Impact of accountable care organizations on acute cholecystitis outcomes in the Rio Grande Valley.

Background: Accountable care organizations through the Affordable Care Act are to improve Medicare beneficiaries' health while reducing costs. We hypothesize that this model may shift care, disease burden, and costs to nonaffiliated hospital facilities in patients with acute cholecystitis.

Methods: A retrospective difference-in-differences analysis was performed to compare severity, postoperative complications, diagnostic modality, length of stay, and costs in patients with acute cholecystitis from a post-accountable care organization implementation period (January 2014 through December 2015) to a pre-accountable care organization period (January 2011 through December 2012).

Diabetes and Its Effect on Abdominal Aortic Aneurysm Growth Rate in Hispanic Patients.

Background: The growth rate of abdominal aortic aneurysms (AAA) can vary depending on age, baseline diameter, blood pressure, race, and history of smoking. Paradoxically, previous studies show evidence of a protective effect of diabetes on the rate of AAA expansion despite its well-established role in the morbidity and mortality of cardiovascular disease. This study aims to investigate the impact diabetes plays on AAA growth within a Hispanic population.

The effect of Hispanic ethnicity on surgical outcomes: An analysis of the NSQIP database.

Background: Existing literature has shown racial/ethnic disparities between white and black surgical populations, however, surgical outcomes for Hispanic patients are limited in both scope and quantity.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2015 was used to analyze surgical outcomes in approximately 3.5 million patients.

Calcium channel blockers and the incidence of breast and prostate cancer: A meta-analysis.

What Is Known And Objective: Breast cancer (BCa) and prostate cancer (PCa), both hormone-dependent cancers, are the second leading cause of death in both women and men, respectively. Calcium channel blockers (CCBs) have been thought to increase the risk of cancer by inhibiting calcium signal-mediated apoptosis, but the evidence for this association remains inconclusive. We have reviewed pertinent literature and pooled data to establish a consensus on the relationship of CCB use and the incidence of these two cancers.

Prevalence of Aflatoxin-Associated Mutation in Hepatocellular Carcinoma in Hispanics in South Texas.

We aimed to determine whether aflatoxin dietary exposure plays a role in the high incidence of hepatocellular carcinoma (HCC) observed among Hispanics in South Texas. We measured somatic mutation, hallmark of aflatoxin etiology in HCC, using droplet digital PCR and RFLP. mutation was detected in 3 of 41 HCC tumors from Hispanics in South Texas (7.

Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms.

Objectives: Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability.

Pediatric Nonalcoholic Fatty Liver Disease: the Rise of a Lethal Disease Among Mexican American Hispanic Children.

Hispanic children of Mexican origin have a high incidence of NAFLD. Susceptibility has been linked to a combination of factors including an increasing epidemic of obesity in children and adolescents, an allele substitution in the PNPLA3 gene that reduces hepatic lipid catabolism, and an altered microbiome that may increase hepatic endotoxins. The combination of NAFLD and portal vein toxins secondary to an indigenous gut microbiome appear to lead to the early occurrence of NASH, which progresses to cirrhosis and early hepatocellular carcinoma.

Sleeve gastrectomy and Roux En Y gastric bypass: current state of metabolic surgery.

Purpose Of Review: Roux En Y gastric bypass (RYGB) is considered the bariatric gold standard. Recently, sleeve gastrectomy has gained significant popularity. Early evidence suggests sleeve gastrectomy as a well tolerated and efficacious alternative to RYGB.

Impact of a blood conservation program on 30-day morbidity and mortality: a cohort study.

Background: There are little published data on outcomes of blood conservation (BC) patients after noncardiac surgery. The objective of this study was to compare the surgical outcomes of patients enrolled in our BC program with that of the general population of surgical patients.

Methods: BC patients at our institution undergoing various surgical procedures were identified from the 2007-2009 National Surgical Quality Improvement Program database and compared with a cohort of conventional care (CC) patients matched by age, gender, and surgical procedure.

Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations.

Objective: The objective of this study was to assess the impact of preoperative anemia (hematocrit <39%) on postoperative 30-day mortality and adverse cardiac events in patients 65 years or older undergoing elective vascular procedures.

