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Journal of the American College of Surgeons

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https://www.readbyqxmd.com/read/28087393/william-glenn-surgeon-scientist-and-leader-of-new-england-surgery
#1
Andrew Cw Baldwin, John C Baldwin, Walter E Longo
No abstract text is available yet for this article.
January 10, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28069529/outcomes-in-older-patients-with-grade-iii-cholecystitis-and-cholecystostomy-tube-placement-a-propensity-score-analysis
#2
Francesca M Dimou, Deepak Adhikari, Hemalkumar B Mehta, Taylor S Riall
BACKGROUND: The Tokyo guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. STUDY DESIGN: We used Medicare data (1996-2010) to identify patients ≥66 years admitted with grade III acute cholecystitis. We evaluated adherence to the Tokyo guidelines and compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a propensity-matched (1:3) cohort of patients with grade III cholecystitis...
January 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28069528/personal-and-professional-well-being-of-surgical-residents-in-new-england
#3
Peter S Yoo, John J Tackett, Mark W Maxfield, Rosemarie Fisher, Stephen J Huot, Walter E Longo
BACKGROUND: Although there is increasing literature about burnout and attrition among surgeons, little is known about personal and professional well-being of surgical trainees. STUDY DESIGN: General surgery residents from the six New England states participated in a cross-sectional, qualitative, self-reported survey to assess the domains of personal health maintenance, personal finance, work environment, and fatigue management as they relate to surgical training...
January 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28069527/liver-transplantation-for-advanced-hepatocellular-carcinoma-after-downstaging-without-up-front-stage-restrictions
#4
William C Chapman, Sandra Garcia-Aroz, Neeta Vachharajani, Kathryn Fowler, Nael Saad, Yiing Lin, Jason Wellen, Benjamin Tan, Adeel S Khan, Majella Doyle
BACKGROUND: The incidence of HCC continues to increase dramatically worldwide. Liver transplantation (LT) is now standard and optimal treatment for patients with HCC in the setting of cirrhosis, but only for tumors within Milan criteria (MC). In patients presenting beyond Milan, locoregional therapy (LRT) may downstage to within-Milan for consideration of LT. While controversial, the current study aims to evaluate the outcomes of LT in patients presenting with advanced stage HCC who underwent downstaging and compare to patients who meet Milan criteria at presentation...
January 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28069526/opportunities-to-improve-care-of-hepatocellular-carcinoma-in-vulnerable-patient-populations
#5
Richard S Hoehn, Dennis J Hanseman, Vikrom Dhar, Derek E Go, Michael J Edwards, Shimul A Shah
BACKGROUND: Hepatocellular carcinoma (HCC) patients with Medicaid or no health insurance have inferior survival compared to privately-insured patients. Safety-net hospitals that care for these patients are often criticized for their inferior outcomes. We hypothesized that HCC survival was related to appropriate surgical management. STUDY DESIGN: The American College of Surgeons National Cancer Data Base was queried for patients diagnosed with HCC (n=111,481) from 1998-2010...
January 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28069525/utilization-of-the-nsqip-pediatric-database-in-development-and-validation-of-a-new-predictive-model-of-pediatric-postoperative-wound-complications
#6
Ilan I Maizlin, David T Redden, Elizabeth A Beierle, Mike K Chen, Robert T Russell
BACKGROUND: Surgical wound classification, introduced in 1964, stratifies the risk of surgical site infection (SSI) based on a clinical estimate of the inoculum of bacteria encountered during the procedure. Recent literature has questioned the accuracy of predicting SSI risk based on wound classification. We hypothesized that a more specific model founded on specific patient and perioperative factors would more accurately predict the risk of SSI. STUDY DESIGN: Using all observations from the 2012 to 2014 pediatric National Quality Surgical Improvement-Pediatric (NSQIP-P) Participant Use File, patients were randomized into model creation and model verification datasets...
January 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28024946/short-and-mid-term-outcomes-after-endoscopic-transanal-or-laparoscopic-transabdominal-total-mesorectal-excision-for-low-rectal-cancer-a-single-institutional-case-control-study
#7
Bernard Lelong, Hélène Meillat, Christophe Zemmour, Flora Poizat, Jacques Ewald, Diane Mege, Jean Claude Lelong, Jean Robert Delpero, Cécile de Chaisemartin
BACKGROUND: Transabdominal laparoscopic proctectomy for rectal cancer was associated with post-operative recovery improvement. Early studies showed favourable short-term results of endoscopic transanal proctectomy with low conversion rates to an open procedure. We aimed to compare efficacy, morbidity, and functional outcomes of endoscopic transanal proctectomy (ETAP) to standard laparoscopic proctectomy (LAP) for low rectal cancer. STUDY DESIGN: From 2008 to 2013, 72 consecutive patients received proctectomy and coloanal manual anastomosis for low rectal adenocarcinoma...
