Journal of the American College of Surgeons
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The Appalachian region of the United States (US) extends from the Mississippi delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed. ⋯ While cancer incidence and mortality rates are declining in Appalachia, they remain substantially higher and demonstrate slower progress than elsewhere in the US-particularly in the Central Appalachian subregion-indicating the need for targeted research to delineate and address the factors driving these cancer health disparities.
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Obesity is directly correlated with wound complications and recurrence following open ventral hernia repair (OVHR). Preoperative weight loss (WL) mitigates these risks, improves overall health, and reduces intraabdominal volume. For patients successful in losing weight, it is unclear whether this WL is maintained. ⋯ Prehabilitation-induced WL averaged 26lbs. With 3.5years follow-up, patients weighed an average of 24lbs less than their initial consult weight. Nearly half of patients continued WL postoperatively, and more than 70% maintained at least half of their WL, demonstrating longevity to preoperative optimization.
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Fresh frozen plasma (FFP) as an adjunct in burn resuscitation to decrease endothelial cell permeability by restoring the glycocalyx is not yet standard of care, despite increasing evidence showing tis benefits. We hypothesize that utilizing an adjusted body weight index and starting resuscitation at a low rate of 2cc/kg/%TBSA with early plasma results in less fluid administration and superior clinical outcomes compared to traditional resuscitation methods such as Parkland formula. ⋯ Patients treated with the restrictive 2cc/kg+FFP formula received less fluid than the 3cc/kg and Parkland formula controls. With reduced fluids, patients had less mechanical ventilation, less dialysis, fewer tracheostomies, and better survival. AKI was minimal despite fluid restriction. Early experience suggests the new protocol is safe and feasible for further study.
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Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). ⋯ Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.