Frequency Of Surgical Procedures Research Articles

Surgery for carpal tunnel syndrome in patients with and without diabetes-Is there a difference in the frequency of surgical procedures?

Carpal tunnel syndrome (CTS) occurs more often among individuals with diabetes. The aim of this retrospective observational registry study was to examine whether individuals with diabetes and CTS are treated surgically to the same extent as individuals with CTS but without diabetes. Data on CTS diagnosis and surgery were collected from the Skåne Healthcare Register (SHR). A total of 35,105 individuals (age ≥ 18 years) diagnosed with CTS from 2004-2019 were included. Data were matched to the Swedish National Diabetes Register (NDR. Cox regression models were used to calculate the risk of the use of surgical treatment. Of the 35,105 included individuals with a CTS diagnosis, 17,662 (50%) were treated surgically, and 4,966 (14%) had diabetes. A higher number of individuals with diabetes were treated surgically (2,935/4,966, 59%) than individuals without diabetes (14,727/30,139, 49%). In the Cox regression model, diabetes remained a significant risk factor for surgical treatment (PR 1.14 (95% CI 1.11-1.17)). Individuals with type 1 diabetes were more frequently treated surgically (490/757, 65%) than individuals with type 2 diabetes (2,445/4,209, 58%). There was no difference between the sexes and their treatment. The duration of diabetes was also a risk factor for surgical treatment in diabetes type 2, but high HbA1c levels were not. Individuals with diabetes are more likely to be treated surgically for CTS than individuals without diabetes. Individuals with type 1 diabetes are more likely to be treated surgically for CTS than individuals with type 2 diabetes.

Effect of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers on need for operative intervention for idiopathic adhesive capsulitis

The exact pathogenesis of idiopathic adhesive capsulitis (IAC) is not fully understood, but an inflammatory profibrotic cascade, largely mediated by transforming growth factor-beta 1 (TGF- β1) has been implicated. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) both decrease the activity of TGF-β1. The aim of this study was to determine the impact of ACE-Is or ARBs use on the need for operative intervention in IAC. This was a retrospective cohort study of patients from a single institutional database with IAC, divided into two cohorts, with and without ACE-I and/or ARB use as the primary exposure and a minimum 2-year follow-up. The primary outcome measured was the incidence of operative intervention including manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR). Additional multivariable logistic regression analysis was performed to evaluate associations between ACE-I/ARB use and likelihood of undergoing an operative procedure. A total of 17,645 patients met inclusion criteria, with 5424 patients in the ACE-I/ARB cohort and 12,221 in the non-ACE-I/ARB cohort. Overall, 422 (2.4%) patients underwent surgical treatment, 378 (2.1%) ACR, and 74 (0.4%) MUA. There was no significant difference between cohorts in the frequency of surgical procedures or time to procedure since diagnosis. There were no significant differences between individual ACE-Is or ARBs, although Losartan was found to have a trend of decreased rate of intervention (31.7% vs. 36.8%, P=.209) when compared to patients not on losartan that did not reach statistical significance. Patient factors predictive of undergoing MUA/ACR were diabetes (P=.013), obesity (P<.001), and male sex (P<.001). Increasing patient age reduces the likelihood of undergoing operative intervention, with patients aged 50-70 years (P=.022) and age >70 years (P<.001) demonstrating reduced odds as compared to patients aged <30 years. Patients with IAC have an overall low (2.4%) rate of requiring surgical intervention. While the antifibrotic mechanism of ACE inhibitors and ARBs did not significantly affect the rate of requiring surgical intervention, male gender, obesity, younger age, and diabetes, all increased the risk for operative intervention. Losartan, specifically, may have a disease modifying effect on IAC that should be investigated with larger controlled trials.

Upper Extremity Musculoskeletal Injuries Presenting to an Emergency Department Before and During the Initial COVID-19 Pandemic Surge.