December 23, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017813/association-between-state-medical-malpractice-environment-and-postoperative-outcomes-in-the-united-states
#8
Christina A Minami, Catherine R Sheils, Emily Pavey, Jeanette W Chung, Jonah J Stulberg, David D Odell, Anthony D Yang, David J Bentrem, Karl Y Bilimoria
BACKGROUND: The U.S. medical malpractice system assumes that the threat of liability should deter negligence but it is unclear whether malpractice environment impacts healthcare quality. We thus sought to explore the association between state malpractice environment and post-operative complication rates. STUDY DESIGN: This observational study included Medicare fee-for-service beneficiaries undergoing one of the following surgeries in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017812/distal-cholangiocarcinoma-and-pancreas-adenocarcinoma-are-they-really-the-same-disease-a-13-institution-study-from-the-us-extrahepatic-biliary-malignancy-consortium-and-the-central-pancreas-consortium
#9
Cecilia G Ethun, Alexandra G Lopez-Aguiar, Timothy Pawlik, George Poultsides, Kamran Idrees, Ryan Fields, Sharon Weber, Clifford Cho, Robert Martin, Charles Scoggins, Perry Shen, Carl Schmidt, Ioannis Hatzaras, David Bentrem, Syed Ahmad, Daniel Abbott, Hong Jin Kim, Nipun Merchant, Charles A Staley, David A Kooby, Shishir K Maithel
BACKGROUND: Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as one entity, yet direct comparisons are lacking. Our aim was to utilize two, large, multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. STUDY DESIGN: Patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000-2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums were included...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017811/use-of-fitc-inulin-as-a-marker-for-intestinal-ischemic-injury
#10
Abedalrazaq AlKukhun, Giorgio Caturegli, Armando Salim Munoz-Abraham, Sami Judeeba, Roger Patron-Lozano, Raffaella Morotti, Manuel I Rodriguez-Davalos, John P Geibel
BACKGROUND: Intestinal ischemia is observed in conditions such as mesenteric ischemia, or during traumatic events such as intestinal transplantation. Intestinal ischemia leads to pathophysiological disruptions that present as increased fluid secretion into the intestinal lumen. We propose a novel method to detect real-time ischemic injury that is employed in an in vitro model that is applicable to intestinal transplantation. STUDY DESIGN: Small intestine segments from rats were procured...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017810/access-to-quaternary-care-surgery-implications-for-accountable-care-organizations
#11
J Hunter Mehaffey, Robert B Hawkins, Matthew G Mullen, Max O Meneveau, Bruce Schirmer, Irving L Kron, R Scott Jones, Peter T Hallowell
BACKGROUND: Accountable Care Organizations (ACO) attempt to provide the most efficient and effective care to patients within a region. We hypothesize that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care. STUDY DESIGN: All (17,582) institutional American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients with a documented zip code and predicted risk who underwent surgery at our institution (2005-2014) were evaluated...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017809/prevalence-of-contralateral-tumors-in-patients-with-follicular-variant-of-papillary-thyroid-cancer
#12
Michael Sullivan, Paul H Graham, Erik K Alexander, Daniel T Ruan, Matthew A Nehs, Atul A Gawande, Francis D Moore, Brooke E Howitt, Kyle C Strickland, Jeffrey F Krane, Justine A Barletta, Nancy L Cho
BACKGROUND: Thyroid lobectomy alone is increasingly being performed for patients with encapsulated follicular variant of papillary thyroid carcinoma (fvPTC). However, the prevalence of contralateral disease in these patients is unknown. Here, we investigated the presence of synchronous disease in fvPTC to improve decision making regarding the extent of surgical resection and need for surveillance. STUDY DESIGN: We performed a retrospective review of patients who underwent thyroid surgery from October 2009 to February 2013 with a diagnosis of fvPTC as their primary lesion...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017808/preoperative-chlorhexidine-gluconate-use-may-increase-risk-for-surgical-site-infections-after-ventral-hernia-repair
#13
Ajita S Prabhu, David M Krpata, Sharon Phillips, Li-Ching Huang, Ivy N Haskins, Steven Rosenblatt, Benjamin K Poulose, Michael J Rosen
BACKGROUND: There is varying evidence regarding the use of preoperative chlorhexidine gluconate to decrease surgical site infection for elective surgery. This intervention has never been studied in ventral hernia repair, the most common general surgery procedure in the United States. We aimed to determine if preoperative chlorhexidine gluconate decreases the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. STUDY DESIGN: All patients undergoing ventral hernia repair in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into two groups: one group received preoperative chlorhexidine scrub, and the other did not...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017807/lymphadenectomy-with-optimum-of-29-lymph-nodes-retrieved-associated-with-improved-survival-in-advanced-gastric-cancer-a-25-000-patient-international-database-study
#14
Yanghee Woo, Bryan Goldner, Philip Ituarte, Byrne Lee, Laleh Melstrom, Taeil Son, Sung Hoon Noh, Yuman Fong, Woo Jin Hyung
