Journal of the American College of Surgeons
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Comparative Study
Predictors of operative mortality in cardiac surgical patients with prolonged intensive care unit duration.
Several systems have been developed to predict mortality after intensive care unit (ICU) admission in medical and surgical patients. However, a similar tool specific to cardiac surgical patients with prolonged ICU duration does not exist. The purpose of the current study was to identify independent perioperative predictors of operative mortality among cardiac surgical patients with prolonged ICU duration. ⋯ Operative mortality can be predicted by select risk factors for cardiac surgical patients with prolonged ICU duration. Patient age, preoperative intra-aortic balloon pump, postoperative cardiac arrest, prolonged ventilation, and stroke have the strongest association with mortality. Identification of these factors in the perioperative setting can enhance resource use and improve mortality after cardiac surgery.
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Randomized Controlled Trial Multicenter Study Comparative Study
Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy.
Minimally invasive techniques have become an integral part of general surgery with recent investigation into single-incision laparoscopic cholecystectomy (SILC). This study presents the final 1-year results of a prospective, randomized, multicenter, single-blinded trial of SILC vs multiport cholecystectomy (4PLC). ⋯ Results of this trial show SILC to be a safe and feasible procedure when compared with 4PLC, with similar total adverse events but with an identified significant increase in hernia formation. Cosmesis scoring and patient preference at 12 months continue to favor SILC, and more than half of the patients were willing to pay more for a single-site surgery over a standard laparoscopic procedure. Additional longer-term population-based studies are needed to clarify if this increased rate of hernia formation as compared with 4PLC will continue to hold true.