Journal of the American College of Surgeons
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Whether patients with positive SLNB should undergo complete lymph node dissection (CLND) is an important unanswered clinical question. ⋯ Treatment of positive SLNB with CLND was associated with improved MSS and nodal recurrence rates. Follow-up beyond 5 years was needed to see a significant difference in MSS rates.
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Discharge location is associated with short-term readmission rates after hospitalization for several medical and surgical diagnoses. We hypothesized that discharge location: home, home health, skilled nursing facility (SNF), long-term acute care (LTAC), or inpatient rehabilitation, independently predicted the risk of 30-day readmission and severity of first readmission after orthotopic liver transplantation. ⋯ When compared with other locations of discharge, inpatient rehabilitation reduces the risk of 30-day readmission and increases the time to first readmission. These benefits come without increasing the severity of readmission. Increased use of inpatient rehabilitation after orthotopic liver transplantation is a strategy to improve 30-day readmission rates.
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The decision for a simultaneous liver and kidney transplantation (SLKT) is fraught with controversy. The aim of this study was to compare SLKT with liver transplantation alone (LTA) in patients with pretransplantation renal failure. ⋯ Patients with end-stage liver disease on dialysis who undergo liver transplantation have significantly better survival when SLKT is performed. In selected patients, SLKT is an appropriate use of a scarce resource, but better prognostic indicators for selection of patients are still needed.
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Traumatic axillosubclavian artery injuries (ASAIs) are uncommon but devastating. There is increasing acceptance of covered stent use for ASAIs. However, epidemiologic and long-term outcomes data are limited. We investigated national trends in ASAI management and our institutional outcomes after emergent covered stent placement and open surgical repairs for ASAIs. ⋯ Covered stents are being used increasingly for ASAIs nationwide, despite variable reports of durability. Follow-up is poor in urban trauma centers and might be responsible for the variable patency. Population-based efforts to improve compliance among trauma patients can help improve covered stent patency in ASAI.
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Comparative Study
Does Hospital Experience Rather than Volume Improve Outcomes in Geriatric Trauma Patients?
Although high absolute hospital geriatric trauma volume (GTV) is associated with improved outcomes among geriatric trauma patients, the actual geriatric trauma proportion (GTP) might be a better predictor of outcomes. ⋯ Treatment at hospitals with higher GTP is associated with lower hospital mortality and FTR among geriatric patients. These findings suggest that creation of specialized services for geriatric trauma care can improve outcomes among geriatric trauma patients.