Archives of surgery (Chicago, Ill. : 1960)
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Patient characteristics and comorbidities, payer type, and operative technique (laparoscopic vs open) predict the risk of gastrointestinal (GI) tract leak in patients with morbid obesity undergoing gastric bypass. ⋯ We identified multiple factors associated with the higher risk of GI tract leak after gastric bypass. Surgeons should use this knowledge to counsel patients and possibly alter operative plans in high-risk patients to minimize this risk.
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To determine the effect of consultant surgeon sleep hours on patient outcomes in cardiac surgery. ⋯ This well-powered prospective study showed no evidence that consultant surgeon sleep hours had an effect on postoperative outcomes.
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Comparative Study
Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers.
To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer. ⋯ Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.
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Comparative Study
Comparative validation of online nomograms for predicting nonsentinel lymph node status in sentinel lymph node-positive breast cancer.
Completion axillary lymph node dissection is recommended for patients with metastases to the sentinel lymph node (SLN) in breast cancer although nonsentinel lymph nodes (NSLN) are often negative for tumor. Online nomograms are available to predict risk of NSLN disease. ⋯ Although the MSKCC and Stanford nomograms performed similarly on the basis of the area under the curve, the MSKCC nomogram was consistently more reliable in predicting actual NSLN outcomes.
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To measure the effect of obesity on surgical site infection (SSI) rates and to define the cost of SSIs in patients undergoing colorectal surgery. ⋯ Obesity increases the risk of an SSI after colectomy by 60%, and the presence of infection increases the colectomy cost by a mean of $17,324. Pay-for-performance policies that do not account for this increased rate of SSI and cost of caring for obese patients may lead to perverse incentives that could penalize surgeons who care for this population.