductal Carcinoma In Situ (DCIS): 3001 Women Treated with Breast-Conserving Surgery (BCS) Over 30 Years Kimberly J. Van Zee, Preeti D. Subhedar*, Cristina Olcese*, Sujata Patil*, Monica Morrow Memorial Sloan Kettering Cancer Center, New York, NY OBJECTIVE: While DCIS has minimal mortality, LR rates after BCS remain signicant, and half of LR are invasive. Positive margins are associated with increased risk of LR, but there is no consensus regarding optimal margin width. Our goal was to investigate the relationship between margin width and LR in a large population of women with long follow-up. METHODS: We retrospectively reviewed a prospective database of DCIS patients undergoing BCS from 1978–2010. Cox proportional hazard models were used to investigate the association between margin width and LR. RESULTS: 3001 women were identied; 2713 had complete data. 324 recurred. Median follow-up for women without LR was 74 mo (range 0-30 years); 680 were followed for 10 yrs. Controlling for age (p < 0.001), family history (p = 0.02), clinical vs. radiologic presentation (p = 0.02), number of excisions (p = 0.006), radiotherapy (RT) (p < 0.0001), endocrine therapy (p < 0.0001), and year of surgery (p = 0.002), margin width was signicantly associated with LR (p = 0.0004) in the entire population. Larger negative margins were associated with lower hazard ratio (HR) compared to positive margins (Table). An interaction between RT and margin width was signicant (p < 0.02); the association of LR with margin width was signicant in those without RT (p < 0.0001)(Table), but not in those with RT (p = 0.9). *By invitation 80 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION Relationship of Margin Width and LR in Cox Proportional Hazards Models Controlling for Other Factors Population in Model Margin Width Hazard Ratio P Entire population (N = 2713) Positive 1 0.0004 2 mm 0.81 No radiotherapy population (N = 1229) 2–10 mm 0.73 >10 mm 0.46 Positive 1 < = 2 mm 0.76 >2–10 mm 0.59 >10 mm 0.31 <0.0001 CONCLUSIONS: In women not receiving RT, margin width was signicantly associated with LR, with wider margins resulting in a signicantly lower rate of LR. Obtaining wider negative margins may be important in reducing the risk of LR in women who choose not to undergo RT. 81 21 Sarcoma Resection with and Without Vascular Reconstruction: A Matched Case-Control Study George A. Poultsides*, Thuy B. Tran*, David G. Mohler*, Matthew W. Mell*, Raf S. Avedian*, Brendan C. Visser*, Jason T. Lee*, Kristen Ganjoo*, E. John Harris*, Jeffrey A. Norton Stanford University Medical Center, Stanford, CA OBJECTIVE: En bloc resection and reconstruction of involved major vessels is being increasingly performed during sarcoma surgery, however the outcomes of this strategy are not well described. METHODS: Patients undergoing sarcoma resection with (VASC) and without (NO-VASC) vascular reconstruction were 1:2 matched on site, histology, grade, size, synchronous metastasis, and primary (vs. repeat) resection. R2 resections were excluded. Endpoints included perioperative morbidity, mortality, recurrence, and survival. RESULTS: From 2000 to 2014, 53 sarcoma patients underwent VASC resection. These were matched with 106 NO-VASC patients having similar clinicopathologic characteristics (Table). Perioperative complications (74% vs. 43%, P < 0.001), grade 3/4 complications (36% vs. 19%, P = 0.02), transfusion (68% vs. 34%, P < 0.001), and reoperation (26% vs. 10%, P = 0.018) were all more common in the VASC group. Thirty-day (2% vs. 0%, P = 0.33) or 90-day mortality (6% vs. 2%, P = 0.19) were not signicantly higher. Local recurrence (25% vs. 36%, P = 0.19) and survival after resection (5-year, 58% vs. 51%, P = 0.56) were similar between the two groups. Within the VASC group, survival after venous only (n = 18), arterial and venous (n = 19), or arterial only (n = 16) reconstruction was comparable (5-year, 72%, 61%, 51%, P = 0.33). CONCLUSIONS: This is the rst matched case-control study examining the impact of concomitant vascular reconstruction on sarcoma resection outcomes. These operations are associated with considerable morbidity and require meticulous multidisciplinary planning. However, the oncologic outcome appears equivalent to cases without vascular involvement. *By invitation 82 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION VASC* Cases (n = 53) NO-VASC Controls (n = 106) P Age (yrs) 57 57 0.69 Female Gender 55% 54% 0.91 Resection Type 1 Synchronous Metastasis Site Retroperitoneum 51% 51% Extremity 36% 36% Trunk 7% 7% Mediastinum 6% 6% 10.1 10.1 Tumor Size (cm) VASC* Cases (n = 53) Grade 0.93 NO-VASC Controls (n = 106) 83 P Primary 81% 81% Repeat (for Recurrence) 19% 19% 1 23% 21% 0.78 28% 28% 0.83 Low Intermediate 21% 17% High 51% 55% 26% 28% Leiomyosarcoma 26% 26% R1 Margin Dediff Liposarcoma 13% 13% UPS, Undifferentiated Pleomorphic Sarcoma; ESS, Endometrial Stromal Sarcoma; PNST, Peripheral Nerve Sheath Tumor UPS 9% 9% Synovial Sarcoma 9% 9% Desmoid 9% 9% Angiosarcoma 8% 8% Myxoid Liposarcoma 6% 6% Well-diff Liposarcoma 4% 4% Osteosarcoma 4% 4% Fibromyxoid Sarcoma 4% 4% Carcinosarcoma 2% 2% ESS 2% 2% Chondrosarcoma 2% 2% PNST 2% 2% Histologic Type 0.61 * Overall, 72 vessels were reconstructed in 53 patients: aorta (n = 6), vena cava (n = 16), iliac artery (n = 5), iliac vein (n = 5), lower extremity artery (n = 17), lower extremity vein (n = 13), upper extremity artery (n = 4), upper extremity vein (n = 2), pulmonary artery (n = 2), superior mesenteric artery (n = 1), and portal vein (n = 1). 