Journal of the American College of Surgeons
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Academic global surgery value to low- and middle-income countries (LMICs) is increasingly understood, yet value to academic health centers (AHCs) remains unclear. ⋯ Academic global surgeons spend a modest amount of time abroad, require minimal financial support, and represent a low-cost investment in an under-recognized scholarship area. This position paper suggests measures of global surgery that could provide opportunities for AHCs and surgical departments to expand missions of service, education, and research and enhance institutional reputation while achieving societal impact.
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For patients undergoing major abdominal operations, acute postoperative hyperglycemia (POHG) is associated with suboptimal outcomes and higher costs of care. This study was performed to determine whether CT-derived indices of nonalcoholic fatty liver disease (hepatic steatosis) or visceral adiposity may serve as predictors of POHG and its consequences in such patients. ⋯ Image-based indices of chronic metabolic disturbance in the liver and adipose tissues may offer novel opportunities for identifying patients at risk for POHG and those who would benefit from preoperative metabolic optimization.
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Parastomal hernia is the most common complication after stoma creation. It can create significant morbidity and is associated with a lower quality of life. Current parastomal hernia repair techniques and outcomes are not well characterized. We aimed to describe patient characteristics, operative techniques, and outcomes of patients undergoing parastomal hernia repair. ⋯ This is the first multi-institutional report of parastomal hernia repair using prospective data complete with operative details. Parastomal hernia repair remains a difficult operation without a clear best practice. Multiple factors appear to influence operative approach. Surgical treatment may improve quality of life at 6 to 12 months postoperatively.
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Patients with increasing age and medical complexity are undergoing colorectal surgery. Medical complications are not uncommon and may contribute to higher mortality. We implemented a surgical comanagement (SCM) model in July 2014 at our institution, where the same 2 SCM hospitalists were dedicated to colorectal surgery year round. Each patient was screened daily by an SCM hospitalist for prevention and management of medical complications. Before SCM, hospitalists were typically consulted after medical complications had occurred. ⋯ Surgical comanagement intervention was associated with a decrease in transfers to the ICU after rapid response team call, LOS, medical consultants, and the cost of care.