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American Surgeon

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https://www.readbyqxmd.com/read/28822405/early-and-late-complications-in-laparoscopic-gastric-bypass-comparative-study-between-manual-and-stapled-anastomosis
#1
(no author information available yet)
No abstract text is available yet for this article.
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822404/an-expanded-preoperative-component-within-an-enhanced-recovery-protocol-improves-outcomes-in-colorectal-surgery
#2
Nathan M Johnson, Sandy L Fogel
Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822403/inpatient-peripherally-inserted-central-venous-catheter-complications-should-peripherally-inserted-central-catheter-lines-be-placed-in-the-intensive-care-unit-setting
#3
Michael Martyak, Ishraq Kabir, Rebecca Britt
Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822402/predictors-of-utilization-and-quality-assessment-in-robotic-rectal-cancer-resection-a-review-of-the-national-cancer-database
#4
Christie Buonpane, Enobong Efiong, Marie Hunsinger, Marcus Fluck, Mohsen Shabahang, Jeffrey Wild, Kristen Halm, Kevin Long, Christopher Buzas, Joseph Blansfield
Robotic surgery (RS) is a novel treatment for rectal cancer resection (RCR); however, this technology is not widely accessible. The objective of this study is to evaluate the utilization of RS in RCR compared with open and laparoscopic techniques and to assess the quality of resection. RCR from 2010 to 2012 were identified using the National Cancer Database and placed into categories: open, laparoscopic, and robotic. A total of 23,857 patients who received open, laparoscopic, and robotic RCR were included (n = 14,735 (61...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822401/esophageal-perforation-a-common-clinical-problem-with-many-different-management-options
#5
Lloyd M Felmly, Hyejin Kwon, Chadrick E Denlinger, Jacob A Klapper
Esophageal perforation is a complex clinical entity that has multiple etiologies and variability in presentation, making it challenging to diagnose and treat. The mortality of esophageal perforation has improved because therapies have evolved. Whereas primary repair is the standard of care, multiple treatments may be employed successfully. We retrospectively reviewed all cases of suspected or confirmed esophageal perforation that were admitted to the thoracic surgery service at our institution between January 2011 and June 2016...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822400/open-retromuscular-repair-of-parastomal-hernias-with-synthetic-mesh
#6
Lucas R Beffa, Jeremy A Warren, William S Cobb, Bryan Knoedler, Joseph A Ewing, Alfredo M Carbonell
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822399/chest-tube-removal-in-simple-pneumothorax-does-water-seal-duration-matter
#7
Lindsay C Bridges, Danny J Torrent, Catalina Mosquera, Michael R Bard
Timing of chest tube (CT) removal after transition from suction to water-seal (WS) varies when treating traumatic simple pneumothoraces (PTXs). Longer periods of WS may identify slow-occurring PTXs reducing CT replacement, whereas shorter periods may expedite patient disposition and have associated cost savings. Prior studies support the need for an interval of WS. We compare durations of WS, looking at rates of CT reinsertion. A 10-year retrospective review on trauma patients with a simple PTX requiring a CT was performed...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822398/variability-in-perioperative-fasting-practices-negatively-impacts-nutritional-support-of-critically-ill-intubated-patients
#8
Molly J Douglas, David Ciraulo
The aim of the study was to quantify nutritional losses related to pre- and postoperative fasts in critically ill intubated patients and to explore whether shorter fasts are safe and appropriate in this population. A retrospective review of mechanically ventilated adults undergoing surgery more than 24 hours after admission to a Level I trauma center over 15 months was done, which yielded 132 procedures and 81 unique patients. Ninety per cent of preoperative periods and 43 per cent of postoperative periods were affected by nonmedical barriers to feeding...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822397/outcomes-after-mastectomy-and-lumpectomy-in-octogenarians-and-nonagenarians-with-early-stage-breast-cancer
#9
Amelia Y Merrill, Doris R Brown, Heidi D Klepin, Edward A Levine, Marissa Howard-Mcnatt
