The American surgeon
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The American surgeon · Sep 2013
Multicenter Study Comparative StudyImpact of hormonal protection in blunt and penetrating trauma: a retrospective analysis of the National Trauma Data Bank.
Over the last decade, gender and age-related hormonal status of trauma patients have been increasingly recognized as outcome factors. In the present study, we examine a large cohort of trauma patients to better appraise the effects of gender and age on patient outcome after blunt and penetrating trauma. We hypothesize that adult females are at lower risk for complications and mortality relative to adult males after both blunt and penetrating trauma. ⋯ Adult females demonstrated a survival advantage over adult males (OR, 0.69; 95% CI, 0.67 to 0.71). Adult females with ISS less than 15 demonstrated a distinct survival advantage compared with adult males after both blunt and penetrating trauma. These results warrant further investigation into the role of sex hormones in trauma.
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The American surgeon · Sep 2013
Comparative StudyInterhospital transfer: an independent risk factor for mortality in the surgical intensive care unit.
Interhospital transfer (IHT) is associated with mortality in medical and mixed intensive care units (ICUs), but few studies have examined this relationship in a surgical ICU (SICU) setting. We hypothesized that IHT is associated with increased mortality in SICU patients relative to ICU patients admitted within the hospital. We reviewed SICU and transfer center databases from a tertiary academic center over a 2-year period. ⋯ After adjusting for age and APACHE II score, IHT remained a risk factor for ICU mortality (odds ratio, 1.60; 95% confidence interval, 1.04 to 2.45; P = 0.032) in SICU patients. Interhospital transfer is an independent risk factor for mortality in the SICU population; this risk is unevenly distributed through service lines. Further efforts to determine the cause of this association are warranted.
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The American surgeon · Sep 2013
Comparative StudyFinancial impact of surgical technique in the treatment of acute appendicitis in children.
Appendicitis is the most common emergent problem encountered by pediatric surgeons. Driven by improved cosmetic outcomes, many surgeons are offering pediatric patients single-incision laparoscopic appendectomy. We sought to investigate the financial impact of different surgical approaches to appendectomy. ⋯ SILA $2991, P < 0.01). In our institution, both multiport laparoscopic and SILA carry higher costs when compared with OA, largely as a result of the cost of disposable instrumentation. Cost efficiency should be considered by surgeons when undertaking a minimally invasive approach to appendectomy.
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The American surgeon · Sep 2013
Comparative StudyAllocation of healthcare dollars: analysis of nonneonatal circumcisions in Florida.
Circumcision remains a controversial operation. Most procedures are performed in the neonatal period and avoid general anesthesia. Legislation driven by policy statements from the American Academy of Pediatrics led to significant changes in circumcisions in Florida with a shift to nonneonatal procedures as a result of costs. ⋯ There has been a significant increase in the number of nonneonatal circumcisions performed. This has resulted in an increase in economic health care. Public funding of neonatal circumcision could result in significant cost savings and avoid potential complications of general anesthesia.