49.05 Impact of Unexpected Surgical Task on Resident Workload and Ergonomics During A Competitive Event

Posted on January 18, 2016

D. Yu1, A. M. Abdelrahman1, B. R. Lowndes1, E. Buckarma2, B. Gas2, D. R. Farley2, M. Hallbeck1,2 1Mayo Clinic,Department Of Health Sciences Research,Rochester, MINNNESOTA, USA 2Mayo Clinic,Department Of Surgery,Rochester, MINNESOTA, USA

Introduction: Surgical simulation is important for training surgical residents, assessing competency, and ensuring patient safety. Understanding the cognitive and physical demands during simulation could aid in evaluating how simulation-based training prepares residents for unknown tasks. The objective of this study is to quantify and compare workload between standard and advanced surgical simulation tasks.

Methods: The study occurred during a semi-annual competitive event at our simulation center. Surgical residents had 3 minutes to complete a well-practiced Peg Transfer Task (PT), then 3 minutes to complete a never-seen before advanced Peg Transfer Task (aPT) mounted on the trainer ceiling. Dependent variables measured during these tasks included performance (time, successful transfers defined as moving a peg from one side to the [max of 12], and scores adjusted for task time and pegs transferred), self-reported workload, and ergonomic risk assessment for musculoskeletal injuries. Workload was measured using the validated NASA-TLX questionnaire with 6 sub-dimensions: mental demands, physical demands, temporal demands, performance, effort, and frustration. Comparison between PT and aPT and relationship among dependent variables were analyzed with paired t-tests, correlations, and regressions at α=0.05.

Results:All 28 surgical residents performed better on PT than aPT (Table), and those who performed better in PT performed better in aPT (ρ=0.54, p=0.003). aPT was significantly more demanding for every workload sub-dimension (Table) except for temporal demand and performance. 21% (PT) and 43% (aPT) of trainees performed tasks in postures requiring immediately action for preventing injuries. Performance (scores and pegs transferred) was negatively correlated (ρ=-0.28 to –0.48, p=0.001-0.036) with every workload sub-dimension except for temporal demand and effort (p>0.05). Regression analysis adjusting for task (PT or aPT) found that perceived performance (β= -0.11, p=0.001) was associated with pegs transferred and effort was associated with task time (β= -2.1, p=0.028). Ergonomic risk scores were positively correlated with frustration and overall workload (ρ=0.37 and 0.29, p=0.006 and 0.033 respectively). After regression analysis adjusting for task, only frustration was associated with higher ergonomic risk (β= 2.5, p=0.015).

Conclusion:Both the questionnaire and ergonomic assessment tools quantified significant increases in workload and injury risks. Better preparation and training for advanced laparoscopic procedures will be mandatory to improve operative performance and prevent serious physical risk to trainees.

49.07 ‘At Home’ Pre-Residency Preparation Improves Surgical Intern Assessment Scores: A Pilot Study

Posted on January 18, 2016

T. Pandian1, E. H. Buckarma1, B. L. Gas1, M. Mohan1, R. R. Li1, N. D. Naik1, D. R. Farley1 1Mayo Clinic – Rochester,Division Of Subspecialty General Surgery,Rochester, MN, USA

Introduction: In late 2014, the American Board of Surgery, the American College of Surgeons, and other surgical governing bodies issued a statement on the importance and success of pre-residency preparatory curricula for medical students transitioning into surgical residencies. In this spirit, we aimed to provide new trainees with simple, low-cost and effective resources to be utilized at home prior to matriculation, to better prepare them for early objective assessments in residency.

Methods: Matched medical students in 2015 were mailed a package of preparatory resources 1 month prior to matriculation into residency. The package consisted of ‘how-to’ videos, low-fidelity models, and surgical instruments for 5 ‘stations’ (arterial blood gas analysis, knot tying ability, suturing dexterity, anatomy knowledge, imaging knowledge) of our program’s bi-annual intern objective assessment activity (Surgical Olympics). These 5 stations accounted for 50 points of the total 130 points possible (total 13 stations, 10 points each). Surgical Olympics’ scores for these stations from 2015 were compared with 2014 controls using the student’s T-test. Residents who repeated the assessment in both years due to transition from preliminary to categorical positions, were excluded.

Results: Twenty-six interns participated in the 2015 Surgical Olympics and were compared to 32 historical controls. Residents were similar in age and operative/procedural experience, prior to matriculation and assessment. Overall mean scores were low in these 5 stations, but significantly higher (19.7 vs. 15.4, p=0.04) in the 2015 class. The largest increase was noted in the anatomy knowledge station (mean 5 vs. 1.9, p<0.01). Scores in stations assessing technical competence (knot tying ability, suturing dexterity) were similar between groups. The number of perfect scores among the five stations was higher (10 vs. 5) in the 2015 group. Mean scores from the other 8 stations, for which no resources were mailed, showed no difference (29.3 vs 27.5, p=0.58).

Conclusion: Enacting a small, home-based curriculum for medical students prior to beginning surgical residency, improved performance on early objective assessments. Low overall scores highlight the importance of and need for preparation prior to matriculation. Despite inherent biases to our pilot-study, we believe similar curricula could augment surgical board-approved pre-residency courses for medical students.

49.08 Are Self-Identified ‘Disadvantaged’ Students Less Likely to Enter Surgical Residencies?

Posted on January 18, 2016

J. T. Unkart1, C. M. Reid1, J. M. Baumgartner1, A. M. Wallace1, C. J. Kelly1 1University Of California, San Diego,La Jolla, CA, USA

Introduction: Students who come from disadvantaged backgrounds are more likely return to practice in these areas. Due to the emphasis on training more primary care physicians for underserved areas, we hypothesized that students who indicate themselves as ‘disadvantaged’ on their AMCAS application are less likely to pursue surgical training.

Methods: We performed a review of a UCSD medical school admissions database on students graduating during 2005-2014. Students were stratified into ‘disadvantaged’ and ‘non-disadvantaged’ groups. Data was recorded on age at entry, undergraduate science GPA, total MCAT scores, gender, surgery clerkship grade, USMLE step 1 score, and residency match into a surgical field at graduation. The primary endpoint, a comparison of the proportion of students matching into a surgical field between the two groups, was assessed with X2 test. Multivariate logistic regression was performed to assess factors that predict the choice of general surgery versus another surgical field.

