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American Journal of Surgery

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https://www.readbyqxmd.com/read/28818297/rothman-index-variability-predicts-clinical-deterioration-and-rapid-response-activation
#1
Brian C Wengerter, Kevin Y Pei, David Asuzu, Kimberly A Davis
BACKGROUND: The overall utility of the Rothman Index (RI), a global measure of inpatient acuity, for surgical patients is unclear. We evaluate whether RI variability can predict rapid response team (RRT) activation in surgical patients. METHODS: Surgical patients who underwent RRT activation from 2013 to 2015 were matched to four control cases. RI variability was gauged by maximum minus minimum RI (MMRI) and RI standard deviation (RISD) within a 24-h period before RRT...
August 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28811004/component-separation-technique-for-giant-incisional-hernia-a-systematic-review
#2
REVIEW
Bram Cornette, Dirk De Bacquer, Frederik Berrevoet
The component separation technique (CST) has gained popularity among general surgeons in the management of giant abdominal hernia. A systematic review of the MedLine and EMBASE databases was performed. 36 observational cohort studies were included for data-analysis and divided in 4 main groups: Open Anterior Approach (OAA), Transversus Abdominis Release (TAR), Laparoscopic Anterior Approach (LAA) and Perforator Preserving Approach (PPA). Surgical Site Occurrences (SSO) occurred in 21.4%, 23.7%, 20.3% and 16...
August 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28807476/a-model-for-a-career-in-a-specialty-of-general-surgery-one-surgeon-s-opinion
#3
Bona Ko, Christopher R McHenry
BACKGROUND: The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons. METHODS: Case logs collected from 1991-2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME "Major Case Categories" and there frequencies were determined. RESULTS: 10,324 operations were performed on 8209 patients...
August 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28784237/groin-hernia-repair-in-women-a-nationwide-register-study
#4
Hanna Nilsson, Henrik Holmberg, Pär Nordin
INTRODUCTION: The aim of this study was to investigate reoperation for recurrence in men and women with respect to method of repair, hernia anatomy and year of operation. METHOD: Since 1992, groin hernia repairs performed in Sweden are prospectively registered in the Swedish Hernia Register, (SHR). Reoperations are noted, regardless of where the reoperation is performed. Risk of reoperation for recurrence is calculated for men and women with respect of method of repair, hernia anatomy and year of operation...
July 25, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28781101/objective-scoring-of-an-electronic-surgical-logbook-analysis-of-impact-and-observations-within-a-surgical-training-body
#5
Cuan M Harrington, Dara O Kavanagh, Donncha Ryan, Patrick Dicker, Peter E Lonergan, Oscar Traynor, Sean Tierney
BACKGROUND: Historically, evaluating operative-volumes has proven difficult due to mass-variability in operative-complexities and participation. This study aimed to introduce a national scoring interface for residents' operative-logs while forming meaningful observations on specialities, training-institutes and technical competency. METHODS: A weighted-scoring algorithm was applied prospectively to residents' operative volumes since July 8th(,) 2013 with daily web-based quantitative feedback...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28764850/surgical-registrars-perceptions-of-surgical-training-and-capacity-in-zambia-results-from-three-cosecsa-affiliated-training-hospitals
#6
Derek M Freitas, James Munthali, Joseph Musowoya, Hebah Ismail, Allyson Herbst, Laston Chikoya, Shubhada Dhage, Mary Ann Hopkins
BACKGROUND: Surgery is a vital component of a comprehensive health system, but there are often personnel limitations in resource constrained areas. Zambia provides post graduate surgical training through two systems to help address this shortage. However, no studies have analyzed surgical trainees' perceptions of these programs. METHODS: Surgical registrars at COSECSA affiliated hospitals in Zambia were surveyed about their programs. Responses were analyzed to identify key strengths and challenges across several categories including: operative training, clinical training, educational experiences, and career plans...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28760356/unplanned-readmission-and-outpatient-examination-90-days-after-acute-appendectomy-in-adults
#7
Bo Bendvold, Arne Refsum, Line Schjøth-Iversen, Kjersti Bringedal, Anders Husby, Kristoffer Watten Brudvik
BACKGROUND: The aim of this study was to determine the frequency and indications for unplanned readmission and outpatient examination after acute appendectomy. METHODS: Adults who underwent acute appendectomy from 2008-2013 were included in the study and events occurring within 90-days from discharge recorded. RESULTS: A total of 710 patients underwent surgery. The appendix was removed in 622 patients and post-discharge contact occurred in 99 (15...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28760355/decreasing-readmissions-by-focusing-on-complications-and-underlying-reasons
