Journal of the American College of Surgeons
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Hemipelvectomy is a complex surgery that is usually performed with curative intent. It is rarely performed for palliation in patients with advanced cancer, and its efficacy in achieving palliation is unknown. ⋯ Palliative-intent hemipelvectomy provided palliation in a minority of patients, did not improve function, and had high morbidity and mortality. Patients with small anterior pelvic tumors may benefit from palliative hemipelvectomy; for others, less invasive approaches should be considered whenever feasible.
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The knowledge required to manage surgical patients has expanded considerably over the past 40 years. Simultaneously, the cost of medical education has increased substantially. Surgical trainees are at particular disadvantage due to the time demands of training. We aim to determine whether surgeon compensation over time has adequately accounted for increasing student debt burden. ⋯ The rate of debt accumulation has outpaced the rate of salary growth for general surgeons to a significant degree.
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Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC. ⋯ The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open surgery.
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Addressing equity in healthcare is necessary to improve population health outcomes. In doing so, a requisite level of foundational resources, organization, and processes are needed. Although increasing attention is being devoted to addressing health inequities, the current landscape supporting these efforts remains unknown. We sought to evaluate the presence of frontline resources, organization, and processes for support of health equity efforts in hospitals participating in American College of Surgeons' (ACS) quality programs. ⋯ Efforts aimed at achieving health equity exist but lack the necessary infrastructure, organization, and processes to support effective frontline practices. The findings from this study support consideration of standards development targeting problems and opportunities at both the institutional and program level for advancing equity in quality improvement efforts.