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American Surgeon

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https://www.readbyqxmd.com/read/28637574/perforated-colonic-diverticula-presenting-as-periorbital-and-cervical-subcutaneous-emphysema
#1
Brian P Fleischer, Martin J Carney, Wesley B Vanderlan
No abstract text is available yet for this article.
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637573/laparoscopic-appendectomy-protocol-expedites-management-of-uncomplicated-acute-appendicitis
#2
Alvaro M Bada, Joseph A Ibrahim, Karen Safcsak, Andrew C Gratzon, Chadwick P Smith, Michael L Cheatham
Bed availability remains a constant struggle for tertiary care centers resulting in the use of management protocols to streamline patient care and reduce length of stay (LOS). A standardized perioperative management protocol for uncomplicated acute appendicitis (UA) was implemented in April 2014 to decrease both CT scan usage and LOS. Patients who underwent laparoscopic appendectomy for UA from April 2012 to May 2013 (PRE group) and April 2014 to May 2015 (POST group) were compared retrospectively. There were no differences in patient demographics or clinical findings between the groups...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637572/investigating-cyclooxygenase-inhibition-in-a-rat-pulmonary-contusion-model-a-laboratory-study-finding-no-improvement-with-ibuprofen
#3
John P Sharpe, Nick R Khan, Arindam R Chatterjee, Jinsong Huang, Louis J Magnotti, Martin A Croce, Timothy C Fabian
Minimal advances have been made in the management of pulmonary contusions (PCs). The purpose of this study was to evaluate the impact of cyclooxygenase inhibition on outcomes following PC in a rat model. PC was induced in anesthetized adult rats. Ibuprofen was given to the treatment group (TG) and water was given to the control group (CG). Lung injury was assessed with pulse oximetry, arterial blood gases, CT, and histopathologic examination. Inflammation was measured with both serum and bronchoalveolar lavage (BAL) levels of tumor necrosis factor α and interleukin-6...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637571/workforce-issues-in-pediatric-surgery
#4
Don K Nakayama
High salaries indicate a demand for pediatric surgeons in excess of the supply, despite only a slight growth in the pediatric-age population and a sharp increase in numbers of trainees. Top-level neonatal intensive care units require 24-hour-7-day pediatric surgical availability, so hospitals are willing to pay surgeons a premium and engage high-priced locum tenens surgeons to fill vacancies in coverage. With increased supply comes an erosion of the numbers of cases performed by trainees and surgeons in practice...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637570/risk-factors-that-predict-recurrent-clostridium-difficile-infections-in-surgical-patients
#5
Craig A Messick, Jeff P Hammel, Tracy Hull
Clostridium difficile (C. difficile) infection (CDI) is a serious problem mostly studied during patients' index infections. The aim of this study is to define the incidence of primary and recurrent postoperative (postop) CDI in a single institution's entire surgical population and to identify risk factors that influence disease recurrence. Using electronic medical records from 2002 to 2012, charts were reviewed from all patients with laboratory-proven (enzyme-linked immunosorbent assay or polymerase chain reaction methods) C...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637569/assessing-field-triage-decisions-and-the-international-classification-injury-severity-score-iciss-at-predicting-outcomes-of-trauma-patients
#6
Casey J Allen, Daniel J Baldor, Carl I Schulman, Louis R Pizano, Alan S Livingstone, Nicholas Namias
Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637568/disparities-in-the-age-related-rates-of-colorectal-cancer-in-the-united-states
#7
Emmanuel Gabriel, Katherine Ostapoff, Kristopher Attwood, Eisar Al-Sukhni, Patrick Boland, Steven Nurkin
The incidence of colorectal cancer (CRC) among Americans under the age of 50 years is increasing. The purpose of this study was to identify racial and socioeconomic disparities associated with this trend. The National Cancer Data Base was used to identify patients with CRC from 1998 to 2011. Patients were stratified by age (<50 versus >60 years), with ages 50 to 60 years omitted from the analysis to minimize overlapping trends between the two age groups. Relative frequencies (RFs) by year were plotted against demographic variables...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637567/the-impact-of-early-recurrence-on-quality-of-life-after-cytoreduction-with-hipec
#8
Nathan M Hinkle, Vandana Botta, John P Sharpe, Paxton Dickson, Jeremiah Deneve, Gitonga Munene
