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American Journal of Surgery

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https://www.readbyqxmd.com/read/28438261/the-affordable-care-act-and-its-association-with-length-of-stay-and-payer-status-for-trauma-patients-at-a-level-i-trauma-center
#1
Vicente Jose Undurraga Perl, Chris Dodgion, Kyle Hart, Bruce Ham, Martin Schreiber, David Zonies
BACKGROUND: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes. METHODS: A retrospective review of adult trauma patients admitted to a level I trauma center between 2012 and 2014 was performed. Demographics, length of stay, payer status, discharge disposition, and complications before and after the ACA implementation were analyzed. RESULTS: 4448 trauma patients were admitted during the study period...
April 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28433229/splenectomy-is-associated-with-higher-infection-and-pneumonia-rates-among-trauma-laparotomy-patients
#2
Kelly A Fair, Christopher R Connelly, Kyle D Hart, Martin A Schreiber, Jennifer M Watters
Splenectomy increases lifetime risk of thromboembolism (VTE) and is associated with long-term infectious complications, primarily, overwhelming post-splenectomy infection (OPSI). Our objective was to evaluate risk of VTE and infection at index hospitalization post-splenectomy. Retrospective review of all patients who received a laparotomy in the NTDB. Propensity score matching for splenectomy was performed, based on ISS, abdominal abbreviated injury score >3, GCS, sex and mechanism. Major complications, VTE, and infection rates were compared...
April 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28416180/revision-of-sleeve-gastrectomy-to-roux-en-y-gastric-bypass-a-canadian-experience
#3
Ekua Yorke, Caroline Sheppard, Noah J Switzer, David Kim, Christopher de Gara, Shahzeer Karmali, Aliyah Kanji, Daniel Birch
INTRODUCTION: Sleeve gastrectomy (SG) can be associated with inadequate weight loss, insufficient resolution of co-morbidities and severe reflux. Conversion to Roux-en-Y Gastric Bypass (RYGB) is a potential solution. The aim of this study was to determine the common indications for conversion from SG to RYGB at our centre, and evaluate patient outcomes with respect to weight loss and co-morbidity resolution. METHODS: A retrospective review of patients who underwent conversion from SG to RYGB between 2008 and 2015...
April 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28404204/global-surgical-electives-in-residency-the-impact-on-training-and-future-practice
#4
Melike Harfouche, Leandra Krowsoski, Amy Goldberg, Zoe Maher
BACKGROUND: The purpose of this study was to evaluate perceptions regarding the value of global surgical electives (GSEs) and pursuit of a career in global surgery amongst residents and surgeons. METHODS: We sent an anonymous questionnaire to all current and former surgical residents of our tertiary-care, university-based institution from the years 2000-2013. Questions addressed the experience and value of practicing surgery in low or middle income countries (LMIC) in residency and as a career...
April 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28410631/comparison-of-three-caval-reconstruction-techniques-in-orthotopic-liver-transplantation-a-retrospective-review
#5
Tiffany Chan, Kristin DeGirolamo, Stephanie Chartier-Plante, Andrzej K Buczkowski
BACKGROUND: Classic caval reconstruction during liver transplantation involves complete cross-clamping and resection of the recipient inferior vena cava (IVC) followed by donor IVC interposition. Other techniques preserve the IVC, with piggyback (PB) to the hepatic veins or side-to-side (SS) caval anastomosis. Avoidance of cross-clamping may be beneficial for minimizing hemodynamic instability and transfusion requirements. METHODS: Retrospective review of a provincial transplant database (2007-2011)...
April 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28408112/outcome-comparisons-between-high-volume-robotic-and-laparoscopic-surgeons-in-a-large-healthcare-system
#6
Laila Rashidi, Chris Neighorn, Amir Bastawrous
Robotic colorectal surgery has been performed for nearly a decade, but has been criticized for high cost. We sought to assess outcomes of colorectal operations performed by surgeons with higher experience in robotics and laparoscopy across a large health system. We performed a retrospective review of colon or rectal resections performed between January 2013 and May 2016 within the Providence Health and Services. Surgeons were only included if they performed 30 or more procedures with an approach per year. We assessed outcomes including operative time, hospital length of stay, complications, readmission, conversion to open rates and total direct costs...
