Surgery
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The objective of this study was to determine the utility of Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging for posthepatectomy remnant liver function assessment in hilar bile duct cancer patients. ⋯ (99m)Tc-GSA SPECT/CT fusion imaging enables accurate assessment of future remnant liver function and suitability for hepatectomy in hilar bile duct cancer patients.
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Observational Study
Hospital readmission after multiple major operative procedures among patients with employer provided health insurance.
Most studies report data only on readmission within 30 days of discharge from the same hospital following a single procedure. We sought to define the incidence of early versus late hospital readmission among patients undergoing multiple major operative procedures. ⋯ Readmission following a major operation is common, with >15% of patients being readmitted within 90 days of index discharge. Compared with patients undergoing a single operative procedure, patients undergoing multiple operative procedures demonstrated an increased risk for readmission within 90 days of discharge and were more likely to be readmitted within 30 days of index discharge.
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Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospitals relative to hospital price markup. ⋯ There is wide variation in hospital markup for cardiothoracic and gastrointestinal procedures, with approximately a quarter of hospital charges being 4 times greater than the actual cost of hospitalization. Hospitals with an extreme markup had greater perioperative morbidity.
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Previous studies have reported on the association between perioperative morbidity and diminished oncologic outcomes in patients undergoing resection for colorectal or pancreatic cancer. However, the effect of anastomotic leak (AL) on the survival of patients with gastric or esophageal cancer remains unclear. ⋯ AL following resection for gastric and esophageal cancer has a negative prognostic impact on long-term survival, independent from tumor stage and biology. Further investigation of the interactions between AL and the development of tumor recurrence as well as the establishment of standardized perioperative care protocols are necessary for the improvement of outcomes after gastric and esophageal resection.
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Obese patients may present with metabolic abnormalities that impact liver regeneration. We sought to assess the impact of body mass index (BMI) on liver volume regeneration index (RI) and kinetic growth rate (KGR) among patients undergoing liver resection. ⋯ BMI did not impact liver regeneration during the first 2 months. In contrast, KGR per week between 2 and 7 months postoperatively was less among overweight and obese patients.