1 84 AMERICAN SURGICAL ASSOCIATION 22 Management of the Parathyroid Glands in Preventative Thyroidectomy for Multiple Endocrine Neoplasia Type 2 Jeffrey F. Moley, Kathryn A. Rowland, Linda Jin*, Amber L. Traugott, Michael A. Skinner*, Samuel A. Wells Washington University School of Medicine, St. Louis, MO OBJECTIVES: Multiple endocrine neoplasia type 2 is characterized by a near 100% risk of medullary thyroid carcinoma (MTC). Genetic testing identies gene carriers in affected families and allows performance of preventative thyroidectomy. Management of the parathyroids in these operations is controversial, with some experts advocating total parathyroidectomy with autotransplantation, and others leaving the parathyroids in situ. METHODS: Between 1993 and 2003 we performed 50 preventative thyroidectomies. All patients had central neck dissection (CND), total parathyroidectomy and autotransplantation to the non-dominant forearm, regardless of preoperative calcitonin level (Group A). Between 2003 and the present, the lead author performed 95 preventative thyroidectomies, leaving the parathyroids in situ with an intact vascular pedicle (group B). Individual parathyroids were autotransplanted only if they appeared non-viable. CND was done only if calcitonin was greater than 40pg/ml. RESULTS: Permanent hypoparathyroidism occurred in 3/50 patients in group A, vs 1/95 in group B (p = 0.1184). There were no permanent recurrent laryngeal nerve injuries in either group. No patient developed subsequent hyperparathyroidism. Recurrence/persistence of MTC requiring re-operation occurred in 2 patients in group A, and in 1 patient in group B (though followup is longer in group A, and several group B patients currently have elevated calcitonin). No patients have died. CONCLUSIONS: Routine total parathyroidectomy with autotransplantation and CND during preventative thyroidectomy has excellent longterm results. Preservation of the parathyroids in situ during preventative thyroidectomy, and selective central neck dissection based upon calcitonin level in MEN 2 gene carriers is an effective and safe alternative. *By invitation AMERICAN SURGICAL ASSOCIATION 85 23 The Society of Thoracic Surgeons Voluntary Public Reporting Initiative: The First Four Years David Shahian1, Frederick Grover2, Richard Prager3, Fred Edwards*4, Giovanni Filardo*5, Sean O’Brien*6, Xia He*6, Anthony Furnary*7, J. Scott Rankin*8, Vinay Badhwar*9, Joseph Cleveland*2, Franco Fazzalari*3, Mitchell Magee*10, Jane Han*11, Jeffrey Jacobs*12 1 Massachusetts General Hospital, Boston, MA; 2University of Colorado Anschutz School of Medicine, Aurora, CO; 3 University of Michigan, Ann Arbor, MI; 4University of Florida, Jacksonville, FL; 5Baylor Scott & White Health, Dallas, TX; 6 Duke Clinical Research Institute, Durham, NC; 7Starr-Wood Cardiac Group, Portland, OR; 8Vanderbilt University, Nashville, TN; 9University of Pittsburgh, Pittsburgh, PA; 1 0HCA Medical City Dallas Hospital, Dallas, TX; 11Society of Thoracic Surgeons, Chicago, IL; 12Johns Hopkins All Children’s Heart Institute, Saint Petersburg, FL OBJECTIVE: We report initial ndings of a voluntary national public reporting program using Society of Thoracic Surgeons (STS) clinical data and quality metrics for index procedures. METHODS: In 9 consecutive semi-annual STS performance rating periods (2010–2014), we studied public reporting participation rates as well as the distributions of risk-adjusted mortality rates, composite performance scores (risk-adjusted morbidity and mortality for each cardiac operation, plus two process measures for CABG), star ratings, and volumes for reporting versus non-reporting sites. RESULTS: Among 8,929 unique STS Database participant rating opportunities (generally hospital/program level), sites were classied as low performing in 916 (10.3%) instances, average in 6,801 (76.2%), and high performing in 1,212 (13.6%). Overall public reporting participation rates ranged from 23.8% in 2010 to 41.8% in October 2014. Risk-adjusted mortality rates for isolated CABG were consistently lower in public reporting sites than in non-reporting sites (e.g., 2.1% versus 2.4%, P = 0.03, in the rst rating period of 2014). Composite performance scores and star ratings were also superior in the former (4.5% low performing and 23.2% high performing, versus 13.8% low performing and 7.6% high performing, respectively). STS public reporting sites had higher mean annualized CABG volumes than non-reporting sites (169 versus 145, p < 0.0001), and high performing programs had higher mean CABG volumes (n = 241) than average (n = 139) or low performing (n = 153) sites. *By invitation 86 AMERICAN SURGICAL ASSOCIATION CONCLUSIONS: Participation in the STS voluntary public reporting program has nearly doubled over 4 years. Reporting programs have signicantly higher volumes and performance. AMERICAN SURGICAL ASSOCIATION 87 24 Complete Pathologic Response to Pretransplant Locoregional Therapy for Hepatocellular Carcinoma Denes Cancer Cure After Liver Transplantation: Analysis of 501 Consecutively Treated Patients Vatche G. Agopian*, Maud Morshedi*, Michael HarlanderLocke*, Justin McWilliams*, Ali Zarrinpar*, Fady M. Kaldas*, Douglas G. Farmer, Daniela Markovic*, Hasan Yersiz*, Jonathan R. Hiatt, Ronald W. Busuttil UCLA, Los Angeles, CA OBJECTIVE: Patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT) have variable risks of tumor progression, waitlist dropout, and post-transplant