American journal of surgery
-
Obesity is a global epidemic that has been increasing in prevalence. The only treatment method for durable weight loss is bariatric surgery. The aim of this study was to observe trends in usage and outcomes of bariatric operations used in the United States from 2008 to 2012. ⋯ The utilization of bariatric procedures has reached a plateau in the United States. Changes in the composition of procedural types suggest that LSG has become a popular alternative to gastric bypass and LGB.
-
Comparative Study
Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy.
We evaluated effect of resident involvement on outcomes after laparoscopic and open colon resection for malignancy. ⋯ Resident participation in colectomy for malignancy is associated with lower mortality at the expense of higher overall morbidity.
-
Randomized Controlled Trial Comparative Study
The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial.
The perioperative safety profile of clopidogrel, a potent antiplatelet agent used in the management of cardiovascular disease, is unknown, and there are no evidence-based guidelines recommending for either its interruption or continuation at this time. The aim of this study was to determine whether patients who are maintained on clopidogrel before general surgical procedures are at increased risk of perioperative bleeding complications. ⋯ The outcomes from this prospective study suggest that, patients undergoing commonly performed elective general surgical procedures can be safely maintained on clopidogrel without increased perioperative bleeding risk.
-
Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education. ⋯ Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time.
-
Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients. ⋯ BCI remains an important diagnostic and management challenge. However, once diagnosed resuscitative therapy focused on correction of hypotension and lactate may prove beneficial. Although the role of troponin in diagnosing BCI remains controversial, elevated troponin may have prognostic significance.