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Morbidity and costs after pancreatoduodenectomy remain increased, driven by postoperative pancreatic fistula (POPF). A risk-based pathway for pancreatoduodenectomy (RBP-PD) was implemented and the clinical and cost outcomes compared with that of our historic practice.Prospective clinical and cost outcomes for our RBP-PD cohort treated from September 2014 to September 2015 were compared with a previously...
One of the main complications of inguinal hernia repair continues to be recurrence. Commonly cited prior reports from relatively small studies estimate this rate to be 1% to 5% in the United States. Although some reports have found higher recurrence rates, they get little attention on the national stage or in other large studies. We sought to determine the trend of inguinal hernia repairs performed...
Rates of obesity and metabolic syndrome continue to rise worldwide; however, the impact of metabolic syndrome on outcomes following adrenalectomy has not been described. In this study, we sought to investigate the effects of metabolic syndrome on postoperative 30-day morbidity, mortality, and utilization of hospital resources in a large cohort of patients undergoing elective laparoscopic adrenalectomy...
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patients’ hospital experience.All inpatient, elective colorectal resections with completed HCAHPS surveys at a single institution between June 2012 and April 2015 were identified. HCAHPS measures were analyzed according to published methodologies. Univariate logistic regression evaluated associations...
Outcomes of neoadjuvant systemic therapy versus an upfront operation for clinical, stage III pancreatic adenocarcinoma remain poorly defined. Our aim was to compare survival among patients receiving neoadjuvant chemotherapy versus surgery-first with an intention-to-treat analysis.The National Cancer Data Base was reviewed from 2002–2011 for patients with clinical, stage III adenocarcinoma of the head...
Due to increasing rates of functional gallbladder disease (FGBD), we used national data to compare rates, patient characteristics, and outcomes of cholecystectomy for FGBD with the more defined diagnosis of biliary colic.The American College of Surgeons National Surgical Quality Improvement Program was reviewed for elective cholecystectomies from 2005–2013. The proportion of cholecystectomies performed...
In patients undergoing elective hepatectomy, we aimed to evaluate the effect of preoperative anemia on postoperative mortality, morbidity, readmission, risk of blood transfusion, and duration of hospital stay.A total of 4,170 patients who underwent elective hepatectomy from 2010 to 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Univariate and...
Urinary tract infections, a risk factor for readmission, have been deemed a potentially preventable problem and, therefore, not reimbursable by the Centers for Medicare and Medicaid Services since 2008. Defining the risk factors for development of urinary tract infection in the postoperative period will provide risk stratification for development of urinary tract infection in these challenging patients...
A diagnostic algorithm for appendicitis in children was created to reduce computed tomography (CT) use owing to the risk of cancer from radiation exposure and cost of CT. This study evaluates the impact of the algorithm on CT use and diagnostic accuracy of appendicitis.Patients ≤18 years who underwent appendectomy for suspected appendicitis after presenting to the emergency department for 2 years...
The adverse effects of blood transfusion after cancer surgery have been recently challenged in older anemic persons or those with substantial intraoperative blood loss. We hypothesized that intraoperative blood transfusions continue to adversely impact short-term cancer surgery outcomes regardless of age or preoperative hematocrit levels.Using the 2005 to 2008 American College of Surgeons National...
Guidelines for the current National Comprehensive Cancer Network recommend radical cholecystectomy, including hepatic resection and portal lymph node (LN) dissection, for patients with early stage gallbladder (GB) cancer. We sought to determine the survival benefit conferred by adequate LN evaluation.We used the surveillance, epidemiology and end results (SEER) neoplasm registry to identify patients...
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