Results: Of the 1140 students enrolled and graduated, 219 (19.2%) students reported ‘disadvantaged’ on their application. One hundred fifty-eight (13.9%) of students chose a surgical field. Students from the disadvantage group were older at entry (24.4 years vs. 23.2 years (p<0.001)), and had lower GPA (3.59 vs. 3.75 (p <0.001) and total MCAT scores (30.1 vs. 33.7 (p<0.001)). Twenty-seven (12.3%) of the 219 disadvantaged students chose a surgical career versus 130 (14.1%) of the 921 non-disadvantaged students (p=0.56). Amongst the surgical specialties chosen, general surgery was selected 57 (36.3%), orthopedic surgery 54 (34.4%), ENT 14 (8.9%), urology 14 (8.9%), neurosurgery 11 (7.0%), plastic surgery 6 (3.8%) and vascular surgery 1 (0.6%) time. On final multivariate logistic model, female gender (OR 3.9 (1.9-8.3), p <0.01), disadvantaged status (OR 2.8 (1.1-7.1), p=0.03), and USMLE step 1 score >227 (OR 0.43 (0.21-0.88), p=0.02) were significantly associated with choosing general surgery versus another surgical specialty.

Conclusion: The percentage of students that pursue surgical specialties from our institution is similar to percentages previously reported. While the disadvantaged cohort at our institution was older and had lower undergraduate GPA and MCAT scores, the proportion of disadvantaged students matching into a surgical specialty was not statistically different from the non-disadvantaged group. In order to address the future shortage of general surgeons in underserved areas, increasing enrollment of ‘disadvantaged’ students may alleviate the surgical desert.

49.09 Evaluating Handoffs in the Context of a Communication Framework

Posted on January 18, 2016

H. Hasan1, P. Barker1, R. Treat3, J. Peschman1, M. Mohorek1, P. Redlich2, T. Webb1 1Medical College Of Wisconsin,Division Of Education/ Department Of Surgery,Milwaukee, WI, USA 2Clement J Zablocki Veterans Affairs Medical Center,Department Of Surgery,Milwaukee, WI, USA 3Medical College Of Wisconsin,Department Of Emergency Medicine,Milwaukee, WI, USA

Introduction: The implementation of resident duty hour restrictions has led to increased patient care handoffs and thus more opportunities for errors during transitions of care. Much of the current handoff literature is empiric, and a recent editorial in the Journal of GME recommended studying handoffs within an established framework.

Methods: This is a prospective, single institution study evaluating the process of patient handoffs in the context of a published communication framework. IRB approval and written consent of participants were obtained. Evaluation tools for the source, recevier and observer were developed to identify factors that impair the handoff process. A subset of handoffs included two observers and/or two receivers to assess rater consistency. Data analysis was generated with IBM® SPSS® 21.0 with Pearson/Spearman correlations and multivariate linear regressions. Rater consistency was assessed with intraclass correlations (ICC 2,1).

Results: 126 handoffs were observed. Evaluations were completed by one observer (N=126), two observers (N=23), two receivers (N=39), one receiver (N=82), and one source (N=78). An average team handoff included 9.2(+4.6) patients, lasted 9.1(+5.4) minutes and had 4.7(+3.4) distractions recorded by the observer. Extraneous staff entering/exiting the room was the most common distraction, occuring 1.5(+1.9) times per handoff. The source and receivers recognized distractions in >67% of handoffs, with the most common internal and external distractions being fatigue (60% of handoffs) and extraneous staff entering/exiting the room (31%), respectively. Teams with more patients spent less time per individual patient handoff (r= -0.298;p=0.001). Statistically significant intraclass correlations (p≤.05) were moderate between observers (r≥0.4), but not receivers (r<0.4). ICC values between different types of raters were inconsistent (p>.05). The quality of the handoff process was predicted by presence of electronic devices (Beta=-0.565;p=0.005), number of teaching discussions (Beta=-0.417;p=0.048), resident hierarchy (Beta=-0.309;p=0.002), and the receiver’s working relationship with the source (Beta=0.829;p<0.001).

Conclusion: Studying the handoff process within an established framework highlights factors that impair communication. Internal and external distractions are common during handoffs, and along with the working relationship between the source and receiver, impact the quality of the handoff process. This information allows further study and targeted interventions of the handoff process to improve overall handoff effectiveness and patient safety.

49.02 Do Resident’s Operative Leadership Skills Correlate with Self-assessments of Technical Skill?

Posted on January 18, 2016

S. J. Gannon3, K. E. Law2, R. D. Ray1, A. D. D’Angelo1, C. M. Pugh1,2 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2University Of Wisconsin,Department Of Industrial And Systems Engineering,Madison, WI, USA 3University Of Wisconsin,Department Of Kinesiology,Madison, WI, USA

Introduction: This study used a simulated environment to explore issues relating to skills decay in research residents. We assessed operative leadership skills and conducted a survey evaluation of residents’ perception of skills decay and prediction of task difficulty. The purpose was to compare residents’ perception of technical skill decay and difficulty with their leadership skills during a simulated bowel repair. Leadership was assessed by the resident’s ability to direct their assistant. We hypothesize that resident’s ratings of difficulty and expected skill decay will be correlated to their utilization of the operative assistant during the simulation.

Methods: Surgical residents (PGY 2-4) in their research years were given 15 minutes to perform a simulated bowel repair. Prior to the procedure, residents were given a survey to rate their perceived difficulty and expected skill decay in performing the repair. The procedure consisted of a simulated gunshot wound to the abdomen that left one small and large full thickness injuries to the anti-mesenteric border of the small bowel. Residents were asked to repair the injuries with an operative assistant. The assistant was instructed not to provide feedback on the repair; however, could clarify with prefixed responses what was expected of the resident. Interactions with the assistant were coded by a researcher using TransanaTM coding software to identify the total number of directional instructions given by the resident during the simulation. Correlations between the number of directional instructions and perceived skill decay and task difficulty were performed.

Results: Twenty-eight residents (55.3% female) participated in the study. Residents provided 3-40 (M=13.96, SD=9.90) directional instructions to the operative assistant during the procedure. Residents who expected to have less decay in their small bowel repair skills during their research time were able to utilize the assistant more by giving them more directions on how to assist during the repair (R2=-.468, p=.016, df = 26). Those who perceived more difficulty on the repair and its related steps gave fewer directional instructions to their assistant. Expected procedural difficulties included selecting the correct suture (R2=-.401, p=.042, df = 26), selecting the correct stitch (R2=-.361, p=.070, df = 26), and successfully performing the entire surgical task (R2=-.398, p=.044, df = 26).

