Arch Surg Chicago
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Population-based hospital data indicate that African American patients undergo major lower extremity (LE) amputation 2 to 3 times more frequently than white patients. Some have attributed this to a lack of access to LE revascularization procedures by African American patients. To determine the likelihood that racial disparities in amputation rates are related to treatment choice, this study examines rates of primary amputation (major amputation without any previous attempt at revascularization) and repeat amputation. ⋯ The racial disparity at the study institution was primarily due to African American patients undergoing repeat major amputation at a significantly higher rate than whites.
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Operative mortality rates for esophageal resection vary across hospital volume groups in a nationally representative sample of hospitals. ⋯ The operative mortality rate for esophageal resection varies across hospitals in the United States. To improve the quality of care and reduce operative mortality rates for patients in need of esophageal surgery, patients should either be referred to higher-volume hospitals, or quality improvement should be directed at lower-volume hospitals.
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Selective non-stapling of the mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty (TEP) may reduce postoperative pain and morbidity rate. ⋯ Selective non-stapling of the mesh did not confer short-term benefits, such as reduced postoperative pain and morbidity, compared with those who had routine stapling of the mesh during TEP. For patients with a hernial defect measuring less than 4 cm, TEP can be performed without stapling the mesh. The selective non-stapling strategy also helps to reduce the cost of the operation and the potential for nerve entrapment.
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Burn-trauma patient encounters constitute 5% of the emergency department population. ⋯ A large urban population will have an increased frequency (2-fold in our center) of burn-trauma injuries. Assault and child abuse are significant contributory factors to burn-trauma injuries in this population.
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Advances in specialized centers for pancreatic diseases have improved surgical morbidity and outcome. In the past, postoperative local complications (pancreatic fistulae) were causing most of the mortality. Now, more patients experience postoperative complications related to their comorbidity. ⋯ Pancreatic resections can be performed with considerable safety and a low rate of pancreatic complications. More patients die of systemic complications than in the past, which increases the demand for precise preoperative patient selection. Completion pancreatectomy should no longer be considered in patients with a pancreatic fistula.