Surgery
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This study aimed to evaluate the effects of indications for thyroidectomy on patient outcomes and to examine the impact of surgical volume on these outcomes. ⋯ Surgery for Graves disease is associated with a higher risk for complications when performed by less experienced surgeons. This finding should prompt recommendations for increasing surgical specialization and referrals to high-volume surgeons in the management of Graves disease.
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The role of prophylactic central neck dissection in the management of papillary thyroid cancer (PTC) is controversial. We report our experience of an observational approach to the cN0 neck in PTC. ⋯ Our results suggest that properly selected patients can be managed safely with observation of the central neck rather than prophylactic central neck dissection, which has a higher complication rate.
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The electronic medical record (EMR) of a large, tertiary referral center was examined to study the prevalence of undiagnosed and unrecognized primary hyperparathyroidism (PHPT). ⋯ PHPT is a more common disorder than previously documented. It is crucial to evaluate even mild hypercalcemia, because 43% of these patients have PHPT. PHPT is underdiagnosed and undertreated.
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Multicenter Study
Detecting postoperative hemorrhage or hematoma from administrative data: the performance of the AHRQ Patient Safety Indicator.
Patient Safety Indicator (PSI) 9, "postoperative hemorrhage or hematoma" (PHH), of the US Agency for Healthcare Research and Quality has been considered for public quality of care reporting. We sought to evaluate its performance in detecting true complications. ⋯ PSI 9 holds promise in detecting serious, possibly preventable complications. The indicator might be improved by specification of the 998.11 hemorrhage code to exclude purely intraoperative events and addition of procedure codes to the indicator's numerator criteria.
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Controversy persists as to whether positive operative margins are an independent prognostic factor for resected pancreatic cancer. This study evaluated the impact of the resection margin status on the patterns of recurrence and prognosis after resection for pancreatic cancer. ⋯ In the setting of pancreatectomy, when we evaluated the definitions of R0 resection, the margin status influenced the local recurrence rate but had no impact on the patients' survival.