American journal of surgery
-
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.
-
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.
-
The aim of this study was to determine factors associated with deviation in length of hospital stay (LOS) from that determined by diagnosis-related groups. ⋯ After colorectal surgery, several modifiable factors are associated with deviation of LOS from expected. An opportunity hence exists to reduce both LOS and financial burden for hospitals in an era of pay for performance.
-
Amylase value in drains (AVD) is a predictor of pancreatic fistula (PF). We evaluated the accuracy of an AVD-based model. ⋯ AVD-based model for predicting PF after pancreatic resection is an accurate tool, although AVD cutoffs should be evaluated for each type of operation.
-
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.