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Journal of the American College of Surgeons

John W Kunstman, Debra A Goldman, Mithat Gönen, Vinod P Balachandran, Michael I D'Angelica, T Peter Kingham, William R Jarnagin, Peter J Allen
BACKGROUND: Morbidity following pancreatectomy is commonly due to leakage of exocrine secretions resulting in abscess or pancreatic fistula (PF). Previously, we authored a double-blind randomized controlled trial demonstrating perioperative pasireotide administration lowers abscess or PF formation by over 50%. Accordingly, we adopted pasireotide usage as standard practice following pancreatectomy in October 2014 and hypothesized a similar PF/abscess rate reduction would be observed. STUDY DESIGN: A prospectively maintained database was queried for all patients who underwent pancreatectomy between October 2014 and July 2017...
November 7, 2018: Journal of the American College of Surgeons
Robert James Touloukian
No abstract text is available yet for this article.
November 7, 2018: Journal of the American College of Surgeons
Ryan Howard, Yue S Yin, Lane McCandless, Stewart Wang, Michael Englesbe, David Machado-Aranda
BACKGROUND: Surgery is a major physiologic stress comparable to intense exercise. Diminished cardiopulmonary reserve is a major predictor of poor outcomes. Current preoperative workup focuses mainly on identifying risk factors; however, little attention is devoted to improving cardiopulmonary reserve beyond counseling. We propose that patients could be optimized for a "surgical marathon" similar to the preparation of an athlete. STUDY DESIGN: The Michigan Surgical and Health Optimization Program (MSHOP) is a formal prehabilitation program that engages patients in 4 activities before surgery: physical activity, pulmonary rehabilitation, nutritional optimization, and stress reduction...
October 22, 2018: Journal of the American College of Surgeons
Steven Schneeberger, Sharon Phillips, Li-Ching Huang, Richard A Pierce, Shervin A Etemad, Benjamin K Poulose
INTRODUCTION: Biologic and biosynthetic meshes typically cost more than synthetic meshes for use in ventral hernia repair (VHR), with unknown comparative effectiveness. METHOD: Cost-utility analysis was performed from a limited societal perspective assessing direct medical costs and outcomes for open, elective, retromuscular VHR. Short-term and five-year major complications and costs were modeled using best available evidence from published studies, Healthcare Cost and Utilization Project data, and Americas Hernia Society Quality Collaborative data...
October 20, 2018: Journal of the American College of Surgeons
Laura A Graham, Todd H Wagner, Joshua S Richman, Melanie S Morris, Laurel A Copeland, Alex Hs Harris, Kamal Mf Itani, Mary T Hawn
INTRO: Long-term trajectories of healthcare utilization in the context of surgery have not been well characterized. The objective of this study was to examine healthcare utilization trajectories among surgical patients and identify factors associated with high utilization that could possibly be mitigated following surgical admissions. METHODS: Hospital medical-surgical admissions within 2 years of an index inpatient surgery in the Veterans Health Administration (10/1/2007-9/30/2014) were identified...
October 20, 2018: Journal of the American College of Surgeons
Matthew P Goldman, Christopher J Clark, Timothy E Craven, Ross P Davis, Timothy K Williams, Gabriela Velazquez-Ramirez, Justin B Hurie, Matthew S Edwards
BACKGROUND: Diabetes mellitus is a major risk factor for peripheral arterial disease and lower extremity amputation (LEA). We evaluated the effects of intensive glucose control (IGC) on risk of LEA in patients with type 2 diabetes during a randomized-controlled multicenter trial. STUDY DESIGN: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial randomized patients with type 2 diabetes to IGC (HbA1c target < 6.0%) or standard glycemic control (SGC; HbA1c target 7...
October 16, 2018: Journal of the American College of Surgeons
Simone Sandler, Kristin Sonderman, Isabelle Citron, Mahmood Bhutta, John G Meara
No abstract text is available yet for this article.
