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    23406 results match your criteria American journal of surgery[Journal]

    1 OF 469

    Evolving treatment of necrotizing pancreatitis.
    Am J Surg 2017 Nov 14. Epub 2017 Nov 14.
    Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address:
    Background: Over the past decade, the treatment of necrotizing pancreatitis (NP) has incorporated greater use of minimally invasive techniques, including percutaneous drainage and endoscopic debridement. No study has yet compared outcomes of patients treated with all available techniques. We sought to evaluate the evolution of NP treatment at our high volume pancreas center. Read More

    Underlying mechanisms of mistreatment in the surgical learning environment: A thematic analysis of medical student perceptions.
    Am J Surg 2017 Nov 7. Epub 2017 Nov 7.
    Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3658, MC 5655, Stanford, CA, 94305, USA. Electronic address:
    Background: Medical students experience more psychological distress than the general population. One contributing factor is mistreatment. This study aims to understand the mechanisms of mistreatment as perceived by medical students. Read More

    Outcomes of rectal resection following neoadjuvant therapy in the elderly: Can rectal cancer patients be too old for a neoadjuvant approach?
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Division of Colon & Rectal Surgery, Department of Surgery, The Ohio State University College of Medicine, USA. Electronic address:
    Background: Neoadjuvant therapy has improved outcomes of resection for rectal carcinoma, however, there is limited data regarding its impact on elderly patients.

    Methods: A retrospective review of 109 patients, 74 patients <70 years (Group 1) vs 35 elderly patients ≥ 70 years (Group 2), who underwent neoadjuvant therapy followed by open resection from 1999 to 2010.

    Results: Neoadjuvant therapy was completed by 73/74 patients in Group 1 (99%) vs 30/35 patients in Group 2 (86%) (p = 0. Read More

    A surgical residency preparatory course for senior medical students leads to earlier independence in ACGME competencies.
    Am J Surg 2017 Nov 8. Epub 2017 Nov 8.
    MetroHealth Medical Center, Case Western Reserve University School of Medicine, Department of Surgery, 2500 MetroHealth Drive, Cleveland, OH 44109, United States. Electronic address:
    Background: It is unknown whether surgery residency preparatory courses lead to earlier independent practice.

    Methods: A four-week surgical residency preparatory course was offered to graduating medical students. Upon entering residency, participants reported supervised and unsupervised performance of patient management and procedural competencies. Read More

    Is it safe to discharge geriatric trauma patients with anemia?
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Section of Trauma and Acute Care Surgery, Department of Surgery, Reading Health System, Reading, PA 19611, USA.
    Introduction: The consequences of discharging anemic geriatric trauma patients are not well studied. We hypothesize that anemia at discharge is associated with adverse outcomes.

    Methods: A 1-year retrospective review of patients ≥65 years was performed. Read More

    Surgical resection improves median overall survival with marginal improvement in long-term survival when compared with definitive radiotherapy in Merkel cell carcinoma: A propensity score matched analysis of the National Cancer Database.
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
    Background: Definitive radiotherapy has been suggested as a treatment alternative to surgical resection in Merkel cell carcinoma (MCC).

    Methods: Patients with MCC were identified from the National Cancer Database. Propensity score matching accounting for age, Charlson-Deyo score, grade, and AJCC stage was used to match patients in 1:1 fashion by primary treatment (surgery vs. Read More

    Surgical clerkship or medical clerkship first: Does it make a difference?
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA; Department of Surgery, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA. Electronic address:
    Introduction: This study compares NBME surgical clerkship scores of students who completed their medicine clerkship before their surgical clerkship with the performance of those who had not previously completed their medical clerkship.

    Methods: The study included 815 New York University School of Medicine students from the years 2014-2018 (571 students took medicine first, while 244 took surgery first). Performance on the surgical clerkship was assessed using the NBME SHELF examination. Read More

    The effect of damage control laparotomy on major abdominal complications: A matched analysis.
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Department of Surgery and the Center for Translational Injury Research, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA. Electronic address:
    Introduction: Damage control laparotomy (DCL) for trauma is thought to be associated with increased abdominal complications. The purpose of this study is to determine the effect of DCL on abdominal complications by comparing two groups of trauma patients: DCL patients who were prospectively adjudicated to potentially being closed at the primary laparotomy (potential DEF or pDEF) and those who underwent definitive laparotomy (DEF).