The SARS-CoV-2 (COVID-19) pandemic significantly impacted emergency department volume and acuity. The Delta and Omicron variants contributed to additional surges. We describe the impact that the initial pandemic phase had on frequency and severity of typically non-life-threatening emergencies using upper extremity injuries as a model for other potentially emergent presentation as compared to pre-pandemic times. We do this using the epidemiology of pre-defined significant upper extremity injuries at our facility as a specific example of what occurred at an urban trauma center. We conducted a comparison of two 6-month periods: between March 2019 and August 2019 (prior to COVID-19) and between March 2020 and August 2020 after the onset of the initial COVID-19 wave. We performed a retrospective chart review of patients who presented with upper extremity injury chief complaints using analysis of the electronic medical record at a single urban tertiary care trauma center in the Midwestern United States. We investigated examination findings, imaging, frequency of surgical procedures and final diagnosis. In the 2019 study period, there were 31,157 ED patients, including 429 with upper extremity injuries, of which 108 patients had significant injuries. In the 2020 study period, there were 24,295 patient presentations, of which 118 of 296 upper extremity presentations were significant. We a priori defined significant injury as follows: fractures, dislocations, neurovascular injuries, or need for operative intervention within 24 hours of ED presentation. Specifically, 25.2% of injuries were significant pre-COVID-19 and 39.9% (p < 0.001) during the initial COVID-19 surge. The absolute number and percentage of significant injuries increased from pre-COVID-19 compared to the initial COVID-19 surge despite an overall 22% decrease in total patient volume. The incidence of significant upper extremity musculoskeletal injuries increased during the pandemic even though the overall number of ED presentations for upper extremity musculoskeletal injuries decreased.

Velika vaskularna hirurgija kod gerijatrijske populacije - stratifikacija srčanog rizika

Reliance on surgery, improvements in surgical techniques, and perioperative management have led to a dramatic increase in the frequency of surgical procedures in the elderly population. According to the European Society of Cardiology and the European Society of Anaesthesiology and Intensive Care, major vascular surgery is defined as high-risk, considering the frequency of myocardial infarction and cardiac arrest, which is higher than 5%. Age is an independent predictor of myocardial infarction and cardiac arrest. Heart function alterations are primary changes that occur with advancing age. Risk stratification represents a set of procedures that include identifying chronic systemic diseases, determining their severity, stability and the need for further evaluation and/or therapy optimization, with the aim of reducing perioperative and postoperative mortality and morbidity. In addition to the application of risk scores, accurate risk stratification requires the combined application of both preoperative and postoperative biomarkers. The main idea of integrating biomarkers with scoring systems is to reveal those patients with clinically unmanifested disease, who carry a mortality risk and remain undetected by scoring systems. Biomarkers, such as NT-proBNP and highly sensitive C-reactive protein, have the greatest predictive influence in geriatric vascular surgery.

Low adherence to treatment is a weak link in the problems of ulcerative colitis

To determine factors of adherence to treatment in patients with ulcerative colitis (UC). The study was performed in the department of treatment of inflammatory bowel diseases in Loginov Moscow Clinical Scientific Center from 2019 till 2021 years by surveying 1089 patients with UC. This analysis revealed patients with high adherence (HAP) and low adherence to treatment (LAP). In the survey analysis was determined, that there were more low-adherence patients, than high-adherence patients [596 (59.6%) and 404 (40.4%), respectively, (p0.001)]. In the group of HAP (100%) were 297 women (73.5%) and 107 (26.5%) men (p0.001). Also in this group prevailed patients with duration of disease more 5 years 305 (75.5%) and extraintestinal manifestations 261 (64.6%); p0.001. In the group of LAP (100%) were more patients younger 44 years, with bad habits and who did not follow diet (p0.001). The rate of UC reccurence more than 1 time per year was higher in LAP group 430 (72.1%), versus 137 (33.9%) patients in HAP (p0.001). The frequency of surgical procedures in UC patients was significantly higher in LAP 12 (2.0%) in comparison with 2 (0.5%) in HAP group (p0.001). In our study was determined, that among UC patients, examined in the department of inflammatory bowel diseases, 60% patients had low adherence to treatment. High adherence to the treatment is statistically significantly associated with female gender, family accommodation, non-working patients, extraintestinal manifestations, additional medical maintenance. Low adherence to the treatment is associated with steroids, male gender, age less than 44 year, bad habits (smoking, alcohol consumption), higher education, complicated UC and frequency of reccurences.

Analysis of orthopedic surgical procedures in children with cerebral palsy

Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America. To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP. This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test. A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05). The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.

