Journal of the American College of Surgeons
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Transfusion practice among surgeons varies despite several trials supporting the restrictive use of blood products. We sought to define the variation in surgeon transfusion hemoglobin (Hb) triggers and targets among patients undergoing hepatopancreaticobiliary (HPB) procedures, as well as assess perioperative outcomes among patients receiving transfusions under a restrictive vs liberal transfusion strategy. ⋯ Nearly 1 in 3 patients undergoing an HPB procedure received a blood transfusion in the perioperative period. Transfusion use, indication ("trigger"), and dose ("target") varied among surgeons. The use of a restrictive transfusion strategy did not affect perioperative outcomes.
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Multicenter Study Comparative Study
Comparison of comorbidity collection methods.
Multiple valid comorbidity indices exist to quantify the presence and role of comorbidities in cancer patient survival. Our goal was to compare chart-based Adult Comorbidity Evaluation-27 index (ACE-27) and claims-based Charlson Comorbidity Index (CCI) methods of identifying comorbid ailments and their prognostic abilities. ⋯ The number, type, and overall severity of comorbid ailments identified by chart- and claims-based approaches in newly diagnosed cancer patients were notably different. Both indices were prognostically significant and able to provide unique prognostic information.
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Comparative Study Clinical Trial
Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children.
For decades, urgent operation has been considered the only appropriate management of acute appendicitis in children. The purpose of this study was to investigate the feasibility of nonoperative management of uncomplicated acute appendicitis in children. ⋯ Nonoperative management of uncomplicated acute appendicitis in children is feasible, with a high 30-day success rate and short-term benefits that include quicker recovery and improved quality of life scores. Additional follow-up will allow for determination of longer-term success rate, safety, and cost effectiveness.