Journal of the American College of Surgeons
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Liver transplantation centers are unevenly distributed within the Donor Service Areas (DSAs) of the United States. This study assessed how market competition and liver transplantation center density are associated with liver transplantation volume within individual DSAs. ⋯ After controlling for demographic and market factors, a greater concentration of centers was associated with more liver transplants without impacting overall survival. These results warrant additional investigation into the relationship between geospatial factors and liver transplantation volume with consideration for the optimization of scarce resources.
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Compared with conventional laparoscopic surgery, single-incision laparoscopic surgery produces better cosmetic benefits. The aim of this study was to investigate the learning curve for single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer using multidimensional methods. ⋯ The learning curve for SILAR for sigmoid colon cancer was 61 to 65 cases according to multidimensional statistical analyses. Single-incision laparoscopic anterior resection is feasible for surgeons experienced in laparoscopic surgery. However, SILAR required more cases for proficiency than the number previously reported for conventional laparoscopic surgery, likely because of its technical challenges.
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Observational Study
Impact of Hemorrhagic Shock on Pituitary Function.
Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. ⋯ Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.
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Benchmarking the quality of intraoperative care by comparing the rates of intraoperative adverse events (iAEs) necessitates adequate risk adjustment. We sought to identify the patient- and procedure-related risk factors for iAEs. ⋯ Adhesiolysis and higher operative complexity predict an increased risk for iAE. Attempts to benchmark the quality of intraoperative care need to adequately risk adjust for these factors.
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Surgical management of liver lesions has moved toward "parenchymal-sparing" strategies. Although open parenchymal-sparing liver resections are supported by encouraging results, the applicability of the laparoscopic approach for nonperipheral tumors is still questionable. Our aim was to assess the feasibility, safety, and oncologic adequacy of laparoscopic parenchymal-sparing liver resection for nonperipheral lesions with a description of the technique adopted in this setting. ⋯ Laparoscopic parenchymal-sparing liver resections for nonperipheral liver lesions are feasible and can be performed safely without compromising perioperative and oncological outcomes.