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American Surgeon

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https://www.readbyqxmd.com/read/28738957/gaps-in-the-postoperative-conversation-a-comprehensive-review-of-current-practices-and-the-unmet-needs-of-surgeons-families-and-waiting-room-personnel
#1
Brandon Singletary, Nisha Patel, Andrew Mims, Andrew Smedley, Jacob Swords, Ronan O'Bierne, Melanie S Morris, Monika Safford, Martin Heslin
Perioperative communication between surgeons and caregivers is an important aspect of patient care, with postoperative conversations (POCs) being critical. Literature suggests current communication practices may be suboptimal. Identifying barriers and opportunities could improve patient and caregiver satisfaction and increase surgeon efficiency. This mixed method study included 1) prospective study of all patients undergoing a surgery at an academic medical center between September 2014 and March 2016 and 2) nominal groups of physicians, caregivers, and waiting room personnel (WRP)...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738956/upper-extremity-pulse-pressure-predicts-amputation-free-survival-after-lower-extremity-bypass
#2
Eric S Wise, Justine E Wergin, Eric H Mace, Justiss A Kallos, Whitney E Muhlestein, Nicholas J Shelburne, Kyle M Hocking, Colleen M Brophy, Raul J Guzman
Increased pulse pressure reflects pathologic arterial stiffening and predicts cardiovascular events and mortality. The effect of pulse pressure on outcomes in lower extremity bypass patients remains unknown. We thus investigated whether preoperative pulse pressure could predict amputation-free survival in patients undergoing lower extremity bypass for atherosclerotic occlusive disease. An institutional database identified 240 included patients undergoing lower extremity bypass from 2005 to 2014. Preoperative demographics, cardiovascular risk factors, operative factors, and systolic and diastolic blood pressures were recorded, and compared between patients with pulse pressures above and below 80 mm Hg...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738955/primary-site-predicts-grade-for-gastroenteropancreatic-neuroendocrine-tumors
#3
Timothy L Fitzgerald, Catalina Mosquera, C Suzanne Lea, Matthew McMullen
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare and abstruse neoplasms with increasing incidence and clinical relevance. The National Cancer Data Base was examined to identify GEP-NET cases from 2004 to 2013. In total, 39,454 patients diagnosed with GEP-NET were identified. Median age was 61 years. Majority was female (50.13%), white (79.49%), and had low-grade neoplasms (84.39%). On univariate analysis, age, sex, race, primary site, tumor size, and regional lymph node involvement were associated with tumor grade (P < 0...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738954/the-utility-of-the-alvarado-score-in-the-diagnosis-of-acute-appendicitis-in-the-elderly
#4
Anastasiya Shchatsko, Rebecca Brown, Trista Reid, Sasha Adams, Amy Alger, Anthony Charles
Clinical scores determining the likelihood of acute appendicitis (AA), including the Alvarado score, were devised using a younger population, and their efficacy in predicting AA in elderly patients is not well documented. This study's purpose is to evaluate the utility of Alvarado scores in this population. A retrospective chart review of patients >65 years old presenting with pathologically diagnosed AA from 2000 to 2010 was performed. Ninety-six patients met inclusion criteria. The average age was 73.7 ± 1...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738953/morbidity-associated-with-diverting-loop-ileostomies-weighing-diversion-in-rectosigmoid-resection
#5
Nathan Belkin, Liliana G Bordeianou, Paul C Shellito, Alexander T Hawkins
Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738952/medication-errors-in-injured-patients
#6
Scott C Dolejs, Christopher F Janowak, Ben L Zarzaur
Trauma patients are vulnerable to medication error given multiple handoffs throughout the hospital. The purpose of this study was to assess trends in medication errors in trauma patients and the role these errors play in patient outcomes. Injured adults admitted from 2009 to 2015 to a Level I trauma center were included. Medication errors were determined based on a nurse-driven, validated, and prospectively maintained database. Multivariable logistic regression modeling was used to control for differences between groups...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738951/evaluation-of-cardiopulmonary-complication-rates-after-port-insertion-is-a-postoperative-x-ray-needed
#7
Justin G Vaughan, Allison B Cauthen, Ahkeel Allen, Paul Dale
It is customary for a postoperative chest radiograph to be obtained after fluoroscopic guided port insertion to exclude acute complications. In this review, we provide a cost-benefit analysis by examination of acute postoperative complications detected by postoperative port insertion chest films at our institution. We conducted a retrospective chart review of complications associated with port insertion procedures performed over a 5-year period. Our study included only ultrasound-assisted internal jugular venous or landmark guided subclavian ports placed with the assistance of fluoroscopy...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738950/a-decade-evaluation-of-a-state-trauma-system-has-access-to-inpatient-trauma-care-at-designated-trauma-centers-improved
