Journal of the American College of Surgeons
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Multicenter Study
Safety of carotid endarterectomy in 2,443 elderly patients: lessons from nonagenarians--are we pushing the limit?
Elderly patients are a rapidly expanding segment of the population. Recent studies suggest that octogenarians have mortality and morbidity after carotid endarterectomy (CEA) similar to that in their younger cohort. Outcomes of CEA performed in nonagenarians have not been commonly reported; this study seeks to determine the safety of CEA in nonagenarians in general practice. ⋯ Carotid endarterectomy is performed in nonagenarians, as a group, with greater rates of perioperative mortality and morbidity than in younger patients, including octogenarians. But nonagenarians have a greater rate of symptomatic and emergent presentations than younger patients, which may account for their increased mortality, morbidity, length of stay, and incurred charges. Asymptomatic nonagenarians have similar outcomes after carotid endarterectomy compared with younger patients, including octogenarians, with low rates of mortality and morbidity.
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Comparative Study
Impact of work-hour restrictions on residents' operative volume on a subspecialty surgical service.
Whether the 80 hours per week limit on surgical residents' work hours has reduced the number or variety of cases performed by residents is unknown. ⋯ The 80-hour limit has had minimal impact on residents' operative experience, in case number and variety, and residents' perceptions of their educational experience. Residents' reduction in duty hours may have been achieved at the expense of outpatient clinic experiences.