Journal of the American College of Surgeons
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Preoperative asymptomatic leukocytosis has been reported as a factor that affects morbidity of surgical patients. We sought to identify the relationship between asymptomatic preoperative leukocytosis and postoperative complications in elective colorectal cancer surgery. ⋯ Preoperative asymptomatic leukocytosis has a prevalence of 5.6% in colorectal cancer resections and carries a significant increased risk of mortality and morbidity. Asymptomatic leukocytosis is associated with preoperative dehydration and malnutrition. Further studies are indicated to validate and explain these findings.
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The rate of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer has increased over the past decade, particularly for young women. This study investigates the impact of race and socioeconomic status (SES) on use of CPM. ⋯ Young, white, breast cancer patients are twice as likely to undergo CPM compared with women in other racial groups, even after accounting for pathologic, patient, and facility factors. Variations in shared decision-making processes between women of different backgrounds may contribute to these trends, supporting the need for future studies investigating decision-making processes and decisional aids.
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Objective measurement of outcomes in surgical care lack standard definitions, effective and consistent surveillance, and identification of significant postdischarge events. ⋯ Adverse outcomes of inpatient deaths, prLOS, and 90-DPd readmissions and deaths provide an objective target for care redesign and improvement. The postdischarge period is the greatest source of adverse outcomes in LC. Composite measurement of adverse outcomes becomes a meaningful tool for the design of surgical warranties for episode-based payment initiatives.
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Suboptimal operating room (OR) efficiency is a universal complaint among surgeons. Nonetheless, maximizing efficiency is critical to institutional success. Here, we report improvement achieved from low-cost, low-technology measures instituted within a tertiary-care academic medical center/Level I trauma center. ⋯ After many years of what seemed an insoluble problem, simple changes fostering collaboration among services, including active management of the OR schedule and transparent data, have resulted in substantial improvement in OR efficiency and case volume.
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Energy-based devices are used in virtually every operation. Our purposes were to describe causes of energy-based device complications leading to injury or death, and to determine if common mechanisms leading to injury or death can be identified. ⋯ Complications due to energy-based devices occur from 4 main causes: thermal burn, hemorrhage, mechanical failure, and fire. Thermal direct application injuries are the most common reason for both injury and death.