    Methods: The pDEF group was matched to DEF patients according to mechanism of injury, abdominal injury severity, operating room transfusions, and performance of a colon resection. Read More

    Quality measurement affecting surgical practice: Utility versus utopia.
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Division of Surgical Oncology, Goshen Center for Cancer Care, 200 High Park Avenue, Goshen, IN 46526, United States. Electronic address:
    The Triple Aim: improving healthcare quality, cost and patient experience has resulted in massive healthcare "quality" measurement. For many surgeons the origins, intent and strengths of this measurement barrage seems nebulous-though their shortcomings are noticeable. This article reviews the major organizations and programs (namely the Centers for Medicare and Medicaid Services) driving the somewhat burdensome healthcare quality climate. Read More

    Why saying what you mean matters: An analysis of trauma team communication.
    Am J Surg 2017 Nov 8. Epub 2017 Nov 8.
    Department of Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.
    Background: We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork.

    Methods: Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Read More

    Individual surgeon practice is the most important factor influencing diverting loop ileostomy creation for patients undergoing sigmoid colectomy for diverticulitis.
    Am J Surg 2017 Nov 10. Epub 2017 Nov 10.
    Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address:
    Background: To identify factors associated with diverting ileostomy creation (DLI) in patients undergoing sigmoid colectomy for diverticular disease in a high volume colorectal unit and to obtain information for better preoperative patient counseling.

    Methods: Patients who underwent sigmoid colectomy with colorectal anastomosis with or without DLI for diverticulitis between 01/1994-12/2014 were identified. Preoperative characteristics, surgeon practice year, individual surgeon and postoperative outcomes were compared between patients with DLI or not. Read More

    Mental skills training effectively minimizes operative performance deterioration under stressful conditions: Results of a randomized controlled study.
    Am J Surg 2017 Nov 8. Epub 2017 Nov 8.
    Carolinas Medical Center, Carolinas Simulation Center, Charlotte, NC, United States; Indiana University, Department of Surgery, Indianapolis, IN, United States. Electronic address:
    Background: Stress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress.

    Methods: Twenty-four residents were stratified then randomized to receive mental skills and FLS training (MSC group), or only FLS training (control group). Read More

    Accurate surgical skills evaluation: Does it mandate raters have a medical background?
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA; Multidisciplinary Simulation Center, Mayo Clinic, Rochester, MN, USA. Electronic address:
    Background: Surgeons rarely have time to assess/rate trainee performance. From a 10 year-experience of implementing OSCE style assessments, we hypothesize that the accurate scoring of interns in selected tests is not affected by the rater's medical background.

    Methods: A prospective collection of quantitative scoring data by both medical school graduates and college students was compared. Read More

    Efficacy of proximal colectomy for surgical management of right-sided first colorectal cancer in Lynch Syndrome mutation carriers.
    Am J Surg 2017 Nov 8. Epub 2017 Nov 8.
    Division of Clinical Research and Evaluative Sciences, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
    Background: This study analyzes the occurrence of colorectal cancer (CRC) in Lynch syndrome (LS) mutation carriers, interval until diagnosis of metachronous CRC, and survival after proximal colectomy (PC) compared with total (TC) and subtotal colectomy (STC) for right-sided first CRC in LS mutation carriers.

    Methods: Sixty-four LS mutation carriers with right-sided first CRC treated with PC or TC + STC were confirmed by clinical records. Bivariate analyses were examined for significance and life tables were generated for risk of metachronous CRC and survival estimates following surgery. Read More

    Early versus delayed appendectomy: A comparison of outcomes.
    Am J Surg 2017 Nov 11. Epub 2017 Nov 11.
    Western Michigan University School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA; Bronson Methodist Hospital, 601 John St, Kalamazoo, MI 49007, USA. Electronic address:
    Background: The optimal timing for performing appendectomy in adults remains controversial.

