Journal of the American College of Surgeons
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Traumatic injury remains the leading cause of preventable morbidity and mortality worldwide, with a large economic burden. One fourth of annual Medicare expenditures result from readmissions, including trauma. The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) has elevated care for >200 trauma programs worldwide. We use ACS TQIP, which does not include 30-day outcomes featured in the ACS NSQIP, affecting observed readmission rates. ⋯ We hypothesized that our observed and actual readmission rates differed. We discovered a significant difference in reported rates. Incorporating an NSQIP-like postdischarge feedback process can improve the accuracy of hospitals' readmission data and complication reporting, and thereby improve the value of the information TQIP uses as benchmarks.
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Training of foreign medical graduates in surgical oncology is an undervalued intervention for improving global cancer care. The aim of this work was to describe the design and results of a clinical training program for international surgeons from a single comprehensive cancer center. ⋯ The International General Surgical Oncology Fellowship has successfully trained foreign surgeons for academic practice in surgical oncology. Most of the graduates have returned to their country of origin and contributed to education and research there.
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The role of routine lymphadenectomy for perihilar cholangiocarcinoma is still controversial and no study has defined the minimum number of lymph nodes examined (TNLE). We sought to assess the prognostic performance of American Joint Committee on Cancer/Union Internationale Contre le Cancer (7(th) edition) N stage, lymph node ratio, and log odds (LODDS; logarithm of the ratio between metastatic and nonmetastatic nodes) in patients with perihilar cholangiocarcinoma and identify the optimal TNLE to accurately stage patients. ⋯ Perihilar cholangiocarcinoma patients undergoing radical resection should ideally have at least 4 lymph nodes harvested to be accurately staged. In addition, although LODDS performed better at determining prognosis among patients with <4 TNLE, both lymph node ratio and LODDS outperformed compared with American Joint Committee on Cancer N stage among patients with ≥4 TNLE.