The Annals of thoracic surgery
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Approximately 10% to 20% of children are readmitted congenital heart surgery. Readmissions are now being viewed by payers as preventable complications of the original surgery or hospitalization, and there have been proposals by insurance agencies to deny coverage of the additional expenses incurred by the readmission. With hopes to reduce the potential impact, we analyzed patients undergoing congenital heart surgery at our institution in order to identify risk factors for readmission. ⋯ Potential risk factors for readmission after congenital heart surgery have been identified. Hopefully, altering the discharge process and the early postoperative care in these high-risk patients can minimize the impact of hospital readmissions after congenital heart surgery.
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Comparative Study
An analysis of preclinical students' perceptions of cardiothoracic surgical procedures.
Interest in cardiothoracic surgery training has decreased, and there is a predicted shortage of 1,500 cardiothoracic surgeons by 2020. This study aims to analyze the attitudes toward cardiothoracic surgery of premedical and medical students in the preclinical years. ⋯ Cardiothoracic surgeons may be better served by aiming their recruiting and mentoring efforts toward premedical students, who are more open to longer training, less concerned about lifestyle and salary, and are generally more interested in pursuing thoracic surgery than are medical students.
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Comparative Study
The role of consolidation therapy for stage III non-small cell lung cancer with persistent N2 disease after induction chemotherapy.
Persistent pathologic mediastinal nodal involvement after induction chemotherapy and surgical resection is a negative prognostic factor for stage III-N2 non-small cell lung cancer patients. This population has high rates of local-regional failure and distant failure, yet the effectiveness of additional therapies is not clear. We assessed the role of consolidative therapies (postoperative radiation therapy and chemotherapy) for such patients. ⋯ Aggressive consolidative therapies may improve outcomes for patients with persistent N2 disease after induction chemotherapy and surgery.
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Comparative Study
Characteristics associated with the use of nonanatomic resections among Medicare patients undergoing resections of early-stage lung cancer.
Racial disparities in access to surgical resection for treatment of early-stage non-small-cell lung cancer (NSCLC) are well documented. However it is unclear how race, clinical, and hospital characteristics affect the surgical approach among patients undergoing resection. ⋯ Since 2000, the use of nonanatomic resections in stage I NSCLC has increased, most significantly among patients with larger tumors. After adjusting for clinical factors, there was no relation between race and type of surgical resection.
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Our aim was to evaluate whether the workload of a surgeon, including number of operations, operative time, or number of rooms per day, influenced patient morbidity or mortality after pulmonary lobectomy. ⋯ The total number of hours a surgeon operates per day is independently associated with an increased risk of complications when performing pulmonary lobectomies. This could be related to surgeon fatigue associated with longer operative days. However, other patient variables are also associated with outcome. The relationship among these factors needs to be better understood with larger-scale models on a multiinstitutional level.