Journal of the American College of Surgeons
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Several popular media and Internet-based hospital quality rankings have become increasingly publicized as a method for patients to choose better hospitals. It is unclear whether selecting highly rated hospitals will improve outcomes after cardiovascular surgery procedures. ⋯ Popular hospital rating systems identify high-quality hospitals for cardiovascular operations. However, patients can experience equivalent outcomes by seeking care at high-volume hospitals.
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This article outlines our current perioperative management of patients undergoing cystectomy and urinary diversion using advancements in perioperative care to allow for early institution of an oral diet and early hospital discharge. ⋯ Successful application of a fast track program has been applied to our patients undergoing radical cystectomy and urinary diversion, with the potential to use evidence-based modifications to reduce morbidity and improve recovery.
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Emergent surgical management of malignant large bowel obstruction (LBO) carries a high rate of morbidity and mortality. Self-expanding metal stents have emerged as an alternative for palliation of malignant LBO. However, there are few long-term studies documenting the effect of surgical palliation or colonic stents on symptoms or quality of life (QoL). ⋯ Both stent placement and surgical diversion provide durable improvement in symptoms from LBO, as readily assessed by the Colon Obstruction Score. QoL is difficult to assess in terminal cancer patients, but colon stent placement is associated with improved overall QoL and QoL related to gastrointestinal symptoms.
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Management of severe traumatic lower extremity injuries remains a considerable challenge. Free tissue transfer is now a standard part of reconstruction for Gustilo IIIB and IIIC injuries. There is limited information on arterial injury patterns in this population. We undertook a review of our experience to gain insight on vascular injury patterns and surgical outcomes. ⋯ Angiography of severe lower extremity injuries requiring free flap reconstruction usually revealed arterial injury and is generally indicated. In our experience, the anterior tibial artery is most commonly injured and the posterior tibial artery is most likely to be spared and used as a recipient.