Langelynggaard9704

001) and ICU LOS (5 versus 4d; P<0.001). Both LI and LII centers had similar mortality rates (8.5% versus 7.0%; P=0.300). On multivariable analysis, receiving care at an LI trauma center was not associated with decreased mortality (odds ratio 0.79, 95% confidence interval 0.42-1.48; P=0.456).

We report that LI trauma center BT patients had an increased hospital and ICU LOS compared with those at LII centers. However, there was no significant difference in mortality between patients cared for at LI and LII trauma centers in risk-adjusted models.

We report that LI trauma center BT patients had an increased hospital and ICU LOS compared with those at LII centers. However, there was no significant difference in mortality between patients cared for at LI and LII trauma centers in risk-adjusted models.

Trauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice.

Three classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater.

Over the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P<0.05) and road traffic crashes were reported more frequently (39 to 60%, P<0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%).

The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.

The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.

The prognosis of patients with papillary thyroid cancer (PTC) who have undergone surgery is usually good. But surgery is risky for elderly patients. The outcomes of surgery or nonsurgery for the very elderly PTC patients have not been reported. Here, weinvestigated the effect of surgery or not on prognosis in very elderly PTC patients (aged≥85 y).

A retrospective study was performed based on data from the Surveillance, Epidemiology, and End Results program. The outcomes of surgery and nonsurgery in very elderly PTC patients were compared using different statistical methods, including propensity score matching.

A total of 1196 very elderly patients with PTC were enrolled in the study. Patients who underwent surgery (n=871) had a much better prognosis than those who did not (n=325) in both overall survival and cancer-specific survival (P<0.001). In the multivariate analysis, nonsurgery was an independent predictor for both overall survival (hazard ratio=2.066; P<0.001) and cancer-specific survival (hazard ratio=2.768; P<0.001).

Surgery is positively associated with an improved prognosis of PTC patients aged ≥85y and is still suggested for these patients after appropriate risk assessment.

Surgery is positively associated with an improved prognosis of PTC patients aged ≥85 y and is still suggested for these patients after appropriate risk assessment.

Hospitalized patients with hematologic malignancies (HMs) may require abdominal operations for complications of malignancy, treatment sequelae, or unrelated abdominal pathology. We determined predictors of mortality after emergency general surgery for patients with HM using national-level data.

We analyzed the 2010-2014 National Inpatient Sample for International Classification of Disease, Ninth Revision, Clinical Modification codes for HM and abdominal operations, comparing adult patient encounters with abdominal operations with HM to those without HM. CP 43 molecular weight Multivariate logistic regression was performed to identify predictors of mortality.

Of the 7.9 million adult inpatient encounters where abdominal surgery was performed, 82,187 (1%) had concomitant diagnoses of HM. Mortality among patient encounters with HM was significantly higher than without HM (9.0% versus 2.0%; P<0.0001). Patient encounters with HM and surgery and a diagnosis of acute abdominal pain had mortality rates as high as 41%. The median standardized risk ratio for death after the top 25 general surgery procedures was 2.9 (interquartile range 2.2-3.8) among patients with HM. In adjusted analyses, odds of mortality among patients with HM undergoing surgery were increased by concomitant acute abdominal pain diagnosis (odds ratio [OR]=2.6; P<0.0001), coagulopathy (OR=2.0; P<0.0001), aplastic anemia (OR=1.7; P<0.0001), peripheral vascular disease (OR=1.4; P=0.001), and weight loss (OR=1.3; P<0.0001).

Although uncommon, surgery on patients with HM is associated with mortality rates nearly five times higher than the general surgical population. Patients with HM requiring surgical intervention may be at particularly high odds of death and postoperative complications.

Although uncommon, surgery on patients with HM is associated with mortality rates nearly five times higher than the general surgical population. Patients with HM requiring surgical intervention may be at particularly high odds of death and postoperative complications.

The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated.

Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival.

The sample included 21,763 patients. The mean age was 59.3y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07).

Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.

Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.

Treatment options for Graves' disease (GD) include medical management with antithyroid medications, radioactive iodine (RAI) ablation, or total thyroidectomy (TT). Definitive treatment with RAI ablation may be associated with worse cardiovascular morbidity and mortality than TT. We sought to determine the rate of cardiovascular morbidity before and after definitive treatment for GD.

This study is a retrospective single-institution study of sequential adult patients with GD from 2012 to 2018 treated with RAI ablation or TT. Patients with prior thyroid surgery or RAI ablation with subsequent thyroidectomy were excluded. Demographic and clinical variables were collected from diagnosis of GD to last follow-up. Data analysis was performed with descriptive statistics, univariate analysis with Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables.

One-hundred and eighty-four patients underwent definitive treatment for GD during the study period, of which 164 met inclusion criteria. One hundred and ten patients (67%) in the study group had TT and 54 (33%) had RAI ablation with a mean dose of 18.4mCi (standard deviation 6.1). There were no differences in clinical or demographic factors in patients undergoing RAI ablation versus TT for definitive treatment including age, sex, thyroid-stimulating hormone level, free thyroxine level, or thyroid-stimulating immunoglobulin level at time of diagnosis, nor was there any difference in pretreatment cardiovascular comorbidity. Patients with TT had higher rates of resolution of arrhythmia after treatment than those undergoing RAI ablation, P=0.02. There were no differences in treatment-related complications between the groups.

For patients undergoing definitive treatment for GD, TT is associated with improved rate of resolution of cardiac arrhythmia compared with RAI ablation.

For patients undergoing definitive treatment for GD, TT is associated with improved rate of resolution of cardiac arrhythmia compared with RAI ablation.

Synchronous colorectal cancer liver metastasis (CRLM) has been viewed as being more aggressive and having shorter survival than metachronous disease. Advances in CRLM management led us to examine differences in treatment characteristics of synchronous versus metachronous CRLM patients along with survival and recurrence.

A retrospective review of hepatic resection for CRLM at a tertiary academic medical center was performed for two periods a historic cohort from 1992 to 2010 (n=121), and a modern cohort (n=179) from 2012 to 2018. Clinical variables were compared between the patient groups, and survival outcomes were characterized.

Five-year disease-specific survival for the modern synchronous group compared to the historic synchronous group was 71.7% versus 44.3% (P=0.02). Modern metachronous versus modern synchronous 5-y disease-specific survival rates were 49.8% versus 71.7% (P=0.31). Compared to the historic cohort, the modern one had significantly different timing of hepatic resection (P<0.01) witrn synchronous cohort contributed to improved survival.