Trends in Surgical Critical Care Fellowship Match: An Analysis of National Resident Matching Program Data.

INTRODUCTION: Surgical Critical Care (SCC) fellowship applications are made through March-July the year prior to the fellowship, while the match process takes place through the National Resident Matching Program (NRMP). There is paucity of high quality data on matching trends in SCC fellowship in the United States. METHODS: We conducted a retrospective cohort study of all applicants in the SCC match over a period of fifteen years (2009-2023). Publicly published data about the SCC fellowship match were retrieved from the NRMP online portal. Mann Kendall trend test was used to obtain a Tau statistic and p-values for temporal trends over time. Chi-square test was used to investigate association between categorical variables. RESULTS: From 2009 to 2023, the number of SCC fellowship positions increased from 143 to 340 (138% increase) while the number of applicants rose from 95 to 289 (204% increase). The overall match rate for applicants significantly rose from 89.5% to 93.4% (7.7% increase; t = 0.600, p = 0.002). The percentage of positions filled also increased from 59.4% in 2009 to 79.4% in 2023. The match rate over the past five years (2019-2023) was 90.8%. US-MD applicants had a significantly higher 94.8% match rate throughout the study period than non-US MD applicants (94.8% vs. 87.3%, p<0.001). While the match rate for US-MD applicants has stayed consistent from 2009 to 2023 (τ = 0.371, p = 0.054), the match rate for non-US-MD applicants increased from 77.3% in 2009 to 86.9% in 2023 (τ = 0.771, p<0.001). CONCLUSION: SCC fellowship continues to grow with more positions and applicants. Match rates into SCC fellowships have increased over the past fifteen years, primarily helping non-US MDs match successfully.

Predictors of in-hospital appendiceal perforation in patients with non- perforated acute appendicitis with appendicolithiasis at presentation.

INTRODUCTION: Appendicolithiasis is a risk factor for perforated acute appendicitis. There is limited inpatient data on predictors of progression in appendicolithiasis-associated non-perforated acute appendicitis. METHODS: We identified adults presenting with appendicolithiasis-associated non-perforated acute appendicitis (on computed tomography) who underwent appendectomy. Logistic regression was used to investigate predictors of in-hospital perforation (on histopathology). RESULTS: 296 patients with appendicolithiasis-associated non-perforated acute appendicitis were identified; 48 (16.2%) had perforation on histopathology. Mean (standard deviation [SD]) age was 39 (14.9) years. The mean (SD) length of stay (LOS) was 1.5 (1.8) days. LOS was significantly longer with perforated (mean [SD]: 3.0 [3.1] days) vs. non-perforated (mean [SD]: 1.2 [1.2] days) appendicitis (p < 0.001). On multivariate analysis, in-hospital perforation was associated with age > 65 years (OR 5.4, 95% CI: 1.4- 22.2; p = 0.015), BMI > 30 kg/m2 (OR 3.5, 95% CI: 1.3-8.9; p = 0.011), hyponatremia (OR 3.6, 95% CI: 1.3-9.8; p = 0.012). There was no significant association with age 25-65 years, gender, race, steroids, time-to- surgery, neutrophil percentage, or leukocyte count. CONCLUSION: Geriatric age, obesity, and hyponatremia are associated with progression to perforation in appendicolithiasis-associated non-perforated acute appendicitis.

Incidental aortocaval fistula in the setting of an unruptured abdominal aortic aneurysm.

An aortocaval fistula, a rare abnormal vascular communication between the aorta and inferior vena cava, is most commonly associated with abdominal aortic aneurysms (AAAs). Other factors leading to aortocaval fistula formation include atherosclerosis, collagen vascular diseases, vasculitis, hematogenous infections, prior spinal surgery, malignancy and radiation exposure. In rare instances, aortocaval fistulas may be discovered incidentally on abdominal imaging. We report an unusual case of an incidental aortocaval fistula in a 93-year-old male patient with an unruptured AAA, presenting with shortness of breath, malaise and lethargy. The patient had no other obvious risk factors for aortocaval fistula formation. Multidetector computed tomography angiography helped identify the fistula, and the patient was eventually transferred to hospice for comfort measures. This case highlights the importance of detailed imaging and preoperative planning in managing aortocaval fistulas and associated AAAs.

Extracellular Vesicle-microRNAs as Diagnostic Biomarkers in Preterm Neonates.

Neonates born prematurely (<37 weeks of gestation) are at a significantly increased risk of developing inflammatory conditions associated with high mortality rates, including necrotizing enterocolitis, bronchopulmonary dysplasia, and hypoxic-ischemic brain damage. Recently, research has focused on characterizing the content of extracellular vesicles (EVs), particularly microRNAs (miRNAs), for diagnostic use. Here, we describe the most recent work on EVs-miRNAs biomarkers discovery for conditions that commonly affect premature neonates.