JAMA surgery
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To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR). ⋯ One in 203 surgical patients undergoes CPR, and more than 70.0% of patients die in 30 postoperative days or less. Complications commonly precede arrest; prevention or aggressive treatment of these complications may potentially prevent CPR and improve outcomes. These data could aid discussions regarding advance directives among surgical patients.
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The risk factors for anastomotic leak (AL) after anterior resection have been evaluated in several studies and remain controversial as the findings are often inconsistent or inconclusive. ⋯ Anastomotic leak after anterior resection increased mortality rates and health care costs. Weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement independently increased the risk of leak. Laparoscopy independently decreased the risk of leak. Further studies are needed to delineate the significance of these findings.
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To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients. ⋯ Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.
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Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days. ⋯ Among patients undergoing noncardiac surgery, the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality.
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Pediatric injury outcomes in racial/ethnic minorities in California: diversity may reduce disparity.
Differences in health outcomes are well documented in adult racial/ethnic minorities. We hypothesize that similar differences exist in pediatric racial/ethnic minorities because their care is a function of their parents' access. We investigated this issue by examining pediatric injury outcomes in California. ⋯ Unlike previous studies that have shown that adult racial/ethnic minorities (age, 18-64 years) have higher mortality relative to non-Hispanic whites, our study demonstrated no significant racial/ethnic differences among pediatric patients with injuries. It may be that differential access does not exist for children. In addition, it may also be possible that the diversity in California leads to culturally competent care and such care has been reported to improve patient outcomes.