#8
Cigdem Benlice, Dilara Seyidova-Khoshknabi, Luca Stocchi, Tracy Hull, Scott Steele, Emre Gorgun
BACKGROUND: To analyze demographics and outcomes of patients focusing on 30-day readmission status and identify procedure-specific risk factors. METHODS: Patients undergoing abdominal colorectal surgery (2011-2013) were identified Demographics and outcomes including in-hospital complications were compared based on readmission status. RESULTS: A total of 6637 patients were identified with a mean age of 51.2(±17.1) years. Seven hundred and seventy five(11...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28754535/stapled-transabdominal-ostomy-reinforcement-with-retromuscular-mesh-storrm-technical-details-and-early-outcomes-of-a-novel-approach-for-retromuscular-repair-of-parastomal-hernias
#9
Arnab Majumder, Sean B Orenstein, Heidi J Miller, Yuri W Novitsky
BACKGROUND: Parastomal hernia repair (PHR) remains a challenge with no optimal repair technique. During retromuscular hernia repair, traversing the stomal conduit through the abdominal wall can result in angulation and compression. Widening of traditional cruciate incisions in mesh and/or fascia likely contributes to recurrences. To address these pitfalls, the Stapled Transabdominal Ostomy Reinforcement with Retromuscular Mesh (STORRM) technique utilizing a circular stapler was developed...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28754534/health-related-quality-of-life-during-trans-arterial-chemoembolization-with-drug-eluting-beads-loaded-with-doxorubicin-debdox-for-unresectable-hepatic-metastases-from-ocular-melanoma
#10
Jack W Rostas, Alda L Tam, Takami Sato, Charles R Scoggins, Kelly M McMasters, Robert C G Martin
BACKGROUND: We have previously reported favorable response and survival rates using drug-eluting beads loaded with doxorubicin (DEBDOX) for unresectable hepatic metastases. This study investigates the quality of life (QoL) impact of DEBDOX for the treatment of unresectable hepatic metastases from melanoma. METHODS: A multi-center, prospective, non-controlled clinical trial was reviewed. QoL was assessed at baseline and after each treatment, and doxorubicin-specific effects were assessed after each treatment...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28751060/should-classification-as-an-acs-nsqip-high-outlier-be-used-to-direct-hospital-quality-improvement-efforts
#11
Elise H Lawson, Patricia L Roberts, Todd D Francone, Peter W Marcello, Thomas E Read, Rocco Ricciardi
BACKGROUND: ACS-NSQIP classifies hospitals as "high outliers" if their performance is significantly worse than expected. We determined how often hospitals return to as-expected performance after being newly identified as outliers. METHODS: Outlier status was identified in ACS-NSQIP semi-annual reports (SARs) 2008-2011 for 13 postoperative adverse events. Pearson correlation and R(2) measured the relationship between frequency of changes in outlier status, frequency of outlier identification, and adverse event rate...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28739121/risk-factors-for-conversion-of-laparoscopic-cholecystectomy-to-open-surgery-a-systematic-literature-review-of-30-studies
#12
REVIEW
A Hu, R Menon, R Gunnarsson, A de Costa
BACKGROUND: The study aims to evaluate the methodological quality of publications relating to predicting the need of conversion from laparoscopic to open cholecystectomy and to describe identified prognostic factors. METHOD: Only English full-text articles with their own unique observations from more than 300 patients were included. Only data using multivariate analysis of risk factors were selected. Quality assessment criteria stratifying the risk of bias were constructed and applied...
July 21, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28784236/operative-outcomes-of-conventional-specimen-radiography-versus-in-operating-room-specimen-radiography-in-radioactive-seed-localized-segmental-mastectomies
#13
Daniel Rhee, Barbara Pockaj, Nabil Wasif, Chee-Chee Stucky, Victor Pizzitola, Marina Giurescu, Bhavika Patel, Janice McCarthy, Richard Gray
INTRODUCTION: In-operating room specimen radiography (ORSR) has not been studied among women undergoing radioactive seed localization (RSL) for breast cancer surgery and had the potential to decrease operative time and perhaps improve intraoperative margin management. METHODS: One hundred consecutive RSL segmental mastectomies among 98 patients using ORSR were compared to 100 consecutive segmental mastectomies among 98 patients utilizing conventional radiography (CSR) prior to the initiation of ORSR from December 2013 to January 2015 after radioactive seed localization...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28778314/surgical-management-of-epiphrenic-diverticulum-a-single-center-experience-and-brief-review-of-literature
#14
Alison E Brandeis, Saurabh Singhal, Tommy H Lee, Sumeet K Mittal
