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    Validity of a smartphone protractor to measure sagittal parameters in adult spinal deformity.
    Spine J 2017 Aug 14. Epub 2017 Aug 14.
    Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 3A, Boston, MA 02114.
    Background Context: Smartphones have become an integral tool in the daily life of healthcare professionals (Franko 2011). Their ease of use and wide availability often make smartphones the first tool surgeons use to perform measurements. This technique has been validated for certain orthopaedic pathologies (Shaw 2012, Quek 2014, Milanese 2014, Milani 2014), but never to assess sagittal parameters in adult spinal deformity. Read More

    Patient with a total artificial heart maintained on outpatient dialysis while listed for combined organ transplant, a single center experience.
    Hemodial Int 2017 Aug 11. Epub 2017 Aug 11.
    Division of Nephrology, Department of Medicine, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
    Advanced mechanical circulatory support is increasingly being used with more sophisticated devices that can deliver pulsatile rather than continuous flow. These devices are more portable as well, allowing patients to await cardiac transplantation in an outpatient setting. It is known that patients with renal failure are at increased risk for developing worsening acute kidney injury during implantation of a ventricular assist device (VAD) or more advanced modalities like a total artificial heart (TAH). Read More

    Outcomes of Gartland Type III Supracondylar Fractures Treated Using Blount's Method.
    Orthop Traumatol Surg Res 2017 Aug 2. Epub 2017 Aug 2.
    Service d'orthopédie infantile, Hôpitaux Pédiatriques de Nice CHU-Lenval, 57 avenue de la Californie, 06000 Nice, France. Electronic address:
    Background: Supracondylar fractures of the elbow with major displacement are usually treated by surgical pinning and less often non-operatively as described by Blount.The objective of this study was to assess the clinical and radiological outcomes of Gartland type III supracondylar fractures treated at least 3 years earlier using Blount's method.

    Hypothesis: Blount's method produces good outcomes after more than 3 years when used to treat Gartland type III supracondylar fractures of the humerus. Read More

    Type B Aortic Dissections: Current Guidelines for Treatment.
    Cardiol Clin 2017 Aug 26;35(3):387-410. Epub 2017 May 26.
    Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA. Electronic address:
    Stanford type B aortic dissections (TBADs) involve the descending aorta and can present with complications, including malperfusion syndrome or aortic rupture, which are associated with significant morbidity and mortality if left untreated. Clinical diagnosis is straightforward, typically confirmed using CT angiography. Treatment begins with immediate anti-impulse medical therapy. Read More

    Comparative outcomes of outpatient and inpatient total shoulder arthroplasty: an analysis of the Medicare dataset.
    Bone Joint J 2017 Jul;99-B(7):934-938
    Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA.
    Aims: The aim of the present study was to compare the 30- and 90-day re-admission rates and complication rates of outpatient and inpatient total shoulder arthroplasty (TSA).

    Patients And Methods: The United States Medicare Standard Analytical Files database was questioned to identify patients who had undergone outpatient or inpatient TSA between 2005 and 2012. Patient characteristics were compared between the two groups using chi-squared analysis. Read More

    Preoperative risk stratification of critically ill patients.
    J Clin Anesth 2017 Jun 7;39:122-127. Epub 2017 Apr 7.
    David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States.
    Study Objective: Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure. Read More

    Outpatient treatment of osteomyelitis with telavancin.
    Int J Antimicrob Agents 2017 Jul 26;50(1):93-96. Epub 2017 Apr 26.
    Infectious Diseases Associates, 1425 S. Osprey Ave., Suite 1, Sarasota, FL 34239, USA.
    Telavancin is a lipoglycopeptide antibiotic with bactericidal activity against Gram-positive pathogens including Staphylococcus aureus, the most frequent cause of osteomyelitis. Treatment is often challenging due to needs for surgical intervention along with prolonged administration of intravenous antimicrobials, frequently in an outpatient setting. This was a retrospective analysis of the efficacy and safety of telavancin for treatment of osteomyelitis provided as outpatient parenteral antimicrobial therapy (OPAT) in physician office infusion centres. Read More

    Outpatient Emergencies: Acute Heart Failure.
    Med Clin North Am 2017 May 2;101(3):507-519. Epub 2017 Mar 2.
    Department of Medicine, Jefferson Heart Institute, Sidney Kimmel Medical College of Thomas Jefferson University, 925 Chestnut Street, Suite 323A, Philadelphia, PA 19107, USA. Electronic address:
    Heart failure is an epidemic in the United States and a major health problem worldwide. The syndrome of acute heart failure is marked by a recent onset of symptoms usually in terms of days to a few weeks of worsening fatigue, shortness of breath, orthopnea, swelling, and sudden onset of weight gain. Physicians caring for patients with heart failure must know the risk factors for this disease, pathophysiology, symptomatology, important examination findings, key diagnostic tests, and management approach so as to improve symptoms and reduce mortality. Read More

    Complications and Outcomes After Gynecomastia Surgery: Analysis of 204 Pediatric and 1583 Adult Cases from a National Multi-center Database.
    Aesthetic Plast Surg 2017 Aug 24;41(4):761-767. Epub 2017 Mar 24.
    Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA.
    Background: Gynecomastia is a common disease that is prevalent across all age groups of boys and men. Although benign in nature, it can lead to psychological and social distress, prompting affected patients to seek medical attention. Management strategies include observation and drug therapy, yet surgical procedures remain the hallmark of treatment. Read More

    Flat detector CT and its applications in the endovascular treatment of wide-necked intracranial aneurysms-A literature review.
    Eur J Radiol 2017 Mar 26;88:26-31. Epub 2016 Dec 26.
    Microvention - Terumo, Tustin, CA, USA. Electronic address:
    Flat detector CT (FDCT) provides cross sectional imaging within an angiographic suite and is increasingly gaining popularity in various areas of interventional radiology, as an alternative imaging modality. Its relatively high spatial resolution improves visualization of intraluminal devices such as intracranial stents or flow-diverters. Device deployment and positioning, in relation to the parent vessel and surrounding structures, are easily assessible with FDCT. Read More

    Risk associated with perioperative red blood cell transfusion in cranial surgery.
    Neurosurg Rev 2017 Feb 3. Epub 2017 Feb 3.
    The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, and Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
    We assessed the impact of intra- and postoperative RBC transfusion on postoperative morbidity and mortality in cranial surgery. A total of 8924 adult patients who underwent cranial surgery were identified in the 2006-2011 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing a biopsy, radiosurgery, or outpatient surgery were excluded. Read More

    You Can't blame the wreck on the train.
    Am J Surg 2016 Dec 21. Epub 2016 Dec 21.
    ACGME, 515 N. State Street, Suite 2000, Chicago, IL, 60654, USA. Electronic address:
    General surgical residency education is faced with a number of challenges today. Among those are resident duty hour limitations, the fact that residency is hospital-based despite the practice of general surgery being largely outpatient, changing diseases and conditions treated by the general surgeon and changing methods of treatment, development and maintenance of a user friendly curriculum and the support and provision for faculty development. The greatest single barrier, though, to education of the surgical resident is the lack of appropriate supervision. Read More

    Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.
    Orthop Clin North Am 2017 Jan 28;48(1):15-23. Epub 2016 Oct 28.
    OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA.
    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. Read More

    Chronic caesarian section scar pain treated with fascial scar release techniques: A case series.
    J Bodyw Mov Ther 2016 Oct 10;20(4):906-913. Epub 2016 Mar 10.
    Physical Therapist, Savannah, GE, USA.
    Objective: To describe outcomes of two subjects with chronically painful Caesarian section (C-section) scars following an intervention of specific myofascial scar release techniques.

    Study Design: Case series.

