Journal of the American College of Surgeons
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Longer operative time (OT) has been associated with negative outcomes in various surgical procedures, but its role in pancreatic resection, a complex, high-acuity endeavor, is not yet well defined. The aim of this study was to analyze the relationship between OT and pancreatectomy outcomes in a risk-adjusted fashion. ⋯ Longer OT is independently associated with worse perioperative outcomes after pancreatic resection, and should be considered a relevant parameter in risk-adjustment processes for outcomes evaluation. These findings suggest possible areas of quality improvement through individual and system-level initiatives.
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Our aim was to compare the pathologic upgrade rates of high-risk breast lesions (HRLs) on digital two-dimensional mammography (DM) vs digital breast tomosynthesis (DBT). ⋯ There is no difference in the upgrade rates of HRLs on DM vs DBT, but the proportion of HRL upgrades that are invasive rather than in situ carcinoma is higher with DBT.
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Obturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH. ⋯ Laparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients.
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The focus of this study was to assess the accuracy of breast MRI in predicting pathologic tumor size in invasive lobular carcinoma (ILC) and to evaluate the incidence and factors associated with the detection of additional MRI lesions in ILC patients. ⋯ Preoperative MRI is a useful adjunct to conventional breast imaging in ILC, particularly in women with dense breast tissue.
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Donation after cardiac death (DCD) is one method of organ donation. Nationally, more than half of evaluated DCD donors do not yield transplantable organs. There is no algorithm for predicting which DCD donors will be appropriate for organ procurement. Donation after cardiac death program costs from an organ procurement organization (OPO) accounting for all evaluated donors have not been reported. ⋯ Mean cost per DCD donor is comparable with DBD donors, however, individual cost of DCD organs increases by almost 40% when all costs of an entire DCD program are included.