Journal of the American College of Surgeons
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Non-operative management (NOM) with antibiotics alone for pediatric uncomplicated appendicitis is accepted to be safe and effective. However, the relative cost-effectiveness of this approach compared to appendectomy remains unknown. We aimed to evaluate the cost-effectiveness of non-operative versus operative management for pediatric uncomplicated acute appendicitis. ⋯ NOM is cost-effective compared to laparoscopic appendectomy for pediatric uncomplicated appendicitis over 1 year.
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The modern generation of trials evaluating the role of adjuvant radiation have turned to genomic profiling as a further risk stratification tool. The LUMINA trial by Whelan et al, published in the New England Journal of Medicine, applied Ki67 testing to identify those with luminal A disease and evaluated locoregional outcomes with Breast Conserving Surgery (BCS) and endocrine therapy (ET) alone. This paper was reviewed at the Canadian Association of General Surgeons' "Evidence-Based Reviews in Surgery" (EBRS) webinar series. ⋯ While the LUMINA study was rigorously designed and executed, there are significant pragmatic limitations to the implementation of the proposed approach using their protocol. We advocate that there is no "one size fits all" approach to early ER+ breast cancer. Choice of treatment strategy should strongly consider patient goals and preferences, with need for incorporation of Quality of Life and patient-reported endpoints into future studies evaluating this population to help guide these nuanced decisions.
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Same-day mastectomy (SDM) protocols have been shown to be safe, and their use increased up to 4-fold compared with prepandemic rates. We sought to identify factors that predict overnight patient admission and evaluate the associated cost of care. ⋯ Preoperative opioid use, American Society of Anesthesiology class, longer postanesthesia care unit length of stay, and PST after noon predict a higher likelihood of admission after planned SDM. OAM translated to higher cost but not to decreased profit for the hospital.