JAMA surgery
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Previous studies investigating patients at risk for hospital readmissions focus on medical services and have found chronic conditions as contributors. Little is known, however, of the characteristics of patients readmitted from surgical services. ⋯ Many readmissions may be unavoidable in our current paradigms of care. While medical comorbidities are contributory, a large number of readmissions were not caused by suboptimal medical care or deterioration of medical conditions but by confounding issues of substance abuse or homelessness. Identification of the highest risk cohort for readmission can allow more targeted intervention for similar populations with socially challenged patients.
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Liver resection is the treatment of choice for hepatocellular carcinoma (HCC) in well-compensated liver cirrhosis. Postoperative liver decompensation (LD) is the most representative and least predictable cause of morbidity and mortality. ⋯ The risk for postoperative LD after resection for HCC in chronic liver disease is associated with preoperative hierarchic interaction of portal hypertension, planned extension of hepatectomy, and the MELD score.
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Patient- and hospital-level factors affecting outcomes after open and endovascular abdominal aortic aneurysm (AAA) repair are each well described separately, but not together. ⋯ Patient-level factors were associated with in-hospital mortality outcomes after elective AAA repair. Hospital case volume and practice patterns were also associated. This demonstrates the importance of adequate institutional experience with OAR techniques, which appear to be critically declining. Based on these data, appropriate patient selection and medical optimization appear to be the most important means by which we can improve outcomes following elective AAA repair, although patient referral to high-volume aortic centers of excellence should be a secondary consideration.
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Multicenter Study Observational Study
Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery.
Severe obesity (body mass index ≥35 [calculated as weight in kilograms divided by height in meters squared]) is associated with significant medical comorbidity and increased mortality. Bariatric surgery induces weight loss, the extent of which can vary. Postoperative predictors of weight loss have not been adequately examined. ⋯ The results suggest the importance of assessing behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs in bariatric surgery candidates and patients who have undergone bariatric surgery, and they suggest that the utility of programs to modify problematic eating behaviors and eating patterns should be addressed in research.
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Reduction of postoperative readmissions has been identified as an opportunity for containment of health care costs. To date, the effect of index hospitalization costs on subsequent readmissions, however, has not been examined. ⋯ Thirty-day readmission rates among patients undergoing major abdominal surgery vary significantly. Higher index hospitalization costs did not translate into lower readmission rates.