The Journal of surgical research
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Nonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury. ⋯ The results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.
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Papillary thyroid cancer (PTC) is the fastest increasing cancer in the United States; incidence increases with age. It generally has a favorable prognosis but may behave more aggressively in older patients. This study aims to describe national treatment patterns for low-risk PTC in older adults. ⋯ Most older adults with PTC underwent total thyroidectomy and a third received RAI; neither treatment improved DSS. In the growing elderly population, less extensive interventions for PTC may reduce morbidity and improve quality of life while preserving an excellent prognosis.
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Comparative Study Observational Study
Application of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery.
Whether continuous intraoperative nerve monitoring (C-IONM) can further reduce the incidence of recurrent laryngeal nerve injury compared with intermittent intraoperative nerve monitoring (I-IONM) in high-risk thyroid surgery is still controversial. This observational study aimed to evaluate the incidence of vocal cord paralysis (VCP) in high-risk thyroid surgeries performed with I-IONM and C-IONM. ⋯ Both I-IONM and C-IONM are equally safe and effective in high-risk thyroid surgery. C-IONM can help predict impending recurrent laryngeal nerve injury in real time and has a good warning feature, thereby minimizing critical maneuvers in high-risk thyroid surgery.
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It is commonly taught that a widened mediastinum (WM) on chest X-ray (CXR) is a marker for aortic injury (AI). We sought to describe the epidemiology of injuries for all patients with WM and compare their CXR to those of patients with confirmed AI. ⋯ Most bluntly injured adults have a WM, and the majority have either no findings or nontraumatic findings. The PPV of a WM for AI is <1%. WM on supine CXR is nonspecific and inaccurate for diagnosing traumatic injuries, especially AI.
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As the nation works to improve the opioid epidemic, safer opioid prescribing is needed. Prescriber education is one method to assist with this aim. To gauge current surgical residents' opioid prescribing practices at a safety-net hospital, an evaluation was completed before a general surgery-specific opioid prescribing education (OPE) session. The effectiveness of this OPE was measured through a postparticipation evaluation. ⋯ A short OPE delivered to surgical residents at a safety-net hospital significantly improved the use of preoperative gabinoids. Although the pill count reductions after the OPE were not statistically significant, there was a consistent reduction in amount of opiates prescribed after the OPE. However, clinical significance is important, as a reduction in any amount of opioid medication can help deter misuse and diversion. This suggests resident surgeons could participate in a specialty-specific OPE to improve opioid prescribing.