Annals of surgery
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We compared the surgical outcomes of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) for esophageal cancer. ⋯ MIE had favorable outcomes in terms of in-hospital mortality, morbidities, and the postoperative hospital stay.
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This study simulates the regionalization of pancreatectomies to assess its impact on spatial access in terms of patient driving times. ⋯ A policy that limits access to low-volume pancreatectomy hospitals will increase round-trip driving time by 24 minutes, but up to 54 minutes for 25% of patients. Population mortality rates may improve by 1.5%.
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We aimed to determine whether gentrification predicts the movement of shooting victims over time and if this process has decreased access to care. ⋯ Shootings in Philadelphia predictably moved out of gentrified areas and concentrated in non-gentrified ones. In this case study of a national crisis, the pattern of change paradoxically resulted in an increased clustering of shootings around trauma centers in non-gentrified areas. Repetition of this work in other cities can guide future resource allocation and be used to improve access to trauma care.
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The aim of this study was to examine relationships between ileostomy formation and subsequent kidney disease. ⋯ Ileostomy formation is strongly associated with subsequent kidney disease. Vigilance for this complication and new strategies for prevention and treatment are necessary.
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The opioid epidemic has stimulated initiatives to reduce the number of unnecessary narcotic prescriptions. We adopted an opt-in prescription system for patients undergoing ambulatory cervical endocrine surgery (CES). We hypothesized that empowering patients to decide whether or not to receive narcotics for pain control would result in fewer unnecessary opioid prescriptions. ⋯ By empowering patients undergoing ambulatory CES to accept or decline a prescription, we reduced the number of prescribed narcotic tablets by 96.6%. Although longer incisions and prior substance abuse predict higher likelihood of requesting pain medication on discharge, 207 of 216 patients were treated with acetaminophen alone.