American journal of surgery
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A variety of biologic mesh is available for ventral hernia repair. Despite widely variable costs, there is no data comparing cost of material to clinical outcome. ⋯ Permacol™ use resulted in similar clinical outcomes with significant cost savings when compared to Strattice™. Biologic mesh choice should be driven by a combination of clinical outcomes and product cost.
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Given potential safety risks when admitting injured patients to nonsurgical services (NSS), the American College of Surgeons mandates trauma centers justification. However, evidence supporting this requirement is lacking. ⋯ As all complications and mortalities were unrelated to injuries per se, admission to a NSS, after protocoled clearance by a trauma or Emergency Department attending, appears to be safe.
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Interhospital transfer is common among patients undergoing colorectal surgery. The purpose of this study was to determine surgical outcomes after transfer vs direct admission in patients undergoing colorectal surgery. ⋯ Preoperative hospital transfer is common among patients requiring colorectal surgery. Despite extensive propensity score matching, nonemergency transfers have higher rates of mortality, longer length of hospital stay, and higher overall complication rates compared with direct admissions. Transfer status is an important variable in hospital performance models and should be taken into consideration when analyzing hospital outcomes.
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Incisional hernia (IH) is a complication following open abdominal hysterectomy. This study addresses the incidence and health care cost of IH repair after open hysterectomy, and identify perioperative risk factors to create predictive risk models. ⋯ Open hysterectomies account for a magnitude of surgical procedures worldwide. This study presents an internally validated risk model of IH in patients undergoing open hysterectomy after a review of 2145 cases. With an increasing emphasis on prevention in healthcare, we create a risk model to improve outcomes after open hysterectomies in effort to identify high-risk patients, facilitate preoperative risk counseling, and implement evidence-based strategies to improve outcomes.
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Distal cholangiocarcinoma remains a rare cancer associated with a dismal outcome. There is a lack of effective treatment options and where disease is amendable to resection, surgery affords the best potential for long-term survival. The aim of this study was to examine the survival outcomes and prognostic factors of patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma. ⋯ Long-term survival may be achieved in selected patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma, especially in patients who achieved an R0 resection.