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Journal of the American College of Surgeons

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https://www.readbyqxmd.com/read/28315812/onset-of-coagulation-function-recovery-is-delayed-in-severely-injured-trauma-patients-with-venous-thromboembolism
#1
Belinda H McCully, Christopher R Connelly, Kelly A Fair, John B Holcomb, Erin E Fox, Charles E Wade, Eileen M Bulger, Martin A Schreiber
BACKGROUND: Altered coagulation function after trauma may contribute to venous thromboembolism (VTE) development. Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely-injured trauma patients. STUDY DESIGN: Secondary analysis was performed on data from The Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours and/or were on pre-injury anticoagulants...
March 15, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28279778/readmission-and-other-adverse-events-after-transsphenoidal-surgery-prevalence-timing-and-predictive-factors
#2
David J Cote, Hormuz H Dasenbrock, Ivo S Muskens, Marike Ld Broekman, Hasan A Zaidi, Ian F Dunn, Timothy R Smith, Edward R Laws
BACKGROUND: Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. STUDY DESIGN: Patients undergoing transsphenoidal surgery from 2006 to 2015 were extracted from the ACS NSQIP database. Logistic regression was used to identify predictors of thirty-day complications. RESULTS: Of 1240 patients included in this analysis; 6...
March 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28279777/sutureless-vs-sutured-gastroschisis-closure-a-prospective-randomized-controlled-trial
#3
Matias Bruzoni, Joshua D Jaramillo, Jonathan L Dunlap, Claire Abrajano, Shobha W Stack, Susan R Hintz, Tina Hernandez-Boussard, Sanjeev Dutta
BACKGROUND: Sutureless gastroschisis repair involves covering the abdominal wall defect with the umbilical cord or a synthetic dressing to allow closure by secondary intention. No randomized studies have described the outcomes of this technique. Our objective was to prospectively compare short-term outcomes of sutureless versus sutured closure in a randomized fashion. STUDY DESIGN: We recruited patients who presented with gastroschisis between 2009 and 2014 and were randomized into either sutureless or sutured treatment groups...
March 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28279776/outcomes-of-laparoscopic-vs-open-common-bile-duct-exploration-analysis-of-the-nsqip-database
#4
Hamzeh M Halawani, Hani Tamim, Farah Khalifeh, Aurélie Mailhac, Ali Taher, Jamal Hoballah, Faek R Jamali
BACKGROUND: Common bile duct exploration (CBDE) is one of the available options in the management of choledocholithiasis. We aim to analyze outcomes comparing the laparoscopic and open approach to CBDE using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. STUDY DESIGN: This is a retrospective cohort study of patients undergoing CBDE from year 2008 to 2013 using ACS NSQIP database. The cohort was split into 2 groups and compared based on the operative approach, laparoscopic versus open CBDE...
March 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28263857/organ-donation-an-unexpected-benefit-of-aggressive-resuscitation-of-trauma-patients-presenting-dead-on-arrival
#5
Abdul Q Alarhayem, Stephen M Cohn, Mark T Muir, John G Myers, James Fuqua, Brian J Eastridge
BACKGROUND: We sought to determine if aggressive resuscitation in trauma patients presenting without vital signs or "dead on arrival" (DOA) was futile. We also sought to determine if organ donation was an unexpected benefit of aggressive resuscitation. STUDY DESIGN: We conducted a review of adults presenting to our Level 1 trauma center with no signs of life (pulse = 0; systolic blood pressure = 0; and no evidence of neurologic activity, GCS = 3). Primary outcome was survival to hospital discharge or major organ donation (heart, lung, kidney, liver or pancreas were harvested)...
