American journal of surgery
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Mutations in BRCA1 or BRCA2 genes results in an elevated risk for developing both breast and ovarian cancers over the lifetime of affected carriers. General surgeons may be faced with questions about surgical risk reduction and survival benefit of prophylactic surgery. ⋯ Clinical management of patients at increased risk for breast cancer requires consideration of risk, patient preference, and quality of life.
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Post-extubation stridor is an uncommon complication in medical intensive care units (ICUs) but has not been well studied in trauma patients. We sought to determine the incidence of reintubation due to stridor in trauma patients and describe associated risk factors. ⋯ Trauma ICU patients are reintubated for stridor at a higher rate than medical ICU patients. Age, gender, blunt mechanism, and duration of intubation are risk factors for this complication.
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The American College of Surgeons Surgical Risk Calculator was developed to improve risk stratification and surgical quality but has not been studied at the institutional level for specific disease states, like ulcerative colitis (UC). ⋯ For UC, the calculator poorly evaluates relevant risks, complications, and is greatly impacted by outliers. These limitations caution use for surgical quality reporting and determining specific patient outcomes, at least in UC.
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Multicenter Study Clinical Trial
Predictive modeling for chronic pain after ventral hernia repair.
Few studies predict which patients have dissolution of their postoperative discomfort or develop chronic pain after ventral hernia repair (VHR). This study develops a predictive model to determine which patients are at the greatest risk of chronic pain after VHR. ⋯ Patients who have preoperative pain and at 1 month postoperatively are significantly more likely to have chronic pain. Both short- and long-term pain can be predicted from female sex, younger age, and repair of recurrent hernias. This predictive model may aid in preoperative counseling and when considering postoperative intervention for pain management in VHR patients.
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There continues to be significant debate in the trauma community regarding the indications for emergency department thoracotomy (EDT). Numerous studies have focused on the duration of arrest in EDT, whereas few have examined other factors that influence surgeon decision-making. We hypothesize that there is continued variability among surgeons in the use of EDT. ⋯ EDT decision-making is more nuanced than previously described. Variation continues in the use of thoracotomy after loss of vital signs, in both blunt and penetrating trauma. For both mechanisms, there remains little consensus on the appropriate duration of arrest before performing EDT after arrest despite published guidelines. A large proportion of surgeons consider other factors such as patient age, total injury burden, and comorbidities in addition to vital signs when deciding to perform an EDT. Technological adjuncts are frequently used by surgeons to determine the need for EDT.