Surgery
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Comparative Study
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
Estimating the risk of postoperative complications can be performed by surgeons with detailed clinical information or by patients with limited information. Our objective was to compare three estimation models: (1) the All Information Model, using variables available from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP); (2) the Surgeon Assessment Model, using variables available to surgeons preoperatively, and (3) the Patient-Entered Model, using information that patients know about their own health. ⋯ Although a small decline in model performance was observed, the magnitude suggests that it may not be clinically meaningful as the risk predictions offered are superior to simply providing unadjusted complications rates. The Surgeon Assessment and Patient-Entered models with fewer predictors can be used with relative confidence to predict a patient's risk.
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The behavior of early stage signet ring cell carcinoma (SRC) is controversial. The purpose of this study was to clarify the behavior of early gastric SRC. ⋯ In mucosal gastric cancer, SRC has an unfavorable risk factor of lymph node metastasis than that of others and should not be considered for endoscopic resection. In submucosal gastric cancer, SRC is a more favorable risk factor of lymph node metastasis than that of other histologic types.
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Limited data exist examining the use of fecal diversion in combatants from modern armed conflicts. Characterization of factors leading to colostomy creation is an initial step toward optimizing and individualizing combat casualty care. ⋯ In this exploratory study of 320 combat-related colostomies, distal colon and rectal injuries continue to be diverted at higher rates independent of other comorbidities. Additional outcomes-directed research is needed to determine whether such operative management is beneficial in all patients.