Journal of the American College of Surgeons
-
Patients undergoing liver resection for colorectal cancer liver metastasis (CRCLM) are often treated with chemotherapy before surgery. However, the associations between chemotherapy, liver injury, perioperative outcomes, and other confounding factors remain unclear. This study investigates the effect of preoperative chemotherapy for CRCLM on nontumoral liver histology and perioperative outcomes in a contemporary cohort. ⋯ With appropriate patient selection, liver resection for CRCLM can be safely performed in patients treated with preoperative chemotherapy.
-
The decision to transfuse packed RBCs (PRBC) during initial resuscitation of trauma patients is based on physiologic state, evidence for blood loss, and potential for ongoing hemorrhage. Initial hematocrit (Hct) is not considered an accurate marker of blood loss. This study tests the hypothesis that admission Hct is associated with transfusion requirements after trauma. ⋯ Admission Hct is more strongly associated with the PRBC transfusion than either tachycardia, hypotension, or acidosis. Admission Hct is also correlated with 24-hour blood product requirements in those receiving early transfusions. These findings challenge current thinking and suggest that fluid shifts are rapid after trauma and that Hct can be important in initial trauma assessment.
-
Congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) are fairly common congenital anomalies, but the occurrence of both is exceedingly rare, with only anecdotal cases reported in the English literature. The primary objective of the current study is to assess the incidence and outcomes of CDH/EA using the Congenital Diaphragmatic Hernia Study Group registry. ⋯ In patients with both CDH and EA, survival is significantly lower than other patients with CDH, but not uniformly lethal, therefore, intent to treat is a viable approach. Although the association of CDH with EA has a substantial impact on survival, it is the presence of low birth weight, cardiac and chromosomal abnormalities, surfactant use, and larger defects--and not the mere presence of EA--that influences the outcomes of this unique cohort.
-
Bone marrow dysfunction is common in severely injured trauma patients, with release of hematopoietic progenitor cells (HPC) into the peripheral blood. Granulocyte colony stimulating factor (G-CSF) is a potent stimulator of HPC mobilization. We hypothesized that plasma G-CSF levels are elevated after trauma and correlate with postinjury anemia and infection. ⋯ Plasma G-CSF is markedly elevated after injury and is greater in patients who present in shock. The rise in G-CSF was also associated with prolonged mobilization of HPC. Elevation of G-CSF in humans after severe trauma may play a significant role in the development of post-traumatic bone marrow dysfunction, anemia, and infection.
-
Surgical site infections (SSI) are a major cause of morbidity in surgical patients and they increase health care costs considerably. Colorectal surgery is consistently associated with high SSI rates. No single intervention has demonstrated efficacy in reducing colorectal SSIs. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a nationally validated system that uses clinically abstracted data on surgical patients and their outcomes to assist participating institutions drive quality improvement. ⋯ Using our ACS NSQIP colorectal SSI outcomes, a multidisciplinary team designed a colorectal SSI reduction bundle that resulted in a substantial and sustained reduction in SSIs. Our study is not able to identify which specific elements contributed to the reduction.