recurrence. Pretransplant locoregional therapies (LRT; percutaneous ablations, transarterial embolizations) mitigate these risks by inducing tumor necrosis. We evaluated the rate of complete pathological response (cPR) in patients undergoing LRT, the effect of LRT on post-LT HCC recurrence and survival, and factors associated with cPR. METHODS: Comparisons were made among HCC recipients with and without cPR who received pre-LT LRT from 1994 to 2013. Multivariate logistic regression identied predictors of achieving cPR. RESULTS: Of 501 patients, 272, 148, and 81 received 1, 2, and 3 or more LRT. Post-LT HCC recurrence developed in 57 of 375 patients (15.2%) without cPR compared to 3 of 126 patients (2.4%) with cPR (P < 0.001). Recipients with cPR had signicantly superior 1-, 3-, and 5-year disease-specic and recurrence-free survival, and only 1 disease-specic death (Figure). Multivariate predictors accurately identied recipients with cPR (c-statistic 0.75, Table). CONCLUSIONS: Achieving cPR in HCC patients receiving LRT strongly predicts tumor free survival with a negligible risk of HCC recurrence. We identify important factors predicting cPR, allowing for differential prioritization of HCC recipients based on their variable risks of post-LT recurrence. *By invitation 88 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION 89 Multivariate Predictors of cPR after LRT for HCC Odds Ratio 95% CI P-Value — No recurrent/residual tumor 1.00 ref ref — Possible recurrent/residual tumor 0.45 0.26–0.78 0.004 — Denite recurrent/residual tumor 0.23 0.11–0.45 < 0.001 Post LRT AFP prior to LT = Max pre-LT AFP 0.23 0.06–0.84 0.027 Radiologic Assessment prior to LT Lab MELD, per SD decrease 1.35 1.04–1.75 0.024 Radiological max tumor diameter, per log SD decrease 1.25 0.98–1.59 0.074 Time from last LRT to LT (days), per SD increase 1.24 1.11–1.39 < 0.001 90 AMERICAN SURGICAL ASSOCIATION 25 Use of a Bundle Checklist Combined with Provider Conrmation Reduced Risk of Nosocomial Complications and Death in Trauma Patients Don Reiff*, Thomas Shoultz*, Russell Grifn*, Benjamin Taylor*, Loring W. Rue, III University of Alabama at Birmingham, Birmingham, AL OBJECTIVES: Bundle checklists are increasingly utilized in patient care, but data is inconsistent regarding their efcacy in reducing nosocomial complication rates. We examined whether checklist usage was associated with nosocomial complications when documented elements were veried by provider bedside rounds. METHODS: We performed a retrospective cohort study of trauma patients admitted to our hospital during a three-phase implementation of a quality improvement project. For this analysis, patients were categorized as pre-documentation (PD), documentation only (DO), or documentation with provider review (PR) cohort based on temporal designations. Logistic regression was used to estimate odds ratios (ORs) and 95% condence intervals (CIs) for the association between documentation cohorts and nosocomial complications. RESULTS: No difference in mean hospital stay, ICU days, or ventilator days was observed. The DO cohort showed no signicant differences in the risk of complications. Among ICU patients, when compared to the PD cohort, the PR cohort demonstrated a decreased risk of all complications OR 0.72 (95% CI 0.55–0.93), pulmonary embolus OR 0.29 (95% CI 0.11– 0.73), pneumonia OR 0.66 (95% CI 0.50-0.88), and death OR 0.50 (95% CI 0.31–0.79). CONCLUSION: Bedside conrmation of bundle checklists during physician extender rounds reduces the risk of pulmonary embolus, pneumonia, and death when compared to chart documentation alone. This study underscores the importance of the team approach to the bundle checklist and it’s ability to reduce morbidity and mortality. *By invitation AMERICAN SURGICAL ASSOCIATION 91 Odds Ratios* (ORs) and Associated 95% Condence Intervals (CI) for the Association Between FASTHUGS Pre-Documentation Cohort (n = 1,136) Documentation Only Cohort (n = 1,160) Documentation and Physician Extender Check Cohort (n = 1,185) OR (95% CI) OR (95% CI) OR (95% CI) ALL PATIENTS Any event Ref 0.93 (0.72–1.19) 0.72 (0.56–0.92) DVT Ref 1.01 (0.64–1.59) 0.77 (0.48–1.24) Pulmonary embolism Ref 0.74 (0.37–1.45) 0.31 (0.13–0.73) Pneumonia Ref 0.89 (0.67–1.17) 0.68 (0.51–0.89) Bacteremia Ref 0.94 (0.61–1.44) 0.94 (0.61–1.43) Death Ref 0.90 (0.59–1.36) 0.50 (0.31–0.79) * Estimated from logistic regression and adjusted for injury severity score and race 92 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION FRIDAY AFTERNOON, APRIL 24th, CONTINUED FRIDAY EVENING, APRIL 24th 4:00 PM – 5:00 PM Marina Ballroom E-G 7:00 PM – 8:00 PM Marina Ballroom Foyer EXECUTIVE SESSION ASA Fellows Only ANNUAL RECEPTION Presentation of the Flance-Karl Award 8:00 PM – 10:30 PM Marina Ballroom ANNUAL BANQUET 93 94 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION SATURDAY MORNING, APRIL 25th patency was 94%, with secondary patency of 95.3%. Type Ia endoleak was present in 5.7% with secondary intervention rates of 37.9%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%. CONCLUSIONS: This global experience is the largest series in the literature of ch-EVAR and demonstrates comparable outcomes to published branched/fenestrated devices and is independent of the type of abdominal device or selected chimney graft, suggesting it’s broad applicability to most surgeons. These results support ch-EVAR as a valid off-the-shelf alternative in the treatment of complex EVAR and give impetus for the standardization of the technique in the future. 