April 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28416179/increased-risk-of-ventral-hernia-recurrence-after-pregnancy-a%C3%A2-nationwide-register-based-study
#7
Erling Oma, Kristian K Jensen, Lars N Jorgensen
BACKGROUND: Female patients of reproductive age constitute a substantial portion of patients undergoing ventral hernia repair, however the impact of pregnancy on the risk of recurrence is scarcely documented. The aim of the study was to evaluate if pregnancy following ventral hernia repair was associated with an increased risk of recurrence. METHODS: This nationwide cohort study included all female patients of reproductive age registered in the Danish Ventral Hernia Database with ventral hernia repair between 2007 and 2013...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28412996/laparoscopic-surgery-versus-open-resection-in-patients-with-gastrointestinal-stromal-tumors-an-updated-systematic-review-and-meta-analysis
#8
Hanchu Xiong, Ji Wang, Yunlu Jia, Chenyang Ye, Yi Lu, Cong Chen, Jianguo Shen, Yongxia Chen, Wenhe Zhao, Linbo Wang, Jichun Zhou
PURPOSES: The contemporary surgery has reported the safety of laparoscopic surgery (LAP) for patients with gastrointestinal stromal tumors (GISTs). However, its use is still debated due to suspicion of the oncologic equivalence to open surgery (OPEN). We conducted a systematic review and meta-analysis of updated original articles to investigate the short- and long-term clinical outcomes of LAP compared with OPEN for GISTs. METHODS: A systematic search was performed in PubMed, Embase, Web of Science, Cochrane Library and CNKI...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28410630/tumor-size-as-a-prognostic-factor-in-patients-with-stage-iia-colon-cancer
#9
Francesco Santullo, Alberto Biondi, Ferdinando C M Cananzi, Valeria Fico, Flavio Tirelli, Riccardo Ricci, Gianluca Rizzo, Claudio Coco, Claudio Mattana, Domenico D'Ugo, Roberto Persiani
BACKGROUND: The aim of this study was to identify stage II colon cancer patients with a high risk of recurrence. METHODS: All patients who underwent surgery for stage II colon cancer (CC) were retrospectively enrolled and sub-grouped according to TNM staging (IIa-b-c) and stage IIa in high (IIaHR) and low risk (IIaLR) according to pathologic features. The primary outcomes measured were the 5-year overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 214 patients were reviewed...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28408113/surgical-outcomes-in-women-%C3%A2-70-years-undergoing-mastectomy-with-and-without-reconstruction-for-breast-cancer
#10
Simone Mays, Hanan Alabdulkareem, Paul Christos, Rache Simmons, Tracy-Ann Moo
BACKGROUND: Approximately 4% of women age 70 will develop breast cancer during the next ten years. Reconstruction has become a standard option for young women undergoing mastectomy for breast cancer, however may not be offered to older women due to the presence of co-morbidities. There is limited data on the outcomes of mastectomy with reconstruction in patient's ≥ 70. This study examines comorbidities and 30-day complication rates in patients ≥70 undergoing mastectomy for breast cancer...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28404205/circumferential-pedicled-omental-flap-for-protection-of-portomesenteric-venous-reconstruction-and-gastroduodenal-artery-stump-following-pancreatoduodenectomy
#11
Angelena Crown, Adnan Alseidi, Thomas Biehl, Scott Helton, Flavio G Rocha
No abstract text is available yet for this article.
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28400048/near-perfect-compliance-with-scip-inf-9-had-no-effect-on-catheter-utilization-or-urinary-tract-infections-at-an-academic-medical-center
#12
Jennifer A Kaplan, Jonathan T Carter
BACKGROUND: The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown. METHODS: Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28396034/optimizing-physician-skill-development-for-medical-students-the-four-part-assessment
#13
Justin J J Watson, Phillip M Kemp Bohan, Katrina Ramsey, John D Yonge, Christopher R Connelly, Richard J Mullins, Jennifer M Watters, Martin A Schreiber, Laszlo N Kiraly
BACKGROUND: Medical student performance has been poorly correlated with residency performance and warrants further investigation. We propose a novel surgical assessment tool to determine correlations with clinical aptitude. METHODS: Retrospective review of medical student assessments from 2013 to 2015. Faculty rating of student performance was evaluated by: 1) case presentation, 2) problem definition, 3) question response and 4) use of literature and correlated to final exam assessment...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28396033/improving-transitions-of-care-across-the-spectrum-of-healthcare-delivery-a-multidisciplinary-approach-to-understanding-variability-in-outcomes-across-hospitals-and-skilled-nursing-facilities
#14
Giana H Davidson, Elizabeth Austin, Lucas Thornblade, Louise Simpson, Thuan D Ong, Hanh Pan, David R Flum
INTRODUCTION: Improving coordination during transitions of care from the hospital to Skilled Nursing Facilities (SNF)s is critical for improving healthcare quality. In 2014, we formed (Improving Nursing Facility Outcomes using Real-Time Metrics, INFORM) to improve transitions of care by identifying structural and process factors that lead to poor clinical outcomes and hospital readmission. METHODS: Stakeholders from 10 SNFs and 4 hospitals collaborated to assess the current hospital and system-level challenges to safe transitions of care and identify targets for interventions...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28396032/dissatisfaction-after-laparoscopic-heller-myotomy-the-truth-is-easy-to-swallow
#15
Alexander Rosemurgy, Darrell Downs, Gianvanna Jadick, Forat Swaid, Kenneth Luberice, Carrie Ryan, Sharona Ross
BACKGROUND: Although laparoscopic Heller myotomy has been shown to well palliate symptoms of achalasia, we have observed a small subset of patients who are "Dissatisfied". This study was undertaken to identify the causes of their dissatisfaction. STUDY DESIGN: Patients undergoing laparoscopic Heller myotomy from 1992 to 2015 were prospectively followed. Using a Likert scale, patients rated their symptom frequency/severity before and after the procedure. Patients graded their experience from "Very Satisfying" to "Very Unsatisfying...
