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American Journal of Surgery

Lisa M Francomacaro, Charles Walker, Kathryn Jaap, James Dove, Marie Hunsinger, Kenneth Widom, Denise Torres, Mohsen Shabahang, Joseph Blansfield, Jeffrey Wild
BACKGROUND: Emergent laparotomies are associated with higher rates of morbidity and mortality. Recent studies suggest sarcopenia predicts worse outcomes in elective operations. The purpose of this study is to examine outcomes following urgent exploratory laparotomy in sarcopenic patients. METHODS: This was a retrospective review of patients in a rural tertiary care facility between 2010 and 2014. Patients underwent a laparotomy within 72 h of admission and had an abdomen/pelvis CT scan were included...
November 6, 2018: American Journal of Surgery
Christina Norrbom, Marianne Steding-Jessen, Carsten Thye Agger, Merete Osler, Marie Krabbe-Sorensen, Annette Settnes, Lisbeth Nilas, Ellen Christine Leth Loekkegaard
BACKGROUND: Adhesive bowel obstruction is associated with considerable morbidity and mortality, but the magnitude of the risk is debated. METHOD: In a national cohort of all Danish women with an abdominal operation (N = 665,423) between 1977 and 2013, the risk of adhesive bowel obstruction was assessed by Cox multiple regression. Covariates were the number of abdominal operations, the surgical methods, the anatomical site involved, and the calendar year. RESULTS: In the cohort, 1...
November 2, 2018: American Journal of Surgery
Matthew M Fleming, Michael P DeWane, Jiajun Luo, Fangfang Liu, Yawei Zhang, Kevin Y Pei
BACKGROUND: Percutaneous cholecystostomy (PC) is an initial alternative to laparoscopic cholecystectomy (LC) for complicated acute cholecystitis (AC). No studies have directly compared costs of index hospitalization and readmissions between PC and LC patients. METHODS: The Nationwide Readmissions Database was queried for patients undergoing PC or LC for AC from 2013 through 2014. Primary outcomes including length of stay, and index and total hospital costs at 30- and 60-days were evaluated after 1:1 propensity score matching for patient and hospital characteristics...
November 2, 2018: American Journal of Surgery
Michael LeCompte, Melissa Stewart, Timothy Harris, Gregory Rives, Christy Guth, Jesse Ehrenfeld, Kevin Sexton, Kyla Terhune
INTRODUCTION: "See one, do one, teach one" has represented the model for surgical education for over a century, however recent changes in education have reduced autonomy in training. The goal of this study was to assess the impact of autonomy on learning a procedural skill. METHODS: Senior medical students were randomized and trained to performance a vascular anastomosis utilizing progressive autonomy vs. constant supervision. Performance was tested using videotaped technical grading and anastomotic pressure testing...
November 1, 2018: American Journal of Surgery
Tarik D Madni, Evan Barrios, Jonathan B Imran, Luis Taveras, Audra T Clark, Holly B Cunningham, Alana Christie, Stephen Luk, Herb A Phelan, Michael W Cripps
BACKGROUND: Surgical training is under scrutiny for the effect increased resident autonomy may have on patient outcomes. We hypothesize that as laparoscopic cholecystectomy (LC) difficulty increases, there will be increased involvement by senior residents and attending physicians with no differences in complications. METHODS: Ten acute care surgeons were asked to fill out a postoperative questionnaire regarding surgical difficulty after every LC between 11/9/2016 and 3/30/2017...
October 31, 2018: American Journal of Surgery
Leonardo de Castro Duraes, Scott R Steele, Mariane Gouvêa Monteiro de Camargo, Emre Gorgun, Matthew F Kalady, Michael Valente, Anuradha Bhama, Conor Patrick Delaney
BACKGROUND: This study aimed to evaluate the oncological outcomes of conversion in patients undergoing resection for colon cancer. METHODS: Patients with stages I-III colon adenocarcinoma operated on between 2000 and 2012 were included. Oncologic outcomes were assessed by surgical approach (laparoscopy vs. open). A secondary analysis compared patients who required conversion to open vs. laparoscopic only. RESULTS: We identified 1196 patients that met inclusion criteria (28% laparoscopic, 72% open)...
October 31, 2018: American Journal of Surgery
Laurel A Milam, Geoffrey L Cohen, Claudia Mueller, Arghavan Salles
No abstract text is available yet for this article.
October 31, 2018: American Journal of Surgery
Charles Walker, Katelyn Young, Ali Moosavi, Nicholas Molacek, James Dove, Marie Hunsinger, Joseph Blansfield, Kenneth Widom, Denise Torres, James Gregory, Jeffrey Wild
BACKGROUND: Current guidelines do not specifically address optimal antibiotic duration following cholecystostomy. This study compares outcomes for short-course (<7 days) and long-course (≥7 days) antibiotics post-cholecystostomy. METHODS: This was a retrospective review of cholecystostomy patients (≥18 years) admitted (1/1/2007-12/31/2017) to one healthcare system. RESULTS: Overall, 214 patients were studied. Demographics were similar, except short-course patients had higher Charlson Comorbidity Index (p < 0...
October 29, 2018: American Journal of Surgery
Cigdem Benlice, Luca Stocchi, Ipek Sapci, Emre Gorgun, Hermann Kessler, David Liska, Scott R Steele, Conor P Delaney
BACKGROUND: The purpose of this study was to determine the impact of the incision used for specimen extraction on wound infection during laparoscopic colorectal surgery. METHODS: All patients undergoing elective laparoscopic colorectal resection in a single specialized department from 2000 to 2011 were identified from a prospectively maintained institutional database. Specific extraction-sites and other relevant factors associated with wound infection rates were evaluated with univariate and multivariate analyses...
