Journal of the American College of Surgeons
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Review Case Reports Biography Historical Article
Surgical management of inoperable lymphedema: the re-emergence of abandoned techniques.
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Multicenter Study Clinical Trial
Prevalence of adverse intraoperative events during obesity surgery and their sequelae.
Adverse intraoperative events (AIEs) during surgery are a well-known entity. A better understanding of the incidence of AIEs and their relationship with outcomes is helpful for surgeon preparation and preoperative patient counseling. The goals of this study are to describe the incidence of AIEs during bariatric surgery and examine their impact on major adverse complications. ⋯ Incidence of an AIE is not infrequent during bariatric surgery and is associated with much higher risk of major complication. Additional study is needed to assess the association between specific AIEs and short-term complications.
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Comparative Study
Optimizing clinical and economic outcomes of surgical therapy for patients with colorectal cancer and synchronous liver metastases.
Traditionally, for patients with colorectal cancer with resectable synchronous liver metastases, resections were performed separately. However, the safety and efficacy of simultaneous resection have been demonstrated in selected patients. The purpose of this study was to evaluate outcomes and economic implications of simultaneous and staged resections. ⋯ The simultaneous resection strategy was oncologically equivalent and more cost efficient for patients with primary colorectal cancer presenting with resectable liver metastases. A reduction in overall length of hospital stay was an associated benefit. Future studies should explore the feasibility and clinical implications of policies to maximize the potential for simultaneous resection in this cohort of patients.
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Surgical site infections (SSI) are a common and costly problem, prolonging hospitalization and increasing readmission. Adherence to well-known infection control process measures has not been associated with substantial reductions in SSI. To date, the global burden of preventable SSI continues to result in patient harm and increased health care costs on a broad scale. ⋯ Formation of small groups of front-line providers to address patient harm using local wisdom and existing evidence can improve patient safety. We demonstrate a surgery-based CUSP intervention that might have markedly decreased SSI in a high-risk population.
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Recently, rib fracture fixation for flail chest has been used increasingly at both academic and nonacademic trauma centers. Although a few small non-US studies have demonstrated a clinical benefit, it is unclear whether this benefit outweighs the added expense and potential perioperative complications related to the procedure. We therefore sought to determine if open reduction and internal fixation of ribs for flail chest (ORIF-FC) represents a cost-effective means for managing these patients. ⋯ Despite the additional cost of surgery, rib fracture fixation dominates the standard of care and should be considered in the management of appropriate flail chest patients.