Journal of the American College of Surgeons
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Knowledge of the factors associated with longer-term reduced capacity to work (RCW) is lacking in patients after polytrauma. ⋯ In this cohort of patients surviving polytrauma, approximately 50% of patients sustained longer-term RCW. Several characteristics, such as level of education or trauma severity, showed an independent association with patients' capacity to work, which was significantly associated with patients' self-rated scorings of well-being.
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Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient?
Regionalization of care has been proposed for complex operations based on hospital/surgeon volume-mortality relationships. Controversy exists about whether more common procedures should be performed at high-volume centers. Using mortality alone to assess routine operations is hampered by relatively low perioperative mortality. We used a large national database to analyze the risk of major in-hospital complications after laparoscopic cholecystectomy (LC). ⋯ Major in-hospital complications after LC are associated with individual patient characteristics rather than surgeon or hospital operative volumes. These results suggest regionalization of general surgical procedures might be unnecessary. Rather, careful patient selection and preoperative preparation can diminish overall complication rates.
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Obesity, like multiple trauma, is associated with an inflammatory condition that leads to an immunodeficient state. Obese trauma patients are thus thought to be at higher risk of infection compared to patients of normal body mass. Despite this risk, studies to date have not defined obesity as an independent risk factor for infection in trauma patients. ⋯ In this retrospective study, obesity was shown to be an independent risk factor for nosocomial infection after trauma. Prospective studies would clarify the reasons associated with this increased risk of infections in obese trauma patients.
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Comparative Study
Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer.
Lobectomy is the standard therapy for patients with stage I non-small cell lung cancer (NSCLC). Recently, sublobar resections (SLR), radiofrequency ablation (RFA), and percutaneous cryablation therapy (PCT) for high-risk patients unfit for standard resection have been reported. This study compares all 3 modalities in stage I NSCLC. ⋯ This experience suggests comparable survival after sublobar resections and ablative therapies at 3 years. Ablative therapies appear to be a reasonable alternative in high-risk patients not fit for surgery. However, larger randomized studies with longer follow-up are needed to make recommendations for therapy.
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Biliary complications (BCs) are a major cause of morbidity and mortality after living donor liver transplantation (LDLT). They occur because the graft hepatic ducts are often small, thin walled, multiple, and may become ischemic during transection. ⋯ By providing a graft with a well-vascularized hepatic duct or ducts with a sheath of supporting tissue that holds sutures well, the HPGS approach minimizes the incidence and severity of BCs in LDLT.