Journal of the American College of Surgeons
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Male breast cancer (MBC) is a rare disease, accounting for 1% of all breast cancers diagnosed in the United States. The rarity of MBC has limited the development of treatment algorithms specific to men. Thus, the standard of care has been mastectomy. The safety and feasibility of breast-conserving surgery (BCS) in MBC are unclear. This study assessed whether overall survival outcomes, local recurrence, and postoperative complications differed between MBC patients who underwent conservative surgery or mastectomy. ⋯ There is no difference in the 5-year OS and LR rate between MBC patients who undergo BCS or mastectomy. The postoperative complication rate was higher with mastectomies. We conclude that BCS for unicentric male breast cancer is feasible and preferred for T1 and T2 cancers.
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The ACS-NSQIP Colectomy-Targeted database provides valuable metrics on surgical outcomes by utilizing clinical data to enhance quality improvement efforts. However, the quality measures offered in the ACS-NSQIP semiannual report do not stratify for the indication for colectomy. We aim to compare postoperative outcomes in patients undergoing colectomy for colon cancer, infectious causes, and inflammatory bowel disease (IBD). ⋯ This study demonstrates that the indication for colectomy impacts postoperative outcomes. Reporting risk-adjusted outcomes based on the underlying disease etiology could lead to identifying high-risk patients, improving benchmarking outcomes, and developing targeted quality initiatives.
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The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel anti-reflux procedure that addresses the hiatus and the gastro-esophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a hiatal hernia repair with endoscopic fundoplication (TIF) vs surgical partial fundoplication (anterior and posterior) with regards to quality-of-life scores at 12 months after surgery. ⋯ There are no differences in outcomes between the c-TIF and a surgical partial fundoplication. QoL scores significantly decrease with all partial fundoplications and there are no differences in dysphagia or bloating between the three types of fundoplication. Long term data is necessary to see if either technique provides superior control of symptoms while minimizing dysphagia and bloating.
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In response to the opioid epidemic, prescribing guidelines and statewide surgical opioid management programs were initiated in 2018-19. This analysis aims to document the sustainability of a regional opioid stewardship consortium through the pandemic and beyond. ⋯ From 2019 to 2023, the percentage of patients taking opioids preoperatively decreased significantly, and the utilization of intraoperative blocks also increased significantly. The PENNJ-SOS program played a key role in combatting the opioid crisis over the four years of data collection, adapting effectively to the challenges posed by the Coronavirus Disease 2019 pandemic.
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In 2012, TQIP guidelines for massive transfusion protocols (MTP) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival. ⋯ With increased MTP activations, delivery of the first cooler was faster and mortality improved. Keeping cooler times under 8 minutes was associated with increased survival. The measurement and monitoring of "Door-to-cooler" time should be considered as a metric to assess performance and delivery of institutional MTP.