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American Surgeon

Rishi Rattan, Casey J Allen, Robert G Sawyer, John Mazuski, Therese M Duane, Reza Askari, Kaysie L Banton, Jeffrey A Claridge, Raul Coimbra, Joseph Cuschieri, E Patchen Dellinger, Heather L Evans, Christopher A Guidry, Preston R Miller, Patrick J O'Neill, Ori D Rotstein, Michaela A West, Kimberley Popovsky, Nicholas Namias
A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay...
September 2016: American Surgeon
Phillip B Ham, Toby Anderton, Ryan Gallaher, Mike Hyrman, Erika Simmerman, Annamalai Ramanathan, David Fallaw, Steven Holsten, Charles Gordon Howell
Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations...
September 2016: American Surgeon
Naureen Iqbal, James Dove, Marie Hunsinger, Anthony T Petrick, Michael E Friscia, Matthew A Facktor, Tania K Arora, Joseph A Blansfield, Mohsen M Shabahang
Literature about combining expertise of two specialties in esophageal cancer surgery is limited. We present the experience at a single institute comparing single-team (ST) versus two-team (TT) approach combining thoracic and abdominal surgeons. This is a retrospective study from a single tertiary care center. Data were collected from electronic medical records. Patients undergoing esophagectomy for esophageal cancer from November 2006 until August 2014 were included. The primary outcome measured was 30-day postoperative morbidity, secondary outcomes measured were operative time, intraoperative blood loss, and 30-day mortality...
September 2016: American Surgeon
Jessica Y Liu, Neil D Saunders, Aaron Chen, Collin J Weber, Jyotirmay Sharma
Neuropsychiatric symptoms (NPSs) of sporadic primary hyperparathyroidism (PHPT) are often subtle and effects of parathyroidectomy (PTX) on symptoms remains poorly characterized. Our aim was to evaluate effects of PTX on NPS in patients with PHPT. A prospective questionnaire was distributed to all patients undergoing PTX and to a thyroidectomy (TX) control group. The questionnaire included the validated scales Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to assess for depression and anxiety respectively, as well as questions modified from Pasieka's Parathyroid Assessment of Symptoms (M-PAS)...
September 2016: American Surgeon
John B Ortolani, Daniel R Tershak, John J Ferrara, Charles J Paget
The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Task Force (ACGTF) on Quality in Endoscopy released updated quality benchmarks for colonoscopy in 2015. Our initial study concluded that surgery residents could perform safe and competent screening colonoscopy within a structured endoscopy curriculum. In this follow-up study, we sought to determine whether surgery residents could achieve the increased adenoma detection rate (ADR) benchmarks endorsed by the ASGE/ACGTF...
September 2016: American Surgeon
Danny Mammo, Claire Peeples, Marc Grodsky, Drew Honaker, Harry Wasvary
This study evaluates whether increased adherence to eight specific practice parameters leads to improved outcomes in patients undergoing elective colorectal resections. In addition, we analyzed whether physicians with better compliance achieved better patient outcomes. Compliance to practice parameters and subsequent outcomes were compared between two groups relative to an educational intervention promoting the eight best practice guidelines selected. A total of 485 patients were identified over a 4-year period and were separated into a pre- (n = 273) and posteducation (n = 212) group...
September 2016: American Surgeon
Kyla D Joubert, Charles D Mabry, Kyle J Kalkwarf, Richard D Betzold, Horace J Spencer, Kara M Spinks, Austin Porter, Saleema Karim, Ronald D Robertson, Michael J Sutherland, Robert T Maxson
Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma. The trauma financial survey collected billing and clinical data on 75 per cent of the state trauma registry patients for fiscal year 2012...
September 2016: American Surgeon
Jamie J Coleman, Saharnaz Tavoosi, Ben L Zarzaur, Brian L Brewer, Grace S Rozycki, David V Feliciano
Problems related to the combination of an arterial injury and a blunt fracture in the lower extremity are well known-delayed diagnosis, damaged soft tissue, and high amputation rate. The actual incidence of this injury pattern is, however, unknown. The purposes of this study were to determine the current incidence of named arterial injuries in patients with blunt fractures in the lower extremities and assess potential associated risk factors. This was a 7-year (2007-2013) retrospective review of patients ≥18 years with blunt lower extremity fractures at a Level I trauma center...
