Journal of the American College of Surgeons
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This landmark paper traces anti-LGBT discrimination in surgery from history to present with particular analysis of discrimination against patients, providers, and within faith-based and military While research alone will not end healthcare iniquity, the work cannot begin until the “Don’t Ask Don’t Tell” era of scholarship on ends. institutions. Discrimination against marginalized individuals is an epidemic in American Healthcare. Research regarding gender- and race- based discrimination in healthcare and surgery is robust; scholarship on anti-LGBT (Lesbian, Gay, Bisexual, and Transgender; see Table 1 for explanations of commonly used terms) discrimination is woefully lacking. ⋯ Delineating all these changes is beyond the scope of any one paper. However, improving and sustaining LGBT equity cannot begin without first providing a common background to create change upon. This paper seeks to correct the discursive gap.
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Women of color with breast cancer are less likely to undergo post-mastectomy reconstruction compared with White women, but it is unclear whether their perioperative outcomes are worse. The goal of this study was to investigate differences in preoperative comorbidities and postoperative complications by race/ethnicity among women with breast cancer undergoing postmastectomy reconstruction. ⋯ Disparities in postmastectomy breast reconstruction between Black and White women extend beyond access to care and include perioperative factors and outcomes. These findings suggest an important opportunity to mitigate inequities in reconstruction through perioperative health optimization and improved access to and co-management with primary care.
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Pancreatic duct diameter and pancreatic texture are important predictive factors for a postoperative pancreatic fistula (POPF) and are assessed intraoperatively by the surgeon. However, surgical evaluation is arbitrary and difficult to objectify, especially in minimally invasive approaches in pancreatic surgery. ⋯ Histopathologically determined pancreatic duct diameter and pancreatic fibrosis are quantitatively measurable independent risk factors for POPF and CR-POPF. An intraoperative objective histopathologic evaluation of these parameters using frozen sections could support the surgical assessment of the pancreatic duct diameter and the pancreatic texture.
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The incidence of, and factors associated with, lymph node metastasis (LN+) in non-functional gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are not well characterized. ⋯ This developed risk-score model, including both patient and tumor variables, can be used to calculate the risk for LN metastases in patients with GEP NETs.
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Patients undergoing emergency general surgery (EGS) and interhospital transfer (IHT) have increased mortality. Prior analyses of IHT have been limited by the inability to track post-discharge outcomes or have not included nonoperative EGS. We evaluated outcomes for IHT to our tertiary care facility compared with direct admission through the emergency department. ⋯ After PSM to reduce confounding variables, patients with common EGS diagnoses transferred to a tertiary care facility have increased inpatient morbidity and mortality. The increased morbidity and resource utilization for these patients extends beyond the index hospital stay.