Mortality after high-risk surgery in Jehovah's Witness patients

Jehovah's Witness (JW) patients strictly refuse allogeneic blood transfusion for religious reasons. Nevertheless, JW also wish to benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The Northwest Hospital in Frankfurt am Main Germany is a confidential clinic of JW and performs approximately 100 surgical interventions per year on this patient group. A retrospective analysis of closed medical cases performed in the years 2008-2018 at the Northwest Hospital aimed to clarify (1)the frequency of surgical procedures in JW patients associated with astatistical allogeneic transfusion risk (presence of preoperative anemia and/or in-house transfusion probability >10%) during this time period, (2)the degree of acceptance of strategies avoiding blood transfusion by JW and (3)the anemia-related postoperative mortality rate in JW patients. In the 11-year observation period 123 surgical procedures with arelevant allogeneic transfusion risk were performed in 105 JW patients. Anemia according to World Health Organization (WHO) criteria was present in 44% of cases on the day of surgery. Synthetic and recombinant drugs (tranexamic acid, desmopressin, erythropoetin, rFVIIa) were generally accepted, acute normovolemic hemodilution (ANH) in 92% and cell salvage in 96%. Coagulation factor concentrates extracted from human plasma and therefore generally refused by JW so far, were accepted by 83% of patients following detailed elucidation. Out of 105 JW patients 7 (6.6%) died during the postoperative hospital stay. In 4 of the 7 fatal cases the cause of death could be traced back to severe postoperative anemia. Given optimal management JW patients can undergo major surgery without an excessive risk of death. The 6.6% in-hospital mortality observed in this institution was in the range of the 4% generally observed after surgery in Europe. The majority of JW patients accepted avariety of blood conservation strategies following appropriate elucidation. This also included coagulation factor concentrates extracted from human plasma enabling an effective treatment of even severe bleeding complications. In this analysis postoperative hemoglobin concentrations below 6 g/dl in older JW patients were associated with ahigh mortality risk due to anemia.

Trends in frequency of surgical procedures at Department of Otorhinolaryngology and Maxillofacial Surgery of Mostar University Hospital, Bosnia and Herzegovina (2013-2017).

Aim To determine whether there has been a change in frequency of selected otorhinolaryngology - head and neck surgical procedures during a 5-year period. Methods Comparative cross-sectional analyses of surgical candidates and procedures performed at the Department of Otorhinolaryngology and Maxillofacial Surgery during the period 2013‒2017 were done. Data on patients' demographics and cases of selected surgical procedures were extracted from the operating room log books. Patients' average age, male:female ratio, and the percent share of all surgical procedures for each selected surgical procedure for each studied year were calculated. Results In comparison with the year 2013, the year 2017 showed no significant difference in age or sex of patients who underwent selected surgical procedures, increase of the number of all operations and the number of investigated selected operations, increase in the share of tonsil surgery, nasal septum and pyramid surgery, nasal polyposis surgery, parathyroid gland surgery, otoplasty, cochlear implantation, laryngeal surgery, and tracheotomy, and decline in the share of thyroid gland surgery, middle ear microsurgery, neck dissection, surgery of parotid gland, and surgery of neck cysts. Conclusion Our finding of variations in utilization of some studied procedures provides a basis for future discussions, research and provision of health care services. Used data are specific to two studied cantons and do not represent a nationally representative database. The generalisability of the present results to Bosnia and Herzegovina as a whole might be limited. Therefore, similar future investigations conducted in other large hospitals in our country are warranted.

Surgical Experience in Two Multicenter, Open-Label Phase 3 Studies of Emicizumab in Persons with Hemophilia A with Inhibitors (HAVEN 1 and HAVEN 2)

Surgical Experience in Two Multicenter, Open-Label Phase 3 Studies of Emicizumab in Persons with Hemophilia A with Inhibitors (HAVEN 1 and HAVEN 2)

Can inter-professional simulation training influence the frequency of blood transfusions after birth?

ObjectiveTo investigate whether inter-professional simulation training influenced the rate of red blood cell (RBC) transfusions after birth.DesignTwo cohorts were compared retrospectively using a pre–post design.SettingNorwegian university hospital with 4800 deliveries annually.PopulationWomen with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011.MethodsIn 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment.Main outcome measuresThe frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage.ResultsIn 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p < 0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38–0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery, and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage (p < 0.01) and uterine artery embolizations (p = 0.01).ConclusionWe found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables.

Patient Safety in the Ambulatory OB/GYN Setting

The frequency of surgical procedures in the office setting is increasing, and patient safety in this setting now has an expanded focus. Methods and strategies, including Ambulatory Patient Safety Guidelines, results tracking, communication, and risk management principles, will be reviewed in this chapter.

