Annals of surgery
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Multicenter Study
Implications for Breast Cancer Restaging Based on the 8th Edition AJCC Staging Manual.
We assessed the changes that have resulted from the latest breast cancer staging guidelines and the potential impact on prognosis. ⋯ Applying the 8th edition staging criteria resulted in a stage change for >35% of patients diagnosed with invasive breast cancer and refined OS estimates. Overall, the transition to the 8th edition is expected to better drive clinical care, treatment recommendations, and future research.
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Multicenter Study
Leveraging the Incidence, Burden, and Fiscal Implications of Unplanned Hospital Revisits for the Prioritization of Prevention Efforts in Pediatric Surgery.
To characterize procedure-level burden of revisit-associated resource utilization in pediatric surgery with the goal of establishing a prioritization framework for prevention efforts. ⋯ A small number of procedures account for a disproportionate burden of revisit-associated resource utilization in pediatric surgery. Gastrostomy, fundoplication, and appendectomy should be considered high-priority targets for prevention efforts within pediatric surgery.
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Randomized Controlled Trial
Inguinal Vascular Surgical Wound Protection by Incisional Negative Pressure Wound Therapy: A Randomized Controlled Trial-INVIPS Trial.
A randomized controlled trial (RCT) was undertaken to determine the effect of negative pressure wound therapy (NPWT) on closed incisions after inguinal vascular surgery regarding surgical site infections (SSIs) and other wound complications. ⋯ NPWT on closed inguinal vascular surgical incisions in elective patients reduces the incidence of SSI.
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: Surgeons universally overprescribe opioids even in surgeries that are minimally invasive. Despite some drops in opioid prescribing nationally, surgeons and dentists have not changed their prescribing habits. Opioid guidelines are inherently flawed by the anchoring heuristic and efforts should center on decreasing exposures to opioids through a physician-lead response. No-opioid minimally invasive surgery should be the goal rather than the exception.
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Multicenter Study
Hospital Volume Matters: The Volume-Outcome Relationship in Open Juxtarenal AAA Repair.
We studied whether the volume-outcome relationship would persist in more complex aortic operations. ⋯ Hospitals with low annualized volumes of open juxtarenal repair have higher perioperative mortality, irrespective of their total open aortic volume. Complex open AAA repairs should be performed at experienced centers, and future efforts should focus on centralization of complex aortic care.