The American surgeon
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The American surgeon · Aug 2013
Laparoscopic appendectomy for acute appendicitis: a safe same-day surgery procedure?
Over 250,000 cases of appendicitis occur annually in the United States. The mainstay of treatment is surgical removal with admission. Recently, antibiotic therapy as an alternative has been introduced and the state of Maryland has incentivized 23-hour procedures. ⋯ Among these patients, there were no readmissions, and 18 (95%) were cases of simple appendicitis (P = 0.4431). There was no significant difference in complications or readmission between patients discharged in less than 24 hours and those who stayed longer. Our subgroup analysis indicated that discharge from the postanesthesia care unit after uncomplicated laparoscopic appendectomy should be further evaluated.
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The American surgeon · Jul 2013
Increase in postoperative insulin requirements does not lead to decreased quality of life after total pancreatectomy with islet cell autotransplantation for chronic pancreatitis.
Previous studies have shown that total pancreatectomy with islet cell autotransplantation improves quality of life in chronic pancreatitis. A significant number of these patients develop postoperative hyperglycemia and daily insulin requirements or increase in daily insulin requirements. Our study investigates whether increased insulin requirements postoperatively have a negative impact on quality of life. ⋯ There is no correlation between physical component score or mental component score QOL scores and daily insulin requirements (r = -0.016 and r = 0.039, respectively). Total pancreatectomy with islet cell autotransplantation is an effective surgery for end-stage chronic pancreatitis. Quality of life significantly improves in physical and mental health components regardless of a postoperative increase in daily insulin requirements.
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The American surgeon · Jul 2013
The green operating room: simple changes to reduce cost and our carbon footprint.
Generating over four billion pounds of waste each year, the healthcare system in the United States is the second largest contributor of trash with one-third produced by operating rooms. Our objective is to assess improvement in waste reduction and recycling after implementation of a Green Operating Room Committee (GORC) at our institution. A surgeon and nurse-initiated GORC was formed with members from corporate leadership, nursing, anesthesia, and OR staff. ⋯ A "Power Down" initiative to turn off all anesthesia and OR lights and equipment not in use resulted in saving $33,000 and 234.3 metric tons of CO2 emissions reduced per year. Converting from soap to alcohol-based waterless scrub demonstrated a potential saving of 2.7 million liters of water annually. Formation of an OR committee dedicated to ecological initiatives can provide a significant opportunity to improve health care's impact on the environment and save money.
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The American surgeon · Jul 2013
Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank.
Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. ⋯ Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.