October 16, 2018: Journal of the American College of Surgeons
Maher El Chaar, Jill Stoltzfus
INTRODUCTION: Obesity rates in the United States have reached epidemic proportions, and sleeve gastrectomy (SG) is the most commonly performed procedure. Controversies exist regarding the most appropriate surgical technique. OBJECTIVE: To compare outcomes of four SG surgical techniques based on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: Using the 2016 MBSAQIP database, we selected all primary SG procedures and compared four surgical techniques [staple line reinforcement (SLR) alone; SLR and oversew (OS); no SLR or OS, and OS alone]...
October 11, 2018: Journal of the American College of Surgeons
Melissa A Hornor, Jessica Y Liu, Q Lina Hu, Clifford Y Ko, Elizabeth Wick, Melinda Maggard-Gibbons
No abstract text is available yet for this article.
October 11, 2018: Journal of the American College of Surgeons
Katherine E Hekman, Eriberto Michel, Eddie Blay, Irene B Helenowski, Andrew W Hoel
BACKGROUND: Surgical site infection (SSI) poses a significant burden to patients and healthcare resources. Vascular Quality Initiative (VQI) data identify a higher rate of SSI for lower extremity bypass surgery than other vascular procedures. Bundled interventions have successfully reduced SSI in other surgical procedures. STUDY DESIGN: We evaluated our institution-specific VQI data for modifiable risk factors associated with index hospitalization SSI from January 2012 through October 2015...
October 9, 2018: Journal of the American College of Surgeons
Cheryl K Zogg, John W Scott, Nizar Bhulani, Abbe R Gluck, Gregory D Curfman, Kimberly A Davis, Justin B Dimick, Adil H Haider
BACKGROUND: The ACA changed the landscape of insurance coverage, allowing young adults to remain on their parents' insurance until age 26y (Dependent Coverage Provision [DCP]) and states to optionally expand Medicaid up to 133% of the federal poverty level. While both improved insurance coverage, little is known about the ACA's impact on observed receipt of timely access to acute care. The objective of this study was to compare changes in insurance coverage and perforation rates among hospitalized adults with acute appendicitis 'after versus before' Medicaid expansion and the DCP using an AHRQ-certified metric designed to measure pre-hospital access to care...
October 8, 2018: Journal of the American College of Surgeons
Mohammad Hamidi, Muhammad Zeeshan, Joseph V Sakran, Narong Kulvatunyou, Terence O'Keeffe, Ashley Northcutt, El Rasheid Zakaria, Andrew Tang, Bellal Joseph
BACKGROUND: Patients with pelvic fractures are prone to venous-thromboembolic(VTE) complications. Recent literature shows superiority of direct-oral-anticoagulants(DOACs) over low-molecular-weight-heparin (LMWH) for thromboprophylaxis in patients undergoing orthopedic surgeries. The aim of our study was to compare in-hospital outcomes for DOACs vs. LMWH in patients with non-operative pelvic fractures. STUDY DESIGN: We performed 2-year (2015-16) analysis of the American College of Surgeons-Trauma Quality Improvement Program(ACS-TQIP) database...
October 8, 2018: Journal of the American College of Surgeons
Carlos Zgheib, Sarah A Hilton, Lindel C Dewberry, Maggie M Hodges, Subhadip Ghatak, Junwang Xu, Sushant Singh, Sashwati Roy, Chandan K Sen, Sudipta Seal, Kenneth W Liechty
BACKGROUND: Diabetic wounds have become one of the most challenging public health issues of the 21st century and yet there's no effective treatment available. We have previously shown that the diabetic wound healing impairment is associated with increased inflammation and decreased expression of the regulatory microRNA miR-146a. We have conjugated miR-146a to cerium oxide nanoparticles (CNP-miR146a) to target reactive oxygen species (ROS) and inflammation. This study aims to evaluate the consequences of CNP-miR146a treatment of diabetic wounds...
