Journal of the American College of Surgeons
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Comparative Study
Racial disparity in surgical mortality after major hepatectomy.
The relationship between surgical mortality and race has not been studied for major hepatectomy. We sought to quantify and explore the nature of racial disparities in surgical mortality after major hepatectomy in a nationally representative cohort of patients. ⋯ In-hospital mortality after major hepatectomy varies substantially by race. After adjustment for potential confounders, African-American patients have two-fold higher population-level odds of surgical mortality than Caucasian patients do. Our analyses suggest that clinical factors, insurance status, and hospital factors do not account for these differences. Additional studies to clarify the nature of this disparity and identify targets for intervention are warranted.
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Comparative Study
Surgery for gallbladder cancer: a population-based analysis.
Gallbladder cancer is an aggressive neoplasm, and resection is the only curative modality. Single institutional studies report an aggressive surgical approach improves survival. This analysis was performed to examine the components of surgical resection and resultant survival. ⋯ Very few patients underwent aggressive surgery. En bloc resection and lymphadenectomy may have stage-specific effects on survival. Additional studies should explore the underuse of aggressive operations, verify survival advantages, and define stage-specific resection strategies.
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Comparative Study
Conservative management of postoperative Fever in gynecologic patients undergoing major abdominal or vaginal operations.
To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics. ⋯ Although postoperative fever is common in gynecologic patients, the incidence of infection is low (3%). A standardized postoperative fever protocol in low-risk gynecology patients decreases use of empiric antibiotics without compromising morbidity.
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Although RBC transfusions can be lifesaving, recent evidence suggests that their use is associated with added morbidity and mortality and that a lower transfusion threshold is safe. It is unclear if this new evidence has translated into decreased RBC use among surgical patients. The purpose of this study is to measure the change in use of RBCs during the last decade. ⋯ Despite evidence supporting more restrictive use of RBC transfusions, RBC use among surgical patients has increased during the last decade.