American journal of surgery
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Incisional hernia (IH) remains a very frequent postoperative complication. The 2 techniques most frequently used are the onlay repair and sublay repair. However, it remains unclear which technique is superior. ⋯ Although the majority of the included studies were retrospective studies, sublay repair seems the preferred technique for IH repair.
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The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment. ⋯ The true prevalence of Amyand's hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix's inflammation status, the patient's general condition, and other factors. Amyand's hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand's hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence.
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Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality. This study sought to determine whether implementation of the Institute for Healthcare Improvement (IHI) Central Line Bundle would reduce the incidence of CLABSIs. ⋯ Implementation of the IHI Central Line Bundle reduced the incidence of CLABSIs in our SICU by 68%, preventing 12 CLABSIs, 2.5 deaths, and saving $198,600 annually.
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Surgical site infection (SSI) is a costly complication leading to increased resource use and patient morbidity. We hypothesized that postdischarge SSI results in a high rate of preventable readmissions. ⋯ A diagnosis of SSI after discharge is associated with a high readmission rate despite occurring in healthier patients. We propose discharge teaching improvements and a wound surveillance clinic within the first week may result in a decreased readmission rate.
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Penetrating cardiac injuries (PCI) causing tamponade causes subendocardial ischemia, arrhythmias, and cardiac arrest. Pericardial drainage is an important principle, but where drainage should be performed is debated. We hypothesize that drainage in the emergency department (ED) does not delay definitive repair. ⋯ ED pericardial drainage for PCI did not appear to delay operation and had an acceptably low mortality rate. Pericardial drainage is a viable option for stabilization before definitive surgery when surgical intervention is not immediately available in the hemodynamically marginal patient.