October 29, 2018: American Journal of Surgery
Abdelkader Hawasli, Moutamn Sadoun, Ahmed Meguid, Mosab Dean, Mohamad Sahly, Bianca Hawasli
BACKGROUND: Management of severe reflux after sleeve gastrectomy (SG) is often done by conversion to Roux-en-Y gastric bypass (RYGB). The LINX® system could be an alternative treatment. METHOD: Between 2015 and 2017, 13 patients had LINX® system placed to manage their reflux after SG. Pre-operative evaluation included a barium swallow, endoscopy with pH monitor and esophageal motility. RESULTS: Ten females and three males with mean age of 49 ± 13 years were evaluated...
October 29, 2018: American Journal of Surgery
Chandrakanth Are, Hugh A Stoddard, Kari L Nelson, Kathryn Huggett, Lauren Carpenter, Jon S Thompson
BACKGROUND: Less than 80% of general surgery (GS) residency positions are filled by graduates from allopathic, U.S. medical schools. The aim of this study was to gauge students' interest in pursuing GS throughout their medical school matriculation and explore students' changing perceptions of the specialty. METHODS: Students at two medical schools were surveyed annually for 4 years. Survey responses regarding interest were compared to actual NRMP match results. RESULTS: Interest in a GS career was highest at the outset of medical school and declined steadily during the program, which was similar at both schools, including a positive effect on interest from the surgical clerkship...
October 28, 2018: American Journal of Surgery
Lauren Okafor, Miriam Nathan
No abstract text is available yet for this article.
October 28, 2018: American Journal of Surgery
Arvind Sabesan, Benjamin L Gough, Carinne Anderson, Raafat Abdel-Misih, Nicholas J Petrelli, Joseph J Bennett
BACKGROUND: We sought to evaluate the post-operative outcomes of patients undergoing pancreaticoduodenectomy at a high volume academic community cancer center. METHODS: A retrospective review was performed of patients undergoing pancreaticoduodenectomy over a 10-year period. RESULTS: Over 10 years, 213 patients underwent pancreaticoduodenectomy. Median age was 66y. Most patients had significant comorbidities (median ASA = 3) and were overweight (median BMI = 27)...
October 28, 2018: American Journal of Surgery
Cynthia M Tom, Erin C Howell, Roy P Won, Scott Friedlander, Rie Sakai-Bizmark, Christian de Virgilio, Steven L Lee
BACKGROUND: The purpose of our study was to assess the outcomes and costs of appendectomies performed at rural and urban hospitals. METHODS: The National Inpatient Sample (2001-2012) was queried for appendectomies at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), and cost) were analyzed. RESULTS: Rural patients were more likely to be older, male, white, and have Medicaid or no insurance...
October 28, 2018: American Journal of Surgery
Jhia Teh, James Ashcroft
No abstract text is available yet for this article.
October 27, 2018: American Journal of Surgery
Byron D Hughes, Eric Sieloff, Hemalkumar B Mehta, Anthony J Senagore
BACKGROUND: In 2008, 2005-2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts. METHODS: Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes...
October 22, 2018: American Journal of Surgery
Barrett A Kielhorn, Jensen B Jantz, Mark S Kosten, Stephen S Phillips, Sarat C Khandavalli, Laurence E McCahill
INTRODUCTION: Adherence to guideline-based care for melanoma remains suboptimal. This study describes the development of a quality monitoring program and compares the quality of care before and after its implementation. METHODS: Thirty quality metrics were adopted. An abstraction tool, manual and electronic database were developed. Metrics were analyzed from 1/1/2008-8/31/2013 (Group A) and compared to melanoma care from 9/1/2013-12/31/2017 (Group B). RESULTS: A total of 311 patients were treated from 2008 to 2017...
October 17, 2018: American Journal of Surgery
Martin Zamora
BACKGROUND: Alpha 1 Antitrypsin Deficiency (AATD) is a genetic cause of emphysema/chronic obstructive pulmonary disease (COPD) and liver disease, making AATD patients a high-risk surgical group. Additionally, patients may eventually require lung and/or liver transplantation or lung volume reduction surgery (LVRS). This narrative review discusses perioperative considerations for elective procedures in AATD patients, and reviews patient outcomes in AATD-related transplantation and LVRS...
October 17, 2018: American Journal of Surgery
Yvonne Ying, Janelle Rekman, Anne McCarthy
BACKGROUND: Surgeons can find it challenging to sustain their global involvement while maintaining a clinical practice. This study gathered advice from surgeons with global surgical experience on how to do so successfully. METHODS: Using a qualitative approach with thematic analysis, 14 semi-structured interviews were conducted with surgeons from different specialties involved in varying international projects. RESULTS: Early involvement is important to set up expectations for one's practice, and makes anticipated costs more manageable...
October 16, 2018: American Journal of Surgery
Hans G Beger, Benjamin Mayer, Bertram Poch
BACKGROUND: Parenchyma-sparing, local pancreatic head resection, but not pancreaticoduodenectomy (PD) preserves tissue and maintains the pancreatic metabolic functions. METHODS: PubMed/Medline, Embase, and Cochrane library collections were systematically searched. Twenty-six cohort studies with 523 cumulative patients, who underwent duodenum-sparing pancreatic head resection (DPPHR), were retrieved. The meta-analysis was based on 14 controlled studies. RESULTS: In total, 338 patients suffered cystic neoplasms and 59 PNETs, IPMN-174, MCN-43 and SPN-23 patients...
October 16, 2018: American Journal of Surgery
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