#8
Dennis W Ashley, Etienne E Pracht, Regina S Medeiros, Elizabeth V Atkins, Elizabeth G Nesmith, Tracy J Johns, James R Dunne, Jeffrey M Nicholas
Recently, the trauma center component of the Georgia trauma system was evaluated demonstrating a 10 per cent probability of increased survival for severely injured patients treated at designated trauma centers (DTCs) versus nontrauma centers. The purpose of this study was to determine the effectiveness of a state trauma system to provide access to inpatient trauma care at DTCs for its residents. We reviewed 371,786 patients from the state's discharge database and identified 255,657 treated at either a DTC or a nontrauma center between 2003 and 2012...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738949/blood-transfusion-and-survival-for-resected-adrenocortical-carcinoma-a-study-from-the-united-states-adrenocortical-carcinoma-group
#9
Caroline E Poorman, Lauren M Postlewait, Cecilia G Ethun, Thuy B Tran, Jason D Prescott, Timothy M Pawlik, Tracy S Wang, Jason Glenn, Ioannis Hatzaras, Rivfka Shenoy, John E Phay, Kara Keplinger, Ryan C Fields, Linda X Jin, Sharon M Weber, Ahmed Salem, Jason K Sicklick, Shady Gad, Adam C Yopp, John C Mansour, Quan-Yang Duh, Natalie Seiser, Carmen C Solorzano, Colleen M Kiernan, Konstantinos I Votanopoulos, Edward A Levine, Charles A Staley, George A Poultsides, Shishir K Maithel
Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738948/socioeconomic-factors-associated-with-readmission-after-deceased-donor-renal-transplantation
#10
Richard S Whitlock, Samantha Seals, Ashley Seawright, James J Wynn, Christopher Anderson, Truman M Earl
Early hospital readmissions after kidney transplantation pose a significant financial burden and hardship for patients and health-care institutions alike. We sought to identify the risk factors associated with increased likelihood of readmission after transplantation, and examined to determine whether patient socioeconomic demographics impacted the likelihood of perioperative readmissions. We evaluated all deceased donor renal transplants performed at our institution between August 2011 and December 2015. In a cohort of 325 transplant operations that met our inclusion criteria, 117 (36%) were readmitted to the hospital within 90 days of discharge...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738947/outpatient-total-thyroidectomy-is-safe-for-moderate-volume-surgeons
#11
Jonathan Black, Travis Cotton, Jen Jen Yeh
Traditionally, total thyroidectomy (TT) was an inpatient procedure, but recent trends indicate that patients are often discharged on the day of surgery. This has been proven safe for high-volume surgeons but has not been studied for low (<10 TT per year) and moderate volume surgeons (<24 TT per year). Retrospective review was performed for 414 total thyroidectomies between 2005 and 2013. Emergency department visits and readmissions within 30 days of surgery were captured, but were considered the same for the purpose of this analysis...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738946/effect-of-implementation-of-intermittent-straight-catheter-protocol-on-rate-of-urinary-tract-infections-in-a-trauma-population
#12
Katherine Kelley, Theresa Johnson, Jessica Burgess, Timothy J Novosel, Leonard Weireter, Jay N Collins
Catheter-associated urinary tract infections (UTIs) are a significant negative outcome. There are previous studies showing advantages in removing Foleys early but no studies of the effect of using intermittent as opposed to Foley catheterization in a trauma population. This study evaluates the effectiveness of a straight catheter protocol implemented in February 2015. A retrospective chart review was performed on all patients admitted to the trauma service at a single institution who had a UTI one year before and one year after protocol implementation on February 18, 2015...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738945/disparities-in-the-care-of-differentiated-thyroid-cancer-in-the-united-states-exploring-the-national-cancer-database
#13
Kathryn Jaap, Rebekah Campbell, James Dove, Marcus Fluck, Marie Hunsinger, Jeffrey Wild, Tania Arora, Mohsen Shabahang, Joseph Blansfield
Differentiated thyroid cancer (DTC) treatment is multifaceted, and may be influenced by socioeconomic factors. The goal of this study is to examine disparities in DTC treatment. DTC patients from 1998 to 2012 were identified using the National Cancer Database. DTC was identified in 262,041 patients. The mean age was 48.2. The majority of patients (52%) received care at Comprehensive Community Cancer Programs (CCCPs). Total thyroidectomy was less common at Community Cancer Programs (CCPs) [odds ratio (OR): 0...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738944/predicting-postoperative-complications-for-acute-care-surgery-patients-using-the-acs-nsqip-surgical-risk-calculator
#14
Jessica R Burgess, Benjamin Smith, Rebecca Britt, Leonard Weireter, Travis Polk
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator has been used to assist surgeons in predicting the risk of postoperative complications. This study aims to determine if the risk calculator accurately predicts complications in acute care surgical patients undergoing laparotomy. A retrospective review was performed on all patients on the acute care surgery service at a tertiary hospital who underwent laparotomy between 2011 and 2012. The preoperative risk factors were used to calculate the estimated risks of postoperative complications in both the original ACS NSQIP calculator and updated calculator (June 2016)...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738943/presenting-stage-in-colon-cancer-is-associated-with-insurance-status
