Journal of the American College of Surgeons
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Obesity is a significant barrier to kidney transplantation for patients with end-stage renal disease (ESRD). We aimed to evaluate the long-term impact of metabolic and bariatric surgery (MBS) on kidney transplantation access and outcomes in individuals with obesity and ESRD patients. ⋯ MBS significantly improves access to kidney transplantation and long-term survival for obese ESRD patients. Patients who underwent MBS demonstrated notable improvements in cardiovascular health, potentially leading to a better quality of life and survival.These findings suggest that MBS should be considered as part of the comprehensive care for this high-risk population.
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Firearm violence in America has been declared a public health crisis. This study investigates variation in firearm injuries by county-level characteristics and intent of firearm use. ⋯ These results suggest that deaths remain a problem in all Florida county communities while hospitalizations are highly influenced by socioeconomic factors and county size. Heatmaps may inform level one trauma hospitals to implement tailored education for high risk surrounding communities.
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The definition of T1b cutaneous melanoma was changed in the 8th edition of the AJCC staging system based on survival differences but not risk of sentinel lymph node (SLN) metastases. We sought to evaluate changes in SLN biopsy (SLNB) use and rates of positive SLNB in response to updated staging criteria, and to evaluate the incidence of high-risk features in T1a melanoma in whom SLNB is now recommended. ⋯ After implementation of the AJCC 8th edition staging criteria, surgeons have become more selective in SLNB use with a resulting increase in SLNB positivity rate. Fewer SLNBs in T1a and more SLNBs in non-ulcerated T1b are being performed.
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Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can improve survival for patients with peritoneal surface malignancy. Completeness of cytoreduction correlates with prognosis. The role of gastrectomy in these patients is not well described. ⋯ 8% of patients who underwent CRS+HIPEC for non-gastric primaries underwent gastrectomy. Gastrectomy patients were more likely to have higher PCI and incomplete resections with increased complications and mortality. PCI, resection status, LN's, tumor grade, and primary site, but not gastrectomy type, are significantly associated with OS.
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Venous thromboembolism (VTE) remains a major source of morbidity and mortality in severely injured patients despite current methods of risk stratification and prophylaxis, suggesting incomplete understanding of VTE risk factors. Given the liver's role in coagulation, we hypothesized that liver injury (LI) is associated with increased rates of VTE in severely injured patients. ⋯ In severely injured patients, LI is an independent predictor of PE, but not DVT, suggesting LI is the source of either emboli or a more complex locally prothrombotic focus leading to downstream thrombi in the lung without causing upstream systemic venous thrombi. Further work should focus on elucidation of mechanisms including the portal venous blood coagulation profile, endothelial injury in the liver, and the potential for stasis of venous blood traversing an injured liver as well as the role for including LI in VTE risk stratification.