April 5, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28431588/chiva-a-prospective-study-of-a-vein-sparing-technique-for-the-management-of-varicose-vein-disease
#16
Marta Zmudzinski, Pierre Malo, Christine Hall, Allen Hayashi
BACKGROUND: Varicose vein disease (VVD) affects approximately one third of adults. Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) is a minimally invasive, vein sparing technique that is emerging as an alternative to ablative techniques for treating VVD. METHODS: This prospective study assessed the rate of recurrence of venous reflux with CHIVA. We evaluated 150 primary procedures with clinical and duplex ultrasound examinations pre and post operatively...
April 4, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28438260/more-is-better-lymph-node-harvesting-in-colorectal-cancer
#17
S O'Boyle, K Stephenson
INTRODUCTION: We sought to determine if lymph node harvesting and survival for CRC were comparable between laparoscopic and open resections in a community hospital setting. METHODS: A retrospective chart review of patients at two community hospitals who underwent open or laparoscopic resection for CRC between January 2008 and September 2013 was performed. RESULTS: Three hundred seventy-one patients had open and 110 had laparoscopic resections...
March 31, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28404206/farming-and-ranching-related-injuries-in-southern-idaho
#18
Jackson Shaver, Drew McRoberts, Brian O'Byrne, Bill Morgan, Kevin Krall, Christian Surjan, John Mayberry
INTRODUCTION: Agriculture is an inherently dangerous industry. We sought injury data for use with the Idaho Time Sensitive Emergency (TSE) system to formulate goals and track improvements. METHODS: Registries in southern Idaho were queried for ICD-9-CM diagnoses related to agriculture in 2014. Injuries known or likely to have occurred on properties intended for farming, ranching, animal care, or milk production, and relating to those activities were included. RESULTS: Among 72 patients, injuries were related to horses (31%), machinery (17%), ATVs (17%), and hay bales/haystacks (13%)...
March 31, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28388972/disparities-in-incidence-of-early-and-late-onset-colorectal-cancer-between-hispanics-and-whites-a-10-year-seer-database-study
#19
Jenna Koblinski, Jana Jandova, Valentine Nfonsam
BACKGROUND: Racial disparities in incidence of colorectal cancer (CRC) exist. In Hispanics, CRC was the second most commonly diagnosed cancer in 2012. METHODS: We abstracted the national estimates for Hispanics/Whites with CRC using the SEER database between 2000 and 2010. Trends in incidence, mortality, gender and stage of disease were analyzed for early-onset (age<50; EO - young) and late-onset (age>50; LO - old) cases. RESULTS: The overall incidence of CRC increased by 48% in Hispanics...
March 31, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28390649/abbreviated-closure-for-remote-damage-control-laparotomy-in-extreme-environments-a-randomized-trial-of-sutures-versus-wound-clamps-comparing-terrestrial-and-weightless-conditions
#20
Andrew W Kirkpatrick, Jessica Lynn McKee, Colonel Homer Tien, Anthony J LaPorta, Kit Lavell, Tim Leslie, Paul B McBeth, Derek J Roberts, Chad G Ball
INTRODUCTION: Far-Forward Damage Control Laparotomies (DCLs) might provide direct-compression of visceral hemorrhage, however, suturing is a limiting factor, especially for non-physicians. We thus compared abbreviated skin closures comparing skin-suture (SS) versus wound-clamp (WC), on-board a research aircraft in weightlessness (0g) and normal gravity (1g). METHODS: Surgeons conducted DCLs on a surgical-simulator; onboard the hangered-aircraft (1g), or during parabolic flight (0g), randomized to either WC or SS...
March 30, 2017: American Journal of Surgery
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