BACKGROUND: Gastric adenocarcinoma is an aggressive disease with frequent lymph node(LN) metastases for which lymphadenectomy results in a survival benefit. In the United States, the NCCN guidelines recommend D2 lymphadenectomy or a minimum of 15 LNs retrieved. However, retrieval of only 15 LNs is considered by most international guidelines as inadequate. We seek to evaluate the survival benefits associated with a more complete lymphadenectomy. STUDY DESIGN: An international database was constructed by combining gastric cancer cases from the SEER database (n=13,932) and the Yonsei University Gastric Cancer database (n=11,358)(total n=25,289)...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017806/predicting-in-hospital-and-1-year-mortality-in-geriatric-trauma-patients-using-geriatric-trauma-outcome-score
#15
Rebecka Ahl, Herb A Phelan, Sinan Dogan, Yang Cao, Allyson C Cook, Shahin Mohseni
BACKGROUND: The Geriatric Trauma Outcome Score, GTOS (= [age] + [Injury Severity Score (ISS)x2.5] + 22 [if packed red blood cells (PRBC) transfused ≤24hrs of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information regarding post-discharge outcomes, nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post-discharge in a mature European trauma registry...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017805/management-of-immediate-post-endovascular-aortic-aneurysm-repair-type-ia-endoleaks-and-late-outcomes
#16
Ali F AbuRahma, Stephen M Hass, Zachary T AbuRahma, Michael Yacoub, Albeir Y Mousa, Shadi Abu-Halimah, L Scott Dean, Patrick A Stone
BACKGROUND: Post endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for Type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzes management and late outcome of these endoleaks. PATIENT POPULATION AND METHODS: This is a retrospective review of prospectively collected date of EVAR patients during a 10-year period. All post-EVAR Type Ia endoleaks on completion angiogram were identified (Group A) and their early (30-day) and late outcomes were compared to patients without endoleaks (Group B)...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017804/persistent-fibrinolysis-shutdown-associated-with-increased-mortality-in-severely-injured-trauma-patients
#17
Jonathan P Meizoso, Charles A Karcutskie, Juliet J Ray, Nicholas Namias, Carl I Schulman, Kenneth G Proctor
BACKGROUND: Acute fibrinolysis shutdown is associated with early mortality after trauma, however no prior studies have investigated the incidence of persistent fibrinolysis or its association with mortality. We test the hypothesis that persistent fibrinolysis shutdown is associated with mortality in critically ill trauma patients. STUDY DESIGN: Thromboelastography was performed upon ICU admission in 181 adult trauma patients and at 1-week in a subset of 78 patients...
December 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27993699/gastroesophageal-mucosal-injury-after-cholecystectomy-an-indication-for-surveillance
#18
Syeda Nadia Shah Gilani, Gary Alan Bass, Natallia Kharytaniuk, Michelle R Downes, Emer Frances Caffrey, Iqbal Tobbia, Thomas Noel Walsh
BACKGROUND: Cholecystectomy alters bile release dynamics from pulsatile meal-stimulated to continuous, and results in retrograde duodeno-gastric bile reflux(DGR). Bile is implicated in mucosal injury following gastric surgery, but whether cholecystectomy causes esophago-gastric mucosal inflammation, thus increasing the risk of metaplasia, is unclear. STUDY DESIGN: This study examined whether cholecystectomy-induced DGR promotes chronic inflammatory mucosal changes of the stomach and/or at the esophago-gastric junction(EGJ)...
December 16, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27993698/lead-time-bias-and-interhospital-transfer-after-injury-trauma-center-admission-vital-signs-underpredict-mortality-in-transferred-trauma-patients
#19
Daniel N Holena, Douglas J Wiebe, Brendan G Carr, Jesse Y Hsu, Jason L Sperry, Andrew B Peitzman, Patrick M Reilly
BACKGROUND: Admission physiology predicts mortality after injury but may be improved by resuscitation prior to transfer. This phenomenon, which has been termed lead-time bias, may lead to underprediction of mortality in transferred patients and inaccurate benchmarking in centers receiving large numbers of transfer patients. We sought determine the impact of using vital signs on arrival at the referring center vs. on arrival at the trauma center in mortality prediction models for transferred trauma patients...
December 16, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27993697/national-accreditation-program-for-breast-centers-accreditation-demonstrates-improved-compliance-with-post-mastectomy-radiation-therapy-quality-measure
#20
Elizabeth R Berger, Chihsiung E Wang, Cary S Kaufman, Ted J Williamson, Julio A Ibarra, Karen Pollitt, Richard J Bleicher, James L Connolly, David P Winchester, Katharine A Yao
BACKGROUND: The National Accreditation Program for Breast Centers (NAPBC) was established in 2008 by the American College of Surgeons as a quality improvement program for patients with breast disease. An NAPBC quality measure states post-mastectomy patients with ≥4 positive lymph nodes should receive lymph node radiation therapy (PMRT). Our objective was to examine how NAPBC accreditation has affected compliance with this quality measure. STUDY DESIGN: Women who underwent mastectomy at either an NAPBC-accredited center or a CoC only accredited hospital were identified (2006-2013) in the National Cancer Data Base(NCDB)...
December 16, 2016: Journal of the American College of Surgeons
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