Journal of the American College of Surgeons
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Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC. ⋯ The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open surgery.
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Addressing equity in healthcare is necessary to improve population health outcomes. In doing so, a requisite level of foundational resources, organization, and processes are needed. Although increasing attention is being devoted to addressing health inequities, the current landscape supporting these efforts remains unknown. We sought to evaluate the presence of frontline resources, organization, and processes for support of health equity efforts in hospitals participating in American College of Surgeons' (ACS) quality programs. ⋯ Efforts aimed at achieving health equity exist but lack the necessary infrastructure, organization, and processes to support effective frontline practices. The findings from this study support consideration of standards development targeting problems and opportunities at both the institutional and program level for advancing equity in quality improvement efforts.
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Patients older than 65 years have unique needs and treatment outcomes goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients ≥65 years undergoing major abdominal surgeries. ⋯ The GSV initiative intervention in geriatric oncology patients undergoing major abdominal surgeries was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.
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There remains clinical equipoise regarding the preference for upfront appendectomy or nonoperative management for patients with complicated appendicitis. However, the natural history of the appendix following nonoperative management and pending interval appendectomy in children is not well characterized, and the risk of recurrent appendicitis as a function of time from index admission not known. ⋯ The highest likelihood of recurrent appendicitis or complications following nonoperative management of complicated appendicitis occurs in the first 50 days following index admission. This information will help surgeons during shared decision-making conversations regarding timing of interval appendectomy.