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After accounting for patient severity, open and laparoscopic appendectomy had similar clinical outcomes. In this case study, propensity score methods and multivariate adjustment yielded nearly identical results.
Archives of Surgery - Mon, 25 October 2010
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Early transfusion of FFP is associated with an increased risk of postinjury MOF, even after adjusting for age, ISS, and PRBC transfusion. Caution is warranted in developing protocols for empirical FFP transfusion. Specifically, transfusion triggers for FFP should be reexamined, as well as the practice of delivering FFP in fixed ratios to the units of PRBCs transfused.
Archives of Surgery - Mon, 25 October 2010
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Recent investigations of nutrition support in the intensive care unit (ICU) have revived discussion of optimal strategies for tight glucose control and the administration of total parenteral nutrition. Mode, timing, and adequacy of nutritional support affect glycemic control and outcomes in critically ill patients.
Archives of Surgery - Wed, 30 June 2010
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Given the immeasurable human distress and health care burden associated with intestinal failure, medical therapies aimed at intestinal rehabilitation are needed. Following massive small-bowel resection, the residual intestine is known to adapt structurally and functionally in an attempt to compensate for the resected portion. However, parenteral nutrition may be associated with many short- and long-term complications, including prevention of intestinal adaptation and promotion of mucosal atrophy due to lack of stimulus provided by oral or enteral nutrition. However, data herein demonstrate that the addition of butyrate, a short-chain fatty acid produced in the colon by dietary fiber fermentation, stimulates intestinal adaptation when added to parenteral nutrition, indicating that current solutions could be formulated to optimize intestinal adaptation and to reduce dependence of individuals with intestinal failure receiving long-term parenteral nutrition regimens.
Archives of Surgery - Wed, 23 June 2010
http://archsurg.ama-assn.org/
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The medical malpractice crisis has smoldered for many years with few new ideas regarding how to improve matters. Physicians promote limits on plaintiff noneconomic damages, but this has been ferociously resisted by the legal community.
Archives of Surgery - Tue, 16 March 2010
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Bronchogenic cysts are aberrations of normal development throughout the embryonic foregut; abdominal or retroperitoneal presentations are rare. They will often present a diagnostic dilemma because their appearance can mimic other, more common diagnoses.
Archives of Surgery - Tue, 16 March 2010
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The current interest in comparative effectiveness research, highlighted by the US Congress 2009 American Recovery and Reinvestment Act and the broader national debate about health care reform in the United States, is a welcome development for those with a long-standing interest in research on the effectiveness of health care interventions.
Archives of Surgery - Mon, 22 February 2010
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The editorial titled "For the Protection of the Public and the Good of the Specialty: Maintenance of Certification" (published in the February 2009 issue of the Archives of Surgery) has prompted us to offer the following article to inform the debate about how assessing surgical care and sorting out the variables to be included in maintenance of certification may develop worldwide. The proposals for revalidation of UK physicians involve the relicensing of all physicians and recertification of all specialists on the specialist register of the General Medical Council. The process will be on a 5-year cycle and is currently under development by the General Medical Council. The Royal Colleges have been charged with creating the standards for recertification, and the responsibility will fall on the Royal Colleges to support their fellows and members as the new regulation is introduced and as it develops. This article outlines developments so far, with particular reference to surgeons.
Archives of Surgery - Mon, 1 February 2010
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Laparoscopic total gastrectomy for advanced gastric cancer is an approach that has been developing since 1999, when it was first described by Azagra et al1 and Uyama et al.2 In this article, Shinohara et al show an expertise and technical skill with outcomes and lymphadenectomy comparable to those of open total gastrectomies.
Archives of Surgery - Fri, 15 January 2010
http://archsurg.ama-assn.org/
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The initiatives taken by the VHA Medical Centers toward patient safety are many and laudable. In this study, a distinguished group of authors reports on the adverse events and close calls recorded from 2001 to 2006 in the VHA database. The results uncover the most frequently involved departments (ophthalmology and orthopedics), the most frequently encountered adverse events (wrong eye implant and unavailable orthopedic implant), the most harmful adverse events (wrong-side thoracentesis by pulmonary medicine and wrong-site operations by different specialists), and the most common root cause of the problem (communication). The authors conclude that earlier communication will prevent surgical adverse events, although this is merely a hypothesis and not a data-driven conclusion.
Archives of Surgery - Thu, 17 December 2009
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