Annals of surgery
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Observational Study
Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program.
To determine whether concurrently performed operations are associated with an increased risk for adverse events. ⋯ In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.
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We hypothesized that inpatient postoperative pain trajectories are associated with 30-day inpatient readmission and emergency department (ED) visits. ⋯ Postoperative pain trajectories identify populations at risk for 30-day readmissions and ED visits, and do not seem to be mediated by postdischarge complications. Addressing pain control expectations before discharge may help reduce surgical readmissions in high pain categories.
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Randomized Controlled Trial Comparative Study
A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery.
The primary objective of this randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient-controlled analgesia (IV-PCA) for pain control over the first 48 hours after hepatopancreatobiliary (HPB) surgery. Secondary endpoints were patient-reported outcomes, total narcotic utilization, and complications. ⋯ In major HPB surgery, TEA provides a superior patient experience through improved pain control and less narcotic use, without increased length of stay or complications.
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Comparative Study
Pharmacological Thromboembolic Prophylaxis in Traumatic Brain Injuries: Low Molecular Weight Heparin Is Superior to Unfractionated Heparin.
We hypothesized that low molecular weight heparin (LMWH) is superior to unfractionated heparin (UH) for venous thromboembolism (VTE) prophylaxis in patients with severe traumatic brain injuries (TBI). ⋯ LMWH prophylaxis in severe TBI is associated with better survival and lower thromboembolic complications than UH.
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We present 8-year follow-up data from the intern class of 2007 to 2008 using a novel, nonparametric predictive model to identify those residents who are at greatest risk of not completing their training. ⋯ This is the first longitudinal cohort study to identify factors at the start of training that put residents at risk for not completing training. Data from this study offer a method to identify interns at higher risk for attrition at the start of training, and next steps would be to create and test interventions in a directed fashion.