Journal of the American College of Surgeons
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Clinically relevant postoperative pancreatic fistulas (CR-POPF) are serious inherent risks of pancreatic resection. Preoperative CR-POPF risk assessment is currently inadequate and rarely disqualifies patients who need resection. The best evaluation of risk occurs intraoperatively, and should guide fistula prevention and response measures thereafter. We sought to develop a risk prediction tool for CR-POPF that features intraoperative assessment and reveals associated clinical and economic significance. ⋯ A simple 10-point Fistula Risk Score derived during pancreaticoduodenectomy accurately predicts subsequent CR-POPF. It can be readily learned and broadly deployed. This prediction tool can help surgeons anticipate, identify, and manage this ominous complication from the outset.
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Comparative Study
Increasing reporting of adverse events to improve the educational value of the morbidity and mortality conference.
The aim of this study was to investigate the impact of a validated complication proforma on surgical Morbidity and Mortality (M&M) conference reporting. ⋯ We demonstrated that prospective standardized incident recording provides significantly more accurate assessment of M&M data compared with current reporting methods. This increased accuracy should favorably affect surgical performance indicators and casemix funding.
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Patients undergoing liver resection for colorectal cancer liver metastasis (CRCLM) are often treated with chemotherapy before surgery. However, the associations between chemotherapy, liver injury, perioperative outcomes, and other confounding factors remain unclear. This study investigates the effect of preoperative chemotherapy for CRCLM on nontumoral liver histology and perioperative outcomes in a contemporary cohort. ⋯ With appropriate patient selection, liver resection for CRCLM can be safely performed in patients treated with preoperative chemotherapy.
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Comparative Study
Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes.
The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training. ⋯ Resident participation increases operative times for laparoscopic surgery considerably. Morbidity is statistically higher with resident participation but differences are unlikely to be clinically significant. Resident participation is a surrogate for the learning environment. These findings provide impetus for additional development of training techniques that occur outside the operating room.