September 2016: American Surgeon
John S Kennedy, Patrick A Robbins
Breast MRI is being used more frequently for advanced screening for breast cancer. Patients may be at increased risk, or are symptomatic, with nonsuspicious mammograms. There is little data regarding the likelihood of a recommendation for biopsy, or for detecting a malignancy, in this population. We intended to determine the malignancy rate, number needed to treat, and positive predictive value for patients receiving adjunctive MRI at our institution. A retrospective review of all breast MRIs from 2008 to 2010 was done...
September 2016: American Surgeon
Paritosh Suman, Chi-Hsiung Wang, Tricia A Moo-Young, Richard A Prinz, David J Winchester
There is no consensus regarding the timing of adjuvant radioactive iodine therapy (RAI) therapy in low- and intermediate-risk papillary thyroid carcinoma (PTC). We analyzed the impact of adjuvant RAI on overall survival (OS) in low- and intermediate-risk PTC. The National Cancer Data Base was queried from 2004 to 2011 for pN0M0 PTC patients having near/subtotal or total thyroidectomy and adjuvant RAI. Tumors ≤1 cm with negative margins were low risk while 1.1- to 4-cm tumors with negative margins or ≤1 cm with microscopic margins were termed intermediate risk...
September 2016: American Surgeon
Mansi Shah, Clayton T Ellis, Michael R Phillips, Amy Marzinsky, William Adamson, Timothy Weiner, Kimberly Erickson, Sang Lee, Patricia A Lange, Sean E McLean
The role of preoperative bowel prep in the pediatric surgical population is uncertain. We performed a randomized prospective study to evaluate noninferiority between the presence or absence of a preoperative bowel prep in elective pediatric bowel surgery on postoperative outcomes. Patients aged three months to 18 years were recruited and randomized to the bowel prep group or the no bowel prep group. Patients were evaluated in-hospital and at postoperative clinic visits. Thirty-two patients were recruited; 18 in the bowel prep group and 14 in the no bowel prep group...
September 2016: American Surgeon
Ilan Maizlin, David A Klima, Elizabeth A Beierle
Posttransplant lymphoproliferative disorder (PTLD) is not uncommon in pediatrics. This case report describes a case of intestinal intussusception that occurred secondary to lymphoid hyperplasia in a child with PTLD following a cardiac transplant. This case was unique in its presentation with multiple areas of intussusception and with need for surgical intervention. The diagnosis of intussusception secondary to lead points from PTLD should be strongly considered in pediatric transplant patients presenting with abdominal complaints...
September 2016: American Surgeon
Ilan Igor Maizlin, Jerry S Chen, Nicholas James Smith, David A Rogers
Posttraumatic esophagomediastinal fistula is an uncommon clinical entity that warrants surgical awareness due to its life-threatening potential. Its management, especially in previously operated field, is controversial and several endoscopic methods are being proposed as alternatives. Ours is the first report of endoscopic fulguration and fibrin injection in successful closure of such fistula. A 9-year-old female sustained complete tracheoesophageal transection from a gunshot wound to the neck and underwent immediate primary repair...
September 2016: American Surgeon
P Benson Ham, Brice Hwang, Linda J Wise, K Christian Walters, Walter L Pipkin, Charles G Howell, Jatinder Bhatia, Robyn Hatley
Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1-18) placed on ECMO in the last 15 years (1999-2014) by the pediatric surgery team for respiratory failure was performed...
September 2016: American Surgeon
Harold Howe, Gautam Bhatia, Christopher C Wright, Barry R Davis, Robert L Gates
No abstract text is available yet for this article.
September 2016: American Surgeon
Jenny M Held, Ryan Restrepo, Robert Ricca
No abstract text is available yet for this article.
September 2016: American Surgeon
Mansi Shah, Richard Frye, Amy Marzinsky, Michael R Phillips, William Adamson, Sean E McLean
No abstract text is available yet for this article.
September 2016: American Surgeon
Yamuna T Krishna, Harold R Howe, Randal S Abrams, Robert Gates
No abstract text is available yet for this article.
September 2016: American Surgeon
Jennifer Ottino, Robert Ricca
No abstract text is available yet for this article.
September 2016: American Surgeon
William F Weber, John M Draus
No abstract text is available yet for this article.
September 2016: American Surgeon
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