The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

Objective: To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures.

Background: Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not.

Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database.

Objective: To compare short-term outcomes after laparoscopic and open abdominal wall hernia repair.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2009), 71,054 patients who underwent an abdominal wall hernia repair were identified (17% laparoscopic, 83% open). Laparoscopic and open techniques were compared.

Significant reduction of wound infections with daily probing of contaminated wounds: a prospective randomized clinical trial.

Hypothesis: Local wound management using a simple wound-probing protocol (WPP) reduces surgical site infection (SSI) in contaminated wounds, with less postoperative pain, shorter hospital stay, and improved patient satisfaction.

Design: Prospective randomized clinical trial.

Setting: Academic medical center.

Laparoscopic versus open appendectomy for the obese patient: a subset analysis from a prospective, randomized, double-blind study.

Background: The clinical outcomes for patients randomized to either open or laparoscopic appendectomy are comparable. However, it is not known whether this is true in the subset of the adult population with higher body mass indexes (BMIs). This study aimed to compare the outcomes of open versus laparoscopic appendectomy in the obese population.

Acute respiratory distress syndrome in nontrauma surgical patients: a 6-year study.

Background: Acute respiratory distress syndrome (ARDS) has been shown to increase morbidity but not mortality in trauma patients; however, little is known about the effects of ARDS in nontrauma surgical patients. The purpose of this study is to evaluate the risk factors for and outcomes of ARDS in nontrauma surgical patients.

Study: A prospective observational study was performed in the surgical intensive care unit (ICU) of an academic tertiary care center.

Natural progression of biochemical markers of biliary tract obstruction in patients with gallstone pancreatitis.

The presenting pattern and natural progression of biochemical markers of biliary tract obstruction in patients with gallstone pancreatitis have not been elucidated. We analyzed serial values of bilirubin levels following admission to discharge in 143 patients. Ninety-four of patients demonstrated a Decrescendo (falling) pattern of bilirubin levels from admission until normalization at 21 hours (median).

Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor.

Objectives: The aims of the present study were to describe the temporal hemodynamic and oxygen transport patterns of patients with head injuries as well as the patterns of those who became brain dead to better understand the role of underlying central regulatory hemodynamic mechanisms and ultimately to improve rates of organ donation.

Methods: We studied 388 consecutive noninvasively monitored patients with severe head trauma; 79 of these became brain dead. Monitoring was started shortly after admission to the emergency department and was designed to describe the sequence of cardiac, pulmonary, and tissue perfusion functions by cardiac index (CI), mean arterial pressure, heart rate, arterial saturation by pulse oximetry (Sapo2), and transcutaneous oxygen and carbon dioxide (Ptco2/Fio2 and Ptcco2) patterns.

Breast abscess bacteriologic features in the era of community-acquired methicillin-resistant Staphylococcus aureus epidemics.

Hypothesis: Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections have also affected the microbial profile of breast abscesses.

Objective: To update the decade-old bacteriologic description of breast abscesses to improve the choice of initial antibacterial drug therapy.

Design: Retrospective case series.

Impact of the 80-hour workweek on patient care at a level I trauma center.

Hypothesis: The 80-hour workweek limitation for surgical residents is associated with an increase in mortality and complication rates among adult trauma surgical patients.

Design: Retrospective cohort study.

Setting: Academic level I trauma center.

Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial.

Objective: To compare the efficacy of endoscopic retrograde cholangiopancreatography +/- endoscopic sphincterotomy (ERCP +/- ES) versus traditional conservative management in early gallstone pancreatitis with persistent ampullary obstruction (GSP + AO).

Summary Background Data: The effectiveness of early ERCP +/- ES in this setting is controversial.

Methods: Sixty-one consecutive patients with GSP + AO within 48 hours from the onset of symptoms were randomized to receive either conservative treatment and selective ERCP +/- ES after 48 hours (control group, 31 patients) or initial conservative treatment and systematic ERCP +/- ES within 48 hours if obstruction persisted 24 hours or longer (study group, 30 patients).

Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit.

Hypothesis: Serum bicarbonate (HCO(3)) measurement may accurately and reliably be substituted for the arterial base deficit (BD) assay in the surgical intensive care unit (ICU).

Design: Retrospective criterion standard analysis.

Setting: Surgical ICU in a tertiary care facility.

Analysis of 185 iliac vessel injuries: risk factors and predictors of outcome.

Hypothesis: Iliac vascular injuries incur high mortality.

Design: Retrospective 100-month study (January 1, 1992, through April 30, 2000).

Patients: One hundred forty-eight patients with 185 iliac vessel injuries.

Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps.

Background: American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality.

Methods: This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively.

Influence of flail chest on outcome among patients with severe thoracic cage trauma.

Flail chest is associated with a higher morbidity compared with multiple rib fractures, and it requires early intubation. This was a prospective comparative uncontrolled study at an academic level 1 trauma center. Twenty-two patients with flail chest (FLAIL) were compared with 90 patients with more than two rib fractures but no flail chest (RIBS) to determine differences in outcomes such as mortality, significant respiratory complications (pneumonia and adult respiratory distress syndrome), need for mechanical ventilation, and length of hospital stay.

Wound management after colon injury: open or closed? A prospective randomized trial.

It is unknown whether leaving the skin wound open to heal by secondary intention is associated with a lower rate of wound infections compared with primary skin-wound closure after operations for colon injuries. From June 1998 to December 2000 at our Level I academic trauma center 48 patients entered into a randomized controlled trial (RCT) and were randomized to have their skin wound primarily closed (CLOSED-RCT) or left open (OPEN-RCT). At the same time patients not included in the RCT were followed prospectively.

A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries.

Background: Angiographic embolization (AE) is used with increasing frequency as an alternative to surgery for control of intraperitoneal and retroperitoneal bleeding. There are no prospective studies on its efficacy, safety, and indications.

Patients: From April 1999 to June 2001, patients with abdominal visceral organ injuries or major pelvic fractures sent for AE were prospectively studied.

Severe trauma is not an excuse for prolonged antibiotic prophylaxis.

Hypothesis: For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures.

Design: Prospective nonrandomized study.

Setting: Surgical intensive care unit (SICU) of an academic hospital with a level I trauma center.

Visceral vascular injuries.

This article deals with injuries to the celiac trunk, superior and inferior mesenteric arterial injuires. Surgical approaches and physiological implications of interruption of the mesenteric arterial circulation are addressed in detail. Surgical techniques for the management of these injuries and the need for second look operations are also examined.