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4% vs 59.8%, p less then 0.0001). After matching (N = 987/group), preoperative transfusion was associated with higher rates of intraoperative/postoperative transfusion (odds ratio 1.24, p 0.017) and surgical site infections (odds ratio 1.67, p 0.004) and longer length of stay (incidence rate ratio 1.06, p less then 0.0001). AMG-193 price Conclusions Preoperative transfusion is associated with increased surgical site infections and longer hospital stay and should be carefully considered in oncologic patients given the absence of improvement in outcomes.Background Excision of the mesopancreas with lymphadenectomy is an important component of pancreatoduodenectomy. However, the optimal extent of lymphadenectomy remains unclear. Furthermore, accurate description of the mesopancreatic lymphatic pathways is difficult, probably because of the complex anatomy. Intestinal derotation simplifies the anatomy and facilitates both examination of lymphatic flow and the surgical procedure. The aim of this study was to evaluate lymphatic flow in the mesopancreas using indocyanine green fluorescence imaging with an intestinal derotation technique, and to clarify the optimal extent of mesopancreas excision and lymphadenectomy in pancreatoduodenectomy. Methods Indocyanine green solution (2.5 × 10-3 mg) was injected into the pancreatic head parenchyma. After intestinal derotation, the spread of indocyanine green was observed using near-infrared imaging. Results Participants comprised 10 patients who underwent pancreatoduodenectomy for periampullary neoplasms. With indocyanine green fluorescence imaging, 9 of the 10 patients showed lymphatic flow from the pancreatic head to the superior mesenteric artery via the inferior pancreaticoduodenal artery and first jejunal artery (but not via the second and more distant arteries), with eventual drainage into the paraaortic region. Conclusions Lymphatic pathways from the pancreatic head were connected to the superior mesenteric artery via the inferior pancreaticoduodenal artery and first jejunal artery. Excision of the mesopancreas with the inferior pancreaticoduodenal artery and first jejunal artery while preserving the second or more distant arteries appears optimal in pancreatoduodenectomy for periampullary malignancies.Purpose To identify perioperative factors that are significantly associated with complications requiring interventional radiology (IR) treatment after hepatectomy. Methods We retrospectively reviewed data from 11,243 patients in the USA who underwent hepatectomy from 2014 to 2016 using the National Surgical Quality Improvement Program database. Data on the following IR procedures were extracted abscess drain placement, endovascular treatment for bleeding, and postoperative percutaneous biliary drain (PBD) placement up to 30 days postoperatively. Patients’ clinical and intraoperative factors were examined. Population, univariate, and multivariable analyses were performed. P less then 0.05 was considered significant. Results A total of 704 patients (6%) required IR treatment postoperatively, and 10,539 patients (94%) did not. On multivariable analysis, biliary reconstruction was a significant predictor of postoperative abscess drain placement (hazard ratio (HR), 3.5; 95% confidence interval (CI) 1.8, 6.5; P less then .001), endovascular treatment for bleeding (HR, 3.3; 95% CI 1.4, 7.8 P = .006), and postoperative PBD placement (HR, 2.9; 95% CI 1.9, 4.2; P less then .001). Compared with hepatectomy without biliary reconstruction, hepatectomy with biliary reconstruction was associated with significantly higher rates of complications treated with IR procedures (26% vs. 4.9%) and death within 30 days (6.0% vs. 1.2%) (both, P less then .001). Conclusion Biliary reconstruction is a strong predictor of the need for postoperative IR treatment after hepatectomy. One in four patients who underwent biliary reconstruction required IR treatment of a complication during the first 30 days after hepatectomy.Background Slaintecare, the Irish government’s plan for the coming decade, relies heavily on integrated, team-based care in the community to achieve its goals. General practice nursing is a key component of that care, both now and in the future, but little is known about the experience and views of those providing this service. This preliminary study is part of a wider national project on teamworking in primary care. Aim To document the experiences and views of practice nurses (PNs) and general practices in a single county of Ireland, in relation to current and future roles. Method Confidential questionnaires sent to all practices and all practice nurses in the county. Results Overall, 28/35 (80%) practices and 36/59 (61%) PNs responded; most PNs work part-time. Almost all practices have PNs; in 93% of practices, patients can see the PN without referral by the GP and there is very good concordance between practices and PNs about the wide range of tasks undertaken. Ninety-four percent of practices and 81% of PNs rated an expanded role for PNs as high or highest priority; barriers identified by both groups were financial and indemnity issues. Conclusion Practice nursing contributes extensively to general practice, and an expansion of the role is advocated by PNs and practices.Background There is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerkships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice. Aim The aim of this study was to identify career destinations of medical school graduates in a medical school with an 18-week longitudinal integrated clerkship in general practice. Design and setting This study was conducted in a single graduate entry medical school at the University of Limerick, Ireland. Participants Medical school alumni 6-8 years after graduation. Method A survey of graduating cohorts of the medical school from 2011 to 2013 was conducted through email and telephone. Results There were a total of 175 alumni for the period 2011 to 2013.