Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Nov 2014
Defining perioperative risk after hepatectomy based on diagnosis and extent of resection.
Outcomes after hepatectomy have been assessed incompletely and have not been stratified by both extent of resection and diagnosis. We hypothesized that operative risk is better assessed by stratifying diagnoses into low- and high-risk categories and extent of resection into major and minor resection categories to more accurately evaluate the outcomes after hepatectomy. ACS-NSQIP was reviewed for 30-day operative mortality and major morbidity after partial hepatectomy (PH), left hepatectomy (LH), right hepatectomy (RH), and trisectionectomy (TS). ⋯ Regardless of the extent of resection, high-risk diagnoses were independently associated with mortality (OR = 3.2 and 3.1, respectively) and major morbidity (OR = 1.5 and 1.5, respectively). Risk of hepatectomy is better assessed when stratified by both the diagnostic risk and the extent of resection. Accurate assessment of these outcomes has significant implications for preoperative planning, informed consent, resource utilization, and inter-institutional comparisons.
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J. Gastrointest. Surg. · Nov 2014
Multicenter Study Comparative StudyLow drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy.
Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out. ⋯ Low DFA1 predicts the absence of a pancreatic fistula. In patients with DFA1 < 90 U/L, early drain removal is advisable.
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J. Gastrointest. Surg. · Oct 2014
Multicenter Study Comparative StudyCrohn's disease but not diverticulitis is an independent risk factor for surgical site infections in colectomy.
Surgical site infections (SSIs) after colectomy for colon cancer (CC), Crohn's disease (CD), and diverticulitis (DD) significantly impact both the immediate postoperative course and long-term disease-specific outcomes. We aim to profile the effect of diagnosis on SSI after segmental colectomy using the National Surgical Quality Improvement Program (NSQIP) data set. ⋯ For patients undergoing segmental colectomy in the NSQIP data set, statistically significant increases in SSI are seen in CD, but not DD, when compared to CC, thus confirming CD as an independent risk factor for SSI.
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J. Gastrointest. Surg. · Oct 2014
Comparative StudyHigh performing whipple patients: factors associated with short length of stay after open pancreaticoduodenectomy.
Despite the decreasing mortality of pancreaticoduodenectomy (PD), it continues to be associated with prolonged length of postoperative hospital stay (LOS). This study aimed to determine factors that could predict short LOS after PD. Additionally, as preliminary data of minimally invasive PD emerges, we sought to determine the average LOS after open PD at a high-volume center to set a standard to which minimally invasive PD can be compared. ⋯ In our experience, median LOS was 7 days, and early discharge (≤5 days) after open PD is safe and feasible in about 10 % of patients. These high performers are more likely to be male, have received neoadjuvant therapy, and had successful epidural analgesia. High performers with cancer are more likely to start chemotherapy <8 weeks after surgery. Minimally invasive PD should be compared to this high standard for median LOS, among other quality metrics, to justify its increased cost, operative duration, and learning curve.
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J. Gastrointest. Surg. · Oct 2014
What is the risk of clinical anastomotic leak in the diverted colorectal anastomosis?
The objective of this study was to identify clinical leak in diverted colorectal anastomoses. ⋯ In diverted anastomoses, most leaks become clinically apparent beyond 30 days. The standard practice of censoring outcomes that occur beyond postoperative day 30 will fail to identify a substantial fraction of leaks in diverted colorectal anastomoses.