Archives of surgery (Chicago, Ill. : 1960)
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Comparative Study
Laparoscopic vs open gastric bypass surgery: differences in patient demographics, safety, and outcomes.
To determine national outcome differences between laparoscopic Roux-en-Y gastric bypass (LRYGB) and open Roux-en-Y gastric bypass (ORYGB). ⋯ In this population-based study, LRYGB provided greater safety than ORYGB even after adjusting for patient-level socioeconomic and comorbidity differences.
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To describe the perspectives of surgical interns regarding the implications of the new Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations for their training. ⋯ Although less pessimistic than program directors, interns beginning their training under the new paradigm of duty-hour restrictions have significant concerns about the effect of these regulations on the quality of their training.
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Despite limited evidence of effect, β-blocker continuation has become a national quality improvement metric. ⋯ β-Blocker continuation on the day of and after surgery was associated with fewer cardiac events and lower 90-day mortality. A focus on β-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes.
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Multicenter Study
Successful nonoperative management of the most severe blunt liver injuries: a multicenter study of the research consortium of new England centers for trauma.
Grade 4 and grade 5 blunt liver injuries can be safely treated by nonoperative management (NOM). ⋯ Nonoperative management was offered safely in two-thirds of grade 4 and grade 5 blunt liver injuries, with a 91.3% success rate. Only 6.5% of patients with NOM required a delayed operation because of liver-specific issues, and none experienced life-threatening complications because of the delay.
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Comparative Study
Routine same-day discharge after acute or interval appendectomy in children: a prospective study.
The outcomes of and parental satisfaction with same-day discharge in children undergoing laparoscopic appendectomy warrant making it the usual and customary pathway. ⋯ Routine same-day discharge after pediatric appendectomy seems safe, with good parental satisfaction.