The American surgeon
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The American surgeon · Sep 2014
Anastomotic leaks after colorectal anastomosis occurring more than 30 days postoperatively: a single-institution evaluation.
National hospital registries only report colorectal anastomotic leaks (ALs) within 30 days postoperatively. The aim of our study was to determine the incidence and significance of ALs that occur beyond 30 days postoperatively. We performed a retrospective review of our prospective database from June 2008 to August 2012. ⋯ Colorectal anastomotic leaks can occur after the 30-day postoperative period. In patients with vague and atypical abdominal findings, anastomotic leak must be suspected. More systematic, prospective studies are required to help us further understand the risk factors and natural history of anastomotic failures in elective colorectal surgery.
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The American surgeon · Sep 2014
Computed tomography of the head in children with mild traumatic brain injury.
Pediatric Emergency Care Applied Research Network (PECARN) guidelines have a near 100 per cent negative predictive value for clinically important traumatic brain injury (ciTBI) in children with mild head injury (Glasgow Coma Score [GCS] 14 or 15). Our goal was to retrospectively apply their criteria to our database to determine the potential impact on the rates of unnecessary head computed tomography (CT) and ciTBI detection. The records of pediatric patients with GCS 14 to 15 that had a head CT for suspected TBI after blunt trauma from 2008 to 2010 were reviewed. ⋯ There were no false-negatives. The negative predictive value for ciTBI was 100 per cent. Observance of PECARN guidelines identifies children who do not require CT, increasing the yield of finding a ciTBI among those who cannot satisfy all six criteria.
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Procalcitonin is used as a marker for sepsis but there is little known about the correlation of the procalcitonin elevation with the causative organism in sepsis. All patients aged 18 to 80 years who were admitted to the surgery service from June 2010 to May 2012 and who had a procalcitonin drawn were evaluated. Culture data were reviewed to determine the causative organism. ⋯ Those with fungal infections had a procalcitonin of 42.90 (P = 0.001). These data suggest that procalcitonin elevation can help guide treatment by indicating likely causative organism and infection type. These data may provide a good marker for initiation of antifungal therapy.
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Though multiple studies have demonstrated superior outcomes amongst adult burn patients at verified burn centers (VBCs) relative to nondedicated burn centers (NBCs), roughly half of such patients meeting American Burn Association (ABA) referral guidelines are not sent to these centers. We sought examine referral patterns amongst pediatric burn patients. Retrospective review of a statewide patient database identified pediatric burn patients from 2000 to 2007 using International Classification of Disease (ICD-9) discharge codes. ⋯ Neither age, gender, nor payer status demonstrated significant association with treatment center. VBCs treated more severely injured patients, but there was no difference in survival or rate of discharge home from NBCs versus VBCs. Studies to evaluate differences in functional outcomes between pediatric burn patients treated at VBCs versus NBCs would be beneficial to ensure optimization of outcomes in this population.
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The American surgeon · Sep 2014
Improved patient outcomes in paraesophageal hernia repair using a laparoscopic approach: a study of the national surgical quality improvement program data.
A consensus on the optimal surgical approach for repair of a paraesophageal hernia has not been reached. The aim of this study was to examine the outcomes of open and laparoscopic paraesophageal hernia repairs (PHR), both with and without mesh. A review of the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2011 was conducted. ⋯ There was no statistically significant difference in any of the primary or secondary outcomes in patients repaired with mesh compared with those without. The overall use of mesh in paraesophageal hernia repairs has increased. The NSQIP data show significantly increased 30-day mortality in open repair compared with laparoscopic as well as a significantly higher perioperative complication rate.