Annals of surgery
-
Multicenter Study
Desmoid-type fibromatosis and pregnancy: a multi-institutional analysis of recurrence and obstetric risk.
Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. ⋯ Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.
-
Multicenter Study
Hospital center effect for laparoscopic colectomy among elderly stage I-III colon cancer patients.
To investigate hospital-level variation in short-term laparoscopic colectomy outcomes among stage I-III elderly colon cancer patients. ⋯ HCE exists for LOS and in-hospital mortality of laparoscopic colectomy, which suggests that the choice of hospital affects outcomes independently of other confounding variables. Reducing the variation in outcomes associated with HCE may improve the quality of cancer care.
-
Multicenter Study
Ranking and rankability of hospital postoperative mortality rates in colorectal cancer surgery.
To examine to what extent random variation and variation in case-mix influence hospital rankings on the basis of mortality rates and to determine the suitability of mortality for ranking hospitals in colorectal surgery. ⋯ Hospital ranks changed after case-mix adjustment and random-effects models, compared with unadjusted analysis. A large proportion of hospital variation in mortality was due to chance. Caution should be warranted when interpreting hospital rankings on the basis of postoperative mortality. Percentiles of expected ranks may help identify hospitals with exceptional performance.
-
Multicenter Study
The impact of general surgeon supply on the risk of appendiceal rupture in North Carolina.
To determine whether individuals from surgery-specific service areas with a low supply of general surgeons (GSs) are at increased risk for ruptured appendicitis (ruptured appendicitis is an indicator of surgical access). ⋯ The supply of GSs does affect access to surgical services for appendicitis. Expanding on this finding, the recently instituted HPSA (health professional shortage area) surgical incentive payment from the Affordable Care Act should be evaluated closely for its effectiveness. Enhancing supply in critical shortage areas could reduce appendiceal rupture and improve surgical access more generally.
-
Randomized Controlled Trial Multicenter Study Comparative Study
A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer.
To compare the efficacy and safety of antithrombotic prophylaxis given for 1 week or 4 weeks in patients undergoing laparoscopic surgery for colorectal cancer. ⋯ After laparoscopic surgery for colorectal cancer, extended antithrombotic prophylaxis is safe and reduces the risk for VTE as compared with 1-week prophylaxis (NCT01589146).