    Method: A one-year retrospective review of adult patients with acute appendicitis who underwent appendectomy. The cohort was divided by time-to-intervention into two groups: patients who underwent appendectomy within 8 h (group 1), and those who had surgery after 8 h (group 2). Read More

    Evaluating the performance of the Minute Feedback System: A web-based feedback tool for medical students.
    Am J Surg 2017 Nov 4. Epub 2017 Nov 4.
    University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
    Background: Medical students often report dissatisfaction with the feedback they receive on their clerkships. This study evaluates the performance of the Minute Feedback System (MFS), a web-based tool designed to facilitate medical student acquisition of same day written feedback from surgery residents and faculty.

    Methods: System-generated data, targeted surveys, and end of clerkship questionnaires were used to evaluate MFS performance over a one-year period. Read More

    What happens after a failed LIFT for anal fistula?
    Am J Surg 2017 Dec 18;214(6):1210-1213. Epub 2017 Sep 18.
    Section of Colon and Rectal Surgery, Creighton University School of Medicine, CHI Medical Center, Omaha, NE, USA. Electronic address:
    Background: Ligation of the intersphincteric fistula tract (LIFT) was developed to treat transsphincteric anal fistulas. The aftermath of a failed LIFT has not been well documented.

    Methods: Retrospective chart review of LIFT procedure for transsphincteric anal fistula between March 2012 and September 2016. Read More

    The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty.
    Am J Surg 2017 Nov 5. Epub 2017 Nov 5.
    Department of Surgery, Southern Illinois University School of Medicine, PO Box 19638, 701 N First St., Springfield, IL 62794, United States. Electronic address:
    Background: Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems.

    Methods: General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns. Read More

    Current robotic curricula for surgery residents: A need for additional cognitive and psychomotor focus.
    Am J Surg 2017 Nov 6. Epub 2017 Nov 6.
    Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA 94143-0470, USA; Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, Room M994, San Francisco, CA 94122, USA.
    Background: Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components.

    Methods: We identified 12 residency programs with robotic curricula. Read More

    Improving surgical residents' communication in disclosing complications: A qualitative analysis of simulated physician and patient surrogate conversations.
    Am J Surg 2017 Nov 7. Epub 2017 Nov 7.
    Department of Surgery, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA. Electronic address:
    Background: In this study, we explore surgical resident communication with simulated patient surrogates (SPs), in an Objective Structured Clinical Examination (OSCE).

    Methods: We use discourse analysis (DA), a qualitative approach to analyzing language, to evaluate our residents' interactions with simulated patient surrogates. After identifying problematic communication patterns, we apply communication theory to discuss our findings and provide suggestions for improvement. Read More

    Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes.
    Am J Surg 2017 Nov 4. Epub 2017 Nov 4.
    School of Allied Health Sciences, Department of Surgery, Baylor College of Medicine, Houston, TX, USA. Electronic address:
    Introduction: Although simulation is an effective method for enhancing team competencies, it is unclear how team familiarity impacts this process. We examined how team familiarity impacted team competencies.

    Methods: Trainees were assigned to stable or dynamic teams to participate in three simulated cases. Read More

    Assessing the 16 hour intern shift limit: Results of a multi-center, mixed-methods study of residents and faculty in general surgery.
    Am J Surg 2017 Nov 4. Epub 2017 Nov 4.
    Department of Surgery, Southern Illinois University School of Medicine, PO Box 19638, 701 N First St., Springfield, IL, 62794, USA. Electronic address:
    Background: The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts.

    Methods: Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items. Read More

    Variation in post-discharge opioid prescriptions among members of a surgical team.
    Am J Surg 2017 Nov 1. Epub 2017 Nov 1.
    Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
    Background: Surgeons play a pivotal role in the opioid epidemic but it is unknown how different members of a surgical team vary in the way they prescribe opioids after surgical episodes.

