Surgery
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The incidence, clinical characteristics, and long-term outcomes of patients with gastroenteropancreatic neuroendrocrine tumors and carcinoid syndrome undergoing operative resection have not been well characterized. ⋯ Among patients undergoing operative resection of gastroenteropancreatic neuroendrocrine tumors, the prevalence of preoperative carcinoid syndrome was low. Although operative intervention with resection or especially debulking in patients with carcinoid syndrome was disappointing and often failed to improve symptoms, after controlling for markers of tumor burden, carcinoid syndrome was not independently associated with worse disease-free survival or overall survival.
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Epidemiologic data related to the surgical management of appendicitis are out of date. As we contemplate the role of nonoperative therapy in uncomplicated appendicitis, a contemporary profile of the risks and benefits of operative appendectomy is needed. ⋯ Preoperative imaging, a laparoscopic approach, and excellent clinical outcomes have become the norm for the surgical management of uncomplicated appendicitis. As surgeons contemplate the role of nonoperative therapy for uncomplicated appendicitis, the data presented here should be used to inform the ongoing debate.
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Laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding all lead to substantial weight loss in obese patients. Long-term weight loss can be highly variable beyond 1-year postsurgery. This study examines and compares the frequency distribution of weight loss and lack of treatment effect rates after laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding. ⋯ This study emphasizes the existing variability in weight loss across bariatric procedures as well as in the lack of a treatment effect for each procedure. Although laparoscopic adjustable gastric banding has the greatest rate of a lack of a successful treatment effect, the rate remained stable over 3 years postoperatively. Laparoscopic sleeve gastrectomy showed a doubling in the rate of a lack of a successful treatment effect every year reaching 25% at year 3. The rates for lack of a successful treatment effect for laparoscopic Roux-en-Y gastric bypass remained stable at about 1% for the first 3 years postoperatively.
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Extracorporeal membrane oxygenation is used as a life-sustaining measure in patients with acute or end-stage cardiac or respiratory failure. We analyzed national trends in extracorporeal membrane oxygenation use and outcomes and assessed the influence of hospital demographics. ⋯ The past decade has seen an exponential growth of ECMO extracorporeal membrane oxygenation in the United States, with the fraction for respiratory failure displaying considerable growth. Overall extracorporeal membrane oxygenation patients experienced substantially reduced mortality, driven by improved outcomes for postcardiotomy patients, along with a trend toward an increased risk profile. Disproportionate use of extracorporeal membrane oxygenation in the Northeast warrants investigation of access to this technology across the United States.
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The role of postoperative day 1 drain fluid amylase level in predicting clinically relevant postoperative pancreatic fistula is under investigation. In a previous multicenter study conducted on 338 patients undergoing distal pancreatectomy, day 1 drain fluid amylase level has been correlated to the development of a clinically relevant pancreatic fistula and an amylase value of 2,000 U/L was found to be most predictive of the development of clinically relevant postoperative pancreatic fistula. Our objective was to validate the previously established cutoff level for drain fluid amylase on postoperative day 1 after distal pancreatectomy as a predictor for clinically relevant postoperative pancreatic fistula using a different patient population from the National Surgery Quality Improvement Program database. ⋯ Using a different population of patients and a different data set as well as an independent analysis, we successfully validated a day 1 drain fluid amylase level of 2,000 U/L as striking the best balance in terms of sensitivity and specificity for the detection of clinically relevant postoperative pancreatic fistula. The identified cutoff might be employed in the design of a trial of early drain removal in patients undergoing distal pancreatectomy.