BACKGROUND The purpose of this study is to compare the compositions of federally-funded surgical research between 2003 and 2013, and to assess differences in funding trends between surgery and other medical specialties. DATA SOURCES The NIH RePORTER database was queried for grants within core surgical disciplines during 2003 and 2013. Funding was categorized by award type, methodology, and discipline. Application success rates for surgery and five non-surgical departments were trended over time. RESULTS Inflation-adjusted NIH funding for surgical research decreased 19% from $270M in 2003 to $219M in 2013, with a shift from R-awards to U-awards. Proportional funding to outcomes research almost tripled, while translational research diminished. Non-surgical departments have increased NIH application volume over the last 10 years; however, surgery’s application volume has been stagnant. CONCLUSIONS To preserve surgery’s role in innovative research, new efforts are needed to incentivize an increase in application volume.

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Background Disparate lower extremity ultrasound (LUS) screening practices among trauma institutions reflect lack of consensus regarding screening indications and whether screening improves outcomes. We hypothesized that LUS screening for DVT is not associated with reduced incidence of pulmonary embolism (PE). Methods The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108 patients treated at institutions reporting at least one LUS and at least one DVT. Institutions performing LUS on more than 2% of admitted patients were designated high screening (HS) facilities and remaining institutions were designated low screening (LS) facilities. Patient characteristics and risk factors were used to develop a logistic regression model to assess the independent associations between LUS and DVT, and between LUS and PE. Results Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were more commonly reported in HS than LS (DVT: 1.12% vs. 0.72%, p<0.0001; PE: 0.40% vs. 0.33%, p=0.0004). Multivariable logistic regression demonstrated that LUS was independently associated with DVT (OR=1.43, CI 1.34-1.53) but not PE (OR=1.01, CI 0.92-1.12) (c-statistic 0.86 and 0.85, respectively). Sensitivity analyses performed at various rates for designating HS facilities did not alter the significance of these relationships. Conclusions LUS in trauma patients is not associated with a change in the incidence of pulmonary embolism. Aggressive LUS DVT screening protocols appear to detect many clinically insignificant DVTs for which subsequent therapeutic intervention may be unnecessary, and the use of these protocols should be questioned.

Background National guidelines recommend one dose of perioperative antibiotics for breast surgery and discourage postoperative continuation. However, reported skin and soft tissue infection (SSI) rates after mastectomy range from 1–26 %, higher than expected for clean cases. Utility of routine or selective postoperative antibiotic use for duration of drain presence following mastectomy remains uncertain. Methods This study included all female patients who underwent mastectomy without reconstruction at our institution between 2005 and 2012. SSI was defined using CDC criteria or clinical diagnosis of cellulitis. Information on risk factors for infection (age, body mass index [BMI], smoking status, diabetes, steroid use), prior breast cancer treatment, drain duration, and antibiotic use was abstracted from medical records. Multivariable logistic regression was used to assess the association between postoperative antibiotic use and the occurrence of SSI, adjusting for concurrent risk factors. Results Among 480 patients undergoing mastectomy without reconstruction, 425 had sufficient documentation for analysis. Of these, 268 were prescribed antibiotics (63 %) at hospital discharge. An overall SSI rate of 7.3 % was observed, with 14 % of patients without postoperative antibiotics developing SSI compared with 3.4 % with antibiotics (p < 0.0001). Factors independently associated with SSI were smoking and advancing age. Diabetes, steroid use, BMI, prior breast surgery, neoadjuvant chemotherapy, prior radiation, concomitant axillary surgery, and drain duration were not associated with increased SSI rates. Conclusions SSI rates among patients who did and did not receive postoperative antibiotics after mastectomy were significantly different, particularly among smokers and women of advanced age. These patient subgroups may warrant special consideration for postoperative antibiotics.