Conclusion: We assessed research residents’ expected skill decay and difficulty during an operative task and then evaluated the relationship of each item to residents’ use of operative assistants. Residents who gave more directional instruction to the operative assistant expected to have less skill decay and difficulty during a small bowel repair. These findings support the use of operative leadership skills as a potential metric for technical confidence and warrants further work regarding leadership and technical competence.

49.03 Evaluating the Effectiveness of a Mock Oral Educational Program on ABS Certifying Exam Pass Rates

Posted on January 18, 2016

L. E. Fischer1,2, M. Snyder1, S. A. Sullivan1, E. F. Foley1, J. A. Greenberg1 1University Of Wisconsin,General Surgery,Madison, WI, USA 2Oregon Health And Science University,General Surgery,Portland, OR, USA

Introduction: In order to obtain board certification, the American Board of Surgery requires graduates of general surgery training programs to pass both the written Qualifying Exam (QE) and the oral Certifying Exam (CE). In 2014, the pass rates for the QE and CE were 79% and 78%, respectively. In 2011, the University of Wisconsin instituted a mandatory, faculty-led, monthly CE preparation educational program as a supplement to their existing annual mock oral exam. We hypothesized that the implementation of these sessions would improve the first time pass rate for residents taking the ABS CE at our institution. Secondary outcomes studied were QE pass rate, correlation with ABSITE and mock oral exam scores, cost and type of study materials used, perception of exam difficulty, and applicant preparedness.

Methods: A sixteen question survey was sent to 57 out of 59 residents who attended the University of Wisconsin between the years of 2007 and 2015. Email addresses for two former residents could not be located. De-identified data for the ABSITE and first time pass rates for the QE and CE exam were retrospectively collected and analyzed along with survey results. Statistical analysis was performed using SPSS version 22 (Armonk, NY). P-values less than 0.05 were considered significant.

Results: Survey response rate was 77.2%. Of the residents who attempted the CE, first time pass rate was 71.4% (15 of 21) prior to the implementation of the formal CE preparation educational program and 100% (21 of 21) after (p = 0.010). Absolute ABSITE score, ABSITE percentile, and mock oral annual exam grades were all significantly improved after the educational program was initiated (p-values < 0.001, 0.031, and 0.002, respectively). ABSITE and mock oral annual exam scores were significantly associated with passing the QE (0.031 and 0.037, respectively), while mock oral annual exam scores alone were associated with passing the CE (p = 0.004). Survey results showed that residents perceived the annual mock oral exam as significantly more helpful in preparing for the CE after the institution of the formal, monthly educational program (p = 0.036). Overall, applicants felt extremely prepared for the CE (4.70 ± 0.5, Likert scale 1-5).

Conclusion: Formal educational programs instituted during residency can improve resident performance on the ABS certifying exam. The institution of a formal, faculty-led monthly CE preparation educational program at the University of Wisconsin has significantly improved the first time pass rate for the ABS CE. ABSITE and mock oral annual exam scores were also significantly improved. Furthermore, ABSITE scores correlate with QE pass rates, and mock oral annual exam scores correlate with pass rates for both QE and CE.

49.04 Exploring Hand Coordination as a Measure of Surgical Skill

Posted on January 18, 2016

K. Law2, A. N. Rutherford3, S. J. Gannon1,4, C. T. Millar1, C. M. Pugh1,2 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2University Of Wisconsin,Department Of Industrial And Systems Engineering,Madison, WI, USA 3University Of Wisconsin,Health Professions,La Crosse, WI, USA 4University Of Wisconsin,Kinesiology,Madison, WI, USA

Introduction: Surgery requires the effective coordination of both dominant and non-dominant hands; however, switching attention between hands during operative tasks can increase cognitive load, leading to longer movement planning and execution times. Researchers have previously investigated the impact of hand dominance on performance and dexterity using focused, psychomotor tasks; however, few efforts have attempted to understand the importance of these skills at the procedural level. The study aim was to identify residents’ coordination between their dominant and non-dominant hands while they grasp for sutures during a simulated laparoscopic ventral hernia repair.

Methods: Residents (PGY2-4) had 15 minutes to complete two steps of a simulated laparoscopic ventral hernia procedure. Residents self-reported their hand dominance in a pre-simulation survey. Those identified as ambidextrous or did not specify a handedness were excluded from analysis. Videos of each procedure were coded for manual coordination events and coordination duration during the active suture grasping phase. Manual coordination events were defined based on two categories: active motion of dominant, non-dominant, or both hands; and bimanual or unimanual manipulation of instruments during suture grasp attempts. A chi-square test was performed on the number of manual coordination events to discriminate between coordination choices.

Results:Thirty-six residents (52.8% female, 91.7% right-handed) participated in the procedure and met inclusion criteria. Residents used various types of manual coordination during active suture grasping, ranging between 6-26 events (M=14.7, SD=4.5) (see Table 1). Residents switched hands 492 times (M=13.7, SD=4.5). Most of the time was spent using bimanual coordination (M=20.6 seconds, SD=27.2), while unimanual non-dominant coordination was used least (M=7.9 seconds, SD=6.9). As expected, residents did not rely on their dominant and non-dominant hands equally (χ2 (2, N=37)=33.27, p<.001). Only during 22.7% of manual coordination events did residents depend on their non-dominant hand (n=120), which was predominantly used to operate the suture passer device.

Conclusion:Time is frequently used as a metric for surgical experience. Having an understanding of those actions that increase operative time in novices may facilitate training. Our results support the use of focused training to improve hand coordination for bimanual tasks and to improve residents’ use of their non-dominant hand. Future work is necessary to better understand how task completion time and overall performance are affected by residents’ hand coordination during surgical tasks.

48.10 4th Year of Medical School Has No Impact on Medical Student Procedural Skill Competence

Posted on January 18, 2016

C. M. Becker1, M. O. Meyers1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA

Introduction: Acquisition of procedural skills during medical school continues to evolve as . In this study, we sought to examine the impact of the 4th year of medical school on actual and desired procedural competence among medical students at a single US institution over a three year period.