    Background: Over 1. Read More

    Estimating the Societal Benefits of THA After Accounting for Work Status and Productivity: A Markov Model Approach.
    Clin Orthop Relat Res 2016 Dec 3;474(12):2645-2654. Epub 2016 Oct 3.
    University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
    Background: Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery.

    Questions/purposes: We asked: (1) What is the expected effect of THA on patients' employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment?

    Methods: Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment. Read More

    Treatment Patterns and Economic Burden in Patients Treated for Acromegaly in the USA.
    Drugs Real World Outcomes 2015 Sep;2(3):299-309
    Ipsen Pharma SAS, Boulogne-Billancourt, France.
    Background: Acromegaly is a rare, debilitating condition for which data on the associated treatment patterns and economic burden are limited.

    Objective: Our objective was to examine patient characteristics, treatment patterns, and healthcare resource utilization (HRU)/costs for individuals with acromegaly treated with surgical and/or medical therapy in the USA.

    Methods: Using a large US claims database, adults with new episodes of acromegaly between 1 July 2007 and 31 December 2010 were identified (the first observed diagnosis being the index date). Read More

    The use of custom 3D printed stereotactic frames for laser interstitial thermal ablation: technical note.
    Neurosurg Focus 2016 Oct;41(4):E3
    Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
    Over the last several years, laser interstitial thermotherapy (LITT) has gained wide acceptance for the treatment of a myriad of cranial lesions. A wide variety of techniques for placement of the laser fiber have been reported with a spectrum of perceived benefits and drawbacks. The authors present the first report of a customized 3D printed stereotactic frame for LITT. Read More

    Evaluation of American Society of Anesthesiologists classification as 30-day morbidity predictor after single-level elective anterior cervical discectomy and fusion.
    Spine J 2017 Mar 23;17(3):313-320. Epub 2016 Sep 23.
    Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair, Chicago, IL 60611, USA. Electronic address:
    Background Context: Higher American Society of Anesthesiologists (ASA) classification is a known predictor of postoperative complication in diverse surgical settings. However, its predictive value is not established in single-level elective anterior cervical discectomy and fusion (SLE-ACDF).

    Purpose: This study aimed to evaluate the predictive value of ASA classification system on 30-day morbidity following SLE-ACDF. Read More

    Aspirin, Plavix, and Other Antiplatelet Medications: What the Oral and Maxillofacial Surgeon Needs to Know.
    Oral Maxillofac Surg Clin North Am 2016 Nov 29;28(4):497-506. Epub 2016 Aug 29.
    Private Practice, Greater Waterbury OMS, 435 Highland Avenue, Suite 100, Cheshire, CT 06410, USA; Beau Visage Med Spa, 435 Highland Avenue, Suite 100, Cheshire, CT 06410, USA; Division of Oral and Maxillofacial Surgery, Department of Craniofacial Sciences, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA. Electronic address:
    Most patients with coronary artery disease and peripheral vascular disease are on long-term antiplatelet therapy and dual therapy. Achieving a balance between ischemic and bleeding risk remains an important factor in managing patients on antiplatelet therapy. For most outpatient surgical procedures, maintenance and continuation of this therapy are recommended. Read More

    Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis.
    Cardiovasc Intervent Radiol 2016 Nov 1;39(11):1580-1588. Epub 2016 Sep 1.
    Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
    Background: Transarterial radioembolization (TARE) has emerged as a newer regional therapy to transarterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to compare clinical outcomes of both the techniques.

