Journal of the American College of Surgeons
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Multicenter Study
Portal Vein Embolization Followed by Right-Side Hemihepatectomy for Hepatocellular Carcinoma Patients: A Japanese Multi-Institutional Study.
Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients. ⋯ Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.
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Comparative Study
Operative vs Nonoperative Management of Pediatric Blunt Pancreatic Trauma: Evaluation of the National Trauma Data Bank.
Traumatic pancreatic injury is associated with significant morbidity and mortality. We evaluated the differences in outcomes among children with blunt pancreatic injuries managed operatively and nonoperatively. ⋯ Overall, children managed nonoperatively have equivalent or better outcomes when compared with operative and delayed operative management in regard to death, overall complications, LOS, ICU LOS, and ICU use.
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Results from validated national databases suggest that a 1-day length of stay (LOS) is not only unattainable in more than 20% of primary laparoscopic Roux-en-Y gastric bypass (LRYGB) operations, but it is also associated with an increased 30-day mortality risk. There are no published data regarding the feasibility and safety of 1-day LOS after revisional LRYGB. ⋯ A 1-day FTP can be successfully implemented in the majority of primary and revisional LRYGB patients regardless of preoperative patient characteristics without increasing the risk of 30-day morbidity, mortality, reoperations, readmissions, emergency department or outpatient fluid visits, or reducing patient satisfaction.
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Comparative Study
Cost-Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services.
The American College of Surgeons Committee on Trauma sets national targets for the accuracy of field trauma triage at ≥95% sensitivity and ≥65% specificity, yet the cost-effectiveness of realizing these goals is unknown. We evaluated the cost-effectiveness of current field trauma triage practices compared with triage strategies consistent with the national targets. ⋯ A high-sensitivity approach to field triage consistent with national trauma policy is not cost-effective. The most cost-effective approach to field triage appears closely tied to triage specificity and adherence to triage-based emergency medical services transport practices.