Surgery
-
Unplanned intensive care unit readmission within 72 hours is an established metric of hospital care quality. However, it is unclear what factors commonly increase the risk of intensive care unit readmission in surgical patients. The objective of this study was to evaluate predictors of readmission among a diverse sample of surgical patients and develop an accurate and clinically applicable nomogram for prospective risk prediction. ⋯ Intensive care unit readmission risk for surgical patients can be predicted using a simple clinical nomogram based on 7 common demographic and physiologic variables. These data underscore the potential of risk calculators to combine multiple risk factors and enable a more accurate risk assessment beyond perception alone.
-
Opioid overprescription can contribute to suboptimal patient outcomes. Surgeon-performed transversus abdominis plane blocks appear to be associated with pain reduction. We compared the analgesic efficacy of surgeon-performed transversus abdominis plane blocks for major hepatectomy with or without concurrent neuraxial analgesia. ⋯ In patients receiving a transversus abdominis plane block, early patient opioid consumption was decreased and utilization was predictive for improved pain control. Routine transversus abdominis plane block administration should be considered during major hepatectomy as a step toward curbing systematic reliance on opioids for pain management. A prospective study on the utility of transversus abdominis plane block in hepatectomy is warranted.
-
Comparative Study
Complications in patients with unilateral breast cancer who undergo contralateral prophylactic mastectomy versus unilateral mastectomy.
The rate of contralateral prophylactic mastectomy has been increasing among patients with unilateral breast cancer. There remains a paucity of data regarding the impact of contralateral prophylactic mastectomy on duration of stay and complications requiring reoperation within 90 days of operation. ⋯ Compared to unilateral mastectomy, contralateral prophylactic mastectomy was associated with an increased hospital stays but not a greater 90-day reoperation rate for complications.
-
Common measures of evaluating surgical resident progression include American Board of Surgery In-Training Exam scores and Accreditation Council for Graduate Medical Education operative case logs. This study evaluates the relationship between operative cases performed and American Board of Surgery In-Training Exam scores in general surgery residents. ⋯ Surgical residents who perform more operative cases do significantly better on the American Board of Surgery In-Training Exam than their peers. This association may be due to increased clinical experience, exposure to pathology, and/or individual resident motivation.
-
Comparative Study
Comparison between robotic and open pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: A propensity score-matched study.
This study is to clarify the feasibility of robotic pancreaticoduodenectomy in terms of surgical risks, clinically relevant postoperative pancreatic fistula, and oncologic outcomes compared with open pancreaticoduodenectomy by using propensity score matching. Traditional open pancreaticoduodenectomy and robotic pancreaticoduodenectomy have been compared only in small, retrospective, and nonrandomized cohort studies with variable quality. ⋯ Robotic pancreaticoduodenectomy is associated with less blood loss, less delayed gastric emptying, and more lymph node yield. Propensity scored-matched analysis revealed that robotic pancreaticoduodenectomy is not inferior to open pancreaticoduodenectomy in terms of clinically relevant postoperative pancreatic fistula, surgical risks, and survival outcomes.