Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Dec 2014
Multicenter StudyHospital volume and patient outcomes in hepato-pancreatico-biliary surgery: is assessing differences in mortality enough?
The impact of regionalization on morbidity, failure to rescue (FTR), length of stay (LOS), and readmission remains unclear. We sought to examine hospital-volume-related differences in outcomes following complex hepato-pancreatico-biliary (HPB) surgery and define potential benefits of regionalization across quality metrics. ⋯ Although patients treated at HV hospitals had more medical comorbidities, outcomes across a wide spectrum of quality metrics were better than at IV or LV hospital following complex HPB surgery. A 20-30 % reduction in morbidity and mortality and an 8 % reduction in hospital patient-days could be anticipated had all patients been treated at HV hospitals.
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J. Gastrointest. Surg. · Dec 2014
Multicenter StudyA nomogram to predict disease-free survival after surgical resection of GIST.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy has resulted in improved disease-free survival (DFS) following resection of primary GIST. The aim of our study was to create a nomogram to predict DFS following resection of GIST. ⋯ Four independent predictors of recurrence following surgery for primary GIST were used to create a nomogram to predict DFS. The nomogram stratified patients into prognostic groups and performed well on internal validation.
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J. Gastrointest. Surg. · Dec 2014
Preoperative dehydration increases risk of postoperative acute renal failure in colon and rectal surgery.
There is limited data regarding the effects of preoperative dehydration on postoperative renal function. We sought to identify associations between hydration status before operation and postoperative acute renal failure (ARF) in patients undergoing colorectal resection. ⋯ Dehydration before operation is a common condition in colorectal surgery (incidence of 27.7 %). Preoperative dehydration is associated with increased rates of postoperative ARF, MI, and cardiac arrest. Hydrotherapy of patients with dehydration may decrease postoperative complications in colorectal surgery.
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The optimal BMI threshold above which gastric bypass surgery should be offered to obese patients is controversial. The objective of this study was to compare the impact of Roux-en-Y gastric bypass (RYGB) vs. diet and exercise (D&E) on life expectancy to find the BMI at which patients experience an improvement in their life expectancy by undergoing surgery. ⋯ Roux-en-Y gastric bypass can improve long-term survival for patients with class I obesity. This study suggests that RYGB should not be reserved solely for patients with class II or III obesity.
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J. Gastrointest. Surg. · Nov 2014
ReviewImproving outcomes and cost-effectiveness of colorectal surgery.
In order to truly make an impact on improving the cost effectiveness, and most importantly, the outcomes of patients undergoing colorectal surgery, all aspects of care need to be scrutinized, re-evaluated, and refined. To accomplish this, everything from the way we train surgeons to the adoption of a minimally invasive approach for colorectal disease, along with the use of adjunct intraoperative measures to decrease morbidity and mortality, may all need to be incorporated within an ERAS program. Only then will this approach lead the provider to a patient-centric care plan which can successfully reduce metrics such as morbidity, mortality, and length of stay (even with the obligatory readmission rate) and provide it all at a lower cost of care.