Journal of the American College of Surgeons
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The persistent shortage of transplantable organs remains a critical issue around the world. The purpose of this study was to investigate outcomes, including organ procurement, in trauma patients undergoing resuscitative emergency department thoracotomy (EDT). Our hypothesis was that potential organ donor rescue is one of the important outcomes after traumatic arrest and EDT. ⋯ Procurement of organs is one of the tangible outcomes after EDT. These organs have the potential to alter the survival and quality of life of more recipients than the number of survivors of the procedure itself.
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Clinical Trial
Surgical management of acute right lower-quadrant pain in pregnancy: a prospective cohort study.
The etiology of right lower-quadrant pain in pregnant patients is a challenge in diagnosis. We discuss the surgical issues among pregnant patients with right lower-quadrant pain and demonstrate the method to diagnosis. ⋯ This is one of the first prospective studies assessing diagnoses and workup of pregnant patients with right lower-quadrant pain. We recommend abdominal ultrasound be the first imaging modality for patients for whom surgical consultation is necessary, thereby determining if the pathology is obstetric. If inconclusive, a CT scan is necessary to guide treatment.
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Clinical Trial
Intense implementation of a strict insulin infusion protocol does not guarantee postoperative glycemic control.
The Surgical Care Improvement Project (SCIP) has benchmarked 6:00 AM blood sugars on postoperative days (PODs) 1 and 2 at <200 mg/dL as an indicator of overall glycemic control (GC) in postoperative cardiac surgery patients. However, even in demonstration hospitals that publicly report for incentive payments, only 10% are compliant with this benchmark. The objectives of this study were to validate that the SCIP indicator correlates with overall GC, and relate the intensity of implementation of an insulin infusion protocol (IIP) (goal, blood sugar 100 to 140 mg/dL) to effective GC. ⋯ The SCIP 6:00 AM blood sugar metric does correlate with average blood sugar on POD 1. Compliance with SCIP 6:00 AM blood sugar measurement is a valid surrogate for GC, though duration of hyperglycemia was still 14% in the compliant group. Use of an IIP does not guarantee GC, despite increased intensity of its application. Even intense use of an IIP may be ineffective when it fails to account for patient risk factors for hyperglycemia.
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The mortality rates associated with hepatectomy are still not zero. Our aim was to define the risk factors for complications and to evaluate our perioperative management. ⋯ Shorter operative times and reduced blood loss were obtained by improving the surgical technique and using new surgical devices and intraoperative management, including anesthesia. Additionally, decision making using our algorithm and perioperative management according to CDC guidelines reduced the morbidity and mortality associated with hepatectomy.