The American surgeon
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The American surgeon · Aug 2013
Laparoscopic appendectomy for acute appendicitis: a safe same-day surgery procedure?
Over 250,000 cases of appendicitis occur annually in the United States. The mainstay of treatment is surgical removal with admission. Recently, antibiotic therapy as an alternative has been introduced and the state of Maryland has incentivized 23-hour procedures. ⋯ Among these patients, there were no readmissions, and 18 (95%) were cases of simple appendicitis (P = 0.4431). There was no significant difference in complications or readmission between patients discharged in less than 24 hours and those who stayed longer. Our subgroup analysis indicated that discharge from the postanesthesia care unit after uncomplicated laparoscopic appendectomy should be further evaluated.
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The American surgeon · Aug 2013
Comparative StudyTransitioning to thoracic endovascular repair: a single institution's analysis of the management of blunt aortic injury.
Over the past 15 years, there has been a rapid transformation in the way blunt aortic injuries (BAIs) are managed shifting from open thoracotomies to thoracic endovascular repairs (TEVAR). As a result of this change, we sought to describe our experience with open and endovascular repairs through a retrospective analysis of all trauma patients admitted with BAI to our Level I trauma center from 2002 to 2011. Demographic data, type of repair, complications, length of stay (LOS) data, and mortality were identified. ⋯ In summary, endovascular repair of BAI is safe and has no increased rate of acute complications or mortality. ICU LOS is much shorter with TEVAR, and there was a trend toward shorter ventilator and hospital LOS, all of which may result in decreased cost. Still, more needs to be learned about potential long-term complications.
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The American surgeon · Aug 2013
Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair.
With evolution of hernia repair surgery, quality of life (QOL) became a major outcome measure in nearly 350,000 ventral hernia repairs (VHRs) performed annually in the United States. This study identified predictors of chronic pain after VHR. A prospective database of patient-reported QOL outcomes at a tertiary referral center was queried from 2007 to 2010; 512 patients met inclusion criteria. ⋯ The former group had smaller hernias (91 vs 194 cm(2), respectively, P = 0.015). Cases of new-onset, long-term pain after VHR were rare (less than 2%). Most patients' symptoms resolve by 6 months after surgery, but those with severe preoperative pain are at risk for persistent postoperative pain.
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Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. ⋯ Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.