September 27, 2018: Journal of the American College of Surgeons
Mark E Hamill, Matthew C Hernandez, Kent R Bailey, Martin D Zielinski, Miguel A Matos, Henry J Schiller
BACKGROUND: Over the last 30 years public opinion and state level legislation regarding the concealed carry of firearms have shifted dramatically. Prior studies of potential effects have yielded mixed results, making policy recommendations difficult. We investigated whether liberalization of state level concealed carry legislation was associated with a change in the rates of homicide or other violent crime. STUDY DESIGN: Data on violent crime and homicide rates were collected from the U...
September 27, 2018: Journal of the American College of Surgeons
F Selcen Kilinc-Balci, Zafer Kahveci, Patrick L Yorio
BACKGROUND: Exposure to patients' blood/body fluids could be life-affecting, when providing care to patients with infectious diseases. Although the glove-gown interface is considered one of the weakest points of the protective ensemble system, there is a lack of research, and existing standards do not provide much guidance on strategies to minimize gaps between the gowns and gloves. Currently, there is no known standard test method to evaluate fluid leakage or assess performance improvements with new gowns/gloves...
September 27, 2018: Journal of the American College of Surgeons
Zain G Hashmi, Molly P Jarman, Tarsicio Uribe-Leitz, Eric Goralnick, Craig D Newgard, Ali Salim, Edward Cornwell, Adil H Haider
BACKGROUND: Timely access to trauma center(TC) care is critical to achieve "Zero Preventable Deaths After Injury." However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, age-adjusted mortality and timely access to trauma center care. STUDY DESIGN: State-level analysis of adult trauma deaths reported to CDC WONDER (1999-2016)...
September 26, 2018: Journal of the American College of Surgeons
Demetrios Demetriades
No abstract text is available yet for this article.
September 25, 2018: Journal of the American College of Surgeons
Luke B Hartford, Julie Ann M Van Koughnett, Patrick B Murphy, Kelly N Vogt, Richard J Hilsden, Collin Fm Clarke, Laura J Allen, Samuel D Gray, Neil G Parry, Daryl K Gray, Ken A Leslie
BACKGROUND: There has been a dramatic rise in opioid abuse, and diversion of excess, unused prescriptions is a major contributor. We assess the impact of implementing a new standardized pain care bundle, to reduce postoperative opioids in outpatient general surgical procedures. STUDY DESIGN: This study was designed to demonstrate non-inferiority for the primary outcome: patient-reported average pain in the first 7 postoperative days. We prospectively evaluated 224 patients who underwent laparoscopic cholecystectomy or open hernia repair (inguinal, umbilical) pre-intervention to 192 patients post-intervention...
September 25, 2018: Journal of the American College of Surgeons
Kathryn A Schlosser, Michael R Arnold, Javier Otero, Tanushree Prasad, Amy Lincourt, Paul D Colavita, Kent W Kercher, B Todd Heniford, Vedra A Augenstein
BACKGROUND: The decision to perform laparoscopic (L) or open (O) ventral hernia repair (VHR) is multifactorial. This study evaluates the impact of operative approach, BMI and hernia size on outcomes after VHR. STUDY DESIGN: The International Hernia Mesh Registry was queried for VHR (2007-2017). A predictive algorithm was constructed, factoring the impact of BMI, hernia size, age, sex, diabetes, and operative approach on outcomes. RESULTS: Of the 1,906 VHRs, 58...
September 21, 2018: Journal of the American College of Surgeons
Shuyan Wei, Erika Gonzalez Rodriguez, Ronald Chang, John B Holcomb, Lillian S Kao, Charles E Wade
BACKGROUND: Endotheliopathy of trauma is characterized by breakdown of the endothelial glycocalyx. Elevated biomarkers of endotheliopathy, such as serum syndecan-1 (Synd-1) ≥ 40 ng/mL, have been associated with increased need for transfusions, complications, and mortality. We hypothesized that severely injured trauma patients who exhibit elevated Synd-1 levels shortly after admission have an increased likelihood of developing sepsis. STUDY DESIGN: We analyzed a subset of patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial who survived at least 72 hours after hospital admission, and we determined elevated Synd-1 levels (≥ 40 ng/mL) 4 hours after hospital arrival...
September 21, 2018: Journal of the American College of Surgeons
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