Journal of the American College of Surgeons
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Neoadjuvant treatment improves survival in resectable esophageal adenocarcinoma, but the optimal regimen has not been defined. Neoadjuvant chemoradiation (nCRT) is associated with higher pathologic complete response (pCR) relative to chemotherapy (nCTX), but has not been shown to improve survival; however, previous studies have been underpowered to demonstrate a survival difference. The objective of this study was to determine if nCRT is associated with increased survival relative to nCTX in patients with resectable esophageal adenocarcinoma. ⋯ Neoadjuvant chemoradiation is not associated with improved survival relative to nCTX for resectable esophageal adenocarcinoma. Radiation may potentially be omitted in some patients with this disease.
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Operative site drainage (OSD) after elective hepatectomy remains widely used despite data suggesting limited benefit. Multi-institutional, quality-driven databases and analytic techniques offer a unique source from which the utility of OSD can be assessed. ⋯ In a propensity score matched cohort, OSD did not improve the rate of diagnosis of major bile leaks and was associated with increased interventions, greater length of stay, and more 30-day readmissions. These data suggest that routine OSD after elective hepatectomy may not be helpful in capturing clinically relevant bile leaks and has additional consequences.
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Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study was to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC. ⋯ Long-term survival after repeat resection for recurrent ACC is feasible when 2 of the following factors are present: solitary tumor, disease-free interval >12 months, and locoregional or pulmonary recurrence.
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Prophylactic anticoagulation is routinely used in the inpatient setting; however, the risk of venous thromboembolism (VTE) remains elevated after discharge. Extensive evidence and clinical guidelines suggest post-discharge VTE prophylaxis is critical in at-risk populations, but it remains severely underused in practice. ⋯ A systematic post-discharge VTE prophylaxis program including provider education, local guideline adaptation, bedside medication delivery, and education for at-risk patients, was associated with significantly fewer post-discharge VTE events.
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The association between the need for trauma care and trauma services has not been characterized previously. We compared the distribution of trauma admissions with state-level availability of trauma centers (TCs), surgical critical care (SCC) providers, and SCC fellowships, and assessed the association between trauma care provision and state-level trauma mortality. ⋯ There is an inequitable distribution of trauma services across the US. Increases in the density of SCC providers are associated with decreases in mortality. There was no association between density of trauma admissions and location of Level I/Level II TCs. In the wake of efforts to regionalize TCs, additional efforts are needed to address disparities in the provision of quality care to trauma patients.