    Study Design: We conducted a retrospective cohort study of all inpatient discharges for 5 common surgeries. Total number of tablets and total milligram equivalents (MME) prescribed were calculated and differences in prescription patterns were determined for attending surgeons, surgical residents and advanced practice providers. Read More

    The benefits of a low dose complex carbohydrate/citrulline electrolyte solution for preoperative carbohydrate loading: Focus on glycemic variability.
    Am J Surg 2017 Nov 8. Epub 2017 Nov 8.
    West Michigan Surgical Specialists LLC, Grand Rapids, MI, USA; Clinical Chief, Division of Colorectal Surgery Mercy Health St Mary's Hospital, Grand Rapids, MI, USA; Clinical Assistant Professor Michigan State University College of Osteopathic Medicine, Department of Osteopathic Surgical Specialties, USA; Clinical Assistant Professor Michigan State University College of Human Medicine, USA.
    Background: Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.

    Methods: Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016-March 2017. Read More

    Emergent cholecystectomy is superior to percutaneous cholecystostomy tube placement in critically ill patients with emergent calculous cholecystitis.
    Am J Surg 2017 Nov 3. Epub 2017 Nov 3.
    Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE 68198-6246, USA; Center for Advanced Surgical Technology, Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE 68198-6245, USA. Electronic address:
    Background: The role of percutaneous cholecystostomy (PC) is undefined in patients with multiple comorbidities presenting with emergent calculous cholecystitis (CC). This study compared outcomes between PC, laparoscopic (LC), and open cholecystectomy (OC).

    Methods: The Vizient UHC database was queried for high-risk patients with CC who underwent PC, LC, OC, or laparoscopic converted to open cholecystectomy (CONV). Read More

    Effect of protected research time on ABSITE scores during general surgery residency.
    Am J Surg 2017 Nov 3. Epub 2017 Nov 3.
    Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
    Background: Objective - To determine whether residents with one or more years of dedicated research time (Research Residents, RR) improved their ABSITE scores compared to those without (Non-Research Residents, N-RR).

    Methods: A retrospective review of general surgery residents' ABSITE scores from 1995 to 2016 was performed. RR were compared to N-RR. Read More

    Improving the feasibility and utility of OpTrust-A tool assessing intraoperative entrustment.
    Am J Surg 2017 Nov 8. Epub 2017 Nov 8.
    University of Michigan, Department of Surgery, USA; University of Michigan, Department of Learning Health Sciences, USA. Electronic address:
    Background: Changes in the surgical training landscape have sparked an interest in developing new educational models anchored on entrustment assessment. We sought to optimize the validated OpTrust entrustment assessment tool by comparing ratings from short-course video reviews to previously validated intraoperative assessments.

    Methods: Entrustment assessment scores for video-based and 1-h (short-course) observations were compared to previously validated intraoperative assessment scores. Read More

    Burn patients with infection-related ventilator associated complications have worse outcomes compared to those without ventilator associated events.
    Am J Surg 2017 Oct 31. Epub 2017 Oct 31.
    Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
    Background: The Centers for Disease Control and Prevention (CDC) replaced its definition for ventilator-associated pneumonia (VAP) in 2013. The aim of the current study is to compare the outcome of burn patients with ventilator associated events (VAEs).

    Methods: Burn patients with at least two days of ventilator support were identified from the registry between 2013 and 2016. Read More

    Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning.
    Am J Surg 2017 Nov 7. Epub 2017 Nov 7.
    Loyola University Medical Center, Department of Surgery, 2160 S. 1st Avenue, Maywood, IL 60153, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153, USA. Electronic address:
    Background: This study aims to identify predictors of survival for burn patients at the patient and hospital level using machine learning techniques.

