Journal of the American College of Surgeons
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The success of parathyroidectomy in primary hyperparathyroidism depends on the intraoperative differentiation of diseased from normal glands. Deep learning can potentially be applied to digitalize this subjective interpretation process that relies heavily on surgeon expertise. In this study, we aimed to investigate whether diseased vs normal parathyroid glands have different near-infrared autofluorescence (NIRAF) signatures and whether related deep learning models can predict normal vs diseased parathyroid glands based on intraoperative in vivo images. ⋯ Normal and diseased parathyroid glands in primary hyperparathyroidism have different intraoperative NIRAF patterns that could be quantified with intensity and heterogeneity analyses. Visual deep learning models relying on these NIRAF signatures could be built to assist surgeons in differentiating normal from diseased parathyroid glands.
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Healthcare is responsible for 8.5% of US greenhouse gas emissions. This impact must be mitigated while maintaining clinical excellence. This study compares clinical outcomes, cost-efficiency, and climate impact of transumbilical laparoscopic-assisted appendectomy (TULAA) vs 3-port laparoscopic appendectomy (LA). ⋯ Although patient safety and excellent clinical outcomes must remain the top priority in healthcare, the current environmental crisis demands consideration of climate impact. When clinical noninferiority can be demonstrated, treatment options with fewer greenhouse gas emissions should be chosen.
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Nonhealing wounds are particularly prevalent in older adults and in patients with multiple comorbidities, and they represent a significant medicoeconomic burden. Autologous split-thickness skin grafts (STSGs) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS vs STSG. ⋯ This study suggests that ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared with traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings.
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Overall, 3% to 12% of opioid-naive patients develop persistent opioid use after surgery. It is still unclear whether persistent opioid use after transabdominal surgery is associated with adverse surgical outcomes. We aimed to assess if new persistent opioid use after transabdominal surgery is associated with increased long-term mortality and readmission rates. ⋯ New persistent opioid use after transabdominal surgery was associated with higher rates of mortality and readmission rates. This calls for increased postoperative support for at-risk patients and increased support during transitions of care for these patients.
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Structured preparation is necessary to conduct quality improvement (QI) strategies that are relevant to the problem, feasible, appropriately resourced, and potentially effective. Recent work suggests that improvement efforts are suboptimally conducted. Our goal was to determine how well preparation for surgical QI is undertaken, including detailing the problem, setting project goals, and planning an intervention. ⋯ Thorough planning is a critical component of effective QI, and our study reflects significant opportunity for its improvement. The ACS Quality Framework may serve as a guide to improve QI planning, thereby promoting efficiency and effectiveness of these efforts.