Journal of the American College of Surgeons
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Randomized Controlled Trial
Ligation of Intersphincteric Fistulous Tract vs Endorectal Advancement Flap for High-Type Fistula in Ano: A Randomized Controlled Trial.
This study aimed to compare the postoperative outcomes and success rate of the endorectal advancement flap and ligation of intersphincteric fistulous tract (LIFT) in high-type fistula in ano. ⋯ The shorter operative duration, better quality of life at 6 months, and higher healing rate make LIFT a superior treatment option for high fistula in ano. However, studies with a large sample size will be needed to verify these results.
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Observational Study
Effect of Present at Time of Surgery on Unadjusted and Risk-Adjusted Postoperative Complication Rate.
Present at the time of surgery (PATOS) is an important measure to collect in postoperative complication surveillance systems because it may affect a patient's risk of a subsequent complication and the estimation of postoperative complication rates attributed to the healthcare system. The American College of Surgeons (ACS) NSQIP started collecting PATOS data for 8 postoperative complications in 2011, but no one has used these data to quantify how this may affect unadjusted and risk-adjusted postoperative complication rates. ⋯ Taking PATOS into account is important for reporting unadjusted event rates. The effect varied by type of complication-lowest for superficial surgical site infection and highest for sepsis and septic shock. Taking PATOS into account was less important for risk-adjusted outcomes (observed to expected ratios), except for sepsis and septic shock.
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There were 23,854 suicides by firearms in 2017 in the US, accounting for 60% of all gun deaths. Studying firearm-related mortalities is vital for reducing preventable gun deaths. This study aims to determine the association between state-level presence of restrictive firearm laws and suicide rates with firearms. ⋯ Background checks and mandatory waiting periods correlated with fewer suicides by all firearms and specific firearm types. This reduction could be due to firearm laws directly preventing people from accessing guns or existing concurrently with other suicide prevention measures. More research should be directed to understanding how firearm laws can help reduce suicide rates.
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The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear. ⋯ ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.