Journal of the American College of Surgeons
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Comparative Study
Short-Term Outcomes of Inflammatory Bowel Disease after Roux-En-Y Gastric Bypass vs Sleeve Gastrectomy.
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies for obesity and may have beneficial effects on the immune system. Therefore, we compared RYGB vs SG outcomes in patients with inflammatory bowel disease (IBD). ⋯ A sizable proportion of patients experienced improvements in IBD post-bariatric surgery. However, in CD patients, RYGB was associated with a significantly greater number of patients with increased IBD-medication requirements. Sleeve gastrectomy led to less weight loss, but had a lower rate of severe complications compared with RYGB. In patients with IBD, and particularly CD, SG may be the safer surgery.
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Frailty in the surgical patient has been associated with increased morbidity, mortality, and failure to rescue. However, there is little understanding of the economic impact of frailty. ⋯ Although a significant number of data exist on the impact of frailty in the surgical patient, the economic impacts have only limited description in the literature. Here we demonstrate that frailty, independent of age, has a detrimental financial impact on cost and hospital income in elective surgery.
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Comparative Study
Comparison of Outcomes Between Total Abdominal and Partial Colectomy for the Management of Severe, Complicated Clostridium Difficile Infection.
Patients with severe, complicated Clostridium difficile infection (CDI) may ultimately require a colectomy. Although associated with high morbidity and mortality, a total colectomy has been the mainstay of surgical treatment. However, small studies have suggested partial colectomy may provide equivalent outcomes. We compared the outcomes of partial and total colectomy for CDI in a nationwide database. ⋯ In a national database, a significant percentage of operations for CDI are partial colectomies. There were no significant differences found in mortality or complications between partial and total colectomy for severe complicated CDI.
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Surgical management of appendiceal carcinoid tumors is heavily debated, despite National Comprehensive Cancer Network guidelines recommending aggressive resection of tumors >2 cm. We investigated national practice patterns and the predictors and impact of guideline non-adherence. ⋯ Despite well-known size-based treatment guidelines for appendiceal carcinoids, one-third of patients in the US undergo hemicolectomy for small tumors and appendectomy for large tumors. Guideline non-adherence, however, is not associated with overall survival. Reasons for these practice patterns should be explored, and guidelines revisited.
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Autologous transfusion (AT) has long been considered unsafe in major oncologic operations due to a theoretic risk of spreading metastatic disease, however, few data support this assumption. ⋯ Autologous blood transfusion is not associated with an increased recurrence risk or a higher mortality rate. Surgeons performing liver resections for patients with colorectal cancer metastases can safely transfuse filtered autologous blood.