March 2, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28259545/selective-nonoperative-management-of-abdominal-gunshot-wounds-from-heresy-to-adoption-a-multicenter-study-of-the-research-consortium-of-new-england-centers-for-trauma-reconect
#6
Thomas Peponis, George Kasotakis, Jielin Yu, Reginald Alouidor, Barbara Burkott, Adrian A Maung, Dirk C Johnson, Noelle Saillant, Heath Walden, Ali Salim, Elizabeth Bryant, Jon D Dorfman, Eric N Klein, Ronen Elefant, Maryam B Tabrizi, Nikolay Bugaev, Sandra S Arabian, George C Velmahos
BACKGROUND: Selective nonoperative management (SNOM) of abdominal gunshot wounds is being practiced in certain trauma centers, but its broader acceptance in the surgical community is unknown. We hypothesized that SNOM has been adopted in New England as an acceptable method of abdominal gunshot wound management. STUDY DESIGN: We reviewed the medical records of abdominal gunshot wound patients admitted from January 1996 to June 2015, in 10 New England Level I and II trauma centers...
March 1, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28242434/rural-general-surgery-a-38-year-experience-with-a-regional-network-established-by-an-integrated-health-system-in-the-midwestern-united%C3%A2-states
#7
Thomas H Cogbill, Marilu Bintz
BACKGROUND: General surgeon (GS) workforce shortages are predicted to worsen, particularly in rural areas. We report on a sustainable model for delivery of GS services within a large rural region that includes an integrated health system. STUDY DESIGN: We conducted a longitudinal study of a rural GS network from 1978 to 2016. Employment data and rural GS survey results were reviewed to document methods of recruitment, retention, and case-volume development. RESULTS: During the 38-year study period, 19 rural GSs were employed by the health system...
February 24, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28284471/does-the-institution-of-a-statewide-trauma-system-reduce-preventable-mortality-and-yield-a-positive-return-on-investment-for-taxpayers
#8
Todd Maxson, Charles D Mabry, Michael J Sutherland, Ronald D Robertson, James O Booker, Terry Collins, Horace J Spencer, Charles F Rinker, Teri L Sanddal, Nels D Sanddal
BACKGROUND: In July 2009, Arkansas began to annually fund $20 million for a statewide trauma system (TS). We studied injury deaths both pre-TS (2009) and post-TS (2013 to 2014), with attention to causes of preventive mortality, societal cost of those preventable mortality deaths, and benefit to tax payers of the lives saved. STUDY DESIGN: A multi-specialty trauma-expert panel met and reviewed records of 672 decedents (290 pre-TS and 382 post-TS) who met standardized inclusion criteria, were judged potentially salvageable, and were selected by a proportional sampling of the roughly 2,500 annual trauma deaths...
February 22, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28235646/identifying-adverse-events-in-pediatric-surgery-comparing-morbidity-and-mortality-conference-with-the-nsqip-pediatric-system
#9
Barrett P Cromeens, Richard E Lisciandro, Richard J Brilli, Johanna R Askegard-Giesmann, Brian D Kenney, Gail E Besner
BACKGROUND: Recent improvements to morbidity and mortality (M&M) conference have focused on the case review system. However, case selection occurs by physician reporting, which is limited by selection bias. We compared the effectiveness of our M&M conference with the NSQIP-Pediatric (NSQIP-P) system for identifying adverse events. STUDY DESIGN: Complications from January 2010 to September 2015 were compared between M&M and NSQIP-P. Only M&M patients meeting NSQIP-P criteria were compared with patients from the NSQIP-P system; exclusions were studied separately...
February 22, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28235647/pediatric-trauma-assessment-and-management-database-leveraging-existing-data-systems-to-predict-mortality-and-functional-status-after-pediatric-injury
#10
Katherine T Flynn-O'Brien, Mary E Fallat, Tom B Rice, Christine M Gall, Michael L Nance, Jeffrey S Upperman, David M Gourlay, John P Crow, Frederick P Rivara
BACKGROUND: Efforts to improve pediatric trauma outcomes need detailed data, optimally collected at lowest cost, to assess processes of care. We developed a novel database by merging two national data systems for five Pediatric Trauma Centers (PTC) to provide benchmarking metrics for mortality and non-mortality outcomes and to assess care provided throughout the care continuum. STUDY DESIGN: Trauma Registry (TR) and Virtual Pediatric Systems (VPS) from five PTCs were merged for children <18 discharged in 2013 from a PICU after traumatic injury...
