Journal of the American College of Surgeons
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Surgery remains the standard for nonmetastatic gastrointestinal stromal tumors (GISTs). Laparoscopic surgery should be considered for these tumors, because their biologic behavior lends them to curative resection without requiring large margins or extensive lymph-adenectomies. ⋯ Laparoscopic resection of GISTs is considered safe and effective. The longterm disease-free survival of 78% establishes this minimally invasive approach as comparable to open techniques.
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Obesity is associated with an increased risk of postoperative complications after colectomy for cancer, but it is unclear which specific complications occur more frequently in obese patients. Our objective was to assess the association of body mass index (BMI) on short-term outcomes after colectomy for cancer. ⋯ Compared with normal weight patients, morbidly obese patients had a higher risk of surgical site infection, dehiscence, pulmonary embolism, and renal failure, but not other complications or mortality. Quality initiatives should include these specific complications.
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Recent studies suggest that preoperative cardiac stress testing is unnecessary in low to intermediate cardiac risk patients undergoing operations, and that targeted beta blockade is cardiac protective. ⋯ In patients undergoing vascular surgery or major amputation, with low to intermediate cardiac risk, preoperative targeted beta blockade alone is more effective than selective cardiac stress testing and nontargeted beta blockade in preventing cardiac morbidity.
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Organ donation serves a public health function but is also an important part of end-of-life care. Nearly 40% of organ donors are the victims of traumatic brain injury (TBI). We report on a series of patients with nonsurvivable TBI and severe coagulopathy or active hemorrhage who went on to successful organ donation with the use of recombinant factor VIIa (rFVIIa). ⋯ Use of rFVIIa facilitated donation in patients with multisystem injuries who otherwise might have been ineligible for organ donation. Use of rFVIIa did not affect early graft function, although longterm outcomes are unknown. Recombinant factor VIIa is expensive, but its use is justified if the donor organ supply can be increased.
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The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides reliable, risk-adjusted outcomes data using standardized definitions and end points. Collection of the data is time consuming, and the surgical clinical nurse reviewers (SCNRs) can sample only a subset of all surgical cases. We sought to test the feasibility of using an informatics tool to automatically identify postoperative complications stored as free-text documents in our electronic medical record. ⋯ Informatics has the potential to improve the efficiency and accuracy of chart abstraction by SCNRs for the ACS-NSQIP. Using such tools may eventually allow all cases at an institution to be reviewed rather than a small subset.