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ered judgements for recommendations as well as generate new evidence to face this challenge.

Surgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency.

Clinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted.

Excluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CE. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.

Indications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.

A significant proportion of surgical inpatients is often admitted longer than necessary. Early identification of patients who do not need care that is strictly provided within hospitals would allow timely discharge of patients to a postoperative nursing home for further recovery. We aimed to develop a model to predict whether a patient needs hospital-specific interventional care beyond the second postoperative day.

This study included all adult patients discharged from surgical care in the surgical oncology department from June 2017 to February 2020. The primary outcome was to predict whether a patient still needs hospital-specific interventional care beyond the second postoperative day. Hospital-specific care was defined as unplanned reoperations, radiological interventions, and intravenous antibiotics administration. Different analytical methods were compared with respect to the area under the receiver-operating characteristics curve, sensitivity, specificity, positive predictive value, and negative prepitals in addressing capacity challenges and improve patient flow, allowing for timely surgical care.

Objective force- and motion-based assessment is currently lacking in laparoscopic skills curricula. This study aimed to evaluate the added value of parameter-based assessment and feedback during training.

Laparoscopy-naïve surgical residents that took part in a 3-week skills training curriculum were included. A box trainer equipped with the ForceSense system was used for assessment of tissue manipulation- (MaxForce) and instrument-handling skills (Path length and Time). Learning curves were established using linear regression tests. Pre- and post-course comparisons indicated the overall progression and were compared to predefined proficiency levels. A post-course survey was carried out to assess face validity.

In total, 4,268 trials, executed by 24 residents, were successfully assessed. SIS3 Smad inhibitor Median (interquartile range) MaxForce outcomes improved from 2.7 Newton (interquartile range 1.9-3.8) to 1.8 Newton (interquartile range 1.2-2.4) between pre- and post-course assessment (P ≤ .009). Instrument Path lengtho indicate progression of skills over time. The ForceSense parameters enable curricula to be designed for specific proficiency-based training goals and offer the possibility for objective classification of the levels of expertise.

The objective of the current study was to assess the impact of case mix index at the hospital level on postoperative outcomes among Medicare beneficiaries who underwent hepatopancreatic surgery.

Medicare beneficiaries who underwent hepatopancreatic surgery between 2013 and 2017 were identified and analyzed. The primary independent variable, Case Mix Index, is a freely available metric; the primary outcome was textbook outcome defined as the absence of complications, extended length of stay, readmission, and mortality.

Among 37,412 Medicare beneficiaries, 64.9% (n= 24,299) underwent a pancreatectomy and 35.1% (n= 13,113) underwent hepatectomy. The overall incidence of textbook outcome was 47.2%, which varied by case mix index (low case mix index 41.6% vs high case mix index 51.3%), as did extended length of stay (low case mix index 27.9% versus high case mix index 19.3%), complications (low case mix index 33.3% vs high case mix index 24.7%), and 90-day mortality (low case mix index 12.5% vs high case mixancreatic surgery. Hospitals with a higher case mix index were more likely to perform hepatopancreatic surgeries with no adverse postoperative outcomes.

Although there are several publications on the new transoral robotic thyroidectomy technique, few have thoroughly reviewed its associated complications. This study analyzed the causes and prevention of transoral robotic thyroidectomy-specific complications and presented preventive measures.

The medical records of patients who underwent transoral robotic thyroidectomy performed by a single surgeon between March 1, 2009 and April 30, 2019 were retrospectively analyzed. Patient demographic, clinical, and operative data were analyzed using descriptive statistics. We describe the transoral robotic thyroidectomy-related complications experienced at our institution and how to overcome them.

This study included a total of 423 patients who underwent transoral robotic thyroidectomy. The general surgical complications included immediate postoperative bleeding (2 cases) and delayed hematoma (3 cases). Chyle leakage and localized wound infection were found in 1 case each. Transient vocal cord palsy occurred in 4 cases, and 1 case developed transient hypoparathyroidism. link2 The transoral robotic thyroidectomy-specific complications included zygoma bruise (2 cases), flap bruise (3 cases), chin flap perforation (2 cases), and oral commissure tearing (2 cases). The complications occurring when creating the flap included flap burns (4 cases), skin dimpling in the midline of the lower chin (2 cases), and hematomas in the intraoral trocar insertion sites (3 cases).