    Methods: The HCUP SID for California, Florida and New York were used to identify patients admitted with a burn diagnosis and merged with hospital data from the AHA Annual Survey. Random forest and stochastic gradient boosting (SGB) were used to identify predictors of survival at the patient and hospital level from the top performing model. Read More

    The impact of the repeal of Michigan's universal helmet law on traumatic brain injury: A statewide analysis.
    Am J Surg 2017 Oct 24. Epub 2017 Oct 24.
    Spectrum Health Helen DeVos Children's Hospital, Pediatric Plastic and Craniofacial Surgery, Michigan State University College of Human Medicine, 426 Michigan St NE, Suite 304, Grand Rapids, MI 49503, United States.
    Background: In April of 2012, Michigan repealed its 35-year-old universal motorcycle helmet law in favor of a partial helmet law, which permits motorcyclists older than 21 years old with sufficient insurance and experience to drive un-helmeted. We evaluated the clinical impact of the repeal.

    Methods: The Michigan Trauma Quality Improvement Program's trauma database was queried for motorcycle crash patients between 1/1/09-4/12/12 and between 4/13/12-12/31/14. Read More

    Technical skill improvement with surgical preparatory courses: What advantages are reflected in residency?
    Am J Surg 2017 Nov 1. Epub 2017 Nov 1.
    Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA. Electronic address:
    Introduction: Sustainability of skill acquisition gained from graduating medical student (GMS) preparatory courses remains uncertain. GMS skills were assessed before (T1) and after a preparatory course (T2) and then again 2 (T3) and 4 (T4) months into residency and compared to surgical interns without such a course.

    Methods: In April, GMS took the preparatory course. Read More

    DRG migration: A novel measure of inefficient surgical care in a value-based world.
    Am J Surg 2017 Oct 26. Epub 2017 Oct 26.
    Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. Electronic address:
    Background: Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC).

    Methods: We assessed the 5% national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS).

    Results: The incidence of DRG migration was 14. Read More

    Mesh sutured repairs of contaminated incisional hernias.
    Am J Surg 2017 Oct 25. Epub 2017 Oct 25.
    Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States.
    Background: We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias.

    Methods: 48 patients with contaminated hernias 5 cm wide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature. Read More

    Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes.
    Am J Surg 2017 Nov 3. Epub 2017 Nov 3.
    Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA. Electronic address:
    Background: The impact of diagnosis location on gastric cancer (GC) outcomes is poorly defined.

    Methods: Detailed chart review was conducted to identify presenting location leading to diagnosis and treatment for GC patients at a single institution (2009-2013). Patients treated non-emergently following a diagnosis prompted by an ED visit (EDdx) were compared with those diagnosed at other locations (non-EDdx). Read More

    The association of hypoalbuminemia with early perioperative outcomes - A comprehensive assessment across 16 major procedures.
    Am J Surg 2017 Nov 3;214(5):871-883. Epub 2016 Dec 3.
    Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Boston, 02115, MA, USA.
    Background: Poor nutritional status is thought to influence peri- and postoperative outcomes. We assessed the association of hypoalbuminemia, a surrogate for poor nutritional status, with perioperative outcomes in patients undergoing one of 16 major surgical procedures.

    Methods: Patients undergoing one of 16 major surgeries were identified using the ACS-NSQIP (2005-2011). Read More

    Operating at night does not increase the risk of intraoperative adverse events.
    Am J Surg 2017 Oct 21. Epub 2017 Oct 21.
    Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. Electronic address:
    Background: We sought to investigate the association between nighttime (NT) operating and the occurrence of intraoperative adverse events (iAEs).

    Study Design: Our 2007-2012 institutional ACS-NSQIP and administrative databases were screened for iAEs using the ICD-9-CM-based Patient Safety Indicator "accidental puncture or laceration". Procedures were defined as AM (06. Read More

    Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates.
    Am J Surg 2017 Nov 2. Epub 2017 Nov 2.
    Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
    Background: This study evaluates the rates of immediate breast reconstruction (IBR) among racial and insurance status subgroups, in the setting of a changing plastic surgeon workforce.

