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5. The role of the Veterans Affairs Medical Centers in patient care, surgical education, research and faculty development

Author

Longo, Walter E., Cheadle, William, Fink, Aaron, Kozol, Robert, DePalma, Ralph, Rege, Robert, Neumayer, Leigh, Tarpley, John, Tarpley, Margaret, Joehl, Ray, Miller, Thomas A., Rosendale, Douglas, and Itani, Kamal

Subjects
United States. Department of Veterans Affairs -- Management, Graduate medical education -- Standards, Postgraduate medical education -- Standards, Surgery -- Study and teaching, Surgery -- Research, Hospitals, Veterans' -- Standards, Patients -- Care and treatment, Patients -- Study and teaching, Patients -- Research, Company business management, Health
Published
2005

7. Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis

Author

Patel, Lava Y., primary, Lapin, Brittany, additional, Gitelis, Matthew E., additional, Brown, Craig, additional, Linn, John G., additional, Haggerty, Stephen, additional, Denham, Woody, additional, Butt, Zeeshan, additional, Barrera, Ermilo, additional, Joehl, Ray, additional, Carbray, JoAnn, additional, Hall, Tyler, additional, and Ujiki, Michael B., additional

Published
2016
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8. Characterization of common bile duct injury after laparoscopic cholecystectomy in a high-volume hospital system.

Author

Kohn, Julia F., Trenk, Alexander, Kuchta, Kristine, Lapin, Brittany, Denham, Woody, Linn, John G., Haggerty, Stephen, Joehl, Ray, and Ujiki, Michael B.

Subjects
BILE ducts, CHOLECYSTECTOMY, LAPAROSCOPIC surgery, REGRESSION analysis, DISEASE risk factors, WOUNDS & injuries
Abstract

Background: Despite the popularity of laparoscopic cholecystectomy, rates of common bile duct injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary injury during laparoscopic cholecystectomy within a high-volume healthcare system.Methods: 800 of approximately 3000 cases between 2009 and 2015 were randomly selected and retrospectively reviewed. A single reviewer examined all operative notes, thereby including all cases of BDI regardless of ICD code or need for a second procedure. Biliary injuries were classified per Strasberg et al. (J Am Coll Surg 180:101-125, 1995). Logistic regression models were utilized to identify univariable and multivariable predictors of biliary injuries.Results: 31.0% of charts stated that the Critical View of Safety was obtained, and 12.4% of charts correctly described the critical view in detail. Three patients (0.4%) had a cystic duct leak, and 4 (0.5%) had a common bile duct injury. Of the four CBDI, three patients had a partial transection of the CBD and one had a partial stricture. Patients who suffered BDI were more likely to have had lower hemoglobin, urgent surgery, choledocholithiasis, or acutely inflamed gallbladder. Multivariable analysis of BDI risk factors showed higher preoperative hemoglobin to be independently protective against CBDI. Acutely inflamed gallbladder and choledocholithiasis were independently predictive of CBDI.Conclusions: The rate of CBDI in this study was 0.5%. Acutely inflamed conditions were risk factors for biliary injury. Multivariable analysis suggests a protective effect of higher preoperative hemoglobin. There was no correlation of CVS with prevention of biliary injury, although only 12.4% of charts could be verified as following the technique correctly. Better implementation of CVS, and increased caution in patients with perioperative inflammatory signs, may be important for preventing bile duct injury. Additionally, counseling patients with acute inflammation on increased risk is important. [ABSTRACT FROM AUTHOR]

Published
2018
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