Willingness to pay as patient preference to bariatric surgery

An obesity epidemic is spreading worldwide. In addition to comorbidities, social and emotional problems contribute to reduce the quality of life (QoL) of obese people. Considering the heterogeneity of outcomes from clinical and surgical approaches, it is recommended that severely obese patients participate in their treatment decisions. This study evaluated preferences of severely obese patients for obesity surgical treatment using the willingness to pay (WTP) and to assess the impact of the presence of some clinical disorders, socioeconomic conditions and QoL on their decisions. The selected patients were invited to answer the WTP questionnaire using two formats of contingent valuation questions: dichotomous choice (yes/no) and a bidding game. The answers were correlated with clinical features, QoL assessed by the SF-36 and the Moorehead-Ardelt Quality of Life Questionnaire II, Brazilian socioeconomic classification, and family and personal incomes. The group of patients who accepted the first bid was older and had higher frequency of sleep apnoea when compared to those who rejected the offer. A significant correlation between the bidding game value and family income was found (r = 0.28; P < 0.02). In the logistic regression model, socioeconomic classification and sleep apnoea were shown to be independently associated with acceptance the bid. Sleep apnoea was the comorbidity that most influenced the acceptance in dichotomous choice for bariatric surgery, probably due to the deleterious effects on daily activities induced by sleep disturbances. Our findings also suggest that the frequency of surgical procedures is below the preference of the obese population in Brazil.

Tracheolaryngeal Complications of Inherited Epidermolysis Bullosa: Cumulative Experience of the National Epidermolysis Bullosa Registry

To accurately determine the frequency with which complications arise in the ears, noses, and throats of patients with inherited epidermolysis bullosa (EB) as well as the cumulative risk of tracheolaryngeal stenosis or stricture. Cross-sectional study (3,280 patients) with a nested, randomly sampled longitudinal subcohort (n=450), representing data collection, stratified by major EB subtype, of the National EB Registry, an epidemiologic project focused on enrolling all EB patients within the continental United States from 1986 to 2002, to permit generalization of findings to the entire American EB population. Systematic epidemiologic case finding and data collection were performed throughout the continental United States, followed by subclassification of patients by EB subtype. ENT complications were quantified via contingency tables (as frequencies) and lifetable analyses. Frequencies of surgical procedures were also determined. The most important clinical ENT complication in inherited EB was tracheolaryngeal stenosis or stricture, arising during early childhood and primarily within infants and children with junctional EB (JEB) (cumulative risk of 39.8% and 12.8% in Herlitz and non-Herlitz JEB, respectively, by ages 6 and 9). Other uncommon complications included chronic otitis media, chronic otitis externa, and hearing loss. Given the potential risk for sudden airway occlusion and death, meticulous surveillance by a pediatric otolaryngologist is a critical part of the overall management of infants and children with EB, especially those with JEB and two rare subtypes of generalized EB simplex. Elective tracheostomy should be considered in EB infants and children with evidence of airway embarrassment.

P0646 PRESENCE OF ANTIBODIES TO SACCHAROMYCES CEREVISIAE (ASCA) CORRELATES WITH RISK OF ILEOCECAL RESECTION IN CHILDREN AND YOUNG ADULTS WITH CROHN???S DISEASE

Introduction: Studies have demonstrated that ASCA antibodies will identify 40–80% of cases of Crohn’s disease (CD) in children and adults. However, it is less well established whether these antibodies identify a particular phenotype of disease, and if ASCA positive patients have a different clinical outcome. Methods: Clinical data and serum were obtained and banked between 1993 and 2000 from 83 children with Crohn’s disease (mean age 14.8 y, M:F 58:25), 54 with ulcerative colitis, and 63 controls. The serum was assayed for ASCA IgG and IgA, in a blinded fashion, with the laboratory being unaware of clinical diagnosis or history. In November 2003, charts of the 83 CD patients were reviewed for disease location data and surgical history. Significant differences in the frequencies of surgical procedures in ASCA positive and ASCA negative patients was established by the chi-square test. Results: Of the 83 CD patients, 36 (43%) were positive for ASCA IgA, ASCA IgG, or both markers. In contrast, 0 of 54 UC patients and 1 of 63 controls were positive for ASCA. Fourteen of 36 (39%) patients with positive ASCA underwent resection of the terminal ileum, TI and cecum, or TI and ascending colon. In contrast, only 11% of ASCA negative patients underwent such a resection (P<0.01). Nine of 17 patients with both ASCA IgA and IgG antibodies underwent resection. In thirteen of the 83 CD patients, serum was obtained after surgery (range 15–720 days after ileocecal resection). Of these thirteen, eleven patients had positive ASCA titers; two of these patients underwent a second ileal resection for restenosis. Conclusion: The presence of ASCA antibodies in pediatric Crohn’s disease correlates with increased risk of ilececal resection. Detection of this subset of children at initial presentation could potentially identify a group of patients at high risk for surgery, and who may warrant more intensive immunosuppressive therapy at disease onset. A prospective study by obtaining serum at initial diagnosis and monitoring the natural history of the disease is necessary to validate this observation.