Methods: Under IRB approval, we conducted a survey of 3rd and 4th year students over a three-year period. Students were surveyed at completion of 3rd year and again at graduation. Experience (number of procedures performed), actual and desired levels of competence were measured for nine procedural skills (Table) using a 4-point Likert scale (1=unable to perform; 2= major assistance; 3= minor assistance; 4=independent). Data was analyzed comparing responses from students at completion of 3rd year to those from the same group of students at graduation. Data were compared by Fisher’s exact test.

Results: A greater level of desired competence than actual competence was seen in both 3rd and 4th year for all skills (p<0.001). For no skill was there a greater level of actual or desired competence by 4th year students compared to 3rd year students. 4th year students in 2012 reported a greater number of procedures performed for every skill assessed as compared to 2011 3rd year students (p<0.001 for all); 2013 4th years reported greater numbers only for NG(p=0.01), intubation(p,0.001), IV(p<0.001), Art(p<0.001), LP(p<0.001) and Thor(p=0.04). Actual skill level is reported in the table. 2011 3rd year students desired greater competence than their graduating counterparts for Foley(p=0.01), NG(p=0.003), venipuncture(p=0.006), IV(p=0.002), Art p=0.0005) and LP(p=0.003). In 2012 this was true only for IV(p=0.03).

Conclusion: No difference in competence was seen between 3rd and 4th year students, despite having greater experience at the end of 4th year. Interestingly, 3rd year students were more likely to desire a higher level of independence with procedures than their 4th year counterparts. Both groups desire a greater level of competence than they achieve.

49.01 Open Abdominal Surgical Training Differences Experienced By Integrated Vascular And General Surgery Residents

Posted on January 18, 2016

A. Tanious1, M. Wooster1, A. Jung1, P. Nelson1, M. Shames1 1University Of South Florida,Vascular And Endovascular Surgery,Tampa, FL, USA

Introduction: As the integrated vascular residency program reaches almost a decade of maturity, various groups have analyzed the training provided by this paradigm to assess its ability to produce technically proficient vascular surgeons. A common area of concern amongst trainees is the adequacy of open abdominal surgical training. Truncating the general surgery training component has likely negatively affected the integrated vascular residents’ overall exposure to open abdominal surgical cases. However, it is our belief that, although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have a focused, effective exposure to open aortic surgery during training.

Methods: National operative case log data supplied by the Accreditation Council for Graduate Medical Education was compiled for both graduating integrated vascular surgery residents and graduating categorical general surgery residents for the years 2012 – 2014. Mean total and open abdominal case numbers were compared between the vascular and general surgery residents with more in depth exploration into open abdominal procedures by organ system.

Results: Overall, the mean total 5-year case volume of integrated vascular residents was 1430 cases compared to 980 total cases for general surgery residents during the same time frame. For the vascular residents, this included a mean of 92.2 open abdominal cases compared to 192.1 for general surgery residents. 68% of the open abdominal experience for vascular residents was focused on procedures involving the aorta and its branches with an average of 62.3 open aortic cases throughout their training. The remaining open abdominal cases were accumulated during their general surgery rotations. 98% of the general surgery residents’ open abdominal experience involved non-vascular abdominal surgery spread over 10 different organ systems including an average of 12.1 (6%) pancreatic cases, 12.9 hepatic cases (7%), 62 large intestine cases (32%), and only 4.4 open aortic procedures (2%). Open aortic surgery comprises an average of 9.1% of the total major vascular cases for the vascular residents, whereas open alimentary tract-large intestinal surgery at 6.2% comprises the largest proportion for the average general surgery resident experience.

Conclusion: Integrated vascular surgery residents graduate with less than half of the overall open abdominal surgical case numbers when compared with concurrent graduating general surgery residents. General surgery residents’ open abdominal exposure is divided across 10 separate organ systems with small numbers in high complexity areas like hepatobiliary procedures and an inadequate exposure to aortic procedures. In contrast, vascular residents’ open surgical experience is heavily focused on aortic surgery indicating that the integrated vascular paradigm offers efficient, focused exposure to open aortic procedures.

48.07 Gender Disparities in Academic Productivity and Advancement of Women Surgeons

Posted on January 18, 2016

C. Mueller1, D. Gaudilliere1, C. Kin1, R. Menorca1, M. Nash1, S. Girod1 1Stanford University,Surgery,Palo Alto, CA, USA

Introduction:

Promotion and retention of women surgeons in academia has been a
challenge. We examined gender disparities in research productivity, as measured by
number publications, h-indices and citations, and suggest strategies on how to support
the careers of surgical faculty.

Methods:
The online profiles of full-time faculty members of surgery departments
of three major peer academic centers were reviewed. Faculty were grouped into six
chronological cohorts based on year of medical school graduation. Gender differences
were examined across cohorts and academic rank.

Results:
The profiles of 978 surgeons (234 female, 744 male) were included. Women
at the assistant and full professor levels published less articles than their male
counterparts. Similar significant gender differences were found in all age cohorts,
except in the youngest cohort who graduated after 2000. Even though the impact of
publications as measured by h-index and citations was also mostly lower for female
surgeons by cohorts and rank, these measures did not show a significant difference
and were equal among associate professors.

Conclusion:
We identified gender disparity in the number of publications for female
faculty members across a fifty-year period and by rank. The impact of publications as
measured by the h-index and number of citations, was not consistently different
between the genders at any age or rank. Although the youngest cohort appeared to
avoid the gender divide, the lower quantitative scholarly productivity of women
surgeons may explain the challenges women face in the current academic promotion
system that is mostly focused on quantitative scholarly productivity.

48.08 The Pregnant Female Surgical Resident

Posted on January 18, 2016

V. Shifflette1, S. Cheek1, M. Lorenzo1, J. D. Amos1, M. Allo2, E. Dunn1 1Methodist Hospital,General Surgery,Dallas, TX, USA 2Santa Clara Valley Medical Center,General Surgery,San Jose, CA, USA

Introduction: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. With the numbers of female surgical residents increasing, we wanted to survey the perceived impact that pregnancy has on surgical programs, and on the pregnant female resident.

Methods: We distributed an electronic, on-line 26-question survey to 32 general surgery programs in the southwestern region. The survey link was emailed to the program directors and coordinators. Each program was also contacted by telephone. We asked each program to distribute our survey to the female surgical residents who have been pregnant during residency in the last 5 years. Each program was re-contacted six weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website.