BACKGROUND: We present single-center experience of surgery for primary epiphrenic diverticulum (PED) over a 12-year period. METHODS: Prospectively maintained database was queried to identify patients who underwent PED surgery. Preoperative and postoperative symptoms, operative data, perioperative complications, and follow-up were reviewed. RESULTS: Twenty-seven patients (14 females; mean age-67-years) underwent PED surgery. The most common primary presenting symptoms were dysphagia and regurgitation (mean duration-3...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28760357/regional-differences-for-pancreaticoduodenectomy-in-florida-location-matters
#15
Alexander S Rosemurgy, Darrell J Downs, Forat Swaid, Carrie E Ryan, Amanda E Smart, Janelle D Spence, Sharona B Ross
INTRODUCTION: Regionalization of care raises potential for differences in cost of care and outcome. This study was undertaken to determine if costs and outcome after pancreaticoduodenectomy vary by region in Florida, and whether costs and outcome are related. METHODS: Inpatient data for pancreaticoduodenectomy in Florida during 2010-2012 were obtained from the Florida Agency for Health Care Administration. Seven geographically different regions were designated based on "cost of living index" and "urban to rural population ratio"...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28751063/a-prospective-randomized-study-comparing-laparoscopic-transabdominal-preperitoneal-tapp-versus-lichtenstein-repair-for-bilateral-inguinal-hernias
#16
Benedetto Ielpo, Hipolito Duran, Eduardo Diaz, Isabel Fabra, Riccardo Caruso, Luis Malavé, Valentina Ferri, Sara Lazzaro, Denis Kalivaci, Yolanda Quijano, Emilio Vicente
BACKGROUND: In literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia. METHODS: Patients were prospectively randomized between March 2013 and March 2015...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28751062/model-for-prioritization-of-graduate-medical-education-funding-at-a-university-setting-engagement-of-gme-committee-with-the-clinical-enterprise
#17
Chandrakanth Are, Melissa Suh, Lauren Carpenter, Hugh Stoddard, Vicki Hamm, Matthew DeVries, Whitney Goldner, Kimberly Jarzynka, Jennifer Parker, Jean Simonson, Geoffrey Talmon, Chad Vokoun, Jeffrey Gold, David Mercer, Michael Wadman
BACKGROUND: Funding for graduate medical education (GME) is becoming scarce and is likely to worsen. There is a higher degree of accountability and return on investment demanded from public funds dedicated to GME. Academic centers (AC) partnered with clinical enterprises (CE) are finding it increasingly difficult to retain sustainable funding streams for GME activities. METHODS: To develop and implement a novel algorithmic funding model at one AC in symbiotic partnership with the CE for all 50 GME programs with nearly 500 residents...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28747252/analysis-of-the-tractive-force-pattern-on-a-knot-by-force-measurement-during-laparoscopic-knot-tying
#18
Kenta Takayasu, Kenji Yoshida, Hidefumi Kinoshita, Syunsuke Yoshimoto, Osamu Oshiro, Tadashi Matsuda
BACKGROUND: Quantifying surgical skills assists novice surgeons when learning operative techniques. We measured the interaction force at a ligation point and clarified the features of the force pattern among surgeons with different skill levels during laparoscopic knot tying. METHODS: Forty-four surgeons were divided into three groups based on experience: 13 novice (0-5 years), 16 intermediate (6-15 years), and 15 expert (16-30 years). To assess the tractive force direction and volume during knot tying, we used a sensor that measures six force-torque values (x-axis: Fx, y-axis: Fy, z-axis: Fz, and xy-axis: Fxy) attached to a slit Penrose drain...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28743381/a-novel-systematic-inflammation-related-index-is-prognostic-in-curatively-resected-non-metastatic-colorectal-cancer
#19
Tingting Hong, Di Shen, Xiaoping Chen, Dongyan Cai, Xiaohong Wu, Dong Hua
BACKGROUD: To better identify patients with high mortality risk, we developed a systematic inflammation index (IPI) based on neutrophil to lymphocyte ratio (NLR) and albumin. METHODS: The performance of pretreatment IPI was evaluated in patients with surgically resected non-metastatic colorectal cancer. IPI was predefined and compared with Glasgow Prognostic Score (GPS)/modified GPS in terms of discrimination and calibration abilities. RESULTS: In multivariate analysis, patients with an IPI of 1 or 2 had 1...
July 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28739123/effects-of-modifiable-non-modifiable-and-clinical-process-factors-in-ventral-hernia-repair-surgical-site-infections-a-retrospective-study
#20
John Chipko, Anthony DeSantis, Erik Quinn, Vic Velanovich
BACKGROUND: The hypothesis of this study is that non-modifiable factors are more important in ventral hernia repair (VHR) surgical site infection (SSI) than care process factors. METHODS: All VHR's which were reviewed retrospectively for both NSQIP-recorded data, and also: preoperative hospitalization, existing mesh, enterocutaneous fistula, open wound, case month, case day, case length, prophylactic antibiotics, skin preparation, other procedure performed, re-do operation, estimate blood loss, hernia size, repair approach, repair type, mesh used, skin closure, suture type, use of drains, and dressing...
July 19, 2017: American Journal of Surgery
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