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Background: Although surgical stabilization for rib fractures (SSRF) has been adopted widely over the past decade, little information is available regarding the prevalence and outcomes of post-operative surgical site infection (SSI). We hypothesized that SSI after SSRF is uncommon but morbid. Patients and Methods: Patients undergoing SSRF at a level 1 trauma center from 2010-2020 were reviewed. The primary outcome was the prevalence of SSI, documented by clinical examination, radiography, systemic markers of infection, and microbiology. Results: Of 228 patients undergoing SSRF, 167 (73.2%) were male, the median age was 53 years (P25-P75; 41-63 years), injury severity score (ISS) was 19 (P25-P75, 13-26), with a median of eight fractured ribs (P25-P75, 6-11). All stabilization plates were titanium. SSRF was typically performed on post-injury day one (P25-P75, 0-2 days) after trauma. All patients received antibiotic agents within 30 minutes of incision, and a median of four ribs (P25-P75, 3-6) were repaired. Four (1.8%) patients developed an SSI and all underwent implant removal. Two patients required implant removal within 30 days (on post-operative day seven and 17) and two for chronic infection at seven and 17 months after SSRF. The causative organism was methicillin-sensitive Staphylococcus aureus (MSSA) bacteria in all patients. After implant removal, three patients received intravenous and oral antibiotic agents, ranging from two to six weeks, without recurrent infection. No patient required additional SSRF. Conclusions: Surgical site infection after SSRF is rare but morbid and can become symptomatic within one week to 17 months. Implant removal results in complete recovery.

Background Resident involvement in operations increases operative duration. This study investigated resident impact on operative time for a single general surgeon in an outpatient surgical setting. Methods A retrospective review was performed of index general surgical operations meeting inclusion criteria. Operative duration, patient demographics, 30-day complication/readmission rates, and degree of resident involvement were collected. Results 625 cases were analyzed. Patient demographics were similar for all procedural comparison groups. Operative time increased with resident involvement for each operation—umbilical hernia repairs were associated with a 19% increase (22.3 ± 6.7 versus 26.5 ± 7.5 min, p = 0.002), laparoscopic cholecystectomies demonstrated a 15% increase (25.8 ± 8.7 versus 29.7 ± 10.2 min, p = 0.001), and laparoscopic inguinal hernia repairs demonstrated a 25% increase (32.1 ± 11.3 versus 40.2 ± 8.9 min, p Conclusions Each surgeon must decide if the increase in operative duration caused by resident involvement is justified by the intangible benefits residents provide.

Background Immediately fatal motorcycle crashes have not been well characterized. This study catalogues injuries sustained in fatal motorcycle crashes and assesses the impact of crash conditions on injury patterns. Methods Autopsy records from the office of the medical examiner of Kent County, MI and publicly available traffic reports were queried for information pertaining to motorcyclists declared dead on-scene between January 1, 2007, and December 31, 2016. Results A total of 71 autopsies of on-scene motorcycle crash fatalities were identified. The two most prevalent injuries were traumatic brain injury (TBI) (85%) and rib fractures (79%). The majority of fatalities occurred in daylight hours (54.3%) and in a 55 mph speed limit zone (63.8%). Conclusions This study provides a catalogue of the injuries sustained in immediately fatal motorcycle crashes and the associated conditions. Advocacy efforts that highlight the risks associated with motorcycle riding and that promote safe riding practices are warranted.

Many postoperative concerns after common general operative procedures may be addressed over the phone, thereby saving time and resources for both the patient and surgeon.Over a 6-month time period, patients who underwent laparoscopic cholecystectomy, appendectomy for uncomplicated appendicitis, and inguinal or umbilical hernia repair were mailed an anonymous survey. The primary outcome measure was whether or not patients felt their concerns could have been addressed adequately over the phone in place of an office visit.A total of 1,406 surveys were mailed with 339 responses (24%: 174 laparoscopic cholecystectomy, 83 inguinal hernia, 41 appendectomy, and 41 umbilical hernia). One hundred twelve (33%) felt their concerns could have been addressed adequately over the phone without an office visit. Patients who spent less time with their doctor at the appointment favored telephone follow-up (P.001). Patients undergoing inguinal hernia were less interested in telephone follow-up compared with laparoscopic cholecystectomy (15% vs 41%; P.001), appendectomy (15% vs 34%; P = .018), and umbilical hernia (15% vs 37%; P = .010). Of 66 patients (20%) with self-reported complications, 44% sought care from a healthcare provider other than their primary surgeon.These observations are important for healthcare organizations seeking to maximize surgeon efficiency while improving patient satisfaction.