Impact of preinjury warfarin and antiplatelet agents on outcomes of trauma patients.

Background: Warfarin and antiplatelet agents (WAA) are prevalent among trauma patients, but the impact of these agents on patient outcomes has not been clearly defined. In this study, we examined the impact of preinjury WAA on outcomes in trauma patients.

Methods: A 40-month (September 2004 to December 2007) retrospective review of data in the trauma registry at a New York State level 1 trauma center was performed.

Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.

Purpose: This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease.

Methods: From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts.

Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions.

Background: Laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most commonly performed bariatric procedures. Although both procedures likely reduce healthcare expenditures related to the resolution of co-morbid conditions, they have different rates of perioperative risks and different rates of associated weight loss. We designed a model to evaluate the incremental cost-effectiveness of these procedures compared with nonoperative weight loss interventions and with each other.

Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures.

Context: Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown.

Objectives: To evaluate the risk of early mortality among Medicare beneficiaries and to determine the relative risk of death among older patients.

A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults.

Background: There are several methods of contrast administration when performing computed tomography (CT) scanning for suspected appendicitis. In this systematic review we evaluated the diagnostic performance of CT with and without contrast material.

Methods: Twenty-three reports were identified using a Medline search.

Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review.

This review was designed to describe the diagnostic performance of computed tomography (CT) in assessing bowel ischemia and complete obstruction in small bowel obstruction (SBO). A MEDLINE search (1966-2004) identified 15 studies dealing with the CT diagnosis of ischemia and complete obstruction in SBO. Ischemia was defined by operative findings, and complete obstruction was defined by enteroclysis or operative findings.

Temporal changes in the management of diverticulitis.

Purpose: This study was designed to evaluate temporal trends in the use and type of operative and non-operative interventions in the management of diverticulitis.

Methods: A retrospective cohort using a statewide administrative database was used to identify all patients hospitalized for diverticulitis in the state of Washington (1987-2001). Poisson and logistic regression were used to calculate changes in the frequency of hospitalization, operative and percutaneous interventions, and colostomy over time.

Hartmann's colectomy and reversal in diverticulitis: a population-level assessment.

Purpose: This study was designed to assess the costs and outcomes of colostomy and colostomy reversal in patients with diverticulitis and examine the impact of such procedures on the health care system.

Methods: We employed a retrospective design and used a Washington State administrative database to identify patients undergoing operations with colostomy (1987-2002) who were followed over time. Descriptive and comparative analysis was performed, focusing on patients with diverticulitis.

Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis? A systematic review.

Purpose: This systematic literature review was designed to summarize and compare the reported outcomes of one-stage and two-stage operations for the treatment of perforated diverticulitis with peritonitis.

Methods: This review identified 98 published studies (1957-2003) dealing with the surgical management of perforated diverticulitis with peritonitis, either with primary resection and anastomosis or with the Hartmann's procedure. Aggregated results of adverse outcomes were calculated but statistical comparisons were not appropriate because of data and design heterogeneity.

The timing of elective colectomy in diverticulitis: a decision analysis.

Background: Determining the optimal strategy for elective colectomy in patients with diverticular disease involves a balance of the morbidity, mortality, costs, and quality of life associated with both elective and expectant management. We used decision and cost analysis to simulate the clinical and economic outcomes after recovery from an episode of nonsurgically treated diverticulitis to determine the preferable management strategy.

Study Design: A Markov model was constructed to evaluate lifetime risks of death and colostomy, care costs, and quality of life associated with elective colectomy after subsequent episodes of diverticulitis.

Impact of surgical clipping on survival in unruptured and ruptured cerebral aneurysms: a population-based study.

Background And Purpose: The management of aneurysms is controversial because little is known about the impact of clipping on long-term outcome. This study was designed to evaluate long-term survival of patients with aneurysms undergoing clipping in a statewide population.

Methods: We used a retrospective design using an administrative database to identify patients hospitalized with aneurysms (1987 to 2001).

Development of epidural abscess following surgical drainage of perianal abscess: report of a case.

Purpose: A case of epidural abscess originating from a perianal abscess is reported.

Methods: The history of the patient, erythrocyte sedimentation rate, magnetic resonance imaging, and bacteriological tests were used to reach a diagnosis and the possible mechanism.

Results: Epidural abscess was suspected because the patient had a fever and intense low back pain following drainage of a perianal abscess.

Acute abdominal pain. Four classifications can guide assessment and management.

Abdominal pain is a common occurrence in older persons and a frequent catalyst for office and emergency room visits. Complaints must be investigated thoroughly because they often indicate serious underlying pathology such as Infection, mechanical obstruction, malignancy, biliary disease, cardiac problems, and GI ischemia. One means of overcoming a sprawling differential diagnosis is to determine whether the problem falls into one of four general categories: peritonitis, bowel obstruction, vascular catastrophe, or nonspecific abdominal pain.