Journal of the American College of Surgeons
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Observational Study
Development of Diabetes after Pancreaticoduodenectomy: Results of a 10-Year Series Using Prospective Endocrine Evaluation.
Limited literature is available on the development of impaired glucose tolerance and diabetes mellitus after pancreaticoduodenectomy. The primary aim was to define the diabetic phenotype and correlate preoperative glycemic laboratory results to new-onset diabetes after pancreaticoduodenectomy. ⋯ Diabetes will develop after pancreaticoduodenectomy in approximately 16.6% of patients. A preoperative glycated hemoglobin >5.4% independently predicts new-onset diabetes. Pre- and postoperative endocrine analysis remains paramount for proper patient risk stratification.
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Data linking ballistics to injury are lacking. To address this data chasm, a partnership with law enforcement was developed to describe clinical outcomes from specific firearms. ⋯ Larger caliber and higher velocity firearms have significantly increased over the past 20 years in conjunction with injury severity, hospital days, and mean number of gun-related homicides per year (112 in 1996 to 2000 vs 143 in 2011 to 2015). Robust data sharing partnerships can be built between police and trauma centers to address the dearth of data on firearm crime and resulting injury.
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Observational Study
Impact of New Vascular Fellowship Programs on Vascular Surgery Operative Volume of Residents in Associated General Surgery Programs.
General surgery (GS) resident vascular surgery (VS) operations have declined significantly in the last 15 years. We hypothesized that initiation of VS fellowship programs (VSFPs) contributes to that decline. This study examined the effect of establishing new VSFPs on VS case volumes of residents in associated GS programs. ⋯ New VSFPs diminished peak VS operative volume of residents in associated GS programs, thereby contributing to declining national average number of VS cases done by GS residents. Nevertheless, resident VS case volumes remained robust in most GS programs associated with new VSFPs. Additional study is required to determine both resident perception and overall impact of VSFPs on associated GS training.
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Current guidelines suggest that cholecystectomy during the third trimester of pregnancy is safe for both the woman and the fetus. However, no population-based study has examined this issue. The aim of this analysis was to compare the results of cholecystectomy during the third trimester of pregnancy with outcomes in women operated on in the early postpartum period in a large population. ⋯ Maternal delivery and procedure-related outcomes were worse when cholecystectomy was performed during the third trimester of pregnancy. Preterm delivery, which is associated with multiple adverse infant outcomes, was increased in third-trimester women. Whenever possible, cholecystectomy should be delayed until the postpartum period.
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Observational Study
Surgical Site Infection after Primary Closure of High-Risk Surgical Wounds in Emergency General Surgery Laparotomies and Closed Negative-Pressure Wound Therapy.
We hypothesized that the universal adoption of closed wounds with negative pressure wound therapy (NPWT) in emergency general surgery patients would result in low superficial surgical infection (SSI) rates. ⋯ Primary closure of high risk incisions combined with NPWT is associated with acceptably low SSI rates. Due to the low morbidity and decreased cost associated with this technique, primary closure with NPWT should replace open wound management in the emergency general surgery population.