Journal of the American College of Surgeons
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Laparoscopic hepatectomy continues to be a challenging operation associated with a steep learning curve. This study aimed to evaluate the learning process during 15 years of experience with laparoscopic hepatectomy and to identify approaches to standardization of this procedure. ⋯ Our 15-year experience clearly demonstrates the stepwise procedural evolution from LLS through left hepatectomy to right hepatectomy, as well as the trend in indications from benign-borderline tumor/living donor to malignant tumors. In contrast to LLS and left hepatectomy, a learning curve was not observed for right hepatectomy. The ongoing development process can contribute to faster standardization necessary for future advances in laparoscopic hepatectomy.
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Comparative Study
Comparison of Conflict of Interest among Published Hernia Researchers Self-Reported to the Centers of Medicare and Medicaid Services Open Payments Database.
Many healthcare providers have financial interests and relationships with healthcare companies. To maintain transparency, investigators are expected to disclose their conflicts of interest (COIs). Recently, the Centers for Medicare and Medicaid Services developed the Open Payment database of COIs reported by industry. We hypothesize that there is discordance between industry-reported and physician self-reported COIs in ventral hernia publications. ⋯ There is substantial discordance between self-reported COI in published articles compared with those in the Centers for Medicare and Medicaid Services Open Payments database. Additional studies are needed to determine the reasons for these differences, as COI can influence the validity of the design, conduct, and results of a study.
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Overlapping surgery is highly contentious, both in terms of the safety of the practice and the degree to which patients should be informed. However, no study has surveyed attitudes of the general public toward overlapping surgery and willingness to consent to such a procedure. ⋯ A small minority of the general public is aware of the practice of overlapping surgery. The majority of responders were not supportive of the practice, although would consider it acceptable in specific circumstances. However, responders consistently reported that the practice of overlapping surgery should be disclosed during the informed consent process.
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As the current healthcare structure moves toward value-based purchasing, it is helpful for stakeholders to understand costs, particularly for those associated with postoperative complications. The objectives of this study were to assess hospital reimbursements for postoperative complications and generate insight into sustainability of quality. ⋯ Postoperative complications add an important marginal cost to Medicare payments, and lead to a substantial portion of payments to hospitals. Using high-quality clinical registry data to measure complication rates, we estimated the cost of complications for 3 commonly performed operations among the Medicare population. Harmonizing financial incentives for both payers and providers are needed to improve the delivery of high-quality surgical care.
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Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. ⋯ Overall rates of adverse events in patients undergoing transsphenoidal surgery are relatively low, and most occur before discharge from the hospital. Post-discharge complications associated with transsphenoidal surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed postoperative cerebrospinal fluid leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.