Journal of the American College of Surgeons
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Phenylephrine can be used to treat postoperative hypotension after renal transplantation. However, its effect on the renal allograft is unknown. We evaluated the safety and efficacy of this approach. ⋯ Although there is a brief association between phenylephrine administration and a slower rate of transplanted kidney recovery, there is no clinically or statistically significant impaired outcome in the phenylephrine group at time of discharge. Administration of phenylephrine to support low blood pressure after renal transplant appears safe.
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Data revealed that our urban, academic, safety net medical center was a high outlier for postoperative venous thromboembolism (VTE). Our goal was to implement and determine the efficacy of a standardized intervention for reducing postoperative VTE complications. ⋯ A patient care program, emphasizing early postoperative mobilization along with mandatory VTE risk stratification and commensurate electronic prophylaxis recommendations, significantly reduced the likelihood of VTE complications among our patients.
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Large studies have documented the safety of laparoscopic paraesophageal hernia (PEH) repair in the general population. Even though this condition affects primarily the elderly, data on the short-term outcomes of this procedure on the oldest-old are lacking. ⋯ In an assessment of modern nationwide practice, laparoscopic PEH repair is performed with minimal morbidity and mortality. Elective repair in patients aged 80 years or older is not associated with significant differences in mortality or major morbidity compared with younger patients.
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The incidence of community-acquired Clostridium difficile (CACD) is increasing in the United States. Many CACD infections occur in the elderly, who are predisposed to poor outcomes. We aimed to describe the epidemiology and outcomes of CACD in a nationally representative sample of Medicare beneficiaries. ⋯ Nearly half of the Medicare beneficiaries admitted with CACD have no recent antibiotic exposure. High mortality and readmission rates suggest that the burden of C difficile on patients and the health care system will increase as the US population ages. Additional efforts at primary prevention and eradication might be warranted.
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Anastomotic leak is a serious complication of gastrointestinal surgery. Abnormal vital signs are often cited in retrospective peer review and medicolegal settings as evidence of negligence in the failure to make an early diagnosis. We aimed to profile the postoperative courses of patients who undergo intestinal anastomosis and determine how reliably abnormal vital signs predict anastomotic leaks. ⋯ Abnormal vital signs are extremely common after bowel resection with anastomosis. Even sustained aberrant vital signs and/or leukocytosis are not necessarily suggestive of a leak or other postoperative complication.