8:00 AM - 11:00 AM Marina Ballroom E-G SCIENTIFIC SESSION V Moderator: New President-Elect 26 Collected World Experience of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Aneurysms: The PERICLES Registry Jason T. Lee*1, Konstantinos Donas*2, Mario Lachat*3, Giovanni Torsello*2, Frank J. Veith4 1 Stanford University Medical Center, Stanford, CA; 2Muenster University Hospital, Muenster, Germany; 3University Hospital Zurich, Zurich, Switzerland; 4New York University – Langone Medical Center, New York, NY OBJECTIVE(S): Endovascular aneurysm repair (EVAR) has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated devices and off the shelf solutions have encouraged an alternative strategy utilizing parallel, or snokel/chimney grafts (ch-EVAR). We sought to examine the collected worldwide experience with use of ch-EVAR for complex aneurysm treatment. METHODS: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008–2014 by pre-arranged dened and documented protocols. RESULTS: 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%). Overall 898 chimney grafts (49% vs 51% balloon-expandable vs selfexpandable covered stents) were placed into 692 renal arteries, 156 SMAs, and 50 celiacs. At a mean follow up of 17.1 months (1–70 months), primary *By invitation 95 96 AMERICAN SURGICAL ASSOCIATION 27 How Well Does Renal Transplantation Cure Hyperparathyroidism? Irene Lou*, Scott Odorico*, David Foley*, David Schneider*, Rebecca Sippel*, Herbert Chen University of Wisconsin-Madison, Madison, WI BACKGROUND: Most patients with end-stage kidney disease will develop renal hyperparathyroidism. Transplantation reportedly resolves secondary hyperparathyroidism in 95% of cases. Therefore, current practice guidelines recommend a watchful waiting approach to hyperparathyroidism the rst 12 months after transplantation to allow maximal allograft function. The purpose of our study is to examine the incidence of hyperparathyroidism, dened as an elevated parathyroid hormone (PTH) level, after renal transplantation in a contemporary cohort. METHOD: A total of 2,039 patients underwent kidney transplantation from 1/1/2004–6/30/2012 with a minimum of 24 months of follow-up. Oneway analysis of variance was used to compare group means. A multivariate logistic regression model was constructed, with signicance at p < 0.05. RESULTS: 603 (30%) of patients achieved normal PTH within the rst year. 659 (32%) attained normal PTH after one year, with the remaining 777 (38%) having recurrent or persistent hyperparathyroidism (RPH). Patients normalizing PTH within 12 months had a longer mean graft-survival (6.9 ± 0.1 years) compared to those with delayed PTH normalization (5.35 ± 0.08 years) and those with RPH (5.08 ± 0.07 years), p < 0.001. There was no statistically signicant difference in graft-survival between those with delayed normalization of PTH and those with RPH (p = 0.054). Factors predictive of RPH include age at transplant (p = 0.025), obesity (p < 0.001), time on dialysis pre-transplant (p < 0.001) and delayed graft failure (p = 0.02) dened as requiring dialysis within 7 days of transplantation. CONCLUSION: Renal transplant resolves hyperparathyroidism in only 62% of patients. Resolution within the rst year portends longer graftsurvival, therefore consideration of earlier intervention for hyperparathyroidism is warranted. *By invitation AMERICAN SURGICAL ASSOCIATION 97 28 A Quarter Century of Organ Protection in Open Thoracoabdominal Repair Anthony L. Estrera*, Harleen K. Sandhu*, Kristofer M. Charlton-Ouw*, Rana O. A*, Ali Azizzadeh*, Charles C. Miller, III*, Hazim J. Sa University of Texas Health Science Center at Houston, Houston, TX OBJECTIVE(S): Thoracoabdominal aortic aneurysm (TAAA) remains a challenging problem. We describe our experience with open TAAA and descending thoracic (DTAA) aortic aneurysm repair. METHODS: Between 1991 and 2014, we repaired 1904 DTAA or TAAA in 1815 patients. Mean age was 64.5±13.6 with 680/1815 (37.5%) women. Of 1904 operations, 664 (35%) were DTAA, 312 (16%) TAAA1, 308 (16%) TAAA2, 186 (9%) TAAA3, 341 (18%) TAAA4, and 111 (6%) TAAA5. 229 (12%) were redo procedures. Adjunct (cerebrospinal uid drainage + distal aortic perfusion) was used in 75%. RESULTS: 653/1904 (34%) had aortic dissection and 141 (7.4%) had rupture. Preoperative glomerular ltration rate (GFR) was 67 ml/min/1.73m2 (interquartile range (IQR) 48–95). Renal failure requiring dialysis occurred in 316 (16.6%). Immediate neurological-decit (ND) occurred in 89 (4.7%) and delayed in 105 (5.5%). Of these, 47/194 (24.2%) recovered by the time of discharge. Postoperative stroke was 90/1904 (4.7%). 30-day mortality was 261/1904 (13.7%). Mortality with GFR > 95 was 25/459 (5.45%), and 112/427 (26.2%) with GFR < 48 (p < 0.0001). In multivariable analysis, immediate ND was greater in females (p < 0.02) and TAAA2 or 3 (p < 0.0001); it was signicantly reduced by higher GFR (p < 0.0001) and use of adjunct (p < 0.02), particularly in TAAA2 or 3 (interaction p < 0.0016). Adjunct is the only signicant predictor of recovery after ND (p < 0.035). Predictors of 30-day mortality were age (p < 0.02), GFR (p < 0.0001), TAAA2 (p < 0.03), TAAA3 (p < 0.002), and emergency (p < 0.0001). CONCLUSIONS: Open thoracoabdominal repair demonstrates acceptable mortality and morbidity and provides a benchmark for endovascular repair. Adjunct is protective against ND in TAAA2 and 3, and improves recovery. *By invitation 98 AMERICAN SURGICAL ASSOCIATION 29 Racial