Journal of the American College of Surgeons
-
The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured emergency general surgery patient population, however, there are variations in the design of ACS service models. This meta-analysis analyzes the impact of implementation of different ACS models on the outcomes for appendicitis and biliary disease. ⋯ The ACS model has been shown to benefit acute care surgery patients with improved access to care, fewer complications, and decreased length of stay for 2 common disease processes. The design and implementation of an ACS service can impact the magnitude of effect.
-
Comparative Study
Submucosal Tunneling Endoscopic Resection vs Thoracoscopic Enucleation for Large Submucosal Tumors in the Esophagus and the Esophagogastric Junction.
Submucosal tunneling endoscopic resection (STER) is regarded as a promising method for resection of submucosal tumors (SMTs); however, little is known about a comprehensive comparison of STER and thoracoscopic enucleation (TE). The aim of this study was to compare the clinical outcomes of STER and TE for large symptomatic SMTs in the esophagus and esophagogastric junction, as well as to analyze the factors that affect the feasibility and safety of STER. ⋯ Submucosal tunneling endoscopic resection is effective and safe for large SMTs in the esophagus and esophagogastric junction. This procedure has the advantage of being more minimally invasive with a shorter procedure time and hospital stay compared with TE. Submucosal tunneling endoscopic resection for tumors with a transverse diameter ≥3.5 cm and an irregular shape is associated with relatively high risk for piecemeal resection, adverse events, and technical difficulties.
-
Online videos are among the most common resources for case preparation. Using crowd sourcing, we evaluated the relationship between operative quality and viewing characteristics of online laparoscopic cholecystectomy videos. ⋯ There is an incredibly low frequency of CVS and average GOALS technical performance in frequently used online surgical videos of LC. Favorable characteristics, such as number of views or likes, do not translate to higher quality.
-
Multicenter Study
Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma using Quantitative Image Analysis.
Microvascular invasion (MVI) is a significant risk factor for early recurrence after resection or transplantation for hepatocellular carcinoma (HCC). Knowledge of MVI status would help guide treatment recommendations, but is generally identified after operation. This study aims to predict MVI preoperatively using quantitative image analysis. ⋯ This study reveals the potential importance of quantitative image analysis as a predictor of MVI.
-
Multicenter Study
Inclusion of Highest Glasgow Coma Scale Motor Score in Mortality Risk-Adjustment for Benchmarking of Trauma Center Performance.
The Glasgow Coma Scale (GCS) is the most widely used measure of traumatic brain injury (TBI) severity. Currently, the arrival GCS motor component (mGCS) score is used in risk-adjustment models for external benchmarking of mortality. However, there is evidence that the highest mGCS score in the first 24 hours after injury might be a better predictor of death. Our objective was to evaluate the impact of including the highest mGCS score on the performance of risk-adjustment models and subsequent external benchmarking results. ⋯ This study supports the concept that additional clinical information has the potential to not only improve the performance of current risk-adjustment models, but can also have a meaningful impact on external benchmarking strategies. Highest mGCS score is a good potential candidate for inclusion in additional models.