Arch Surg Chicago
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Patients aged 70 years and older undergo proportionately more emergency and permanent fecal ostomy procedures than younger patients. Older patients have comparable short-term outcomes in morbidity and mortality, with adverse outcomes dependent on comorbid conditions and timing of the procedure rather than age alone. Older patients should be treated similarly to younger patients in terms of subsequent ostomy takedown, if an acceptable operative risk. ⋯ Patients aged 70 and older undergo proportionately more permanent fecal ostomy procedures than younger patients, with longer hospital stays, more postoperative complications, and higher mortality rates. However, surgical outcome measures in older patients following ostomy procedures remain within acceptable standards. Furthermore, older patients tolerate ostomy reversal with minimal morbidity and should not be denied consideration based on age alone if an eligible candidate.
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Comparative Study
Effect of patient position on size and location of the subclavian vein for percutaneous puncture.
Large-bore subclavian intravenous access is important during trauma resuscitation and to provide central access in the intensive care unit. Controversy exists as to the patient position that best facilitates the insertion of this line. Duplex scanning of the subclavian vein in different body positions may help define which provides the largest vein size and distance from the clavicle. ⋯ These data demonstrate that arching of the shoulders and turning of the head may reduce target size and provide an unsatisfactory position for subclavian puncture. The Trendelenburg position with no other positioning maneuvers may be helpful.
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Comparative Study
Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers.
This study compared outcomes to determine whether patient safety is similar in Florida ambulatory surgery centers and offices. ⋯ In this review of surgical procedures performed in offices and ambulatory surgery centers in Florida during a recent 2-year period, there was an approximately 10-fold increased risk of adverse incidents and death in the office setting. If all office procedures had been performed in ambulatory surgery centers, approximately 43 injuries and 6 deaths per year could have been prevented.
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Clinical Trial
Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery.
One of the most frequent complications after laparoscopic antireflux surgery is estimated to be the intrathoracic herniation of the wrap into the chest. Therefore, in up to 5% of patients, revisional surgery is necessary. ⋯ Laparoscopic refundoplication with prosthetic hiatal closure is a safe and effective procedure for preventing recurrent intrathoracic wrap herniation, with good to excellent functional outcome for a complete follow-up of 1 year.