Results: The surveys were sent to 32 general surgery programs and 26 programs responded (81%). Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents). Seven of the programs (27%) stated that they have had zero residents pregnant. We had 22 residents respond (37%). Over half of the residents (55%) were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. The majority of the residents missed elective rotations. Ninety percent of the program directors were accommodating. Most of the faculty were very understanding (55%) and continued to educate (81%). However, 24% of the residents stated that the faculty actually operated with them less. Half of the residents felt that their medical knowledge and technical skills fell behind that of their fellow residents. Thirty-one percent had a lower ABSITE score. Ninety percent of the residents were out 4 weeks or more of maternity leave. Most of the residents (95%) stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work with a child at home was the most difficult part.

Conclusion: As the female influence in medicine increases, pregnancy and the length of maternity leave may need to be better addressed by the American Board of Surgery and residency programs. Our study shows that the programs surveyed were accommodating to the female surgical resident. Nevertheless, despite adequate support from their program and an overall positive experience, many residents indicated that they had a decline in their education and performance.

48.09 Surgery Intern Preparatory Curriculum: A Step-Up Approach to Decrease Anxiety & Improve Performance?

Posted on January 18, 2016

Z. J. Ahola1, S. Sullivan1, S. Agarwal1, A. O’Rourke1, H. Jung1, A. Liepert1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA

Introduction: The transition from medical school to surgical internship is a period of heightened anxiety. To ease this transition, over 50 medical schools have developed courses to prepare graduating medical students for intern responsibilities. This study aimed to demonstrate that a surgical intern preparatory course (S-IPC) decreases student anxiety pertaining to intern year and that an orientation to a simulation experience improves clinical decision-making while lowering anxiety during the simulation.

Methods: Nine fourth year medical students who had matched into an ACGME-accredited general surgery internships participated in the two-week S-IPC. The curriculum was instructed in a step-up approach consisting of lecture-based review sessions, hands-on technical skill instruction, small group discussions, high-fidelity clinical decision-making simulations, and a live porcine surgical experience. The students’ anxiety levels were measured via a six-question short form of the State-Trait Anxiety Index (STAI) prior to the course and surrounding the simulations. Simulation confidence levels were also obtained after each session. For the first simulation session, participants were divided into two groups with only one group receiving an orientation to the simulation environment. An attending surgeon evaluated each participant’s performance during the simulation using a standardized assessment tool. All students received the same orientation prior to the second simulation session which occurred at the end of the course and was comprised of two case scenarios. Following the course, students were asked to reassess anxiety levels regarding intern year.

Results: Prior to the first simulation, the entire cohort reported a heightened level of state anxiety (M = 2.28 ± 0.62) when compared to trait scores (M = 1.64 ± 0.44, Z = –2.31, p = 0.021) with no significant difference observed between the control and oriented groups. Following the first simulation scenario, the oriented group reported a higher confidence level (M = 2.63 ± 0.78) regarding the simulation experience than the control group (M = 1.63 ± 0.29, U = 0.00, p = 0.014). The oriented group significantly outperformed the control group (M = 4.57 ± 0.23 vs. M = 3.11 ± 0.53, U = 0.00, p = 0.014) during that simulation. A difference in performance was not observed during the second or third simulation scenarios. After completion of the course, a decrease in anxiety regarding intern year was observed, although the result was not significant (M = 3.00 ± 0.47 vs. M = 2.78 ± 0.42, Z = –1.414, p = 0.157).

Conclusion: There was not a significant change in participant anxiety regarding the beginning of intern year associated with this S-IPC. However, in the high-fidelity simulation scenario, the oriented group outperformed and reported higher confidence in their performance following the simulation experience than the control group.

48.04 Simulation-Based Training for Pediatric Trauma Resuscitation: A Qualitative Study

Posted on January 18, 2016

R. V. Burke1,2, N. E. Demeter1, C. J. Goodhue1, H. Roesly2, T. P. Chang1,2, A. Rake1,2, E. Cleek1, I. Morton1, J. S. Upperman1,2, A. R. Jensen1,2 1Children’s Hospital Los Angeles,Los Angeles, CA, USA 2University Of Southern California,Keck School Of Medicine,Los Angeles, CA, USA

Introduction: The initial management and stabilization of a critically injured patient requires a large multi-disciplinary team working as a single cohesive unit. Severely injured (ISS>25) children present to freestanding Pediatric Trauma Centers at a relatively low frequency. Major trauma resuscitations in this setting occur infrequently, and as such, team familiarity is lacking. Thus, we implemented simulated trauma resuscitations to assess teamwork, confidence, and communication in the trauma bay. We hypothesized that simulated trauma resuscitations would help identify key components of an effective trauma team.

Methods: Cross-disciplinary trauma team members were recruited from a free-standing Level I pediatric trauma center in Los Angeles County. A demographic survey was administered to participants, and a semi-structured guide was used to lead the focus group. Discussions explored team members’ experiences during trauma activations and simulations. Thematic content analysis was supported using Atlas.ti analytical software examining the following constructs: confidence, leadership, cooperation, communication, situational awareness, and opportunities for improvement.

Results: After institutional review board approval, ten focus groups were conducted between July-August 2014 with a total of 55 participants. Of the 55 participants, 32 (57%) had participated in one of the simulated trauma scenarios followed by debriefing. Participants had an average of 10.3 years of trauma experience and 42 (76%) were female. Provider discipline breakdown was: three surgeons, 12 ED physicians, eight respiratory therapists, 12 ED nurses, five IV nurses and 14 PICU nurses. Themes emerging from the analysis included: characteristics of a strong leader during a trauma, factors impacting trauma team members’ confidence, and effective communication as a key component during trauma response. Participants recommended continued simulations to enhance trauma team trust and efficiency.

Conclusion: Results from this study will be used to design future simulations and refine current protocols to improve trauma response within a freestanding children’s hospital. Results from this study are applicable to other trauma centers as simulated trauma resuscitations provide an opportunity to explore teamwork, confidence, and communication among trauma team members.

48.05 How Motion Tracking Relates to End Product Quality in Laparoscopic Procedures

Posted on January 18, 2016

H. Mohamadipanah1, C. T. Millar1, D. N. Rutherford1, K. E. Law1, R. D. Ray1, C. M. Pugh1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA

Introduction:

Objective measures of surgical skill are needed to improve the feedback trainees receive during their surgical education. Research using motion tracking technology has helped to quantify surgeons' dexterity into performance metrics such as path length, working volume and motion smoothness. This work has successfully shown a difference in these metrics when comparing experts and novices. However, comparing motion metrics with end product quality could provide specific feedback on psychomotor skills and how trainees may improve task completion quality. The purpose of this study is to identify and model the relationship between motion metrics and a quantitative measure of end product quality (‘hernia repair score’) in a simulated laparoscopic ventral hernia (LVH) repair. We hypothesize that lower values of path length, working volume, and motion smoothness relate to higher hernia repair score.

