Journal of the American College of Surgeons
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Component separation (CS) is an effective technique for reconstructing complex abdominal wall defects. Violation of the rectus abdominis complex is considered a contraindication for CS, but we hypothesized that patients have similar outcomes with or without rectus complex violation. ⋯ CS surgical outcomes were similar whether or not the rectus complex was violated. To our knowledge, this study is the first to evaluate the effects of rectus violation on surgical outcomes in CS patients. Surgeons should not routinely avoid CS when the rectus complex is violated.
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Randomized Controlled Trial
Effect of peritoneal lavage with clindamycin-gentamicin solution on infections after elective colorectal cancer surgery.
Colorectal surgery may lead to infections because despite meticulous aseptic measures, extravasation of microorganisms from the colon lumen is unavoidable. ⋯ Antibiotic lavage of the peritoneum is associated with a lower incidence of intra-abdominal abscesses and wound infections.
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Patients requiring discharge to a continuing care facility after cardiac surgery (non-home discharge) frequently have prolonged hospital stays while arrangements are made for posthospital care. We hypothesized that preoperatively identifying patients likely to require non-home discharge would allow earlier discharge planning, shorten length of stay, and thereby reduce resource use. This study sought to develop a validated tool for preoperative planning of non-home discharge. ⋯ Non-home discharge can be easily predicted using data obtained during routine preoperative evaluation of cardiac surgical patients. We expect that early identification of patients at high risk for non-home discharge will allow for more intensive, personalized discharge planning, and will reduce wasted days and resource use.
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The role of obesity as a risk factor after carotid endarterectomy is not well-described. We undertook a study of the association of obesity with 30-day outcomes after carotid endarterectomy. ⋯ Obesity is an independent risk factor for death and cardiac complications after carotid endarterectomy. Surgeons should consider this when evaluating the risks and benefits of carotid endarterectomy in obese patients. Carotid artery stenting was not assessed, and future studies are needed to examine its role in management of obese patients.
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The American Board of Surgery has emphasized that palliative care education should be included in surgical training. The few formal curricula for teaching palliative care, although effective, are time-intensive and have low longitudinal participation rates. The aim of this project was to design a feasible and effective palliative care intervention for general surgery residency training. ⋯ A brief, interactive workshop is effective in changing general surgery residents' attitudes toward and knowledge of palliative care. The results demonstrate that a single teaching session is a useful intervention.