Disparity in African American Renal Transplants: Is Alemtuzumab Induction the Great Equalizer? Alison A. Smith*, Mira John*, Isabelle Dortonne*, Anil S. Paramesh*, Mary Killackey*, Rubin Zhang*, Belinda Lee*, Bernard M. Jaffe, Joseph F. Buell* Tulane University, New Orleans, LA OBJECTIVE: African Americans (AA) renal transplant recipients experience inferior outcomes compared to Caucasians (CA). Numerous unsuccessful attempts have been made to identify specic immunologic and socioeconomic factors contributing to this discrepancy. Our objective was to examine the effect of induction therapy on racial outcomes for renal transplantation. METHODS: Retrospective analysis of outcomes in consecutive adult renal transplant recipients from 2006–2014 was performed. Patients were separated by race and further stratied by induction therapy, alemtuzumab (AL) vs. no alemtuzumab (nAL). Kaplan Meier curves, log rank tests, and hazard ratios (HR) were generated for mortality and allograft survival. Multiple linear regression modeling measured the effect of independent variables (nAL, rejection, delayed graft function, CMV infection) on AA allograft survival. RESULTS: 433 patients (172 CA and 261 AA) were identied. Mortality was equivalent between CA and AA (23.2% vs. 17.2%, p = 0.1068, HR = 0.6970) while the incidence of allograft failure was lower for CA vs. AA (9.3% vs. 21.8%, p = 0.0037*, HR = 2.079). Stratication by induction agent (267 AL vs. 166 nAL induction) found no difference in allograft survival between CA vs. AA with AL induction (5.9% vs. 9.7%, p = 0.2364, HR = 1.728) compared to nAL induction (14.2% vs. 42.7%, p = 0.0058*, HR = 2.296). Multiple linear regression conrmed the strongest predictor for AA allograft failure was nAL induction (p < 0.05*). CONCLUSIONS: This is the rst study to suggest that a modern induction agent can eliminate the historic racial disparity previously ascribed to AA renal transplant recipients. The results of this study should stimulate further investigations on optimizing healthcare outcomes for AA. *By invitation AMERICAN SURGICAL ASSOCIATION 99 30 Trans-Abdominal Redo Ileal Pouch Surgery for Failed Restorative Proctocolectomy Lessons Learned Over 500 Patients Feza H. Remzi*, Erman Aytac*, Jean Ashburn*, Jinyu Gu*, Tracy L. Hull*, David W. Dietz*, Luca Stocchi*, James M. Church, Bo Shen* Cleveland Clinic, Cleveland, OH OBJECTIVE(S): Reported ileal pouch-anal anastomosis (IPAA) failure rate ranged from 3 to 15%, mainly due technical or inammatory conditions. Surgical revision is the only option for patients with a failed IPAA to avoid permanent stoma. Data regarding surgical, functional and quality of life (QOL) outcomes of redo surgery for failed IPAA are limited. We aimed to evaluate single center experience on trans-abdominal redo surgery for failed IPAA. METHODS: Patients undergoing trans-abdominal redo surgery for failed IPAA between 1983 and 2014 were evaluated based on prospectively maintained institutional registry. RESULTS: There were 502 (43% male) patients with a mean age of 38 and body mass index 30 kg/m2 at the time of revision surgery. 407 patients (81%) were referred from outside institutions. Operative indications are listed in the table. Prior pouch types were J (81%), S (18%) and W (0.3%). The new pouch was created in 40% of patients. Of these patients with neoIPAA, there were J (87%) and S (13%) pouches. Short-term anastomotic leak was 8%. The mean postoperative length of stay was 10 days. Failure rate after redo ileal pouch surgery was 19% within a mean of 9 years follow-up. Overall functional outcomes and QOL scores were similar to that in patients who had had the rst time IPAA. Patients with nal diagnosis of Crohn’s disease,pouch vaginal stula had high failure rates where septic complication as primary indication had higher success rates. *By invitation 100 AMERICAN SURGICAL ASSOCIATION Indications of Redo Surgery n = 502 Septic complications Anastomotic leak/stula/anastomotic sinus/ pelvicor perianal abscess 305 (61%) Obstruction/prolapse 125 (25%) Dysfunction/chronic pouchitis 60 (12%) Neoplasia 12 (2%) CONCLUSIONS: Redo ileal pouch surgery provides high salvage sates, avoids permanent stoma with acceptable functional outcome and QOL. AMERICAN SURGICAL ASSOCIATION 101 31 Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures Anai N. Kothari*1, Matthew A.C. Zapf*2, Robert Blackwell*3, Victor Chang*2, Zhiyong Mi*1, Gopal N. Gupta*3, Paul C. Kuo1 1 Loyola University Chicago, Department of Surgery, Maywood, IL; 2Stritch School of Medicine, Maywood, IL; 3Loyola University Chicago, Department of Urology, Maywood, IL OBJECTIVE(S): The “weekend effect” (WE) is the observation that surgeon-independent patient outcomes are worse on the weekend compared to weekdays. We hypothesized that perioperative hospital resources could overcome the WE in patients undergoing emergent/urgent surgeries. METHODS: Emergent/urgent surgeries were identied using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007–2011 and were linked to the American Hospital Association Annual Survey database to determine hospital level characteristics. Extended median length of stay on the weekend compared to the weekday (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. RESULTS: Included were 127,221 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identied high resolution CT scanner (OR 1.33)*, home health program (OR 1.88)*, social work program (OR 1.37)*, full adoption of electronic medical records (OR 1.62)*, and increased nurse-to-bed ratio (OR 2.55)* as hospital resources that overcame the WE following implementation. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared to those hospitals which overcame the WE. (*p < 0.0001). CONCLUSIONS: Specic hospital resources can overcome the WE seen in urgent general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care. *By invitation 102 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION Comparing Hospitals With and Without WE Hospital Factor Hospitals That Overcame WE (n = 17) Hospitals with Persistent WE (n = 40) p-Value Nurse to Bed Ratio 1.46 1.22 0.0001 Home Health Program (%) 27.3% 29.6% 0.8609 Patient Controlled Analgesia (%) 93.8% 83.3% 0.2896 Electronic Medical Records (%) 55.6% 13.1% 0.0008 Social Work (%) 98.7% 82.3% 0.0091 High Resolution CT Scanner (%) 61.4% 50.4% 0.4461 103 32 A Longitudinal Assessment of Outcomes, Cost, and Healthcare Resource Utilization Following Immediate Breast Reconstruction – Comparing Implant and Autologous Reconstruction John P. Fischer*, Justin P. Fox*, Liza C. Wu*, Suhail K. Kanchwala*, Joshua Fosnot*, Stephen J. Kovach*, Joseph M. Serletti Hospital of the University of Pennsylvania, Philadelphia, PA OBJECTIVES: Immediate breast reconstruction (IBR) has increased in recent years, yet long-term comparative data on complication and cost proles are lacking. We perform a comparison of cumulative healthcare resource utilization and outcomes following implant- and autologous-based breast reconstruction. METHODS: 2007–2011 CA, FL, NE, and NY inpatient and ambulatory surgery databases were used (AHRQ HCUP) encompassing 25% of all-payer 2010 population. Discharges for women 18 years who underwent mastectomy with breast reconstruction (10/1/2008–10/31/2009), excluding those with metastatic disease. Outcomes included: 90-day surgical complications, 3-year breast surgery procedures, and cumulative healthcare costs. RESULTS: 11,493 patients underwent IBR generating costs of $273 million, of which $101 million was for secondary procedures. Adjusted 90-day complication proles favored expander reconstruction (6.5%) relative to direct implant (6.6%) and autologous (13.2%). However, \ adjusted rate of breast procedures within 3 years was highest in expander reconstruction (2,018 per 1,000 discharges) compared to direct implant (1,427 per 1,000 discharges) and autologous (944 per 1,000) (P < 0.001). Cumulative adjusted healthcare costs across procedures differed between autologous ($51,948), expander ($57,366), and direct implant ($56,784) modalities (P < .001) (Figure 1). *By invitation 104 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION IN MEMORIAM CONCLUSION: This analysis provides 3-year data on healthcare resource utilization across common reconstructive modalities from a cohort comprising 25% of the all-payer US population and demonstrates the signicant and differing costs of breast reconstruction surgery including revision surgery and the long-term performance of autologous tissue relative to implants. 11:00 AM ADJOURN R. Peter Altman, M.D., New York City, NY Jay L. Ankeney, M.D., Chagrin Falls, OH Robert E. Condon, M.D., Clyde Hill, WA Richard E. Edlich, M.D., Brush Prairie, WA Robert L. Goodale, Jr., M.D., Minneapolis, MN Raymond Heimbecker, M.D., Collingwood, ON, Canada Anthony L. Imbembo, M.D., Cockeysville, MD Adib D. Jatene, M.D., Sao Paulo, Brazil Gerard A. Kaiser, M.D., Miami, FL Henry L. Laws, M.D., Clanton, AL Robert S. Litwak, M.D., Concord, MA John B. Lynch, M.D., Nashville, TN Robert A. Macbeth, M.D., Toronto, ON, Canada Lloyd D. MacLean, M.D., Verdun, QC, Canada James V. Maloney, Jr., M.D., Los Angeles, CA Frank T. Padberg, M.D., Little Rock, AR William W Pfaff, M.D., Gainesville, FL Peter Randall, M.D., Gwynedd, PA Raymond C. Read, M.D., Little Rock, AR Thomas R. Russell, M.D., San Francisco, CA Robert B. Rutherford, M.D., Boerne, TX Keiji Sano, M.D., Tokyo, Japan Erwin R. Thal, M.D., Dallas, TX Colin G. Thomas, Jr., M.D., Chapel Hill, NC Stephen L. Wangensteen, M.D., Rembert, SC David I. Williams, M.D., London, England 309 310 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION MEDALLION FOR SCIENTIFIC ACHIEVEMENT (Continued) MEDALLION FOR SCIENTIFIC ACHIEVEMENT 2000 BERNARD FISHER, M.D. Pittsburgh, Pennsylvania 1970 LESTER R. DRAGSTEDT, M.D. Gainesville, Florida 2001 JOHN W. KIRKLIN, M.D. Birmingham, Alabama 1973 ROBERT E. GROSS, M.D. Boston, Massachusetts 2002 ROBERT H. BARTLETT, M.D. Ann Arbor, Michigan 1976 OWEN H. WANGENSTEEN, M.D. Minneapolis, Minnesota 2003 CLYDE F. BARKER, M.D. Philadelphia, Pennsylvania 1977 ROBERT M. ZOLLINGER, SR., M.D. Columbus, Ohio 2004 SAMUEL A. WELLS, JR., M.D. Durham, North Carolina 1978 FRANCIS D. MOORE, SR., M.D. Boston, Massachusetts 2006 STEVEN A, ROSENBERG, M.D. Bethesda, Maryland 1979 JONATHAN E. RHOADS, M.D. Philadelphia, Pennsylvania 2007 RONALD W. BUSUTTIL, M.D. Los Angeles, California 1981 MICHAEL E. DEBAKEY, M.D. Houston, Texas 2008 JOSEF E. FISCHER, M.D. Boston, Massachusetts 1987 RICHARD L. VARCO, M.D. Minneapolis, Minnesota 2009 STANLEY J. DUDRICK, M.D. Waterbury, Connecticut 1990 THOMAS E. STARZL, M.D. Pittsburgh, Pennsylvania 2010 DENTON A. COOLEY, M.D. Houston, Texas 1991 JOSEPH E. MURRAY, M.D. Boston, Massachusetts 2012 PATRICIA K. DONAHOE, M.D. Boston, Massachusetts 1992 NORMAN E. SHUMWAY, M.D. Stanford, California 2014 DAVID N. HERNDON, M.D. Galveston, Texas 1995 FOLKERT O. BELZER, M.D. Madison, Wisconsin 1997 M. JUDAH FOLKMAN, M.D. Boston, Massachusetts 