    Methods: Online search for studies comparing TARE to TACE from 2005 to present was performed. Read More

    Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery.
    Plast Reconstr Surg Glob Open 2016 May 19;4(5):e710. Epub 2016 May 19.
    DAVinci Plastic Surgery, Wash.; DAVinci Plastic Surgery, Georgetown University School of Medicine, Wash.; and Department of Mathematics and Statistics, American University, Wash.
    Background: A best practice goal to reduce surgical site infection includes administration of antibiotics in the ideal preoperative window. This article evaluates an office surgical suite antibiotic administration rate and compares it with the timing of a local hospital treating a similar patient population. The hypothesis was that similar or better compliance and surgical site infection rates can be achieved in the office-based suite. Read More

    A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis.
    Surg Endosc 2017 Mar 5;31(3):1436-1441. Epub 2016 Aug 5.
    Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 654, Columbus, OH, 43210, USA.
    Introduction: Robotic-assisted surgery is gaining popularity in general surgery. Our objective was to evaluate and compare operative outcomes and total costs for robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC).

    Methods And Procedures: A retrospective review was performed for all patients who underwent single-procedure RC and LC from January 2011 to July 2015 by a single surgeon at a large academic medical center. Read More

    Advanced Ultrasound-Guided Interventions for Tendinopathy.
    Phys Med Rehabil Clin N Am 2016 Aug;27(3):733-48
    Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
    Tendinopathy is increasingly recognized as an important cause of musculoskeletal pain and disability. Tendinopathy is thought to be principally a degenerative process, rather than inflammatory as was traditionally believed. Consequently, traditional tendinopathy treatments focused solely on decreasing inflammation have often been ineffective or even harmful. Read More

    Palliative epilepsy surgery in Dravet syndrome-case series and review of the literature.
    Childs Nerv Syst 2016 Sep 27;32(9):1703-8. Epub 2016 Jul 27.
    Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, 63130, USA.
    Purpose: Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is a rare genetic disorder that results in severe childhood-onset epilepsy. Children with DS initially present with seizures in the first year of life that are often associated with fevers. With age, multiple seizure types develop. Read More

    CT-Guided, Ethanol Sympatholysis for Primary Axillary-Palmar Hyperhidrosis.
    Cardiovasc Intervent Radiol 2016 Dec 26;39(12):1722-1727. Epub 2016 Jul 26.
    Vascular & Interventional Radiology, Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower-Suite 7203, Baltimore, MD, USA.
    Purpose: Primary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis.

    Materials And Methods: Nine consecutive patients with axillary-palmar hyperhidrosis were treated between 2013 and 2015. Read More

    Treatment outcomes and lessons learned from 5134 cases of outpatient office-based endovascular procedures in a vascular surgical practice.
    Vascular 2017 Apr 9;25(2):115-122. Epub 2016 Jul 9.
    2 University Vascular Associates, Los Angeles, CA, USA.
    Introduction The office-based endovascular facility has increased in number recently due in part to expedient patient experience. This study analyzed treatment outcomes of procedures performed in our office-based endovascular suite. Methods Treatment outcomes of 5134 consecutive procedures performed in our office-based endovascular suites from 2006 to 2013 were analyzed. Read More

    Bimodal analgesia vs fentanyl in pediatric patients undergoing bilateral myringotomy and tympanostomy tube placement: a propensity matched cohort study.
    J Clin Anesth 2016 Aug 22;32:162-8. Epub 2016 Apr 22.
    Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University School of Medicine, 2200 Children's Way, Suite 3115, Nashville, TN 37232, USA. Electronic address:
    Study Objective: Bilateral myringotomy and tympanostomy tube placement (BMT) is one of the most frequently performed pediatric outpatient procedures with 667,000 children receiving tympanostomy tubes annually. Because of this high volume, discovering the ideal analgesic regimen may lead to decreased overall postanesthesia care unit (PACU) costs while increasing patient and parent satisfaction. The purpose of this study is to determine if there is any benefit in supplementing intranasal (IN) fentanyl with intramuscular (IM) ketorolac with regard to immediate recovery characteristics. Read More

    Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty.
    Clin Orthop Relat Res 2017 Feb;475(2):364-372
    The Rothman Institute & Thomas Jefferson University Hospital, Philadelphia, PA, USA.
    Background: Length of stay after total hip arthroplasty (THA) has decreased over the last two decades. However, published studies that have examined same-day and early discharge protocols after THA have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects.