Improved oncological outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in highly selected patients have been well documented. The extensive nature of the procedure adversely affects quality of life (QoL). The aim of this study is to longitudinally evaluate QoL following CRS/HIPEC. This is a retrospective review of a prospectively maintained database of patients with peritoneal malignancies undergoing CRS/HIPEC. Clinicopathological data, oncologic outcomes, and QoL were analyzed preoperatively and postoperatively at 2 weeks, and 1, 3, 6, and 12 months...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637566/evolving-role-of-hepatic-resection-for-metastatic-urologic-malignancies
#9
John B Hamner, Mustafa Raoof, Sinziana Dumitra, Hans F Schoellhammer, Carly Crowder, Philip H G Ituarte, Joseph Kim, Gagandeep Singh
Liver resection for noncolorectal, nonneuroendocrine metastases remains controversial. Here, we evaluate a single institutional experience with hepatic resection for metastatic urologic malignancies. A single-institution review of patients who underwent hepatic resection for metastatic urologic tumors between the years of 2000 and 2013 was performed. Patient charts were analyzed for pathologic data and perioperative outcomes including short- and long-term morbidity, mortality, and overall and disease-free survival...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637565/is-percutaneous-cholecystostomy-a-good-alternative-treatment-for-acute-cholecystitis-in-high-risk-patients
#10
Davide Papis, Eiman Khalifa, Ricky Bhogal, Amit Nair, Saboor Khan, Zaed Hamady, Jawad Ahmed, Gabriele Marangoni
Cholecystectomy is the treatment of choice for acute cholecystitis but the management of high-risk surgical patients is a difficult dilemma. Percutaneous cholecystostomy (PC) could represent a safer and less invasive option. The aim of the study was to assess the outcomes of PC in high-risk patients. This is a retrospective single-center study; data were collected from our hospital electronic record system. From February 2009 to March 2014, there were 753 patients admitted with acute cholecystitis. Of these 39 were considered high risk for surgery and underwent PC during their hospital stay...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637564/do-iodine-impregnated-adhesive-surgical-drapes-reduce-surgical-site-infections-during-open-ventral-hernia-repair-a-comparative-analysis
#11
Neal Moores, Steven Rosenblatt, Ajita Prabhu, Michael Rosen
This study evaluated the role of iodine-impregnated adhesive drapes to reduce surgical site infections and occurrences in open ventral hernia repairs. All patients undergoing open ventral hernia repair of clean wounds with a retromuscular repair using synthetic mesh by a single surgeon were prospectively evaluated from the American Hernia Society Quality Collaborative. Patients were divided into those that had an Ioban drape and those that did not. The primary endpoints of this study were postoperative surgical site occurrence and infections...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637563/postoperative-neutrophil-to-lymphocyte-ratio-as-a-predictor-of-long-term-prognosis-after-pancreatectomy-for-pancreatic-carcinoma-a-retrospective-analysis
#12
Eiji Tsujita, Yasuharu Ikeda, Nao Kinjo, Yo-Ichi Yamashita, Terumasa Hisano, Masayuki Furukawa, Ken-Ichi Taguchi, Masaru Morita, Yasushi Toh, Takeshi Okamura
To clarify the prognostic value of the postoperative blood neutrophil-to-lymphocyte ratio (NLR) in patients undergoing pancreatectomy for pancreatic carcinoma (PAC). A high preoperative NLR has been reported to be a predictor of poor survival in patients with various cancers including PAC. However, it has not been extensively examined in postoperative NLR after pancreatectomy for PAC. This retrospective study enrolled 86 patients who underwent pancreatectomy without preoperative therapy for PAC from 2005 to 2013...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637562/ibd-a-growing-and-vulnerable-cohort-of-hospitalized-patients-with-clostridium-difficile-infection
#13
Allan Mabardy, Justin McCarty, Alan Hackford, Haisar Dao
The most recent nationwide data show a rising incidence of Clostridium difficile infection in hospitalized patients with ulcerative colitis (UC). We describe recent national trends with regard to incidence, mortality, and the rate of total colectomy. The Nationwide Inpatient Sample database identified patients admitted to hospitals in the United States with diagnoses of C. difficile and inflammatory bowel disease (IBD) during the study years 2007 to 2013. We analyzed incidence of C. difficile, mortality, and colectomy rates...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637561/considering-postoperative-functional-hypoaldosteronism-after-unilateral-adrenalectomy
#14
Lee F Starker, Ioannis Christakis, Jamii St Julien, Kelly Schwarz, Paul Graham, Elizabeth G Grubbs, Jeffrey E Lee, Nancy D Perrier
