Annals of surgery
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Comparative Study
Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006.
This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006. ⋯ Laparoscopic appendectomy is safe and associated with lower postoperative mortality rates than open procedures. The cost implications are uncertain as this technique is associated with shorter hospital stay but higher subsequent readmission rates.
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Multicenter Study
Racial disparity in the relationship between hospital volume and mortality among patients undergoing coronary artery bypass grafting.
To examine whether the volume-mortality relationship in coronary artery bypass grafting (CABG) differs by race and operative risk. ⋯ Blacks have greater reduction in mortality than whites by undergoing CABG at higher-volume hospitals, regardless of operative risk. Because of limited generalizability, these findings should be confirmed using more representative database.
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To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation. ⋯ The reliability of expert witness testimonies in bile duct injury litigation is frail. Defendants, plaintiffs, experts, and lawyers should be aware of the drawbacks of expert witness testimonies. Raising consensus concerning the standards of surgical care may be required to improve agreement in judgments on negligence.
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The authors assessed the long-term pain relief after local nerve blocks or neurectomy in patients suffering from chronic pain because of Pfannenstiel-induced nerve entrapment. ⋯ Peripheral nerve blocking provides long-term pain reduction in some individuals. An iliohypogastric or ilioinguinal nerve neurectomy is a safe and effective procedure in most remaining patients.
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Eliminating health care disparities in the United States will require a multifaceted approach that will include increasing diversity in the health care workforce. Historically, the field of medicine, and particularly surgery, has had an incumbent that grossly misrepresents the patient population. Delineating the exact demographics of the U.S. surgical residents and faculty could provide outstanding information, yielding insight into a possible deficit that, if rectified by the medical education system, could change the face of surgery and the entire health care system. ⋯ Academic surgery is exceedingly deficient of minority residents, junior faculty, and professors. Correcting this misrepresentation would facilitate establishing a more culturally and ethnically sensitive health care environment for patients who otherwise would not seek care. Additionally, with more minority academic surgeons, there will likely be a commensurate increase in investigative studies highlighting minority specific health care needs and provide additional role models and mentors for future minority surgeons.