February 21, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28219677/nsqip-based-quality-improvement-curriculum-for-surgical-residents
#11
Mary M Mrdutt, Claire L Isbell, Justin L Regner, Bonnie R Hodges, Yolanda Munoz-Maldonado, J Scott Thomas, Harry T Papaconstantinou
BACKGROUND: General surgery training has historically lacked a standardized approach to resident quality improvement (QI) education aside from traditional morbidity and mortality conference. In 2013, the ACGME formalized QI as a component of residency training. Our residency chose the NSQIP Quality In-Training Initiative (QITI) as the foundation for our QI training. We hypothesized that a focused curriculum based on outcomes would produce change in culture and improve the quality of patient care...
February 21, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28232059/liver-transplantation-for-malignant-primary-pediatric-hepatic-tumors
#12
Adeel S Khan, Brittany Brecklin, Neeta Vachharajani, Vijay Subramanian, Michelle Nadler, Janice Stoll, Yumirle Turmelle, Jeffery A Lowell, William C Chapman, Mb Majella Doyle
BACKGROUND: Malignant primary pediatric hepatic tumors (MPPHTs) are rare and account for approximately 1% of all childhood malignancies. In recent years, liver transplantation has emerged as a viable treatment options for select patients with MPPHTs. STUDY DESIGN: We performed a single-center retrospective study using a prospective database to compare outcomes of pediatric liver transplant recipients, with and without cancer, between January 2000 and December 2014...
February 20, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28232058/decreasing-hospital-readmission-in-ileostomy-patients-results-of-novel-pilot-program
#13
Virginia O Shaffer, Tari Owi, Mathu A Kumarusamy, Patrick S Sullivan, Jahnavi K Srinivasan, Shishir K Maithel, Charles A Staley, John F Sweeney, Greg Esper
BACKGROUND: Nearly 30% of patients with newly formed ileostomies require hospital readmission from severe dehydration or associated complications. This contributes to significant morbidity and rising healthcare costs associated with this procedure. Our aim was to design and pilot a novel program to decrease readmissions in this patient population. STUDY DESIGN: An agreement was established with Visiting Nurse Health System (VNHS) in March 2015 that incorporated regular home visits with clinical triggers to institute surgeon-supervised corrective measures aimed at preventing patient decompensation associated with hospital readmissions...
February 20, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28223197/bethesda-category-iii-iv-and-v-thyroid-nodules-can-nodule-size-help-predict-malignancy
#14
Colleen M Kiernan, Carmen C Solórzano
BACKGROUND: The association of tumor size with malignancy in thyroid nodules with indeterminate cytology (atypia of undetermined significance [AUS]/follicular lesion of undetermined significance [FLUS], suspicious for follicular neoplasm [SFN]/Hürthle cell neoplasm [HCN], and suspicious for malignancy [SM]) has not been clearly studied. STUDY DESIGN: We retrospectively identified 1,104, patients who underwent thyroid FNA and subsequent thyroidectomy. Patients with indeterminate cytology were reviewed...
February 20, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28214556/isolated-limb-infusion-as-a-limb-salvage-strategy-for-locally-advanced-extremity-sarcoma
#15
John E Mullinax, Hidde M Kroon, John F Thompson, Neel Nath, Paul J Mosca, Jeffrey M Farma, Rajendra Bhati, Danielle Hardmann, Sean Sileno, Cristina O'Donoghue, Matthew Perez, Syeda Mahrukh Hussnain Naqvi, Y Ann Chen, Ricardo J Gonzalez, Jonathan S Zager
BACKGROUND: Treatment-resistant, locally advanced soft tissue sarcomas often require amputation for complete tumor extirpation. Isolated limb infusion (ILI) selectively delivers high-dose chemotherapy to the extremity in an attempt to achieve limb salvage. The aim of this study was to report perioperative and oncologic outcomes after ILI in patients with extremity soft tissue sarcomas. STUDY DESIGN: From 1994 to 2016, 77 patients underwent 84 ILIs at a total of 5 institutions...