    Methods: Using state level inpatient and ambulatory surgery data, we identified discharges for adult women who underwent mastectomy for breast cancer. This information was supplemented with plastic surgeon workforce data and aggregated to the health service area-level (HSA). Read More

    Peri-operative emergency department utilization in inpatient and outpatient Medicare laparoscopic cholecystectomy.
    Am J Surg 2017 Oct 24. Epub 2017 Oct 24.
    MPA Healthcare Solutions, Chicago, IL, USA.
    Background: Preoperative emergency department (ED) visits may reflect the patient's biliary disease, or may signal unstable comorbid conditions that have relevance following inpatient laparoscopic cholecystectomy (ILC) and outpatient laparoscopic cholecystectomy (OLC) in Medicare patients.

    Methods: We used the Medicare inpatient and outpatient Limited Datasets to identify elective laparoscopic cholecystectomy patients from 2011 to 2014. ED visits for 30-days before the surgical event were identified and correlated with the probability of patients returning to the ED in the 30-days following the procedure. Read More

    Outcomes of complicated appendicitis: Is conservative management as smooth as it seems?
    Am J Surg 2017 Oct 31. Epub 2017 Oct 31.
    Department of General Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, USA. Electronic address:
    Background: This study characterized the failure rate of non-operative management (NOM) for complicated appendicitis (CA; perforation, abscess, phlegmon), and compared outcomes among patients undergoing acute appendectomy (AA), elective interval appendectomy (EIA), and unplanned appendectomy after failing to improve with NOM.

    Methods: Adults treated at one facility between 2007 and 2014 were retrospectively studied.

    Results: Ninety-five patients presented with CA. Read More

    Variation in markup of general surgical procedures by hospital market concentration.
    Am J Surg 2017 Oct 23. Epub 2017 Oct 23.
    Department of Surgery, Wexner Medical Center at the Ohio State University, Columbus, OH, United States. Electronic address:
    Background: Increasing hospital market concentration (with concomitantly decreasing hospital market competition) may be associated with rising hospital prices. Hospital markup - the relative increase in price over costs - has been associated with greater hospital market concentration.

    Methods: Patients undergoing a cardiothoracic or gastrointestinal procedure in the 2008-2011 Nationwide Inpatient Sample (NIS) were identified and linked to Hospital Market Structure Files. Read More

    Exponential decay modeling can define parameters of weight loss trajectory after laparoscopic Roux-en-Y gastric bypass.
    Am J Surg 2017 Oct 23. Epub 2017 Oct 23.
    Department of Surgery, Division of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
    Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) produces durable and clinically significant weight loss. We aim to characterize the trajectory of weight loss, and demonstrate the predictive ability of three-month performance on final weight loss.

    Methods: Retrospective analysis of 1097 consecutive LRYGB patients allowed for assessment of conformity of various weight loss trajectory models. Read More

    Clinical usefulness of postoperative C-reactive protein/albumin ratio in pancreatic ductal adenocarcinoma: Methodological issues.
    Am J Surg 2017 Oct 23. Epub 2017 Oct 23.
    Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China. Electronic address:

    Utility of Sequential Organ Failure Assessment score in predicting bacteremia in critically ill burn patients.
    Am J Surg 2017 Oct 21. Epub 2017 Oct 21.
    Department of Surgery, Division of Trauma, Critical Care, Burn and Acute Care Surgery, MetroHealth Medical Center, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA; Case Western Reserve University, School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44106, USA. Electronic address:
    Background: We evaluated whether qSOFA ≥2 and an increase in SOFA (ΔSOFA) ≥2 can help predict bacteremia in a critically ill burn population.

    Methods: Patients age ≥15 and TBSA ≥15% admitted between 2009 and 2015 were included. All blood cultures were recorded, and positive and negative blood culture days were defined based on the culture results. Read More

    "Energy-less technique" with mini-clips for recurrent laryngeal nerve lymph node dissection in prone thoracoscopic esophagectomy for esophageal cancer.
    Am J Surg 2017 Oct 23. Epub 2017 Oct 23.
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
    Background: Meticulous recurrent laryngeal nerve (RLN) lymph node dissection in thoracoscopic esophagectomy for esophageal cancer often results in RLN paralysis.

    Methods: We had attempted to simply cut the vessels around RLN sharply with scissors without using energy device in order to prevent RLN paralysis. However, these procedures often result in minor bleeding. Read More

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