Abdisutton7273

5%) for pneumatosis (Kappa = 0.29; 95% CI 0.10-0.48), 79/96 (82.3%) for portal venous gas (Kappa = 0.07, 95% CI 0.00-0.47) and 91/96 (94.8%) for pneumoperitoneum (Kappa = 0.52, 95% CI 0.11-0.93). Each finding was present more frequently on AUS than AXR. On AUS, pneumatosis and focal fluid collection were independently associated with a longer antibiotic course (4.1 days longer, p=0.03, and 21.3 days longer, p less then 0.001, respectively). CONCLUSIONS Abdominal sonography holds promise as a useful adjunct to radiography for neonates with possible NEC. It may be more sensitive for the presence or absence of bowel ischemia and can reveal findings not detectable by radiograph that may aid provider decision-making. BACKGROUND Elderly patients (65 years of age and older) undergo an increasing number of operations performed annually in the US and they present with unique healthcare needs. Preventing postoperative readmission remains an important challenge to improving surgical care. CDK and cancer This study examined whether geriatric-specific variables were independently associated with postoperative readmissions of elderly patients. METHODS The American College of Surgeons (ACS) Geriatric Surgery Research File (GSRF) was joined with the ACS NSQIP Participant Use Data Files for 2014 to 2016. This data set included 13 GSRF variables and 26 ACS NSQIP variables. Associations between clinically relevant variables and readmission were tested with multivariable logistic regression. RESULTS The data represented 6,039 general surgery patients age 65 years and older. Fifty-eight percent of patients had colorectal operations, 19% pancreatic or hepatobiliary, 15% hernia, 4% thyroid or esophageal, and 3% had appendix operations. Twenty-four percen of the relationship between clinical variables and readmissions in elderly surgical patients. BACKGROUND Intraoperative drain use for pancreatoduodenectomy (PD) has been practiced in an unconditional, binary manner (placement/no-placement). Alternatively, dynamic drain management has been introduced, incorporating the Fistula Risk Score (FRS) and drain fluid amylase (DFA) analysis, to mitigate clinically-relevant pancreatic fistula (CR-POPF). STUDY DESIGN An extended experience with dynamic drain management was employed at a single institution for 400 consecutive PDs (2014-2019). This protocol consists of two-parts; (1) drains omitted for negligible/low risk FRS (0-2); (2) drains placed for moderate/high FRS (3-10) with early (POD3) removal if POD1 DFA≤5,000 U/L. Adherence to this protocol was prospectively annotated and outcomes were retrospectively analyzed. RESULTS The overall CR-POPF rate was 8.7% with none occurring in the negligible/low risk cases. Moderate/high risk patients manifested a 11.9% CR-POPF rate (N=35/293), which was lower on-protocol (9.5 vs. 21%, p=0.014). After drain placement, POD1 DFA≥5,000 U/L was a better predictor of CR-POPF than FRS (OR 14.7, 95% CI 4.3-50.3). For POD1 DFA≤5,000 U/L, early drain removal was associated with fewer CR-POPFs (2.8 vs. 23.5%, p less then 0.001), and substantiated by multivariable analysis (OR 0.09, 95% CI 0.03-0.28). Surgeon adherence was inversely related to CR-POPF rate (R=0.846). CONCLUSION This extended experience validates a dynamic drain management protocol, providing a model for better drain management and individualized patient care after PD. This study confirms that drains can be safely omitted from negligible/low risk patients, and moderate/high risk patients benefit from early drain removal. BACKGROUND Rib fractures are common among trauma patients and analgesia remains the cornerstone of treatment. Intercostal nerve blocks provide analgesia but are limited by the duration of the anesthetic. This study compares outcomes of epidural analgesia to intercostal nerve block using liposomal bupivacaine for the treatment of traumatic rib fractures. METHODS A retrospective chart review was used to identify patients who received either epidural analgesia or intercostal nerve block with liposomal bupivacaine for the treatment of traumatic rib fractures. Patients were matched in a 11 ratio on age, injury severity score (ISS), and number of rib fractures. Outcomes included intubations, mechanical ventilation days, ICU length of stay (LOS), hospital LOS, and mortality. RESULTS After matching, 116 patients were included in the study. Patients receiving intercostal nerve blocks with liposomal bupivacaine were less likely to require intubation (3% vs. 17% p = 0.015), had shorter hospital LOS (8 ± 6 vs. 11 ± 9, p = 0.020) and ICU LOS (2 ± 5 vs. 5 ±6, p = 0.007). There were no differences in ventilator days or mortality. Minor complications occurred in 26% of patients that received an epidural catheter for rib fractures. No complications occurred in the intercostal nerve block patients. CONCLUSION Patients who received intercostal nerve blocks with liposomal bupivacaine required intubation less frequently and had shorter ICU and hospital LOS compared to epidural analgesia patients. These results suggest that intercostal nerve blocks with liposomal bupivacaine may be equal or superior to epidural analgesia. INTRODUCTION Magnetic sphincter augmentation (MSA) is a promising surgical treatment for patients with GERD. The aim of this study is to evaluate the outcome of MSA in a large cohort of GERD patients and to determine the factors predicting a favorable outcome. METHODS This is a retrospective review of prospectively collected data of 553 patients who underwent MSA at our institution in a 5-year period. Preoperative clinical, endoscopic, manometric and pH data were used in a univariate analysis. This was followed by a regression multivariable analysis to determine the factors predicting a favorable outcome. Favorable outcome was defined as freedom from PPI and 50% or more improvement in GERD-HRQL total score. RESULTS At a mean follow up of 10.3 (10.6) months after MSA, 89.9% of the patients were free of PPI use and 84% reported at least 50% improvement in their GERD-HRQL total score. GERD-HRQL total score was improved from baseline value of 33.8 (18.7) to 7.2 (9.0) (p15 and abnormal DeMeester score are the four preoperative factors predicting a favorable outcome and can be used in patient counseling and MSA utilization.