Archives of surgery (Chicago, Ill. : 1960)
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Postoperative pancreatic fistula (POPF) is one of the most severe surgical complications of pancreatoduodenectomy (PD) with pancreaticojejunostomy (PJ) reconstruction. Recently, POPF has been classified as grade A, B, or C. Relaparotomy is mandatory for POPF associated with sepsis or hemorrhage (grade C). Peripancreatic drainage and completion pancreatectomy are the procedures most commonly used, but associated morbidity and mortality remain high. We hypothesized that the results of pancreatogastrostomy (PG) for treatment of grade C POPF following PD with PJ in the rare patients for whom relaparotomy is necessary would be similar to the results in a historical series of similar patients who underwent completion pancreatectomy. ⋯ In selected patients, salvage PG can be considered a safe and efficient alternative to completion pancreatectomy for the treatment of grade C POPF after PD with PJ.
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Comparative Study
Race and insurance status as risk factors for trauma mortality.
To determine the effect of race and insurance status on trauma mortality. ⋯ Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.
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We hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk. ⋯ Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.
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Review Meta Analysis
Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis.
To review the impact of epidural vs systemic analgesia on postoperative pulmonary complications. ⋯ Epidural analgesia protects against pneumonia following abdominal or thoracic surgery, although this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.
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To critically analyze a large single-institution experience with distal pancreatectomy (DP), with particular attention to the risk factors, outcome, and management of the postoperative pancreatic fistula (PF). ⋯ Pancreatic fistula is the most common complication after DP and its incidence varies depending on the definition applied. Several risk factors for developing a PF were identified. Splenic preservation after DP is safe. The grade of a PF correlates well with clinical outcomes, and most PFs may be managed nonoperatively.