Annals of surgery
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The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal (GI) tract in a large unselected cohort of patients with necrotizing pancreatitis. ⋯ Perforation and fistula of the GI tract occurred in one out of six patients with necrotizing pancreatitis. Risk factors were high C-reactive protein within 48 hours and early organ failure. Prior intervention was identified as a risk factor for perforation or fistula of the lower GI tract. The clinical course was mostly affected by involvement of the lower GI tract.
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To explore how surgery residents cope with unwanted patient outcomes including postoperative complications and death. ⋯ In this novel qualitative study, general surgery residents described the coping strategies that they organically used after postoperative complications and deaths. To improve resident well-being, it is critical to first understand the natural coping processes. Such efforts will facilitate structuring future support systems to aid residents during these difficult periods.
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To develop a fistula risk score for auditing, to be able to compare postoperative pancreatic fistula (POPF) after pancreatoduodenectomy among hospitals. ⋯ The auditing fistula risk score was successful in case-mix adjustment and enables fair comparisons of POPF rates among hospitals.
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We hypothesized that, on average, patients do not benefit from additional adjuvant therapy after neoadjuvant therapy for locally advanced esophageal cancer, although subsets of patients might. Therefore, we sought to identify profiles of patients predicted to receive the most survival benefit or greatest detriment from adding adjuvant therapy. ⋯ Adjuvant therapy after neoadjuvant therapy has value primarily for patients with more advanced esophageal cancer. Because the benefit is often small, patients considering adjuvant therapy should be counseled on benefits versus morbidity. In addition, given that the overall benefit was meaningful in a small number of patients, emerging modalities such as immunotherapy may hold more promise in the adjuvant setting.
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Evaluate the association of evidence-based opioid prescribing guidelines with new persistent opioid use after surgery. ⋯ Evidence-based opioid prescribing guidelines were associated with a significant reduction in the incidence of new persistent opioid use and the quantity of opioids prescribed after surgery.