Journal of the American College of Surgeons
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There have been no comprehensive studies across an organized statewide trauma system using a standardized method to determine cost. ⋯ Patient care cost rose with increasing ISS, length of stay, ICU days, and ventilator days for patients with length of stay >2 days and ISS 9+. Level I centers had the highest mean ISS, length of stay, ICU days, and ventilator days, along with the highest PCC. Lesser trauma accounted for lower charges, payments, and PCC for Level II, III, and IV TCs, and the margin was variable. Verification and response costs per patient were highest for Level I and II TCs.
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Multicenter Study Comparative Study
Retained foreign bodies: risk and outcomes at the national level.
Retained foreign bodies (RFB) after operative interventions are linked to an increased risk of morbidity and mortality, and represent a medico-legal liability. We aimed to identify associated risk factors and outcomes related to iatrogenic RFB in the United States. ⋯ Retained foreign bodies have unfavorable and nationally tangible clinical and economic outcomes. The risk profile for RFB at the national level seems to demonstrate an association with demographic and clinical factors including nature of the procedure, type of admission, and trauma status. Teaching hospitals are associated with a higher risk. Targeted efforts toward identified high-risk populations are needed to avoid these morbid and costly complications.
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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
Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients.
The value of routine primary (intraoperative) drain placement after major hepatectomy remains unclear. We sought to determine if primary drainage led to decreased rates of complications, specifically, intra-abdominal biloma or infection requiring a secondary (postoperative) drainage procedure. ⋯ Primary intraoperative drain placement after major hepatectomy does not decrease the need for secondary drainage procedures and may be associated with increased bile leaks and 30-day readmissions. Routine drain placement is not warranted.
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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.