The American surgeon
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The American surgeon · Oct 2013
Predictors of early postoperative outcomes in 375 consecutive hepatectomies: a single-institution experience.
Although the safety of hepatic resection has improved, it is still a highly morbid procedure. A retrospective cohort of 375 patients undergoing hepatectomy (2004 to 2012) was done. All procedures were performed by a single surgeon at a tertiary center. ⋯ Higher Model for End-stage Liver Disease score and advanced ECOG status were correlated with mortality. Outcomes of hepatic resection improved time despite more complex patient characteristics and an equal number of major hepatectomies being performed. However, worse ECOG performance status was a major predictor of postoperative complications and increased mortality.
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The American surgeon · Oct 2013
Evaluation of heparin prophylaxis protocol on deep venous thrombosis and pulmonary embolism in traumatic brain injury.
There is currently no accepted standard for deep venous thrombosis (DVT) and pulmonary embolism (PE) prophylaxis in patients with traumatic brain injury (TBI). The objective of our study was to evaluate the effects of implementing a subcutaneous heparin prophylaxis protocol for patients with TBI that began in our hospital as of June 2009. In our retrospective cohort study, we examined 3812 TBI records between January 2007 and December 2011. ⋯ A clear trend between heparin use and DVT occurrence could not be determined from a review of TBI records after June 2009. The use of heparin after initiation of our protocol among operative TBI cases without intracranial hemorrhage (ICH) based on admission head computed tomography was 58 per cent. ICH complication from heparin prophylaxis was 10.6 per cent for patients with TBI with ICH on admission (five of 47 cases) compared with 0.7 per cent for those without ICH on admission (four of 535 cases).
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The American surgeon · Oct 2013
Comparative StudyComputed tomography blush and splenic injury: does it always require angioembolization?
The implication of splenic contrast blush on computed tomography (CT) in blunt trauma patients and whether it is an indication for angioembolization (AE) remains controversial. Our objective was to determine whether CT blush and its subsequent treatment have any impact on outcomes in blunt trauma patients with low-grade splenic injuries. A retrospective review identified adult patients with splenic injury (American Association for the Surgery of Trauma grades 1 to 3) from blunt abdominal trauma who were evaluated with a CT scan over a 3.5-year period at a Level I trauma center. ⋯ Additionally, patients with CT blush who underwent AE did not show any significant improvement in outcomes compared with patients who were observed with CT blush. Our study suggests that CT blush does not predict worse outcomes for blunt trauma patients with low-grade splenic injury who underwent observation. Furthermore, AE does not seem to provide any advantage to this subset of patients.
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The American surgeon · Oct 2013
Comparative StudyRate of re-excision after breast-conserving surgery for invasive lobular carcinoma.
Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. ⋯ In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.
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The American surgeon · Oct 2013
Predictive risk factors of early postoperative enteric fistula in colon and rectal surgery.
Early postoperative enteric fistula (PEF) is a complication associated with a high rate of morbidity and mortality in colon and rectal surgery. We evaluated the effect of patient characteristics, comorbidities, pathology, resection type, surgical technique, lysis of adhesions, and admission type on the rate of PEF in colorectal surgery. Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. ⋯ Although teaching hospitals (AOR, 1.69), obesity (AOR, 1.40), male gender (AOR, 1.30), emergent surgery (AOR, 1.27), age older than 65 years (AOR, 1.24), and diabetes mellitus (AOR, 1.21) also had statistically significant impact on rates of PEF, these were less clinically significant than the other factors. The presence of Crohn's disease and lysis of abdominal adhesions are strongly associated with the development of PEF after colorectal surgery. Laparoscopic surgery was associated with a lower rate of PEF; further studies would be needed to evaluate the importance of this finding.