Prospective studies have shown equal outcomes after mastectomy or breast conservation in patients with invasive breast cancer; however, many of these studies excluded elderly patients. We identified patients in their eighties and nineties with clinical stage 0 to II breast cancer undergoing mastectomy or lumpectomy with or without radiation from the prospective sentinel lymph node database at Wake Forest Baptist Health and analyzed their treatment and survival. Of 92 patients, 24 (26.1%) underwent mastectomy, 22 (23...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822396/an-evaluation-of-parastomal-hernia-repair-using-the-americas-hernia-society-quality-collaborative
#10
MULTICENTER STUDY
Sarah S Fox, Randy Janczyk, Jeremy A Warren, Alfredo M Carbonell, Benjamin K Poulose, Michael J Rosen, William W Hope
The purpose of this review was to evaluate outcomes relating to parastomal hernia repair. Data from the Americas Hernia Society Quality Collaborative were used to identify patients undergoing parastomal hernia repair from 2013 to 2016. Parastomal hernia repairs were compared with other repairs using Pearson's test and Wilcoxon test with a P value <0.05 considered significant. Parastomal hernia repairs were performed in 311 patients. Techniques of repair include open in 85 per cent and laparoscopic in 15 per cent...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822395/patient-and-tumor-disparities-in-breast-cancer-based-on-insurance-status
#11
COMPARATIVE STUDY
Celia Quang, Seth Hill, Scott Blair, Donna Lynn Dyess, Joe Spencer Liles
This study seeks to determine whether uninsured breast cancer patients are more likely to present with advanced disease relative to insured patients. We retrospectively reviewed newly diagnosed breast cancer patients over a 27-month period. Patients were sorted based on insurance status at diagnosis. Demographic and tumor-specific data were collected and analyzed using nonparametric testing. We identified 276 breast tumors in 260 patients. Out of the 260 patients, 71 patients (27.3%) were uninsured and were more likely to be black (P < 0...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822394/the-clinical-utility-and-cost-of-postoperative-mammography-completed-within-one-year-of-breast-conserving-therapy-is-it-worth-it
#12
Ahkeel Allen, Allison Cauthen, Justin Vaughan, Paul Dale
Breast conserving therapy (BCT), lumpectomy followed by radiotherapy, is an effective treatment for a majority of breast cancers. According to the National Comprehensive Cancer Network, mammographic imaging should be completed at least six months after completion of radiation. This study evaluates the clinical significance and financial cost of postoperative breast imaging within one year of BCT. Patients treated with BCT between 2014 and 2016 at an academic center were identified retrospectively. The medical records were reviewed to identify the timing and type of the first imaging study after BCT...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822393/identifying-futile-interfacility-surgical-transfers
#13
Kristy Kummerow Broman, Sharon E Phillips, Jesse M Ehrenfeld, Mayur B Patel, Oscar M Guillamondegui, Kenneth W Sharp, Richard A Pierce, Benjamin K Poulose, Michael D Holzman
Surgeons perceive that some surgical transfers are futile, but the incidence and risk factors of futile transfer are not quantified. Identifying futile interfacility transfers could save cost and undue burdens to patients and families. We sought to describe the incidence and factors associated with futile transfers. We conducted a retrospective cohort study from 2009 to 2013 including patients transferred to a tertiary referral center for general or vascular surgical care. Futile transfers were defined as resulting in death or hospice discharge within 72 hours of transfer without operative, endoscopic, or radiologic intervention...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822392/optimal-modified-frailty-index-cutoff-in-older-gastrointestinal-cancer-patients
#14
Mary Garland, Fang-Chi Hsu, Perry Shen, Clancy J Clark
The newly characterized modified frailty index (mFI) is a robust predictor of postoperative outcomes for surgical patients. The present study investigates the optimal cutoff for mFI specifically in older gastrointestinal (GI) cancer patients undergoing surgery. All patients more than 60 years old who underwent surgery for a GI malignancy (esophagus, stomach, colon, rectum, pancreas, liver, and bile duct) were identified in the 2005 to 2012 National Surgical Quality Improvement Program, Participant Use Data File (NSQIP PUF)...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822391/the-impact-of-hemodynamic-transesophageal-echocardiography-on-the-use-of-continuous-renal-replacement-therapy-in-trauma
