American journal of surgery
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The Medicare sustainable growth rate (SGR) formula is used to control Medicare spending on physician services. Under the current SGR formula, physicians face an almost 24% cut to the Medicare fee schedule on April 1, 2015. The US House Way & Means and Energy & Commerce Committees and the Senate Finance Committee released jointly proposed legislation to permanently repeal the SGR, and transition Medicare physician payment to a value-based payment method. This review summarizes the key components of the proposed legislation, and discusses some of the political challenges ahead. ⋯ Physician Medicare reimbursement will move from a volume-based model to a value-based model over the next decade. Surgeons should remain engaged with the political process to ensure repeal of the SGR.
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Comparative Study
Effect of preinjury warfarin use on outcomes after head trauma in Medicare beneficiaries.
Elderly Americans are at increased risk of head trauma, particularly fall related. The effect of warfarin on head trauma outcomes remains controversial. ⋯ Warfarin at the time of head injury increases the risk of adverse outcomes in Medicare beneficiaries with head injuries. Caution should be used when initiating anticoagulation in elderly Americans at risk for trauma.
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Comparative Study
Opening Pandora's box: understanding the nature, patterns, and 30-day outcomes of intraoperative adverse events.
Little evidence exists regarding the characteristics of intraoperative adverse events (iAEs). ⋯ iAEs commonly occur in reoperative cases requiring lysis of adhesions and possibly lead to increased patient morbidity. Understanding iAEs is essential to prevent their occurrence and mitigate their adverse effects.
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Cholangiocarcinoma is a lethal disease with increasing incidence worldwide. Perihilar cholangiocarcinoma represents the most common type of cholangiocarcinoma. ⋯ The recent use of aggressive approaches based on better image modality, specific perioperative management, and a multidisciplinary approach have enabled to convert the use of palliative therapies to more radical surgery. This review focuses on the recent advances in surgical treatment for perihilar cholangiocarcinoma including liver transplantation with their respective impact on patient survival.
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Thirty-day readmissions are common in general surgery patients and affect long-term outcomes including mortality. We sought to determine the effect of complication timing on postoperative readmissions. ⋯ The development of complications after hospital discharge places patients at significant risk for readmission. Early identification and treatment of gastrointestinal complications and surgical site infections in the outpatient setting may decrease postoperative readmission rates.