The American surgeon
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The American surgeon · Oct 2014
Management of patients with evisceration after abdominal stab wounds.
In the era of nonoperative management of abdominal stab wounds, the optimal management of patients with evisceration remains unclear. Furthermore, the role of imaging in guiding management of these patients has not been defined. Patients admitted to a Level I trauma center (2005 to 2012) with evisceration after an abdominal stab wound were retrospectively identified. ⋯ In conclusion, the rate of intra-abdominal injury in patients with evisceration remains high. Even in the age of nonoperative management, evisceration continues to be an indication for immediate laparotomy. The diagnostic yield of CT is low and CT should not impact management of these patients.
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Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal. ⋯ A total of 69 cases were reported over a 20-month period: 32 (46%) were plaintiffs' verdicts, whereas 37 (54%) were in favor of the surgeon. Only 10 (31%) of the plaintiff verdicts were by jury trial, whereas the rest were settled by pretrial agreement, mediation, or arbitration. Of cases settled by alternate dispute resolution, the median settlement was $820,000 (n = 22) compared with a median jury trial award of $300,000 (n = 10).
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The American surgeon · Oct 2014
Observational StudyMagnetic sphincter augmentation with the LINX device for gastroesophageal reflux disease after U.S. Food and Drug Administration approval.
Magnetic sphincter augmentation (MSA) of the gastroesophageal junction with the LINX Reflux Management System is an alternative to fundoplication for gastroesophageal reflux disease (GERD) that was approved by the U. S. Food and Drug Administration (FDA) in March 2012. ⋯ There were eight patients with persistent dysphagia that required balloon dilation with improvement in symptoms. MSA with LINX is a safe and effective alternative to fundoplication for treatment of GERD. The most common postoperative complaint is mild to moderate dysphagia, which usually resolves within 12 weeks.
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The American surgeon · Oct 2014
The cost of preventing readmissions: why surgeons should lead the effort.
In accordance with the Affordable Care Act, Medicare has instituted financial penalties for hospitals with 30-day readmission rates that exceed a predetermined value. Currently, this value only considers "excess" readmissions for myocardial infarction, heart failure, and pneumonia with a maximum fine being one per cent of total Medicare reimbursements. In 2015, this penalty will increase to three per cent and encompass more surgical diagnoses. ⋯ Whereas the calculated net profit for readmission was $144,000, inclusion of Medicare's penalty resulted in a loss of $11,950. A readmission reduction program with an annual cost exceeding $11,950 would lead to financial loss. The financial implications of Medicare's readmission penalty alone necessitate the development of cost-effective strategies to reduce rehospitalization.
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The American surgeon · Oct 2014
Comparative StudyLaparoscopic versus robotic-assisted rectal surgery: a comparison of postoperative outcomes.
Rectal surgery continues to be an area of advancement for minimally invasive techniques. However, there is controversy regarding whether a robotic approach imparts any advantages over established laparoscopic procedures. The aim of this study was to analyze and compare outcomes of laparoscopic and robotic rectal resection operations. ⋯ Conversion rate was 7.9 per cent for the laparoscopic group and zero per cent for the robotic (P = 0.09). There were no mortalities in either group. A pure laparoscopic or robotic rectal surgery may be associated with a shorter hospital stay compared with a laparoscopic-assisted approach.