    Questions/purposes: The purpose of this study was to evaluate and compare patients undergoing THA who are discharged on the same day as the surgery ("outpatient," less than 12-hour stay) with those who are discharged after an overnight hospital stay ("inpatient") with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission, emergency department or physician office); and (3) relative work effort for the surgeon's office staff. Read More

    A prospective observational study of the effect of critical illness on ultrastructural and microscopic morphology of duodenal mucosa.
    Crit Care Resusc 2016 Jun;18(2):102-8
    Discipline of Acute Care Medicine, University of Adelaide, SA, Australia.
    Objective: Disturbed intestinal barrier function due to 'leaky' tight junctions may cause secondary sepsis via paracellular translocation across the gut wall. Our objective was to describe the effects of critical illness on duodenal morphology and ultrastructure.

    Design, Setting And Participants: Prospective observational study of 12 mechanically ventilated critically ill patients in an intensive care unit and 15 control participants in an outpatient endoscopy suite. Read More

    Long-term influence of body mass index on cardiovascular events after atrial fibrillation ablation.
    J Interv Card Electrophysiol 2016 Sep 20;46(3):259-65. Epub 2016 May 20.
    Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
    Background: Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. However, being both overweight and underweight drives long-term cardiac and general health risks. Read More

    Patient attitudes towards outpatient cervical ripening prior to induction of labour at an Australian tertiary hospital.
    J Obstet Gynaecol 2016 Oct 18;36(7):921-928. Epub 2016 May 18.
    b School of Women's and Infants' Health, The University of Western Australia , Crawley , WA , Australia.
    A prospective patient questionnaire was conducted to assess attitudes and opinions towards outpatient cervical ripening in women attending an Australian tertiary hospital's labour and birth suite for a booked induction of labour. Questionnaires were distributed over a three-month period and information collected included demographic data, pregnancy and obstetric history, attitudes towards cervical ripening and willingness to undergo cervical ripening in the outpatient setting. Responses to 57 completed questionnaires were analysed. Read More

    Lower Abdominal Pain.
    Emerg Med Clin North Am 2016 May;34(2):229-49
    Department of Emergency Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, G-CCC, Washington, DC 20007, USA; Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA.
    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Read More

    Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy.
    Int J Pediatr Otorhinolaryngol 2016 May 26;84:119-23. Epub 2016 Feb 26.
    Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States; Division of Pediatric Otolaryngology, CHOC Children's Specialists, CHOC Children's Hospital, 1010 W. La Veta Ave., Suite 640, Orange, CA 92868, United States. Electronic address:
    Introduction: Postoperative hemorrhage is one of the serious complications of adenotonsillar surgery. This study seeks to investigate the relationship between post-tonsillectomy/adenotonsillectomy hemorrhage in the pediatric population and obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA) in the immediate post-operative setting.

    Methods: The California Ambulatory Surgery Data for the years 2005-2011 were reviewed. Read More

    Heart Failure Update: Outpatient Management.
    FP Essent 2016 Mar;442:18-25
    University of South Florida Bayfront Health Medical Center, 625 Sixth Avenue South Suite 430, St. Petersburg, FL 33701.
    Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Read More

    Perioperative Pain Control in the Ambulatory Setting.
    Curr Pain Headache Rep 2016 Mar;20(3):18
    Department of Anesthesiology, LSUHSC School of Medicine, 1542 Tulane Avenue, Suite 659, New Orleans, LA, 70112, USA.
    Across the USA and various parts of the world, ambulatory surgery centers have transitioned to accepting patients with advanced ASA statuses, leading to a larger volume and higher complexity of surgeries performed, while still urging for same-day patient discharges. Inadequate postoperative pain management and opioid analgesia side effects, such as sedation, respiratory depression, and postoperative nausea and vomiting, are the most common complications and most common reasons for readmission after ambulatory surgery. The trend to limiting these complications and achieve a more rapid patient discharge currently emphasizes a multifactorial, balanced analgesia strategy. Read More

    Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy.
    Surg Endosc 2016 Oct 28;30(10):4294-9. Epub 2016 Jan 28.
    Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
    Introduction: Common bile duct (CBD) injury is a serious and dreaded complication of cholecystectomy. A paucity of data assessing long-term outcomes exists. This study aimed to determine long-term mortality and liver transplantation rates following CBD injury requiring operative intervention. Read More

    Effect of anesthesia type on perioperative outcomes with a midurethral sling.
    Int Urogynecol J 2016 Sep 25;27(9):1327-32. Epub 2016 Jan 25.
    Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior, Suite 05-2370, Chicago, IL, 60611, USA.
    Introduction And Hypothesis: There is no consensus on the most appropriate type of anesthesia for placement of a midurethral sling. Our objective was to compare intra- and perioperative outcomes for this procedure performed under general anesthesia versus monitored anesthesia care.

    Methods: Retrospective cohort analysis of women undergoing outpatient placement of synthetic retropubic midurethral sling under general anesthesia (n = 141) or monitored anesthesia care (n = 84). Read More

    The Utility of a Predictive Model for Cochlear Implant Operating Time.
    Otol Neurotol 2016 Feb;37(2):e104-9
    The Otology Group of Vanderbilt University, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
    Objective: This study analyzes multiple factors and their significance in determining the operative timing for cochlear implants at one institution over a 10-year period.

    Study Design: Retrospective case review.

    Setting: Tertiary referral center. Read More

    Assessing the safety of outpatient ventral hernia repair: a NSQIP analysis of 7666 patients.
    Hernia 2015 Dec 27;19(6):919-26. Epub 2015 Oct 27.
    Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL, 60611, USA.
    Purpose: Given the paucity of literature on outpatient ventral hernia repair (VHR), and that assessment of the safety of outpatient surgical procedures is becoming an active area of investigation, we have performed a multi-institutional retrospective analysis benchmarking rates of 30-day complications and readmissions and identifying predictive factors for these outcomes.

    Methods: National surgical quality improvement project data files from 2011 to 2012 were reviewed to collect data on all patients undergoing outpatient VHR during that period. The incidence of 30-day peri-operative complication and unplanned readmission was surveyed. Read More

    A randomized trial to compare exercise treatment methods for patients after total knee replacement: protocol paper.
    BMC Musculoskelet Disord 2015 Oct 16;16:303. Epub 2015 Oct 16.
    Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
    Background: Although the outcome of total knee replacement (TKR) is favorable, surgery alone fails to resolve the functional limitations and physical inactivity that existed prior to surgery. Exercise is likely the only intervention capable of improving these persistent limitations, but exercises have to be performed with intensity sufficient to promote significant changes, at levels that cannot be tolerated until later stages post TKR. The current evidence is limited regarding the effectiveness of exercise at a later stage post TKR. Read More

    Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy: Impact on Prices, Spending, and Surgical Complications.
    J Bone Joint Surg Am 2015 Sep;97(18):1473-81
    Dell Medical School, University of Texas, 1912 Speedway, Suite 564, Austin, TX 78712.
    Background: Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. Read More

    Propofol and non-propofol based sedation for outpatient colonoscopy-prospective comparison of depth of sedation using an EEG based SEDLine monitor.
    J Clin Monit Comput 2016 Oct 12;30(5):551-7. Epub 2015 Sep 12.
    Department of Clinical Anesthesiology and Critical Care, Perelman School of Medicine, 680 Dulles Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
    Propofol is a popular anesthetic sedative employed in colonoscopy. It is known to increase the patient satisfaction and improve throughput. However, there are concerns among the clinicians with regard to the depth of sedation, as a deeper degree of sedation is known to increase the incidence of aspiration and other adverse events. Read More

    Emergency Department Visits After Hand Surgery Are Common and Usually Related to Pain or Wound Issues.
    Clin Orthop Relat Res 2016 Feb 6;474(2):551-6. Epub 2015 Aug 6.
    Orthopaedic Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
    Background: As payment models shift toward a focus on value and reimbursement becomes increasingly tied to quality and patient experience, minimizing unexpected acute health needs has become a priority for both policymakers and clinical leaders. Despite recent emphasis on emergency department (ED) visits as a quality measure in surgery, little is known about the role of the ED in the early postoperative period after hand surgery.