Methods:

Surgical residents (PGY 2-3, N = 39) from Midwestern programs performed a simulated LVH repair. During the procedure, three electromagnetic sensors were placed on each hand (thumb, index finger, and wrist). Position data was used to calculate path length, working volume, and motion smoothness during the placement of the first transfacial suture. After the simulation, the hernia repair was rated using a previously validated checklist to score the quality of mesh attachment on a 24-point scale. To prepare the data, a log transform was applied to the motion smoothness data and factor analysis was used to combine metrics from the six sensors into one or two standardized variables. The relationship between these standardized variables and hernia product score was modeled using linear regression.

Results:

Multiple regression analysis tested if path length significantly predicted hernia repair score. The results indicated that the path length of the dominant (β = -2.084, p = .021) and non-dominant hand (β = -1.830, p = .040) explained 26.1% of the variance in hernia repair score (R2 = .261, F(2, 30) = 5.284, p = .011). However, multiple regression analysis showed that working volume did not significantly predict hernia product score (R2 = .083, F(2, 31) = 1.412, p = .259). A simple regression analysis demonstrated that the log transform of motion smoothness (β = -2.878, p = .001) significantly predicted hernia product score, explaining 28.9% of the variance (R2 = .289, F(2, 31) = 12.616, p = .001).

Conclusion:

Regression analyses show that shorter path lengths and smoother movements significantly predict higher hernia repair quality. While the independent variables account for less than 30% of the variance, it is noteworthy that the motion metrics of a single stitch have significant, predictive validity for final product outcomes. While additional work is needed, these findings have significant implications for the potential use of motion tracking in measuring surgical performance.

48.06 Efficacy of Virtual Reality to Teach Medical Students Laparoscopic Skills

Posted on January 18, 2016

J. Matzke2, C. Ziegler1, S. Crawford1, K. Martin1, E. Sutton1 1University Of Louisville,Hiram C. Polk, Jr. Department Of Surgery,Louisville, KY, USA 2Eureka College,Eureka, ILLINOIS, USA

Introduction: This study evaluates if undergraduate medical trainees’ laparoscopic skills acquisition could be monitored and assessed using a virtual reality (VR) simulator and how the resultant metrics correlate with actual performance of Fundamentals of Laparoscopic Surgery™ (FLS) tasks. A central tenet in creating competency-based curricula in undergraduate medical education is the development of meaningful assessments of medical student performance. Therefore, we studied the use of VR to characterize and assess the laparoscopic skills attained in a competency-based curriculum designed for graduating medical students applying for general surgery residency. Our overall goal is to integrate the milestone competencies for surgery across the educational continuum and document trainee progress toward proficiency.

Methods: Seventeen fourth year medical students applying for surgical residency completed a monitored VR training curriculum comprised of camera navigation (CN), hand eye coordination (HEC) and FLS tasks: circle cutting (CC), ligating loop (LL), peg transfer (PT), and intracorporeal knot tying (IKT). Students completed the curriculum at their own pace over eight weeks. Performance goals were those of the simulator for CN and HEC tasks and the standard goals given in the FLS instruction manual. After 8 weeks, students were observed performing FLS tasks. The best VR performance for each FLS task and the observed performance of the FLS tasks were scored by assigning penalties as described in the FLS instruction manual. The ability of the VR simulator to detect penalties in each of the FLS tasks and correlations of time taken to complete tasks are reported. Additional metrics from the VR simulator were examined for correlation to the commission of penalties.

Results: Sixteen students trained in 100% of the curriculum, though no student achieved proficiency in all of the VR modules within eight weeks. All students were proficient in CN and HEC tasks. Proficiency was achieved in CC, LL PT and IKT by 15, 12, 15, and 1 student respectively. VR simulation showed high specificity for predicting zero penalties on the observed CC, LL, and PT tasks (84%, 81%, and 75%). VR consistently underestimates time for CC, LL, and PT tasks. The interrater reliability of manual and VR times was highest for PT (r=0.508, p=0.014). The number of movements and dominant hand path length positively correlated with the commission of penalties. Needle drops, passes, loading time and time needle is out of view did not correlate with penalties for any task.

Conclusion: VR can be used to monitor and assess medical student acquisition of laparoscopic skills. The absence of penalties in the simulator reasonably predicts the absence of penalties in manual demonstration of CC, LL and PT skills, but not IKT. The documented skills acquired by trainees can be transferred to a graduate medical education program for further monitoring of progress toward proficiency.

48.01 Comparison of Two- and Three-Dimensional Monitor in Laparoscopic Performance by the Position Tracker

Posted on January 18, 2016

M. Nishi1, S. Kanaji1, H. Harada1, M. Yamamoto1, K. Kanemitsu1, K. Yamashita1, T. Oshikiri1, Y. Sumi1, T. Nakamura1, S. Suzuki1, Y. Kakeji1 1Kobe University Graduate School Of Medicine,Division Of Gastrointestinal Surgery, Department Of Surgery,Kobe, HYOGO, Japan

Introduction:

Recently, the stereoscopic vision using three-dimensional (3D) monitor has been expected that improves surgical techniques in laparoscopic surgery. Several studies have reported technical advantages in using 3D monitor regarding accuracy and working speed already. To the best of our knowledge, there have been no reports that analyze motion of forceps by 3D optical tracking systems during performance in laparoscopic phantom tasks.

We attempt to develop the 3D motion analysis system for laparoscopic phantom tasks, and to clarify the efficacy of stereoscopic vision using 3D monitor regarding tracking forceps’ movement.

Methods:

Twenty surgeons performed 3 tasks (task1: simple operation by dominant hand, task2: simple operation by both hands, task3: complicated operation for both hands) under the 2D and 3D vision. During the performance, we tracked and recorded the motion of the forceps’ tip with optical marker that captured by 3D position tracker. This system enables us to visualize track of forceps’ tip. We analyzed the factor of distances of forceps’ tip movement, working times, and technical errors for each tasks from obtained data, and compared these results of using 3D monitor with that of using 2D monitor.

Results:

The mean captured rate for optical marker on forceps was 96.6 percent.

