The American surgeon
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The American surgeon · Oct 2014
Comparative StudyRole of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital.
Laparoscopic appendectomy (LA) has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy (OA). LA in patients with a gangrenous or perforated appendicitis carries increased rate of pelvic abscess formation when compared with OA. We hypothesized routine placement of pelvic drains in gangrenous or perforated appendicitis decreases pelvic abscess formation after LA. ⋯ Presurgery computed tomography (CT) with appendicolith and CT with abscess were more prevalent in Group I. The use of JP drainage in patients with perforated or gangrenous appendicitis during LA has decreased rates of pelvic abscess. This was demonstrated despite the drain group having appendicolith or abscess on preoperative CT.
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The American surgeon · Oct 2014
Comparative StudyHomeward bound: the safety of discharging postappendectomy patients directly home from the recovery room.
The discharge of the patients directly from the recovery room after appendectomy has only recently been described in the literature. Because the 30-day readmission rate is used as a surrogate for safety and as a means to identify complications from appendicitis, it is our aim to demonstrate that the 30-day readmission rate of patients with acute appendicitis discharged from the recovery room is not higher than that of a control group and that from other studies in the literature for traditional hospital discharge. The operating room electronic database at Kaiser Riverside and Kaiser Moreno Valley hospitals was used to identify all appendectomies from September 1, 2008, to April 30, 2013. ⋯ There were 12 (1.4%) total readmissions with nine (1%) related to previous appendectomy compared with one (0.9%) in the control group. None of the readmissions were the result of early life-threatening problems such as bleeding, bowel injury, intraperitoneal bladder injury, or stump leak. Patients with acute appendicitis who were discharged home from the recovery room did not have an increased incidence of 30-day readmission when compared with traditional hospital discharge.
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The American surgeon · Oct 2014
Incidence of intracranial hemorrhage and outcomes after ground-level falls in geriatric trauma patients taking preinjury anticoagulants and antiplatelet agents.
Antiplatelet and anticoagulant medication increases the risk of intracranial hemorrhage (ICH) after a fall in geriatric patients. We sought to determine whether there were differences in ICH rates and outcomes based on type of anticoagulant or antiplatelet agent after a ground-level fall (GLF). Our institutional trauma registry was used to identify patients 65 years old or older after a GLF while taking warfarin, clopidogrel, or aspirin over a 2-year period. ⋯ Of 562 patients who met inclusion and exclusion criteria, 218 (38.8%) were on warfarin, 95 (16.9%) were on clopidogrel, and 249 (44.3%) were on aspirin. Overall ICH frequency was 15 per cent with no difference in ICH rate, type of ICH, need for craniotomy, mortality, or intensive care unit or hospital length of stay between groups. Patients with ICH were more likely to present with abnormal Glasgow Coma Score, history of hypertension, and/or loss of consciousness.
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The American surgeon · Oct 2014
Resorbable biosynthetic mesh for crural reinforcement during hiatal hernia repair.
The use of mesh to reinforce crural closure during hiatal hernia repair is controversial. Although some studies suggest that using synthetic mesh can reduce recurrence, synthetic mesh can erode into the esophagus and in our opinion should be avoided. Studies with absorbable or biologic mesh have not proven to be of benefit for recurrence. ⋯ A recurrent hernia was found in one patient (0.9%) three years after repair. The use of crural relaxing incisions and Collis gastroplasty in combination with crural reinforcement with resorbable biosynthetic mesh is associated with a low early hernia recurrence rate and no mesh-related complications. Long-term follow-up will define the role of these techniques for hiatal hernia repair.
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The American College of Surgeons (ACS) recommends trauma overtriage rate (OT) below 50 per cent to maximize efficiency while ensuring optimal care. This retrospective study was undertaken to evaluate OT rates in our Level I trauma center using the most recent criteria and guidelines. OT rates during a 12-month period were measured using six definitions based on combinations of Injury Severity Score (ISS), length of hospital stay (LOS, in days), procedures, and disposition after the emergency department. ⋯ Physiologic assessment criteria and anatomic injury had the lowest OT rates and contained all mortalities. Passenger space intrusion (PSI), pedestrian versus automobile (criterion and guideline), and extrication (guideline) all had consistently high rates of OT. We conclude that PSI should be reduced to a guideline, the pedestrian versus automobile criterion and guideline should be combined, and extrication could be removed from the triage scheme.