1998 BASIL A. PRUITT, JR., M.D. San Antonio, Texas 311 312 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION MEDALLION FOR THE ADVANCEMENT OF SURGICAL CARE AMERICAN SURGICAL ASSOCIATION 313 FLANCE-KARL AWARD RECIPIENTS 2012 TOM R. DEMEESTER, M.D. San Marino, California 2013 EDWARD E. MASON, M.D. Iowa City, Iowa 2014 DONALD L. MORTON, M.D. Santa Monica, California The Flance-Karl Award was established in 1996 by Samuel A. Wells, Jr., M.D., who was then President of the Association. The primary endowment for the award was a gift from Mr. David Farrell, Chief Executive Ofcer of the May Corporation, and the Barnes-Jewish-Christian Health Care System, both of St. Louis, Missouri. The award recognizes I. Jerome Flance, M.D., and Michael M. Karl, M.D., two physicians in St. Louis, who cared for Mr. Farrell and his family. The Flance-Karl Award is presented to a surgeon in the United States of America who has made a seminal contribution in basic laboratory research which has application to clinical surgery. The recipient should be active in clinical or laboratory research and preferably is less than 60 years of age. Prior recipients of the Association’s Medallion for Scientic Achievement are not eligible for the Flance-Karl Award. 1997 STANLEY J. DUDRICK, M.D. Waterbury, Connecticut & JONATHAN E. RHOADS, M.D. Philadelphia, Pennsylvania 1998 M. JUDAH FOLKMAN, M.D. Boston, Massachusetts 1999 NORMAN E. SHUMWAY, M.D. Stanford, California 2000 FRANCIS D. MOORE, SR., M.D. Boston, Massachusetts 2001 BERNARD FISHER, M.D. Pittsburgh, Pennsylvania 2002 STEVEN A. ROSENBERG, M.D. Bethesda, Maryland 2003 STEVEN F. LOWRY, M.D. New Brunswick, New Jersey 314 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION FLANCE-KARL AWARD RECIPIENTS (Continued) AMERICAN SURGICAL ASSOCIATION FOUNDATION FELLOWSHIP AWARD RECIPIENTS 2004 PATRICIA K. DONAHOE, M.D. Boston, Massachusetts 2005 ALEXANDER W. CLOWES, M.D. Seattle, Washington 2006 DAVID N. HERNDON, M.D. Galveston, Texas 2007 RONALD V. MAIER, M.D. Seattle, Washington 2008 TIMOTHY R. BILLIAR, M.D. Pittsburgh, Pennsylvania 2009 JOSEPH P. VACANTI Boston, Massachusetts 2010 B. MARK EVERS, M.D. Lexington, Kentucky 2011 MICHAEL T. LONGAKER, M.D. Stanford, California 2012 JEFFREY A. NORTON, M.D. Stanford, California 2013 JAMES S. ECONOMOU, M.D. Los Angeles, California 2014 CHRISTIAN P. LARSEN, M.D. Atlanta, Georgia Dana K. Andersen, M.D. Michael E. Shapiro, M.D. Ronald G. Tompkins, M.D. Lawrence Rosenberg, M.D. B. Mark Evers, M.D. Jonathan S. Bromberg, M.D., Ph.D. Ronald J. Weigel, M.D., Ph.D. Bruce R. Rosengard, M.D. Michael S. Conte, M.D. John A. Goss, M.D. Vivian Gahtan, M.D. Robert C. Gorman, M.D. Gilbert R. Upchurch, Jr., M.D. James S. Allan, M.D. Michael S. Mulligan, M.D. Herbert Chen, M.D. Christopher R. Mantyh, M.D. James C.Y. Dunn, M.D. Daniel A. Saltzman, M.D. Shahab A. Akhter, M.D. John R. Renz, M.D. Nita Ahuja, M.D. Christopher K. Breuer, M.D. Marc G. Jeschke, M.D. Christopher E. Touloukian, M.D. Michael J. Englesbe, M.D. Robert W. O’Rourke, M.D. Christopher L. Wolfgang, M.D. Andrew M. Cameron, M.D. Rebecca A. Gladdy, M.D. Jennifer F. Tseng, M.D. Caprice Greenberg, M.D. James O. Park, M.D. Jen Jen Yeh, M.D. Eric Chien-Wei Liao, M.D. Tippi C. MacKenzie, M.D. Genevieve Melton-Meaux, M.D. Vishal Bansal, M.D. David Rabkin, M.D. 315 1982–1984 1984–1986 1986–1988 1988–1990 1990–1992 1992–1994 1994–1996 1996–1998 1997–1999 1998–2000 1999–2001 2000–2002 2000–2001 2001–2003 2001–2003 2002–2004 2002–2004 2003–2005 2003–2005 2004–2006 2004–2006 2005–2007 2005–2007 2006–2008 2006–2008 2007–2009 2007–2009 2007–2009 2008–2010 2008–2010 2008–2010 2009–2011 2009–2011 2009–2011 2010–2012 2010–2012 2010–2012 2011–2013 2011–2013 316 AMERICAN SURGICAL ASSOCIATION Bryan Tillman, M.D. Ryan C. Fields, M.D. James J. Mezhir, M.D. Sunil Singhal, M.D. Bao-Ngoc H. Nguyen, M.D. Kimberly J. Riehle, M.D. Joseph J. Skitzki, M.D. Daniel S. Eiferman, M.D. Karin M. Hardiman, M.D., Ph.D. Shirling Tsai, M.D. Todd W. Costantini, M.D. Paige Porrett, M.D., Ph.D. Brian R. Untch, M.D. 2011–2013 2012–2014 2012–2014 2012–2014 2013–2015 2013–2015 2013–2015 2014–2016 2014–2016 2014–2016 2015–2017 2015–2017 2015–2017 326 AMERICAN SURGICAL ASSOCIATION AUTHOR INDEX Program # Author 8 Michael Abecassis 11 Kareem M. Abu-Elmagd 14 Ali AbuRahma 28 Rana O. A 24 Vatche G. Agopian 18 Steven M. Albelda 12 Peter J. Allen 19 Mustafa Arain 17 Michaele J. Armstrong 30 Jean Ashburn 21 Raf S. Avedian 30 Erman Aytac 28 Ali Azizzadeh 23 Vinay Badhwar 8 Talia Baker 16 Galinos Barmparas 8 Charlotte Beil 19 Gregory Beilman 19 Melena Bellin 8 Carl Berg 3 Donald T. Berry 5 Thomas A. Biester 10 Nancy J. Birkmeyer 7 Christopher M. Blackwell 31 Robert Blackwell 9 Rachel C. Brennan AMERICAN SURGICAL ASSOCIATION Program # Author 29 Joseph F. Buell 24 Ronald W. Busuttil 14 James Campbell 15 Joe Canner 17 Sally E. Carty 13 Sricharan Chalikonda 31 Victor Chang 28 Kristofer M. Charlton-Ouw 27 Herbert Chen 19 Srinath Chinnakotla 1 Cody Chiuzan 16 Konstantinos Chouliaras 30 James M. Church 3 Constance T. Cirrincione 19 Alfred Clavel 23 Joseph Cleveland 5 Thomas H. Cogbill 11 Guilherme Costa 2 Bryan Cotton 2 Michael W. Cripps 11 Ruy J. Cruz 12 Michael I. D’Angelica 9 Andrew M. Davidoff 9 Noel Delos Santos 12 Ronald P. DeMatteo 16 Demetrios Demetriades 2 Mark DeRosa 18 Charuhas Deshpande 327 328 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION Program # Author Program # Author 30 David W. Dietz 21 Kristen Ganjoo 9 Jeffrey S. Dome 6 Nicole S. Gibran 