Systemic glucocorticoid exposure and postoperative infection risk in 143,782 appendectomy patients-a Danish longitudinal nationwide study.

Background: Glucocorticoids are conventionally associated with increased postoperative infection risk. It is necessary to clarify if preoperative glucocorticoid exposure is associated with postoperative infection in appendectomy patients and if the association is different for open and laparoscopic appendectomies.

Methods: A Danish nationwide study of appendectomy patients between 1996 and 2018.

Self-reported and genetically predicted coffee consumption and smoking in dementia: A Mendelian randomization study.

Background And Aims: Studies of self-reported coffee consumption and smoking on risk of dementia have shown results conflicting with two-sample Mendelian randomization studies. We tested the hypotheses that coffee consumption and smoking influence risk of dementia using observational and one-sample Mendelian randomization designs with individual level data.

Methods: We included 114,551 individuals from two Danish general population cohorts (median age 58 years).

Causal relationship from coffee consumption to diseases and mortality: a review of observational and Mendelian randomization studies including cardiometabolic diseases, cancer, gallstones and other diseases.

Purpose: High coffee consumption is associated with low risk of mortality and morbidity, but the causality remains unclear. This review aims to discuss findings from observational studies on coffee consumption in context of Mendelian randomization studies.

Methods: The PubMed database was searched for all Mendelian randomization studies on coffee consumption and corresponding observational studies.

The Obesity Paradox in Elderly Patients Undergoing Emergency Surgery: A Nationwide Analysis.

Background: Obesity has long been considered a risk factor for postoperative adverse events in surgery. We sought to study the impact of body mass index (BMI) on the clinical outcomes of the high-risk emergency general surgery (EGS) elderly patients.

Methods: All EGS ≥65 years old patients in the 2007-2016 ACS-NSQIP database, identified using the variables 'emergency' and 'surgspec,' were included.

The Geriatric Nutritional Risk Index is a powerful predictor of adverse outcome in the elderly emergency surgery patient.

Background: The degree to which malnutrition impacts perioperative outcomes in the elderly emergency surgery (ES) patient remains unknown. We aimed to study the relationship between malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), and postoperative outcomes in elderly patients undergoing ES.

Methods: Using the 2007 to 2016 American College of Surgeons National Surgical Quality Improvement Program database, all patients 65 years or older undergoing ES were included in our study.

Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study.

Objective: The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world.

Summary Of Background Data: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic.

Smoking and risk of surgical bleeding: nationwide analysis of 5,452,411 surgical cases.

Background: Although smoking is associated with several postoperative complications, a possible association with surgical bleeding remains unclear. We examined if smoking is associated with a higher risk of surgical bleeding.

Study Design And Methods: We included patients from the American College of Surgeons National Surgical Quality Improvement Program 2007-2016 from 680 hospitals across the United States.

Red blood cell transfusion in surgery: an observational study of the trends in the USA from 2011 to 2016.

Guidelines recommend restrictive red blood cell transfusion strategies. We conducted an observational study to examine whether the rate of peri-operative red blood cell transfusion in the USA had declined during the period from 01 January 2011 to 31 December 2016. We included 4,273,168 patients from all surgical subspecialties.

Coffee intake protects against symptomatic gallstone disease in the general population: a Mendelian randomization study.

Background And Objectives: Coffee intake is associated with low risk of symptomatic gallstone disease (GSD). We tested the hypothesis that high coffee intake causally protects against symptomatic GSD using a Mendelian randomization design.

Methods: First, we tested whether high coffee intake was associated with low risk of GSD in 104 493 individuals from the general population.

Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients.

Background: Recent studies suggest that obesity is a risk factor for Clostridium difficile infection, possibly due to disruptions in the intestinal microbiome composition. We hypothesized that body mass index (BMI) is associated with increased incidence of C. difficile infection in surgical patients.

Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care.

Background: Hospital length of stay (LOS) is currently recognized as a key quality indicator. We sought to investigate how much of the LOS variation in the high-risk group of patients undergoing Emergency general surgery could be explained by clinical versus nonclinical factors.

Methods: Using the 2007 to 2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we included all patients who underwent an emergency appendectomy, cholecystectomy, colectomy, small intestine resection, enterolysis, or hernia repair.

Life after 90: Predictors of mortality and performance of the ACS-NSQIP risk calculator in 4,724 nonagenarian patients undergoing emergency general surgery.

Background: The decision to emergently operate on nonagenarian patients (NONAs) can be complex due to the uncertainty about outcomes and goals of care at this advanced age. We sought to study: (1) the outcomes and predictors of mortality for NONAs undergoing emergency general surgery (EGS) and (2) the accuracy of ACS-NSQIP mortality risk calculator in this special population.

Methods: Using the 2007 to 2015 ACS-NSQIP database, we included all patients older than 90 years of age who underwent an emergent operation with a Current Procedural Terminology (CPT) code for "digestive system.

Emergency Surgery Score Accurately Predicts the Risk of Post-Operative Infection in Emergency General Surgery.

