Surgery
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The benefit of somatostatin for the prevention of pancreatic fistula has been debated widely in the literature. The aim of this study was to evaluate the efficacy of somatostatin in preventing pancreatic fistulas and improving postoperative outcomes after pancreatic resection. ⋯ Somatostatin use was associated with a significant decrease in both the rate of fistula formation and the number of clinically important fistulas in our pancreatectomy patients. Continued evaluation of somatostatin use in relation to both intraoperative predictors and costa are needed to better define the population that will gain clinical benefit and cost savings.
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Acute care surgery (ACS) remains in its infancy as a defined surgical specialty within hospital systems. Little has been published regarding the financial impact of this method of care delivery to hospital systems and departments when combining trauma, surgical critical care, emergent, and elective general surgery into a single practice model. We sought to compare hospital net income and divisional clinical productivity measures of a newly formed, university division of ACS based on patient type-trauma, emergency general surgery, and elective surgery-to determine the best avenues by which to focus on programmatic growth. ⋯ Per-patient hospital system income and a majority of clinical wRVU productivity remains greatest for the care of injured patients in our ACS practice model; emergent general surgical encounters demonstrate the greatest per-patient rates of divisional clinical productivity.
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Despite widespread use of intraoperative nerve monitoring (IONM) as an adjunct to visual identification of the recurrent laryngeal nerve (RLN), published studies have shown little or no benefit. No long-term studies exist detailing the effect of experience gained from IONM on the rate of RLN injury. The aim of this study was to evaluate the impact of IONM feedback on surgical outcomes over time at a single institution. ⋯ With experience, routine use of IONM during thyroid and parathyroid operations significantly decreased the incidence of injury to the RLN for thyroid lobectomy with paratracheal lymph node dissection and provided useful assistance with RLN identification for 10% of nerves at risk.
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Randomized Controlled Trial
Single-incision results in similar pain and quality of life scores compared with multi-incision laparoscopic cholecystectomy: A blinded prospective randomized trial of 100 patients.
Our objective was to compare hospital charges and both perioperative and mid-term quality of life between single- (SILC) and multi-incision (MILC) laparoscopic cholecystectomy in a randomized controlled trial. ⋯ SILC results in longer operative time and greater hospital charges with similar pain and quality of life scores compared with a standard laparoscopic approach.
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Routine, whole-body computed tomography imaging (PAN-SCAN) has been shown to identify unexpected injuries and alter the management of patients presenting with blunt trauma. We sought to characterize the changes in practice over time and the utility of PAN-SCAN imaging in elderly patients who fall and require admission to a trauma center. ⋯ PAN-SCAN imaging has become more common over time in elderly patients having a ground-level fall. Although PAN-SCAN imaging during the initial trauma evaluation was not associated with an independent decrease in the risk of mortality, it was independently associated with lesser hospital resource use. These data suggest that whole-body computed tomography imaging may benefit trauma center resource use for patients with ground-level falls.