Surgeons familiar with thyroid surgery and experienced in robotic surgery can perform transoral robotic thyroidectomy without causing more complications than those seen with traditional surgery.

Surgeons familiar with thyroid surgery and experienced in robotic surgery can perform transoral robotic thyroidectomy without causing more complications than those seen with traditional surgery.

Imatinib resistance is associated with a poor prognosis in patients with gastrointestinal stromal tumors. Although novel tyrosine kinase inhibitors have improved outcomes in imatinib-resistant gastrointestinal stromal tumors, the role of resection remains unclear. We sought to investigate factors predictive of overall and progression-free survival in patients with imatinib-resistant gastrointestinal stromal tumors.

A query of our prospectively maintained Comprehensive Cancer Center registry was performed from 2003 to 2019 for patients with imatinib-resistant gastrointestinal stromal tumors. Clinicopathologic characteristics and medical and surgical treatments were collected; overall survival and progression-free survival after imatinib-resistance were analyzed with Kaplan-Meier and Cox proportional hazards modeling.

A total of 84 patients developed imatinib resistance at a median age of 59 years. Median time to imatinib resistance after diagnosis and overall survival after imatinib resistance was 50 and 51 months, respectively. After being diagnosed with imatinib resistance, 17 (20%) patients underwent resection. On multivariable analysis, resection after imatinib resistance was independently associated with improved progression-free survival (hazard ratio 0.50; P= .027) but not overall survival (hazard ratio 0.62; P= .215). Similar findings were found on subgroup analysis of patients treated with second-line sunitinib (n= 71).

Long-term survival can be achieved in patients who develop imatinib-resistant gastrointestinal stromal tumors. Surgical resection of imatinib-resistant gastrointestinal stromal tumors is associated with improved progression-free survival and should be considered in selected patients.

Long-term survival can be achieved in patients who develop imatinib-resistant gastrointestinal stromal tumors. Surgical resection of imatinib-resistant gastrointestinal stromal tumors is associated with improved progression-free survival and should be considered in selected patients.

The objective of the study was to develop a portal natural language processing approach to aid in the identification of postoperative venous thromboembolism events from free-text clinical notes.

We abstracted clinical notes from 25,494 operative events from 2 independent health care systems. A venous thromboembolism detected as part of the American College of Surgeons National Surgical Quality Improvement Program was used as the reference standard. A natural language processing engine, easy clinical information extractor-pulmonary embolism/deep vein thrombosis (EasyCIE-PEDVT), was trained to detect pulmonary embolism and deep vein thrombosis from clinical notes. International Classification of Diseases discharge diagnosis codes for venous thromboembolism were used as baseline comparators. The classification performance of EasyCIE-PEDVT was compared with International Classification of Diseases codes using sensitivity, specificity, area under the receiver operating characteristic curve, using an internal aocessing may augment manual chart abstraction for large registries such as National Surgical Quality Improvement Program.

Accurate surveillance of postoperative venous thromboembolism may be achieved using natural language processing on clinical notes in 2 independent health care systems. These findings suggest natural language processing may augment manual chart abstraction for large registries such as National Surgical Quality Improvement Program.

Despite improvements in neonatal care the outcomes of Necrotizing Enterocolitis (NEC) remain unchanged over previous decades. The study aims to explore whether different indications for surgical intervention in NEC are associated with timing of surgery and outcomes.

Population-based, prospective, observational study of all 27 paediatric surgical centres in the United Kingdom and Ireland identified using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System from 1st February 2013 to 28th February 2014. link3 Infants were included if they had NEC and underwent first surgical intervention within 7 days of diagnosis. Primary outcomes were death, parenteral nutrition requirement or a composite outcome of death or PN requirement at 28 days post surgery.

There were 133 infants meeting inclusion criteria. Indications for surgery were bowel perforation (n=67), suspected necrotic bowel without bowel perforation and not deemed to have failed medical management (n=20), those who had failed medical management (n=42) and a palpable mass without any other indication (n=4).