Surgery
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The National Surgical Quality Improvement Program (NSQIP) has reduced complications for surgery patients in the Department of Veterans Affairs Healthcare System. The American College of Surgeons Committee on Trauma maintains the National Trauma Data Bank (NTDB) to track injured patient comorbidities, complications, and mortality. We sought to apply the NSQIP methodology to collect comorbidity and outcome data for trauma patients. Data were compared to the NTDB to determine the benefit and validity of using the NSQIP methodology for trauma. ⋯ Complications occurred more frequently in trauma patients than general surgery patients. The UM NSQIP Trauma patients had higher rates of complications than reported in the NTDB. The NTDB data potentially underreport important comorbidity and outcome data. Application of the NSQIP methodology to trauma may present an improved means of effectively tracking and reducing adverse outcomes in a risk-adjusted manner.
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The field of postgraduate minimally invasive surgery/gastrointestinal surgery (MIS/GIS) training has undergone substantial growth and change. To determine whether fellowships are meeting a strategic need in training, we conducted a survey to assess the current status and trends of change in MIS/GIS fellowships. ⋯ It seems that the MIS/GIS Fellowship is meeting a real need among graduating surgical residents; fellows felt unprepared for clinical practice at the completion of residency. It is encouraging to note the improvements in fellowship structure, standards, and overall experience, brought by the efforts of the FC. It is hoped that this report of the state of MIS fellowship with a comprehensive review of current data will aid in further evaluation and improvement.
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Postoperative ileus is a transient cessation of bowel motility that occurs after bowel resection (BR). Alvimopan, a peripherally acting mu-opioid receptor antagonist accelerated gastrointestinal (GI) recovery in 5 randomized, double-blind, phase III postoperative ileus trials. ⋯ These post hoc analyses support that alvimopan (12 mg) accelerates GI recovery across various patient populations.
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Achieving and maintaining hemostasis in neurosurgical procedures is critical to the outcome. After trauma to the brain, a cascade of events initiated by tissue factor (TF) or thromboplastin results in a coagulation process that develops into an exaggerated fibrinolytic response, called disseminated intravascular coagulation (DIC). ⋯ Recombinant factor VIIa (rFVIIa) also is discussed, including its mechanism of action and use in neurosurgery. The ultra-early administration of rFVIIa also is covered, in both the military and the civilian settings.
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Major bile duct injuries remain a potentially devastating complication after laparoscopic cholecystectomy. A retrospective review was conducted of patients who underwent a biliary-enteric reconstruction of a biliary injury to assess their long-term outcome. ⋯ Bile duct injuries that require a biliary-enteric repair are commonly associated with long-term complications. Level of injury and likely timing of repair predict risk of postoperative stricture.