Background: Preoperative anemia is associated with adverse outcomes after cardiac surgery, but its association with postoperative outcomes after open and endovascular procedures is not well established. Elderly patients have a decreased tolerance to anemia and are at high risk for complications after vascular procedures.

Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians.

Background: The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80-89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality.

Study Design: Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2007-2008). Univariate analysis was performed using chi square, Fisher's exact test and t test.

Development and validation of a bariatric surgery mortality risk calculator.

Background: While the epidemic of obesity continues to plague America, bariatric surgery is underused due to concerns for surgical risk among patients and referring physicians. A risk score estimating postoperative mortality (OS-MRS) exists, however, is limited by consideration of only 12 preoperative variables, failure to separate open and laparoscopic cases, a lack of robust statistical analyses, risk factors not being weighted, and being applicable to only gastric bypass surgery. The objective of this study was to develop a validated risk calculator for 30-day postoperative mortality after bariatric surgery.

Carcinoembryonic antigen (CEA) and its receptor hnRNP M are mediators of metastasis and the inflammatory response in the liver.

This article discusses the role of carcinoembryonic antigen (CEA) as a facilitator of the inflammatory response and its effect on colorectal cancer hepatic metastasis. Colorectal cancer accounts for 11% of all cancers in the United States and the majority of deaths are associated with liver metastasis. If left untreated, median survival is only six to 12 months.

Development and validation of a risk calculator predicting postoperative respiratory failure.

Background: Postoperative respiratory failure (PRF) (requiring mechanical ventilation > 48 h after surgery or unplanned intubation within 30 days of surgery) is associated with significant morbidity and mortality. The objective of this study was to identify preoperative factors associated with an increased risk of PRF and subsequently develop and validate a risk calculator.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a multicenter, prospective data set (2007-2008), was used.

Development and validation of a risk calculator for prediction of cardiac risk after surgery.

Background: Perioperative myocardial infarction or cardiac arrest is associated with significant morbidity and mortality. The Revised Cardiac Risk Index is currently the most commonly used cardiac risk stratification tool; however, it has several limitations, one of which is its relatively low discriminative ability. The objective of the present study was to develop and validate a predictive cardiac risk calculator.

Outcomes after thyroidectomy and parathyroidectomy.

Background: Previous reports on postoperative outcomes following thyroid and parathyroid surgery are limited by relatively small sample size. We report 30-day outcomes following thyroid and parathyroid surgery and analyze factors affecting length of stay (LOS) and postoperative adverse events (AEs).

Methods: The multicenter, prospective, National Surgical Quality Improvement Program (NSQIP) datasets (2007/2008) were used.

Can we continue to ignore gender differences in performance on simulation trainers?

Background: There are differences between the genders in their innate performances on simulation trainers, which may impair accurate assessment of psychomotor skills.

Methods: The performance of fourth-year students with no exposure to the Minimally Invasive Surgical Trainer compared based on gender, and other psychomotor skills.

Results: Our study included 16 male and 16 female students.

Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients.

Background: Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB.

Methods: Patients who underwent LRYGB in 2007 and 2008 were identified from the NSQIP database.

Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset.

Background: Although a risk score estimating postoperative mortality for patients undergoing gastric bypass exists, there is none predicting postoperative morbidity. Our objective was to develop a validated risk calculator for 30-day postoperative morbidity of bariatric surgery patients.

Study Design: We used the American College of Surgeons' 2007 National Surgical Quality Improvement Program (NSQIP) dataset.

Preoperative weight gain might increase risk of gastric bypass surgery.

Background: Weight loss improves the cardiovascular and metabolic risk associated with obesity. However, insufficient data are available about the health effects of weight gain, separate from the obesity itself. We sought to determine whether the changes in body weight before open gastric bypass surgery (OGB) would have a significant effect on the immediate perioperative hospital course.

FAST scan: is it worth doing in hemodynamically stable blunt trauma patients?

Background: During the last decade, focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients. It is still questionable, however, whether its use results in the underdiagnosis of intra-abdominal injury. It also remains doubtful whether a positive focused assessment with sonography for trauma affects clinical decision making in hemodynamically stable blunt trauma patients as evidenced through abdominal computerized tomography use.