Mean distances of forceps’ tip movement were shorter for all tasks under 3D vision than 2D vision (Mean distances ± SE (cm) Task1: 2D; 48.22 ± 1.33, 3D; 38.79 ± 1.00, P<0.001, Task2: 2D; 132.26 ± 4.20, 3D; 127.21 ± 4.52, P=0.23, Task3: 2D; 606.86 ± 32.13, 3D; 483.23 ± 18.40, P=0.008). Mean working time and technical errors were significant improved for all tasks under 3D vision (Mean working time ± SE (seconds) Task1: 2D; 14.08 ± 0.61, 3D; 12.3 ± 0.51, P=0.035, Task2: 2D; 21.59 ± 0.73, 3D; 18.39 ± 0.42, P=0.0016, Task3: 2D; 76.56 ± 3.46, 3D; 65.11 ± 3.13, P=0.0071, Mean technical errors ± SE (numbers) Task1: 2D; 6.45 ± 0.58, 3D; 2.13 ± 0.22, P<0.001, Task2: 2D; 4.58 ± 0.32, 3D; 1.84 ± 0.17, P<0.001,Task3: 2D; 8.29 ± 0.69, 3D; 4.82 ± 0.48, P<0.001).

Conclusion:

Our results show that the stereoscopic vision using 3D monitor improved surgical techniques with accurate operation and short distances of forceps’ movement, which resulted in short operation time in laparoscopic basic phantom tasks.

48.02 Surgical Investigators Funded through the National Institutes of Health: Then and Now

Posted on January 18, 2016

Y. Hu1, B. L. Edwards1, K. Hu1, K. D. Brooks1, C. L. Slingluff1 1University Of Virginia,Surgical Oncology/Surgery/School Of Medicine,Charlottesville, VA, USA

Introduction: Over the past decade, funding toward surgical research through the National Institutes of Health (NIH) has diminished relative to other medical specialties primarily due to stagnant application volume. The purpose of this study is to characterize key features of academically-successful clinicians, researchers, and institutions. We hypothesized that PhD investigators comprise a growing workforce within the surgery research engine, and that clinically-active junior faculty (assistant and associate professors) are increasingly engaged in outcomes-based research.

Methods: The NIH RePORTER database was queried for all grants awarded in the United States to Departments of Surgery for research in core surgical disciplines during fiscal years 2003 and 2013. F- and T-awards were excluded. Grant summary descriptions were reviewed by two investigators and categorized by research methodology (basic science or translational, clinical trials, outcomes, and other). Principal investigator specialty training and academic position at the time of funding was determined through the RePORTER database and through online academic biographies. Institutions were ranked by number of grants funded. Categorical comparisons between 2013 and 2003 were assessed using Fisher’s Exact test.

Results:Between 2003 and 2013, the total number of grants awarded diminished by 19% (512 vs 613). The number of funded, clinically-active surgeons (MD’s) decreased by 11% (231 vs 264), while funded PhD’s increased by 9% (161 vs 148). Junior faculty are comprising an increasing proportion of funded MD’s (38% vs 19%). Among funded MD’s, an increasing proportion of both junior faculty (16% vs 2%, p = 0.005) and full professors (16% vs 5%, p = 0.018) are engaging in outcomes-based research. Among the top 20 institutions for surgical research in 2003, 15 remained in the top 20 in 2013. Within these 15 institutions, the ratio of MD’s to PhD’s was 2:1 in both fiscal years. Among institutions falling out of the top 20, this ratio was lower than 1:1 in both periods.

Conclusion:An expansion of outcomes-based research is evident across surgeons of all academic positions. Although an increasing fraction of the surgical research workforce is comprised of PhD investigators, the most consistently successful institutions are those that actively cultivate a robust roster of MD researchers. Encouragingly, the population of surgeon-scientists in America is becoming younger, foretelling a promising future for surgical innovation.

48.03 ‘I Got It On Ebay!’: Cost-Effective Approach To Design and Implementation Of Surgical Skills Labs

Posted on January 18, 2016

E. Schneider2, P. J. Schenarts1, V. Shostrom3, C. H. Evans1 1University Of Nebraska Medical Center,Department Of Surgery / Division Of Acute Care Surgery,Omaha, NE, USA 2University Of Nebraska Medical Center,College Of Medicine,Omaha, NE, USA 3University Of Nebraska Medical Center,College Of Public Health/Department Of Biostatistics,Omaha, NE, USA

Introduction:
Surgical education is witnessing a surge in the use of simulation, as time in the OR is too valuable to be used for the acquisition of basic surgical skills. Simulation provides learners the opportunity to become familiar with instruments, improve dexterity, and gain knowledge about surgical techniques outside of the OR. However, implementation of simulation is often cost-prohibitive. Online shopping offers a low budget alternative. The aim of this study is to design and implement cost-effective surgical skills labs and analyze online versus manufacturers’ prices to evaluate for savings.

Methods:
Four surgical skills labs were designed: suturing, tube thoracostomy, bowel anastomosis and laparoscopy, for the general surgery clerkship from July 2014 to June 2015. Each lab was 2 hours in length, including a 30 minute lecture followed by 90 minutes of practice led by 3 faculty surgeons. Skills labs were implemented using hand-built equipment and instruments purchased online on Ebay, Amazon or eSuture. The online and manufacturers’ prices of supplies were compiled and compared. Learners were asked to rate their level of satisfaction (1=not satisfied to 5= highly satisfied) for all educational activities during the clerkship, including live lectures, small group activities and the skills labs.

Results:
119 third year medical students participated in each of the 4 skills labs. Supply lists and costs were compiled for each lab, with per-lab and per-year costs calculated by adding durable and disposable equipment costs. A descriptive cost analysis of online and manufacturers’ prices was performed. Per-lab costs are shown in Table 1. Online prices were substantially lower than manufacturers, with a per-lab savings of: $1779.26 (suturing), $1752.52 (chest tube), $2448.52 (anastomosis), and $1891.64 (laparoscopic), resulting in a per-year savings of $47,285. A general linear model and pairwise comparisons of satisfaction scores was completed, and p-values adjusted using Tukey’s adjustment for multiple comparisons. Satisfaction scores for the skills labs were 4.32, with statistical significance when compared to live lectures at 2.96 (p<0.0001) and small group activities at 3.67 (p<0.0001).

