Journal of the American College of Surgeons
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There have been no comprehensive studies across an organized statewide trauma system using a standardized method to determine cost. ⋯ Patient care cost rose with increasing ISS, length of stay, ICU days, and ventilator days for patients with length of stay >2 days and ISS 9+. Level I centers had the highest mean ISS, length of stay, ICU days, and ventilator days, along with the highest PCC. Lesser trauma accounted for lower charges, payments, and PCC for Level II, III, and IV TCs, and the margin was variable. Verification and response costs per patient were highest for Level I and II TCs.
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Multicenter Study
Postmastectomy radiation for N2/N3 breast cancer: factors associated with low compliance rate.
The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines recommend postmastectomy radiation therapy (PMRT) for women with N2/N3 breast cancer. We examined the compliance rate of PMRT using the National Cancer Data Base and determined what factors are associated with low compliance rate with PMRT. ⋯ One third of patients with N2/N3 disease did not receive PMRT. Socioeconomic variables were not contributory factors. Noncompliance with PMRT is related to lack of receipt of chemotherapy, nonreadmission, or death within 30 days after surgery.
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Multicenter Study
Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients.
The value of routine primary (intraoperative) drain placement after major hepatectomy remains unclear. We sought to determine if primary drainage led to decreased rates of complications, specifically, intra-abdominal biloma or infection requiring a secondary (postoperative) drainage procedure. ⋯ Primary intraoperative drain placement after major hepatectomy does not decrease the need for secondary drainage procedures and may be associated with increased bile leaks and 30-day readmissions. Routine drain placement is not warranted.
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Multicenter Study
Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicenter study.
Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding. ⋯ Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.
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Multicenter Study
Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.
Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). ⋯ Emergency general surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding.