Journal of the American College of Surgeons
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Multicenter Study
Examining national outcomes after thyroidectomy with nerve monitoring.
Previous intraoperative nerve monitoring (IONM) studies have demonstrated modest-to-no benefit and did not include a nationwide sample of hospitals representative of broad thyroidectomy practices. This national study was designed to compare vocal cord paralysis (VCP) rates between thyroidectomy with IONM and without monitoring (conventional). ⋯ According to this study, IONM has not been broadly adopted into practice. Overall, IONM was associated with a higher rate of VCP even after correction for numerous confounders. In particular, low institutional use of IONM and use in partial thyroidectomies are associated with higher rates of VCP. Further studies are warranted to support the broader application of IONM in patients where benefit can be reliably achieved.
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Multicenter Study
Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis.
Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer. ⋯ Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.
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Frailty has emerged as an important predictor of operative risk among elderly surgical patients. However, the complexity of prospective frailty scores has limited their widespread use. Our goal was to develop two frailty-based surgical risk models using only routine preoperative data. Our hypothesis was that these models could easily integrate into an electronic medical record to predict 30-day morbidity and mortality. ⋯ Our work demonstrates that routine preoperative data can approximate frailty and predict geriatric-specific surgical risk. The models' predicative powers were comparable with that of established prospective frailty scores. Our calculator could be used as a low-cost simple screen for high-risk individuals who might require additional evaluation or specialized services.
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Comparative Study
Comparison of two comorbidity scoring systems for older adults with traumatic injuries.
The purpose of this study was to determine the mortality predictive value of two different comorbidity scores, Comorbidity-Polypharmacy Score (CPS) and Charlson scoring system, in a large sample of older trauma patients. ⋯ The addition of a comorbidity score improves multivariate models predicting long-term mortality in older trauma patients. There was no advantage to using CPS instead of Charlson score, and each was an independent predictor of fatal outcomes.