American journal of surgery
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Exposure is especially important for procedures performed on the liver and biliary tract where careful, precise anatomic dissection of vascular and biliary structures is required. We describe a modified subcostal incision that provides both safe exposure and versatility for most hepatobiliary procedures.
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Trauma centers and the services they provide are a unique and necessary component of our health system. By design trauma centers treat all injured patients regardless of their clinical or economic needs. The purpose of this study was to quantify the costs associated with the preparation of the capacity to provide trauma care at trauma centers within the State of Florida. ⋯ Trauma centers like fire departments and police services are required to be available 24 hours a day, 7 days a week. This level of commitment by trauma centers and the reciprocal expectation from the community force trauma centers to make considerable investments in readiness. This cost of readiness is expended regardless of the patient volume or insurance status. Thus trauma centers have a large component of costs that are not captured by the traditional billing and cost accounting mechanisms within health systems and this fixed expense is extraordinarily difficult to recover given the current reimbursement environment.