Journal of the American College of Surgeons
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Assigning trauma team activation levels for trauma patients is a classification task that machine learning models can help optimize. However, performance is dependent upon the "ground-truth" labels used for training. Our purpose was to investigate two ground-truths, the Cribari matrix and the Need for Trauma Intervention (NFTI), for labeling training data. ⋯ To prioritize patient safety, Cribari+NFTI appears best for training a machine learning algorithm to predict trauma team activation level.
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The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year old Markov analysis. Recently we have shown that elective laparoscopic PEH repair (ELHR) provides an increase in life-years compared to watchful waiting (WW) in most healthy patients aged 40-90. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients. ⋯ Using a Markov model with updated values for key variables associated with management options for patients with a PEH we showed that life expectancy was improved with ELHR in most men and women aged 40-90, particularly in the presence of symptoms and / or Cameron lesions. Comorbid conditions increase the risk for surgery, but ELHR remained the preferred strategy in the majority of symptomatic patients. This model can be used to provide individualized management guidance for patients with a PEH.
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As the COVID-19 pandemic shifts to an endemic phase, an increasing proportion of cancer patients with a preoperative history of COVID-19 will require surgery. This study aimed to assess the influence of preoperative COVID-19 on postoperative risk for major adverse cardiovascular and cerebrovascular events (MACE) among those undergoing surgical cancer resection. Secondary objectives included determining optimal time-to-surgery guidelines based on COVID-19 severity and discerning the influence of vaccination status on MACE risk. ⋯ Together, these data highlight that assessment of the severity of preoperative COVID-19 infection should be a routine component of both preoperative patient screening as well as surgical risk stratification. In addition, strategies beyond vaccination that increase patients' cardiovascular fitness and prevent COVID-19 infection are needed.
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The aim of this study is to evaluate the impact of pre-operative weight loss on surgical outcomes and OR times after primary bariatric procedures, including Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (RYGB). ⋯ In patients undergoing primary bariatric surgery, pre-operative weight loss does not lead to a consistent improvement in outcomes or OR times. In those with BMI≥50 there may be improvement in select outcomes that is procedure specific. Overall, this data does not support a uniform policy of pre-operative weight loss, although selective use in some high-risk patients may be appropriate.