Journal of the American College of Surgeons
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The feasibility of day case surgery (DCS) appendectomy for uncomplicated acute appendicitis (UCAA) was evaluated by the prospective AppendAmbu (Feasibility of Outpatient Appendectomy for Acute Appendicitis) study (ClinicalTrials.gov ID NCT01839435). The aim of this study was to evaluate the real-life feasibility of DCS for UCAA. ⋯ Day case surgery constitutes progress in surgery as a result of enhanced recovery programs. It avoids unnecessary prolonged hospitalization.
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Patient engagement is an increasingly important component of surgical decision making. Given the many factors associated with successful ventral hernia repair (VHR), we developed and validated the Outcomes Reporting App for Clinical and Patient Engagement (ORACLE) tool to help facilitate preoperative surgeon-patient discussions about VHR. ⋯ Using a national data set for development, ORACLE can be used to facilitate patient engagement, with the goal of tailoring interventions for VHR given each patient's unique factors. With ongoing data input into the Americas Hernia Society Quality Collaborative and a continuous re-evaluation of these risk models, it is our intention that this tool will serve as an up-to-date resource for hernia surgeons and ventral hernia patients.
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Opioids are overprescribed after surgical procedures, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgical procedures. ⋯ Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway, and still reported high satisfaction and pain control. These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids after discharge from minor surgical procedures.
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Comparative Study
Surgical Outcomes in Lateral Abdominal Wall Reconstruction: A Comparative Analysis of Surgical Techniques.
Lateral abdominal wall (LAW) myofascial defects are a challenging reconstructive problem, and no consensus exists on their surgical management. We hypothesized that mesh repairs anchored to the nonyielding LAW boundaries (pillar-anchored repairs [PARs]) would provide more durable reconstructions, with lower hernia recurrence and bulge occurrence rates, compared with mesh repairs anchored to the surrounding oblique muscle complexes (direct repairs [DRs]). ⋯ The PAR technique is superior to DR for reconstructing LAW defects in order to achieve the lowest hernia recurrence rates in this complex patient population.