Background: The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding one to three integer points for each of 22 pre-operative variables (demographics, co-morbidities, and pre-operative laboratory values); increasing scores accurately and gradually predict higher mortality rates. We sought to evaluate whether ESS can predict the occurrence of post-operative infectious complications in EGS patients.

Variation of Opioid Prescribing Patterns among Patients undergoing Similar Surgery on the Same Acute Care Surgery Service of the Same Institution: Time for Standardization?

Background: Diversion of unused prescription opioids is a major contributor to the current United States opioid epidemic. We aimed to study the variation of opioid prescribing in emergency surgery.

Methods: Between October 2016 and March 2017, all patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, or inguinal hernia repair in the acute care surgery service of 1 academic center were included.

Heavier smoking increases coffee consumption: findings from a Mendelian randomization analysis.

Background: There is evidence for a positive relationship between cigarette and coffee consumption in smokers. Cigarette smoke increases metabolism of caffeine, so this may represent a causal effect of smoking on caffeine intake.

Methods: We performed Mendelian randomization analyses in the UK Biobank (N = 114 029), the Norwegian HUNT study (N = 56 664) and the Copenhagen General Population Study (CGPS) (N = 78 650).

The effect of resuscitation strategy on the longitudinal immuno-inflammatory response to blunt trauma.

Introduction: Resuscitation strategies following blunt trauma have been linked to immuno-inflammatory complications leading to systemic inflammatory syndrome (SIRS), sepsis and multiple organ failure (MOF). The effect of resuscitation strategy on longitudinal inflammation marker trajectories is, however, unknown. We hypothesized that the effect of resuscitation strategy extends beyond the trauma-related coagulopathy, perhaps affecting the longitudinal immuno-inflammatory response to injury.

Coffee intake, cardiovascular disease and all-cause mortality: observational and Mendelian randomization analyses in 95 000-223 000 individuals.

Background: Coffee has been associated with modestly lower risk of cardiovascular disease and all-cause mortality in meta-analyses; however, it is unclear whether these are causal associations. We tested first whether coffee intake is associated with cardiovascular disease and all-cause mortality observationally; second, whether genetic variations previously associated with caffeine intake are associated with coffee intake; and third, whether the genetic variations are associated with cardiovascular disease and all-cause mortality.

Methods: First, we used multivariable adjusted Cox proportional hazard regression models evaluated with restricted cubic splines to examine observational associations in 95 366 White Danes.

Coffee intake and risk of obesity, metabolic syndrome and type 2 diabetes: a Mendelian randomization study.

Background: Coffee is one of the most widely consumed beverages. We tested the hypothesis that genetically high coffee intake is associated with low risk of obesity, metabolic syndrome and type 2 diabetes, and with related components thereof.

Methods: We included 93,179 individuals from two large general population cohorts in a Mendelian randomization study.

Major vascular injuries during laparoscopic procedures.

Background: Major vascular complications following laparoscopic procedures are rare, with only 20 cases reported in the literature.

Patients And Methods: The cases of 4 patients who sustained 5 vascular injuries during laparoscopic procedures between June 1991 and May 1994 are presented, and previously reported cases in the literature are reviewed.

Results: All injuries occurred during pelvic laparoscopy (2 diagnostic procedures, 1 tubal ligation, and 1 hernia repair).

Omphalocaval shunt: an alternative procedure for portal decompression.

We report a case in which umbilical vein was used to construct an omphalocaval shunt in a patient with a long history of alcoholic liver disease and recurrent esophageal and gastric variceal bleeding episodes. The indication for the choice of this procedure included the presence of dense adhesions in the porta hepatis, arteriographic documentation of continuity with the portal venous system, and an umbilical vein 12 mm in internal diameter. The hypertensive portal system was successfully decompressed and proved patent 6 months postoperatively.

Contemporary management of amebic liver abscess.

In a retrospective review covering 16 years divided into two time periods, 133 patients with amebic liver abscess were evaluated. Most of the patients were young, Hispanic men, and one-third had coexistent disease. A reliable diagnosis can be established in 24 hours using ultrasound or computed tomography scans.

High grade occlusion of the iliac vein by a traumatic pelvic hematoma without fracture.

A case of a man with a massive pelvic hematoma from blunt trauma without bony fracture is presented. The pressure of the hematoma on the iliac vein prevented fluid resuscitation using this route. A pelvic hematoma should be suspected in patients with iliac vein obstruction after blunt pelvic trauma even in the absence of fractures.

Effect of Aspirin and Dipyridamole on Sequential Graft Platelet Accumulation after Implantation of Small Diameter PTFE Prosthesis.

The optimal duration of antiplatelet therapy was evaluated by sequential measurement of platelet accumulation on polytetrafluoroethylene (PTFE) grafts. Sixty four New Zealand white rabbits received aspirin (ASA, 10 mg/kg/day) and dipyridamole (DPM, 10 mg/kg/day) (n = 34), or placebo (n = 30), beginning 3 days prior to insertion of a 10 mm x 3 mm PTFE interposition aortic graft. Using autologous In-111 labelled platelets, a graft platelet accumulation index (GPAI) was calculated as the grafttreference aorta ratio of activity of In-111.