Journal of the American College of Surgeons
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Damage control surgery is a staged approach to the trauma patient in extremis that improves survival, but leads to open abdominal wounds that are difficult to manage. We evaluated whether directed peritoneal resuscitation (DPR) when used as a resuscitation strategy in severely injured trauma patients with hemorrhagic shock requiring damage control surgery would affect the amount of and timing of resuscitation and/or show benefits in time to abdominal closure and reduction of intra-abdominal complications. ⋯ The addition of adjunctive DPR to the damage control strategy shortens the interval to definitive fascial closure without affecting overall resuscitation volumes. As a result, this mitigates intra-abdominal complications associated with open abdomen and damage control surgery and affords better patient outcomes.
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African American women have a higher breast cancer mortality rate than Caucasian women. Estrogen receptor (ER)-negative tumors, which are more aggressive than ER-positive tumors, occur more frequently in African American women than in Caucasian women and may contribute to apparent disparities in outcomes. However, outcome results need to be controlled for socioeconomic status (SES). We evaluated the effect of race and ethnicity on outcomes of patients with ER-negative tumors by determining outcomes in African American and Caucasian women with low SES but similar access to care. ⋯ In a predominantly indigent population, race and ethnicity had no impact on outcomes for ER-negative breast cancer.
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Cholecystectomy during initial hospitalization is the current recommended therapy for acute cholecystitis. The rate of cholecystectomy and subsequent health care trajectory in elderly patients with acute cholecystitis has not been evaluated. ⋯ Our study demonstrated that 25% of cholecystectomies on Medicare beneficiaries were not performed on initial hospitalization, leading to readmissions in 38% of surviving patients. For patients requiring readmission, the percentage of open procedures was increased, and the additional Medicare payment was $7,000 per re-admission. Cholecystectomy for acute cholecystitis in elderly patients should be performed during initial hospitalization to prevent recurrent episodes of cholecystitis, multiple readmissions, higher readmission rates, and increased costs.
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In 1978 in Washington, DC, we became aware of the scarcity of minority donors, especially African Americans. ⋯ The investment of $10 million may seem substantial when we look at the cost-to-benefit ratio associated with the cost savings of $135,000 per donor. But it is small when compared with the more than $200 million saved by kidney donors alone, which is associated with the expected increase in the percentage of minority donors to 35% by 2010, or the equivalent of 1,750 minority donors.
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Moving beyond traditional measurement of mortality after injury: evaluation of risks for late death.
The purpose of this study was to evaluate long-term mortality after trauma, and to determine risk factors and possible disparities related to mortality after hospital discharge. ⋯ There is significant mortality attributable to trauma for up to 1 year after hospital discharge. These findings suggest that mortality after trauma needs to be measured beyond hospital discharge in order to assess the complete impact of injury.