Journal of the American College of Surgeons
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Large studies have documented the safety of laparoscopic paraesophageal hernia (PEH) repair in the general population. Even though this condition affects primarily the elderly, data on the short-term outcomes of this procedure on the oldest-old are lacking. ⋯ In an assessment of modern nationwide practice, laparoscopic PEH repair is performed with minimal morbidity and mortality. Elective repair in patients aged 80 years or older is not associated with significant differences in mortality or major morbidity compared with younger patients.
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The incidence of community-acquired Clostridium difficile (CACD) is increasing in the United States. Many CACD infections occur in the elderly, who are predisposed to poor outcomes. We aimed to describe the epidemiology and outcomes of CACD in a nationally representative sample of Medicare beneficiaries. ⋯ Nearly half of the Medicare beneficiaries admitted with CACD have no recent antibiotic exposure. High mortality and readmission rates suggest that the burden of C difficile on patients and the health care system will increase as the US population ages. Additional efforts at primary prevention and eradication might be warranted.
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Anastomotic leak is a serious complication of gastrointestinal surgery. Abnormal vital signs are often cited in retrospective peer review and medicolegal settings as evidence of negligence in the failure to make an early diagnosis. We aimed to profile the postoperative courses of patients who undergo intestinal anastomosis and determine how reliably abnormal vital signs predict anastomotic leaks. ⋯ Abnormal vital signs are extremely common after bowel resection with anastomosis. Even sustained aberrant vital signs and/or leukocytosis are not necessarily suggestive of a leak or other postoperative complication.
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Thyroid surgery is associated with low mortality and morbidity and often is performed in an ambulatory setting. The majority of patients undergoing thyroidectomy have an uncomplicated outcome, but common comorbidities may increase mortality and morbidity. Due to low complication rates, studies using single surgeon or single institutional data to identify risk factors for adverse outcomes may be limited by inadequate patient volume. ⋯ Thyroid surgery is generally safe. Common comorbidities significantly increase the risk of adverse outcomes and death. Clinically applicable risk calculation based on overall health may improve patient selection, surgical management, and informed consent.
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Paracolostomy hernia repair (PHR) can be a challenging procedure associated with significant morbidity and high recurrence rates. We sought to analyze the complication rate and 30-day mortality among patients undergoing PHR. ⋯ This study revealed that most PHRs are performed electively. Although elective repair remains a relatively safe procedure, even in the elderly, emergency PHR is associated with increased morbidity, especially pulmonary and septic complications, and higher mortality. These results are amplified among patients older than 70 years undergoing emergent repair. These findings suggest that greater consideration should be given to elective repair of paracolostomy hernias in the elderly because emergency repair is associated with considerable risk and worse outcomes.