26 Konstantinos Donas 8 Brenda Gillespie 29 Isabelle Dortonne 3 Mehra Golshan 18 Jeffrey A. Drebin 2 Dina Gomaa 19 Ty Dunn 12 Mithat Gonen 23 Fred Edwards 25 Russell Grifn 15 Aslam Ejaz 12 Bas Groot Koerkamp 14 Mary Emmett 23 Frederick Grover 8 Jean Emond 30 Jinyu Gu 1 David Estrada 31 Gopal N. Gupta 28 Anthony L. Estrera 4 Ansab A. Haider 8 Gregory Everson 23 Jane Han 24 Douglas G. Farmer 24 Michael Harlander-Locke 23 Franco Fazzalari 21 E. John Harris 17 Robert L. Ferris 11 Koji Hashimoto 23 Giovanni Filardo 14 Stephen Hass 32 John P. Fischer 23 Xia He 27 David Foley 18 Daniel F. Heitjan 1 Kenneth A. Forde 10 Mark R. Hemmila 32 Joshua Fosnot 10 Peter K. Henke 32 Justin P. Fox 24 Jonathan R. Hiatt 19 Martin Freeman 6 Anne M. Hocking 8 Chris Freise 17 Steven P. Hodak 11 Masato Fujiki 2 John B. Holcomb 11 John Fung 6 Shari Honari 23 Anthony Furnary 7 Yinin Hu 6 Maricar Ga 3 Clifford Hudis 329 330 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION Program # Author Program # Author 30 Tracy L. Hull 13 Eric Kortz 11 Abhinav Humar 31 Anai N. Kothari 16 Kenji Inaba 32 Stephen J. Kovach 9 Rodrigo B. Interiano 9 Matthew J. Krasin 16 Crystal Ives 4 Narong Kulvatumyou 23 Jeffrey Jacobs 31 Paul C. Kuo 29 Bernard M. Jaffe 13 David Kwon 12 William R. Jarnagin 26 Mario Lachat 3 Sara Jasinski 12 Julie Leal 22 Linda Jin 21, 26 Jason T. Lee 29 Mira John 29 Belinda Lee 5 Andrew Jones 18 Leslie A. Litzky 4 Bellal Joseph 27 Irene Lou 24 Fady M. Kaldas 18 Philip S. Low 32 Suhail K. Kanchwala 5 Fred A. Luchette 18 Jane J. Keating 23 Mitchell Magee 18 Gregory T. Kennedy 5 Mark A. Malangoni 10 John P. Kepros 24 Daniela Markovic 11 Ajai Khanna 13 Robert C.G. Martin 9 Kathleen Kieran 9 M. Elizabeth McCarville 29 Mary Killackey 17 Kelly L. McCoy 7 Helen Kim 2 Belinda McCully 15 Yuhree Kim 13 Kelly M. McMasters 12 T. Peter Kingham 24 Justin McWilliams 2 Laszlo Kiraly 21 Matthew W. Mell 1 Ravi P. Kiran 31 Zhiyong Mi 5 Mary E. Klingensmith 28 Charles C. Miller 16 Nikos Koronakis 2 Joseph Minei 331 332 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION Program # Author Program # Author 14 Asmita Modak 21 George A. Poultsides 21 David G. Mohler 23 Richard Prager 22 Jeffrey F. Moley 19 Timothy Pruett 20 Monica Morrow 19 David Radosevich 24 Maud Morshedi 23 J. Scott Rankin 14 Albeir Mousa 25 Don Reiff 6 Lara A. Mufey 6 Alexander P. Reiner 1 A.C. Murray 30 Feza H. Remzi 14 Aravinda Nanjundappa 4 Peter Rhee 17 Kristina J. Nicholson 2 Bryce Robinson 18 Shuming Nie 22 Kathryn A. Rowland 17 Yuri E. Nikiforov 25 Loring W. Rue 17 Marina N. Nikiforova 12 Eran Sadot 21 Jeffrey A. Norton 28 Hazim J. Sa 23 Sean O’Brien 5 Kelli Samonte 27 Scott Odorico 8 Benjamin Samstein 4 Terence O’Keeffe 28 Harleen K. Sandhu 18 Olugbenga T. Okusanya 15 Eric Schneider 20 Cristina Olcese 27 David Schneider 3 David W. Ollila 2 Martin A. Schreiber 8 Kim M. Olthoff 19 Sarah Jane Schwarzenberg 10 Nicholas H. Osborne 13 Charles R. Scoggins 4 Viraj Pandit 13 Marty Sellars 29 Anil S. Paramesh 32 Joseph M. Serletti 11 Neha Parekh 23 David Shahian 10 Sujal G. Patel 8 Abraham Shaked 20 Sujata Patil 30 Bo Shen 15 Timothy M. Pawlik 12 Jinru Shia 333 334 AMERICAN SURGICAL ASSOCIATION AMERICAN SURGICAL ASSOCIATION Program # Author Program # Author 25 Thomas Shoultz 26 Frank J. Veith 3 William M. Sikov 21 Brendan C. Visser 18 Sunil Singhal 13 Kevin T. Watkins 27 Rebecca Sippel 3 Tracy F. Weisberg 16 Emre Sivrikoz 22 Samuel A. Wells 22 Michael Skinner 9 Mark A. Williams 7 Craig L. Slingluff 3 Eric P. Winer 8 Abby Smith 32 Liza C. Wu 29 Alison A. Smith 9 Lynn Wynn 7 Mark E. Smolkin 24 Hasan Yersiz 3 George Somlo 17 Linwah Yip 6 Ravi F. Sood 17 Jenny Yoo 15 Gaya Spolverato 16 Scott Zakaluzny 14 Mohit Srivastiva 31 Matthew A.C. Zapf 17 Michael T. Stang 24 Ali Zarrinpar 2 Ronald Stewart 29 Rubin Zhang 30 Luca Stocchi 14 patrick A. stone 20 Preeti D. Subhedar 19 David Sutherland 4 Andrew Tang 25 Benjamin Taylor 16 Pedro Teixeira 26 Giovanni Torsello 21 Thuy B. Tran 22 Amber L. Traugott 2 Samantha Underwood 20 Kimberly J. Van Zee 335 SCHEDULE-AT-A-GLANCE THURSDAY, APRIL 23rd 8:15 AM Opening Session Marina Ballroom E-G President's Opening Remarks Secretary's Welcome and Introduction of New Fellows Elected in 2014 President’s Introduction of Honorary Fellows Presentation of the Medallion for Scientific Achievement Presentation of the Medallion for the Advancement of Surgical Care Eulogies of Past Presidents Report of the Committee on Arrangements 9:10 AM Scientific Session I Marina Ballroom E-G Moderator: Anna M. Ledgerwood, M.D. 10:50 AM Presidential Address Marina Ballroom E-G Introduction: John M. Daly, M.D. Address: Anna M. Ledgerwood, M.D. 1:30 PM Scientific Session II Marina Ballroom E-G Moderator: James S. Economou, M.D., Ph.D. FRIDAY, APRIL 24th 7:00 AM 8:00 AM ASA Women in Surgery Breakfast Mission Hills Scientific Session III Marina Ballroom E-G Moderator: Anna M. Ledgerwood, M.D. 10:30 AM Forum Discussion: Marina Ballroom E-G “Development of Surgical Scientists” Moderator: Anna M. Ledgerwood, M.D. 1:30 PM Scientific Session IV Marina Ballroom E-G Moderator: John M. Daly, M.D. 4:00 PM Executive Session (Fellows Only) Marina Ballroom E-G Presentation of the Flance-Karl Award 7:00 PM Annual Reception Marina Ballroom Foyer 8:00 PM Annual Banquet Marina Ballroom E-G (Black tie preferred, but dark suits are acceptable.) SATURDAY, APRIL 25th 8:00 AM Scientific Session V Moderator: New President-Elect 11:00 AM Adjourn Marina Ballroom E-G
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