Surgery
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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.
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Comparative Study
The Affordable Care Act's Medicaid expansion and utilization of discretionary vs. non-discretionary inpatient surgery.
While pre-Affordable Care Act expansions in Medicaid eligibility led to increased utilization of elective inpatient procedures, the impact of the Affordable Care Act on such preference-sensitive procedures (also known as discretionary procedures) versus time-sensitive non-discretionary procedures remains unknown. As such, we performed a hospital-level quasi-experimental evaluation to measure the differential effects of the Affordable Care Act's Medicaid expansion on utilization of discretionary procedures versus non-discretionary procedures. ⋯ In this multi-state evaluation, the Affordable Care Act's Medicaid expansion preferentially increased utilization of discretionary procedures versus non-discretionary procedures in expansion states compared to non-expansion states among non-privately insured patients. These preliminary findings suggest that increased Medicaid coverage may have contributed to the increased use of inpatient surgery for discretionary procedures.
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Recommendations of the Joint Commission discourage the use of surgical skull caps in favor of bouffant or helmet headwear; however, data supporting such recommendations are limited and have been questioned in recent studies, as well as by our departmental and hospital leadership. At the end of December 2015, surgical caps were removed from our institution with the theoretic goal of decreasing surgical site infections. We aimed to assess the impact of this intervention on surgical site infection occurrence at our institution. ⋯ In our institution, the strict implementation of bouffant or helmet headwear, with removal of skull caps from the operating room, was not associated with decreased surgical site infections for clean and clean-contaminated cases. Further evidence is required to assess the validity of this headwear guideline of the Joint Commission and support nationwide implementation of this policy.
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The optimal nutritional therapy in the field of pancreatic surgery is still debated. ⋯ The importance of this position paper is the consensus reached on the topic. Concentrating on nutritional support and therapy is of utmost value in pancreatic surgery for both short- and long-term outcomes.
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In pediatric Graves' disease, operative morbidity after total thyroidectomy remains ill defined. The present study aimed to clarify whether total thyroidectomy entails greater operative morbidity in children with Graves' disease, in particular when they are very young, as compared with an age-matched reference group of children with hereditary C-cell disease who underwent total thyroidectomy at the same time. ⋯ Disease impacts more than age on operative morbidity in children with Graves' disease after total thyroidectomy but is fairly low overall and rarely permanent in experienced hands.