Journal of the American College of Surgeons
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Randomized Controlled Trial
Early angiopoietin-2 levels after onset predict the advent of severe pancreatitis, multiple organ failure, and infectious complications in patients with acute pancreatitis.
Acute pancreatitis is a severe condition that requires early identification of patients at risk of developing potentially lethal complications. Current clinical scoring systems and biochemical parameters are insufficient. In this study, we aimed to assess whether early plasma Angiopoietin-2 (Ang-2) is associated with adverse outcomes in patients with predicted severe acute pancreatitis (SAP). ⋯ In the setting of this randomized controlled trial, early plasma Ang-2 was found to be an accurate predictor of SAP, multiorgan failure, and infectious complications. As a biomarker, it did outperform all of the investigated conventional predictors that are currently used in clinical practice.
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Complications after cholecystectomy in children are poorly characterized. The aim of this study was to assess risk factors for major surgical complications for children undergoing cholecystectomy. ⋯ Serious complications and readmissions from pediatric cholecystectomy are uncommon. Surgeons performing cholecystectomy in young children must have an elevated concern about BDI. Routine IOC or surgical volume might not be helpful in lowering BDI rates.
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The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. ⋯ Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment.
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Chronic kidney disease (CKD) is known to adversely affect cardiac and vascular surgery outcomes. We examined the effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection. ⋯ Few patients with significant renal insufficiency are candidates for pancreatic resection. Severe CKD (stages 4-5) is associated with increased risk of complication and respiratory failure. Serum creatinine ≥ 1.8 mg/dL may serve as a useful marker of renal insufficiency and identifies patients at significantly increased risk of any complication, major complication, and respiratory failure after pancreatic resection.
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Ninety percent of global trauma deaths occur in under-resourced or remote environments, with little or no capacity for injury surveillance. We hypothesized that emerging electronic and web-based technologies could enable design of a tablet-based application, the electronic Trauma Health Record (eTHR), used by front-line clinicians to inform trauma care and acquire injury surveillance data for injury control and health policy development. ⋯ The eTHR has potential to be used as an electronic medical record, guiding clinical care while providing data for injury surveillance, without significantly hindering hospital workflow in various health-care settings.