February 15, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28216422/systemic-chemotherapy-combined-with-resection-for-locally-advanced-gallbladder-carcinoma-surgical-and-survival-outcomes
#16
John M Creasy, Debra A Goldman, Vikas Dudeja, Maeve A Lowery, Andrea Cercek, Vinod P Balachandran, Peter J Allen, Ronald P DeMatteo, T Peter Kingham, Michael I D'Angelica, William R Jarnagin
BACKGROUND: Preoperative chemotherapy is a strategy for converting to resection and/or assessing disease biology before operation. The utility of such an approach in gallbladder carcinoma (GBCA) is unknown. This study evaluated outcomes of GBCA patients treated with chemotherapy for locally advanced or lymph node-involved tumors. STUDY DESIGN: Patients who received systemic chemotherapy for locally advanced or lymph node-positive GBCA were identified from a departmental database...
February 13, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28196693/public-perceptions-of-overlapping-surgery
#17
Michael Kent, Richard Whyte, Aaron Fleishman, David Tomich, Lachlan Forrow, James Rodrigue
BACKGROUND: Overlapping surgery is highly contentious, both in terms of the safety of the practice and the degree to which patients should be informed. However, no study has surveyed attitudes of the general public toward overlapping surgery and willingness to consent to such a procedure. STUDY DESIGN: A survey on overlapping surgery was completed by participants using Amazon Mechanical Turk, an online crowd-sourcing worksite. Responders completed a 51-question survey on their knowledge of overlapping surgery, expectations on disclosure during the informed consent process, and their willingness to participate in such a procedure...
February 11, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28189662/operating-room-fires-and-surgical-skin-preparation
#18
Edward L Jones, Douglas M Overbey, Brandon C Chapman, Teresa S Jones, Sarah A Hilton, John T Moore, Thomas N Robinson
BACKGROUND: Operating room fires are "never events" that remain an under-reported source of devastating complications. One common set-up that promotes fires is the use of surgical skin preparations combined with electrosurgery and oxygen. Limited data exist examining the incidence of fires and surgical skin preparations. STUDY DESIGN: A standardized, ex vivo model was created with a 15 × 15 cm section of clipped porcine skin. An electrosurgical "Bovie" pencil was activated for 2 seconds on 30 Watts coagulation mode in 21% oxygen (room air), both immediately and 3 minutes after skin preparation application...
February 9, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28189663/patient-symptoms-are-the-most-frequent-indicators-of-recurrence-in-patients-with-american-joint-committee-on-cancer-stage-ii-melanoma
#19
Adam C Berger, David W Ollila, Adrienne Christopher, John C Kairys, Michael J Mastrangelo, Kendra Feeney, Nooreen Dabbish, Benjamin Leiby, Jill A Frank, Karyn B Stitzenberg, Michael O Meyers
BACKGROUND: Patients with stage II melanoma have a considerable risk for recurrence. Current guidelines are imprecise as to optimal follow-up. We hypothesized that by examining recurrence patterns, we could help to better inform guidelines. STUDY DESIGN: We queried IRB-approved melanoma databases of Thomas Jefferson University and University of North Carolina, identifying 581 patients with stage II melanoma between 1996 and 2015 with at least 1 year of follow-up...
February 8, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28188839/if-charles-l-scudder-could-see-us-now
#20
J Wayne Meredith
No abstract text is available yet for this article.
February 7, 2017: Journal of the American College of Surgeons
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