Surgery
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Regional surgical quality improvement consortiums are becoming more common. Herein we have reported the effectiveness of a statewide consortium focusing on open vascular operative procedures. ⋯ A statewide quality-of-care consortium with timely feedback of data was associated with decreased morbidity over a relatively short follow-up period in vascular patients. Focusing on best processes in real-world practice, such as appropriate transfusion and length of operation, may further improve vascular surgical outcomes.
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Atrial fibrillation prophylaxis with warfarin and strong antiplatelet agent use in cardiovascular diseases has increased the incidence of anticoagulation in the elderly. We studied traumatic intracranial hemorrhage (TICH) in patients ≥55 years of age on anticoagulation and antiplatelet agents in a stable population. ⋯ TICH in patients on anticoagulants is epidemic in patients ≥55 years of age. Despite national trends, our well-served population has not seen an increase in warfarin use for atrial fibrillation. Instead, use of antiplatelet agents has increased and is associated with an increased incidence of TICH.
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Multicenter Study Controlled Clinical Trial
Multicenter analysis of diaphragm pacing in tetraplegics with cardiac pacemakers: positive implications for ventilator weaning in intensive care units.
Diaphragm pacing (DP) can replace mechanical ventilation in tetraplegics and in trials has assisted respiration in amyotrophic lateral sclerosis patients. This report describes results of DP in patients with cardiac pacemakers. ⋯ DP can be safely implanted in tetraplegics having cardiac pacemakers. Applications for temporary use of DP to maintain diaphragm type 1 muscle fiber and improve posterior lobe ventilation may benefit complex critical care patients.
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Symptomatic hypocalcemia, the most common complication of total thyroidectomy, can lead to postoperative emergency room visits for laboratory testing and intravenous calcium infusion. A method to identify patients reliably at risk for postoperative hypocalcemia could allow prophylactic treatment to avoid this. We hypothesized that quick parathyroid hormone testing within 4 hours of thyroidectomy and a protocol to treat parathyroid-hormone-deficient patients would reduce symptomatic hypocalcemia, eliminating the need for emergency room visits. ⋯ Postoperative parathyroid hormone testing reliably identifies patients at risk for hypocalcemia after thyroid surgery. Moreover, parathyroid hormone testing and calcitriol administration to patients at risk decreases the incidence of hypocalcemia and associated emergency room visits after total thyroidectomy. Therefore, patients with postoperative serum parathyroid hormone levels <10 pg/mL after thyroid surgery should be treated with calcitriol and calcium to prevent symptomatic hypocalcemia.
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Multicenter Study Comparative Study
Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals.
The benefit of laparoscopic (LA) versus open (OA) appendectomy, particularly for complicated appendicitis, remains unclear. Our objectives were to assess 30-day outcomes after LA versus OA for acute appendicitis and complicated appendicitis, determine the incidence of specific outcomes after appendectomy, and examine factors influencing the utilization and duration of the operative approach with multi-institutional clinical data. ⋯ Within ACS NSQIP hospitals, LA is associated with lower overall morbidity in selected patients. However, patients with complicated appendicitis may have a greater risk of organ space SSI after LA. Academic affiliation does not seem to influence the operative approach. However, LA is associated with similar durations of stay but slightly greater operative times than OA at academic versus community hospitals.