#15
David Lawrence, Lauren Weigel, Paul Dale, Betsy Smith, Michael D Honaker
Colorectal cancer continues to be the third most common cause of cancer death in the United States. Access to health care is also a nationwide problem. The purpose of the current study is to see if insurance status is associated with stage of colon cancer at presentation. The tumor registry was queried for all patients with colon cancer from 2009 to 2014. Demographics, including insurance status was statistically analyzed to determine if an association existed between insurance status and stage of colon cancer at the time of presentation...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738942/in-the-modern-era-of-ct-do-blunt-trauma-patients-with-markers-for-blunt-bowel-or-mesenteric-injury-still-require-exploratory-laparotomy
#16
Katelyn Young, Melina Benson, Andrew Higgins, James Dove, Marie Hunsinger, Mohsen Shabahang, Joseph Blansfield, Denise Torres, Kenneth Widom, Jeffrey Wild
After blunt trauma, certain CT markers, such as free intraperitoneal air, strongly suggest bowel perforation, whereas other markers, including free intraperitoneal fluid without solid organ injury, may be merely suspicious for acute injury. The present study aims to delineate the safety of nonoperative management for markers of blunt bowel or mesenteric injury (BBMI) that are suspicious for significant bowel injury after blunt trauma. This was a retrospective review of adult blunt trauma patients with abdominopelvic CT scans on admission to a Level I trauma center between 2012 and 2014...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738941/disparities-in-rural-breast-cancer-care-factors-affecting-choice-of-breast-reconstruction-in-a-west-virginia-tertiary-care-hospital
#17
Tyler L Holliday, Patrick D Suggs, Stephanie N Thompson, Bryan K Richmond
The decision to pursue immediate postmastectomy breast reconstruction (IBR) is not uniform across all groups of women in the United States. We sought to investigate if the challenges of caring for a socioeconomically and geographically challenged rural population affected the incidence of IBR and to identify predictive factors of IBR in this population. Using our institution's cancer registry, we conducted a 10-year review of women with early-stage, unilateral breast cancer who received mastectomy. Demographics, insurance status, comorbidities, and surgeon graduation year were compared for patients receiving IBR versus no reconstruction...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738940/factors-affecting-choice-of-treatment-for-early-stage-breast-cancer-in-west-virginia-a-10-year-experience-from-a-rural-tertiary-care-center
#18
Patrick D Suggs, Tyler L Holliday, Stephanie N Thompson, Bryan K Richmond
Recent literature shows changing trends in use of breast conservation surgery (BCS), mastectomy, and contralateral prophylactic mastectomy (CPM) in women with early-stage breast cancer (ESBC). We analyzed factors associated with selection of these treatment modalities in a rural West Virginia tertiary care hospital. We conducted a 10-year analysis of women treated for ESBC at our institution from the institutional cancer registry. Variables were compared between patients choosing BCS versus mastectomy. In women who chose mastectomy, predictors for choice of CPM were also examined...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738939/can-tumor-biology-predict-occult-multifocal-disease-in-breast-cancer-patients
#19
Anees B Chagpar, Ali F Cicek, Malini Harigopal
The SHAVE trial is a prospective trial in which 235 women with stage 0 to 3 disease undergoing partial mastectomy were randomized intraoperatively to either have cavity shave`s (CSMs) taken at the time of initial surgery or not. In this study, 9 of the 76 patients (11.8%) with initially negative margins randomized to the "shave" group had occult cancers found in the CSM. Seven of these patients had sufficient primary tumor tissue available for further analysis. These patients were age and stage matched in a 1:2 ratio to other patients in the trial who had no further disease found in their CSM...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738938/minimally-invasive-incision-and-drainage-technique-in-the-treatment-of-simple-subcutaneous-abscess-in-adults
#20
Hai V Salfity, Nakul Valsangkar, Melissa Schultz, Joseph Salfity, Katie Jo Stanton-Maxey, Ben Zarzaur, David V Feliciano, Michelle R Laughlin
A minimally invasive (MI) approach using small incisions and vessel loops for drainage of simple perianal abscesses has been described in the pediatric population with decreased postoperative pain and comparable results to the traditional incision and drainage (I&D). The hypothesis was MI I&D will yield similar outcomes in adults. Patients who underwent I&D of perianal abscesses at an urban hospital from January 2008 to December 2015 were identified by Current Procedural Terminology code. Patients below 18 years of age, with inflammatory bowel diseases, or fistulae were excluded...
July 1, 2017: American Surgeon
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