    Questions/purposes: The purpose of this study was to determine the rates, reasons, and factors associated with ED visits within 30 days of elective outpatient hand surgery. Read More

    Surgical site infection in hand surgery.
    Int Orthop 2015 Nov 9;39(11):2191-8. Epub 2015 Jul 9.
    Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA, 02114, USA.
    Purpose: As ambulatory surgery becomes increasingly common, there is growing interest in assessing, monitoring, and tracking complications that occur secondary to outpatient procedures. We sought to determine the rates of 14- and 30-day acute care visits for surgical site infection after outpatient hand surgery, and to identify associated factors.

    Methods: Using the California State Ambulatory Surgery database for 2010 and 2011, we identified 44,305 patients undergoing common outpatient hand surgery procedures. Read More

    Rapid growth in surgeons' use of secure messaging in a patient portal.
    Surg Endosc 2016 Apr 27;30(4):1432-40. Epub 2015 Jun 27.
    Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.
    Background: Use of secure messaging through patient portals has risen substantially in recent years due to provider incentives and consumer demand. Secure messaging may increase patient satisfaction and improve outcomes, but also adds to physician workload. Most prior studies of secure messaging focused on primary care and medical specialties. Read More

    Outpatient medical abortion is safe and effective through 70 days gestation.
    Contraception 2015 Sep 26;92(3):197-9. Epub 2015 Jun 26.
    Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY 10010, USA.
    Data show that an outpatient regimen of 200-mg mifepristone followed by a single dose of misoprostol is safe and effective for medical abortion for up to 70 days from last menstrual period (LMP). Yet, many clinics only provide services up to 63 days LMP, and some practice guidelines do not recommend the higher gestational age limit. We review the studies published to date that include women 64 to 70 days LMP and conclude that outpatient medical abortion is safe and effective in this interval and that there are no clinically meaningful differences between outcomes at 57 to 63 days LMP and 64 to 70 days LMP. Read More

    Retained wound vacuum foam in non-healing wounds: a real possibility.
    J Wound Care 2015 Jun;24(6 Suppl):S18-20
    Department of Orthopedics, University of Arkansas for Medical Sciences, 4301 W. Markham, Suite # 531, Little Rock, AR 72205, USA;
    Negative pressure wound therpay (NPWT) has revolutionised the management of chronic wounds, particularly pressure ulcers (PU). Frequently, PUs are too large to close primarily, so NPWT is used to assist in management on an outpatient basis. If not closely monitored, NPWT closure foam can be accidentally left in patients. Read More

    Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room.
    J Am Coll Radiol 2015 Jun;12(6):563-71
    Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address:
    Purpose: To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR).

    Methods: This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. Read More

    Risk assessment tools used to predict outcomes of total hip and total knee arthroplasty.
    Orthop Clin North Am 2015 Jul 24;46(3):351-62, ix-x. Epub 2015 Mar 24.
    Department of Orthopedic Surgery, Yawkey Center for Outpatient Care, Massachusetts General Hospital, Suite 3B, 55 Fruit Street, Boston, MA 02114-2696, USA.
    This article reviews recently proposed clinical tools for predicting risks and outcomes in total hip arthroplasty and total knee arthroplasty patients. Additionally, we share the Massachusetts General Hospital experience with using the Risk Assessment and Prediction Tool to predict the need for an extended care facility after total joint arthroplasty. Read More

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