Journal of the American College of Surgeons
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Hepatic resection is increasingly performed for primary and metastatic tumors. Reports from tertiary care centers show improved outcomes over time with lower operative mortality rates. The objective of this investigation was to characterize trends in the use and outcomes of hepatic resection in the US during a recent 13-year period. ⋯ The number of hepatic resections performed in the US has increased significantly. Short-term outcomes have also improved over the same time period, with more improvement seen at higher volume centers than in lower volume centers.
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Inadvertent passage of a nasoenteric feeding tube into the tracheobronchial tree can result in pneumothorax. Measures requiring feeding tube passage to 35 cm only followed by a radiograph to verify intraesophageal placement and creation of a specialized placement team were implemented to decrease the incidence of procedure-related pneumothorax. This study evaluates the effectiveness of our safety measures. ⋯ Creating a specialized placement team, and initiating the safety measure of limiting feeding tube placement to 35 cm and obtaining a radiograph before full advancement reduced the incidence of procedure-related pneumothorax.
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Academic divisions of general surgery are facing ever-increasing financial pressures. Cost-cutting is a common approach to maintaining profitability, but strategies to increase revenue should not be ignored. One specific avenue for enhanced revenue generation in general surgery is that of coding for evaluation and management (E&M). Although this is the financial life-blood for many of the consultative services in departments of medicine, E&M coding is an often neglected and misunderstood component of surgical care. ⋯ We conclude that the ICD-9 and APR-DRG models may serve as benchmarks to determine the limits for E&M revenue stream, and E&M coding may represent an underutilized source of revenue among academic departments of surgery.
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Clinical care pathways reduce postoperative stay after major bowel operations. Concerns about unexpected early readmissions and delays in diagnosis of complications remain unanswered. The objectives of this study were determination of readmission rate and outcomes for patients undergoing intestinal operations. ⋯ Early readmission is an unpredictable sequel of major bowel operations; it does not correlate with shorter hospital stay. Identification of unpredictable complications after discharge that require later invasive intervention does not adversely affect clinical outcomes. Readmission within 30 days of a patient who has attained standardized discharge criteria may not be a valid indicator of poor quality of care.
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The c-Src tyrosine kinase is a determinant of malignant cellular behavior in a variety of human cancers. We sought to determine the effect of suppressing c-Src expression on pancreatic adenocarcinoma chemosensitivity to gemcitabine. ⋯ c-Src is a determinant of pancreatic adenocarcinoma chemoresistance and represents a potential target for therapeutic intervention.