Annals of surgery
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Comparative Study
Surgical Outcomes for Mastectomy Patients Receiving Neoadjuvant Chemotherapy: A Propensity-Matched Analysis.
To evaluate the risk of neoadjuvant chemotherapy for surgical morbidity after mastectomy with or without reconstruction using 1:1 matching. ⋯ This large, matched cohort study, controlled for preoperative risk factors and most importantly for the surgical procedure performed, demonstrates that breast cancer patients receiving neoadjuvant chemotherapy have no increased risk for surgical morbidity.
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Comparative Study
Hospital Teaching Status and Medicare Expenditures for Complex Surgery.
To evaluate the relationship between hospital teaching intensity, Medicare payments, and perioperative outcomes. ⋯ After price-standardization to account for intended differences in Medicare spending, risk-adjusted Medicare payments for an episode of surgical care were similar at teaching hospitals and nonteaching hospitals for three complex inpatient operations.
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Observational Study
Traumatic Endotheliopathy: A Prospective Observational Study of 424 Severely Injured Patients.
Investigate and confirm the association between sympathoadrenal activation, endotheliopathy and poor outcome in trauma patients. ⋯ We confirmed that sympathoadrenal activation was strongly and independently associated with endothelial glycocalyx and cell damage (ie, endotheliopathy) and furthermore that sympathoadrenal activation and endotheliopathy were independent predictors of mortality in trauma patients.
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Comparative Study
Variation in the Utilization of Minimally Invasive Surgical Operations.
The goal of this study was to examine regional variation in use of minimally invasive surgical (MIS) operations. ⋯ Variation in utilization of MIS exists and differs by operation. Patient demographics, patient disease, and the ability to access care are associated only with variation in use of MIS for colectomy. For all other operations studied, these factors do not explain variation in MIS use. Further investigation is warranted to identify and eliminate causes of variation.
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Publicly reported hospital ratings aim to encourage transparency, spur quality improvement, and empower patient choice. Travel burdens may limit patient choice, particularly for older adults (aged 65 years and more) who receive most medical care. For 3 major hospital ratings systems, we estimated travel burden as the additional 1-way travel distance to receive care at a better-rated hospital. ⋯ To receive care at a better-rated hospital, travel distances commonly exceeded 25 miles: HCAHPS (39.2%), STS-CABG (62.7%), and US News Top Hospital (85.2%). Additional 1-way travel distances exceeded 25 miles commonly: HCAHPS (23.7%), STS-CABG (36.7%), US News Top Hospitals (81.8%). Significant travel burden is common for older adults seeking "better" care and is an important limitation of current hospital ratings for empowering patient choice.