The Journal of surgical research
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Damage to the recurrent laryngeal nerve (RLN) can lead to vocal cord paralysis, resulting in hoarseness, aspiration, stridor, and respiratory distress. The purpose of this study was to examine the impact of intraoperative nerve monitoring (IONM) on RLN injury during thyroidectomy when it is used as an adjunct to confirm the functional integrity of the RLN during delineation of its anatomic course after it has been visually identified. ⋯ The use of IONM had no impact on the rate of permanent RLN injury during thyroidectomy. Because of the low rate of RLN injury, a much larger sample size is needed to determine if IONM will a valuable adjunct in thyroid surgery, especially in specific high-risk subgroups.
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Comparative Study Clinical Trial
Ultrasonographic measurements of the inferior vena cava variation as a predictor of fluid responsiveness in patients undergoing anesthesia for surgery.
Both hypovolemia and hypervolemia are connected with increased morbidity and mortality in the treatment and prognosis of patients. An accurate assessment of volume state allows the optimization of organ perfusion and oxygen supply. Recently, ultrasonography has been used to detect hypovolemia in critically ill patients and perioperative patients. The objective of our study was to assess the correlation between inferior vena cava (IVC) variation obtained with ultrasound and stroke volume variation (SVV) measured by the Vigileo/FloTrac monitor, as fluid responsiveness indicators, in patients undergoing anesthesia for surgery. ⋯ Our data show that IVC variation and SVV proved to be reliable predictors of fluid responsiveness in patients undergoing anesthesia for surgery with mechanical ventilation.
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Comparative Study Observational Study
Short-term outcomes of minimally invasive versus open colectomy for colon cancer.
Laparoscopic and open approaches to colon resection have equivalent long-term outcomes and oncologic integrity for the treatment of colon cancer. Differences in short-term outcomes should therefore help to guide surgeons in their choice of operation. We hypothesized that minimally invasive colectomy is associated with superior short-term outcomes compared to traditional open colectomy in the setting of colon cancer. ⋯ This retrospective study of patients undergoing colectomy for colon cancer demonstrates significantly improved outcomes associated with a MIS approach, even when controlling for baseline differences in illness severity. When feasible, minimally invasive colectomy should be considered gold standard for the surgical treatment of colon cancer.
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This study describes risk factors leading to the development of various postoperative complications and recurrence after the Karydakis procedure. ⋯ Patients with no history of previous pilonidal surgery, a short length of extracted part, and long distance of caudal pit from anal verge are best candidates for the Karydakis flap procedure.
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Unintended rehospitalizations after surgical procedures represent a large percentage of readmissions and have been associated with increased morbidity and cost of care. Beginning in 2017, Medicare will expand diagnostic categories subject to financial penalties for excess postoperative readmissions to include coronary revascularization procedures. Arrhythmias and pulmonary complications comprise the largest categories for readmission after cardiac surgery. Technologic advances in remote monitoring have led to the use of web-based digital health kits (DHK) aimed at reducing readmissions and improving postoperative outcomes. The present study was performed to determine the added benefit of incorporating DHK's into a formal readmissions reduction program (RRP) in preventing 30-d readmissions and to evaluate patient and provider satisfaction with the use of these devices. ⋯ In our study, adding DHKs to a formal RRP was not associated with a significant decrease in 30-d readmission rates. We also found that notifications because of abnormal biometric measures were significantly correlated with required interventions. In contrast, notifications due to abnormal health survey responses were not associated with increased interventions. Both patients and members of the healthcare team were highly satisfied with this technology. DHKs appear to extend care beyond the inpatient period and provide a portal for telemonitoring of surgical patients. However, this modality is highly resource intensive and may not significantly reduce readmissions. Further studies are warranted to evaluate the efficacy of such kits in reducing readmissions and costs of care.