Conclusion:
A cost-effective approach for design and implementation of surgical skills labs showed substantial savings on a per-lab and per-year basis. By utilizing online resources to purchase surgical equipment for use in nonhuman settings, surgical educators overcome financial obstacles limiting the use of simulation and provide learning opportunities that medical students perceive as beneficial to their education.

47.08 Absence of Platelet-Derived TLR4 Improves Perfusion Recovery in Ischemic Skeletal Muscle

Posted on January 18, 2016

B. Xie1, M. Xie1, X. Cui1, J. Xu1, E. Tzeng1, T. Billiar1, U. Sachdev1 1University Of Pittsburgh,Surgery,Pittsburgh, PA, USA

Introduction: We have previously shown that lack of Toll-like Receptor 4 (TLR4), a pattern recognition receptor in the innate immune system, promotes perfusion recovery, angiogenesis and muscle fiber regeneration in a murine hindlimb ischemia model. However, the cell-type responsible for this protective effect has not been elucidated. In other experimental models, platelet-derived TLR4 has been shown to a mediator of damage, possibly through expression of the platelet activation marker P-selectin. We therefore hypothesized that platelet-specific TLR4 similarly mediates inflammation from muscle hypoxia, and that targeted deletion of TLR4 in platelets is protective in limb ischemia.

Methods: Targeted deletion of TLR4 was performed using Cre-Lox site-specific recombinase technology. To generate endothelial cell, platelet and myeloid specific TLR4 knockout mice, TLR4-floxed mice were bred with VE-cadherein-Cre (VEC), platelet-factor 4-Cre (PF4) and LysM-Cre(LysM) mice, respectively. Homozygous mutation was confirmed using PCR. In cell-specific TLR4KO as well as TLR4-floxed (control) mice, femoral artery ligation (FAL) was performed on the right hindlimb, while vessels were exposed without ligation on the left. Perfusion was assessed at baseline, 1, 7 and 14 days after FAL using Laser Doppler perfusion imaging (LDPI). IL-6 ELISA levels 6 hours after FAL were measured from control and PF4-TLR4KO mice. Platelets from control and global TLR4KO mice were isolated from whole blood and activated with buffer, LPS (TLR4 agonist), Pam3CSK4 (TLR2 agonist), HMGB1 (TLR2 and TLR4 agonist) or thrombin (0.25U), and subjected to flow cytometry to assess P-selectin expression.

Results: FAL uniformly resulted in significant, unilateral ischemia. Two weeks after FAL, platelet-specific TLR4KO mice (PF4) demonstrated more perfusion recovery compared to endothelial cell specific (VEC) or myeloid specific (LysM) TLR4KO mice (Figure 1, p<0.02; N=5-8/group; ANOVA). PF4-TLR4KO mice had less serum IL-6 levels compared with controls six hours after FAL (p<0.03, N=3-5/group;t-test). Platelets from control and global TLR4KO mice responded to treatment with thrombin and Pam3CSK4 with increased P-selectin expression. However, when exposed to either LPS or HMGB1, platelet P-Selectin expression did not increase significantly over baseline.

Conclusion: As opposed to myeloid and endothelial cells, platelet sources of TLR4 negatively mediated perfusion recovery following FAL, promoting release of IL-6 after injury. However, platelets with functional TLR4 did not respond to traditional TLR4 agonists with P-selectin expression. Thus, the mechanism for a protective effect of platelet –specific TLR4 deletion in muscle ischemia may be P-selectin independent.

47.09 Cytokines and Neuropeptide Receptors in a Neuroischemic Rabbit Model of Wound Healing

Posted on January 18, 2016

J. M. Johnson1, M. Orrgren1, M. Auster1, F. W. LoGerfo1, L. K. Pradhan-Nabzdyk1 1Beth Israel Deaconess Medical Center,Vascular And Endovascular Surgery/Surgery,Boston, MA, USA

Introduction: The role of inflammatory cytokines and neuropeptides in peripheral neuropathy and ischemia is not completely understood. These complications of diabetes are known to be major factors in the development of chronic diabetic foot ulcers and non-traumatic limb amputation. This study investigates gene expression of inflammatory cytokines (IL-8, its receptor CXCR1 and IL-6) and neuropeptide receptors (NPY receptors, NPY2R and NPY5R and Substance P receptor, NK1R) in a diabetic rabbit neuroischemic wound healing model.

Methods: New Zealand White rabbits received saline or alloxan monohydrate for the induction of diabetes. 30 days post-alloxan or saline all rabbits underwent wound procedure. In all rabbits, the central and rostral, arteries and nerves in one ear were ligated and resected to induce neuroischemia while in the other ear, arteries and nerves were left intact (sham). Four 6mm full thickness wounds were created in both ears. Rabbits were euthanized at two or ten days post-surgery and wounds were harvested. To confirm diabetes, blood glucose (BG) levels and glycated hemoglobin (HbA1c) were monitored. Rabbits with BG over 250mg/dL and HbA1c levels above 6.5 were considered diabetic. Wound size (% of original wound) was monitored in the 10-day group using computerized planimetry. Using Q-RT-PCR, gene expression was compared between the skin of non-diabetic and diabetic rabbits. Change in gene expression within the sham and neuroischemic wounds (D2 or D10) relative to skin (D0) were also measured and comparisons were made between non-diabetic and diabetic rabbits. All measurements are presented as mean±SEM. N= 3-6 rabbits.

Results: Compared to non-diabetic rabbits, rabbits treated with alloxan had higher BG and HbA1C levels on the day of surgery (112±5.16 mg/dL and 4.65±0.18 vs. 289±22.6 mg/dL and 7.3±0.36). Ten days post-surgery, compared to non-diabetic sham wounds, healing was significantly impaired in diabetic sham wounds (51.74±5.66% vs.62.97±4.65%). Within the neuroischemic wounds, there was no difference in healing between non-diabetic (83.52±3.34) and diabetic (86.49±1.73) rabbits. Gene expression of inflammatory markers, IL-8, CXCR1 and IL-6 was different between non-diabetic and diabetic sham wounds but not neuroischemic wounds, and that of neuropeptide markers, NPY2R, NPY5R and NK1R was significantly different between non-diabetic and diabetic sham and neuroischemic wounds (Figure).

Conclusion: Inflammatory cytokines and neuropeptide markers may play an important role in diabetic wound healing. The rabbit neuroischemic model can be used to study chronic wound-healing impairment in diabetes.

« Previous Page
Next Page »