#15
Madison Griffin, Brett Howard, Sam Devictor, Josh Ferenczy, Frances Cobb, D Benjamin Christie
Post-traumatic fluid management is a widely debated topic. No best-practice consensus exists. Adverse outcomes such as acute kidney injury or volume overload are common. Continuous renal replacement therapy (CRRT) is an adjunct therapy for severe acute renal failure and volume overload, but is costly and not without risk. Hemodynamic transesophageal echocardiography (hTEE) is widely accepted as a reliable way to monitor volume status of intensive care unit (ICU) patients. Although data exist evaluating hTEE and CRRT independently, there is a lack of research mutually inclusive of the two...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822390/physiologic-features-of-brain-death
#16
Eno-Obong Essien, Kristina Fioretti, Thomas M Scalea, Deborah M Stein
Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822389/mammographic-screening-at-age-40-or-45-what-difference-does-it-make-the-potential-impact-of-american-cancer-society-mammography-screening-guidelines
#17
COMPARATIVE STUDY
Crystal E Fancher, Anthony Scott, Ahkeel Allen, Paul Dale
this is a 10-year retrospective chart review evaluating the potential impact of the most recent American Cancer Society mammography screening guidelines which excludes female patients aged 40 to 44 years from routine annual screening mammography. Instead they recommend screening mammography starting at age 45 with the option to begin screening earlier if the patient desires. The institutional cancer registry was systematically searched to identify all women aged 40 to 44 years treated for breast cancer over a 10-year period...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822388/outcomes-following-noncardiac-surgery-in-patients-with-ventricular-assist-devices-a-single-center-experience
#18
Shawna M Kettyle, Nikhil L Chervu, Appajosula Sarada Rao, Salaam Sadi, David Majure, Jack A Sava, Laura S Johnson
the prevalence of ventricular assist devices (VADs) is increasing as advanced cardiac therapies progress. These patients commonly require non-cardiac surgical procedures (NCS), although data are scant regarding the safety, timing, and operations that may safely be performed. We aim to describe our experience with VAD patients undergoing NCS. We retrospectively reviewed records on patients who underwent NCS after VAD implantation between 2013 and 2015 at a single Joint Commission-accredited VAD institution. Data collection included demographics, ischemic cardiomyopathy or nonischemic cardiomyopathy, operative details, and perioperative anticoagulation management and outcomes...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822387/indicators-of-survival-and-favorable-functional-outcomes-after-decompressive-craniectomy-a-multi-institutional-retrospective-study
#19
MULTICENTER STUDY
Abid D Khan, Anna J Elseth, Brian Head, Jack Rostas, Julie A Dunn, Thomas J Schroeppel, Richard P Gonzalez
The role of decompressive craniectomy (DC) for severe traumatic brain injury (STBI) remains controversial. The purpose of this study was to identify factors that are indicators of survival and improved functional outcome in patients who undergo DC for STBI. A retrospective review of STBI patients who underwent DC was performed at four trauma centers during a 45-month period. Data collected included age, gender, mechanism of injury, Injury Severity Score (ISS), admission Glasgow Coma Scale (GCS), time from admission to DC, mortality, and extended Glasgow Outcome Score before discharge...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822386/the-sestamibi-paradox-improving-intraoperative-localization-of-parathyroid-adenomas
#20
Jessica L Buicko, Kandace M Kichler, Julia R Amundson, Stephanie Scurci, Robert A Kozol
Accurate localization of parathyroid adenomas allows for minimally invasive parathyroidectomy. This results in a shorter length of stay and increased patient satisfaction. Preoperative Technetium (99mTc) sestamibi scans accurately localize parathyroid adenomas in 70 to 85 per cent of cases. If a patient has a negative scan, it is logical to believe that with a preoperative sestamibi injection, the gamma probe may fail to help find an adenoma. We hypothesized that the gamma probe would not be useful intraoperatively for patients with primary hyperparathyroidism (PHPTH) and a negative sestamibi scan...
August 1, 2017: American Surgeon
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