Conn's Syndrome is an uncommon condition. Patients who have undergone adrenalectomy in the early postoperative period can demonstrate biochemical hypoaldosteronism. Given the rare nature of this phenomenon we investigated its incidence and whether it translated to clinical findings. A single-institution retrospective review of all patients with biochemically proven hyperaldosteronism from 2005 to 2014 that underwent unilateral adrenalectomy. A total of 29 patients fit the inclusion criteria. Functional hypoaldosteronism had appreciated in 18/29 (62%) patients, whereas 11 patients (38%) had normal postoperative aldosterone...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637560/despite-trauma-center-closures-trauma-system-regionalization-reduces-mortality-and-time-to-definitive-care-in-severely-injured-patients
#15
Jack C He, David Schechtman, Debra L Allen, Jillian J Cremona, Jeffrey A Claridge
The Northern Ohio Trauma System (NOTS), consisting of multiple hospital systems, was established in 2010 to improve trauma outcomes. This study assessed its impact on mortality and time to definitive care, focusing especially on the severely injured patients. NOTS trauma registry was queried for all trauma activations from 2008 to 2013. The years between 2008-2009 and 2011-2013 were designated as pre- and post-NOTS, respectively. Data from 2010 was excluded as a transitional year. Two trauma centers (TCs) closed in 2010...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637559/complex-abdominal-wall-hernia-repair-in-contaminated-surgical-fields-factors-affecting-the-choice-of-prosthesis
#16
Manuel López-Cano, María Teresa Quiles, José Antonio Pereira, Manuel Armengol-Carrasco, María Antonia Arbós Vía
To compare patients with complex abdominal wall hernias undergoing surgical repair using synthetic nonabsorbable or biologic meshes in contaminated fields. Retrospective review of 62 patients with complex abdominal wall hernia with surgical repair in an elective setting and in the context of a clean-contaminated or contaminated fields (January 2009-April 2015). Two groups according to the prosthesis (synthetic nonabsorbable, n = 48 or biologic, n = 14). Mean follow-up was 24.6 (15.8) months. Clean-contaminated wounds were significantly more frequent in the synthetic group...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637558/travel-time-influences-readmission-risk-geospatial-mapping-of-surgical-readmissions
#17
Florence E Turrentine, Patrick J Buckley, Min-Woong Sohn, Michael D Williams
The University of Virginia (UVA) has recently become an Accountable Care Organization (ACO), intensifying efforts to provide better care for individuals. UVA's ACO population resides across the entire Commonwealth, with a large percentage of patients living in rural areas. To provide better health for this population, the central tenet of the ACO mission, we identified geographic risk factors influencing hospital readmission. We analyzed the relationship between the distance of patients' residence to the nearest hospital and 30-day readmission in general surgery patients...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637557/nomogram-derived-prediction-of-postoperative-ileus-after-colectomy-an-assessment-from-nationwide-procedure-targeted-cohort
#18
Ahmet Rencuzogullari, Cigdem Benlice, Meagan Costedio, Feza H Remzi, Emre Gorgun
Postoperative ileus (POI) is a clinical burden to health-care system. This study aims to evaluate the incidence and predictors of POI in patients undergoing colectomy and create a nomogram by using recently released procedure-targeted nationwide database. Patients who underwent elective colectomy in 2012 and 2013 were identified from American College of Surgeons National Surgical Quality Improvement Program using the new procedure-targeted database. Demographics, comorbidities, and 30-day postoperative outcomes were evaluated...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637556/pretrauma-functional-independence-measure-score-predicts-survival-in-geriatric-trauma
#19
Brian Fletcher, Eric Bradburn, Christopher Baker, Bryan Collier, Mark Hamill, Katherine Shaver
The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637555/overview-of-nonoperative-blunt-splenic-injury-management-with-associated-splenic-artery-pseudoaneurysm
#20
Chet A Morrison, Brian W Gross, Matthew Kauffman, Katelyn J Rittenhouse, Frederick B Rogers
The delayed development of splenic artery pseudoaneurysm (SAP) can complicate the nonoperative management of splenic injuries. We sought to determine the utility of repeat imaging in diagnosing SAP in patients managed nonoperatively without angioembolization. We hypothesized that a significant rate of SAPs would be found in this population on repeat imaging. Patients undergoing nonoperative splenic injury management from January 2011 to June 2015 were queried from the trauma registry. Rates of repeat imaging, angioembolization, readmission, and SAP development were analyzed...
June 1, 2017: American Surgeon
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