Journal of the American College of Surgeons
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Ventral incisional hernias (VIH) develop in up to 20% of patients after abdominal surgery. No widely applicable preoperative risk-assessment tool exists. We aimed to develop and validate a risk-assessment tool to predict VIH after abdominal surgery. ⋯ The HERNIAscore accurately identifies patients at increased risk for VIH. Although external validation is needed, this provides a starting point to counsel patients and guide clinical decisions. Increasing the use of laparoscopy, weight-loss programs, community smoking prevention programs, and incisional reinforcement may help reduce rates of VIH.
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Multicenter Study
Postmastectomy radiation for N2/N3 breast cancer: factors associated with low compliance rate.
The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines recommend postmastectomy radiation therapy (PMRT) for women with N2/N3 breast cancer. We examined the compliance rate of PMRT using the National Cancer Data Base and determined what factors are associated with low compliance rate with PMRT. ⋯ One third of patients with N2/N3 disease did not receive PMRT. Socioeconomic variables were not contributory factors. Noncompliance with PMRT is related to lack of receipt of chemotherapy, nonreadmission, or death within 30 days after surgery.
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Multicenter Study
Risk stratification for readmission after major hepatectomy: development of a readmission risk score.
Hospital readmission is becoming a quality measure, despite poor understanding of the risks of readmission. This study examines readmission risk factors after major hepatectomy and develops a predictive model. ⋯ The risk of hospital readmission within 90 days after major hepatectomy is high and is reliably predicted with a novel scoring system.
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Multicenter Study
Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicenter study.
Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding. ⋯ Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.
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Selected patients with chronic pancreatitis can benefit from total pancreatectomy with islet autotransplantation. Patient selection is challenging and outcomes assessment is essential. ⋯ Total pancreatectomy with islet autotransplantation improves QOL for selected patients with chronic pancreatitis. The physQOL improves quickly after surgery, and psychQOL improvements are more gradual. Opioid misuse can predict physQOL improvement.