Journal of the American College of Surgeons
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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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Multicenter Study Observational Study
Compliance with recommended care at trauma centers: association with patient outcomes.
State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. ⋯ Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality.
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We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM). ⋯ This study showed that selection of patients by response to prehepatectomy chemotherapy may be extremely important before planning TSH because tumor progression while receiving prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcomes can be achieved with results similar to those observed after single-stage hepatectomy.
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Multicenter Study
Liver planning software accurately predicts postoperative liver volume and measures early regeneration.
Postoperative or remnant liver volume (RLV) after hepatic resection is a critical predictor of perioperative outcomes. This study investigates whether the accuracy of liver surgical planning software for predicting postoperative RLV and assessing early regeneration. ⋯ Preoperative virtual planning of future liver remnant accurately predicts postoperative volume after hepatic resection. Early postoperative liver regeneration is measureable on imaging beginning at 5 days after surgery. Measuring TLV directly from CT scans rather than calculating based on equations accounts for extremes in TLV.