The Journal of surgical research
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The most common 3rd-year surgery clerkship uses general surgery services while limiting the involvement of subspecialty services. A novel surgery clerkship in which students were assigned to either general surgery or subspecialty services for the entire clerkship was tried at a large Midwestern medical school. The purpose of this study was to investigate the outcomes of clerks from subspecialty services and compare them with clerks from general surgery services. ⋯ These findings inform surgical educators to consider a more prominent role of subspecialty surgery in teaching 3rd-year medical students. However, caution is advised to accommodate the difference in stringency observed between subspecialty and general surgery faculty in rating medical student performance. Faculty development in student evaluation for subspecialty surgical faculty is recommended.
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The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection. ⋯ Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer.
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This study evaluated peripheral vascular injuries in a pediatric trauma population to identify injury patterns, to identify diagnostic and therapeutic modalities used, and to understand the role of pediatric surgical subspecialists. ⋯ Pediatric traumatic vascular injuries are associated with a higher rate of penetrating trauma than other pediatric trauma and have a relatively high rate of operative intervention. Diagnosis and treatment of pediatric vascular injuries can be made difficult by a high rate of vasospasm. Additionally, traumatic vascular injuries in the pediatric population present a unique challenge in the overlap of their management by many different surgical subspecialists.
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Different mechanisms of injury (MOI), such as motor vehicle crashes, falls, or pedestrians struck by motor vehicle impart varying degrees of force and energy transfer that may impact outcomes. This study analyzed the independent relationship between MOI and mortality and functional outcomes following blunt trauma among adults. ⋯ After adjusting for confounders, MOI was found to independently predict mortality and functional impairment at hospital discharge. Current injury assessment models could be greatly enhanced by including MOI, and we propose routine adjustment for injury mechanism in trauma outcomes research.