Surgical Management of Lingual Nerve Injuries

Injuries to the lingual nerve remain a relatively uncommon event. However, given the frequency of surgical procedures in this anatomic region, it is likely that every oral and maxillofacial surgeon will be required to manage such an injury. When spontaneous recovery of lingual sensation is absent, microsurgical reconstruction can predictably achieve improved sensation in a majority of patients provided that such injuries are properly assessed and treated early. The quality of the sensory improvement is related to the age of the patient, the timing of surgery, the extent of the neural injury, and the quality of the repair.

Otitis media and eustachian tube dysfunction: Connection to allergic rhinitis

Otitis media and otitis media with effusion are among the most common childhood illnesses and contribute a great deal to health care costs. The cause of otitis media is multifactorial. Eustachian tube dysfunction, bacterial or viral infection of the middle ear, and nasal inflammation resulting from allergic rhinitis or upper respiratory infection are acknowledged contributing factors. Data from epidemiology studies indicate that 25% to 40% of upper respiratory infections in children younger than 3 years are accompanied by an episode of otitis media; 40% to 50% of children older than 3 years with chronic otitis media have confirmed allergic rhinitis. Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions, and eustachian tube dysfunction. Nasal inflammation due to allergen challenge results in classic signs and symptoms of allergic rhinitis and eustachian tube dysfunction. Eustachian tube dysfunction leads to increased negative pressure in the middle ear and improper ventilation. Both viral upper respiratory infection and nasal allergic reaction provoke nasal inflammation, eustachian tube dysfunction, and enhanced nasal protein transudation and secretion, which is likely to be sustained and modulated by inflammatory mediators and cytokines. In a study of experimental infection with influenza A virus, histamine release increased from peripheral blood basophils of patients with allergic rhinitis. These data support an interaction between viral infection and nasal allergy in enhancing certain pathophysiologic responses. Viral upper respiratory infections may promote secondary bacterial infections by altering bacterial adherence, modulating host immune and inflammatory responses, and impairing eustachian tube function. In acute otitis media, bacteria are cultured from approximately 70% of middle ear effusions, with Streptococcus pneumoniae being the most common organism. Initial management of otitis media consists of appropriate antimicrobial therapy. In the presence of allergic rhinitis, antiallergic therapies may be used to augment symptom resolution and therapeutic response. Surgical insertion of tympanostomy or ventilation tubes to promote drainage of unresolved effusions has become common. Further delineation of the pathogenesis of otitis media and otitis media with effusion will guide appropriate medical management and may decrease the need and frequency of surgical procedures. (J Allergy Clin Immunol 1997;99:S787-97.)

Risk factors for latex hypersensitivity in childhood.

As hypersensitivity to natural rubber latex (NRL) has become an increasingly recognized problem in children, identification of all groups at risk seems important. In this study hypersensitivity to NRL was evaluated in 337 children with potential risk factors. We identified by questionnaire children's underlying diseases, history of surgical procedures, evidence of atopy and patient's history of NRL-specific reactions. Hypersensitivity to NRL and other allergens relevant in the Düsseldorf area was evaluated by skin prick test and specific IgE. In 9.2% of all children hypersensitivity to NRL was observed. Significant risk factors for hypersensitivity to NRL were, among the underlying diseases, spina bifida (odds ratio 29.2), hydrocephalus internus (10.1), gastrointestinal malformation (5.2) and atopy (2.2). Surgical procedures with significant risk were the implantation of a ventriculo-peritoneal shunt (15.7) and surgery of the gastrointestinal tract (3.1). Frequency of surgical procedures correlated (p < 0.001) with risk of hypersensitivity. Frequent surgery and atopy were found to have an additional effect on the risk of hypersensitivity. Information about previous NRL-specific reactions obtained by questionnaire was of little predictive value when performing multivariate analysis. For children at high risk for hypersensitivity to NRL preoperative evaluation and, in case of hypersensitivity, preventive measures seem to be advised.

The Frequency of Surgical Procedures in a General Population Group: Based on Records for 9,000 Families in Eighteen States Visited Periodically for Twelve Consecutive Months, 1928-1931

The Frequency of Surgical Procedures in a General Population Group: Based on Records for 9,000 Families in Eighteen States Visited Periodically for Twelve Consecutive Months, 1928-1931

Frequency of Surgical Procedures among 9,000 Families, Based on Nation-Wide Periodic Canvasses, 1928-31

Frequency of Surgical Procedures among 9,000 Families, Based on Nation-Wide Periodic Canvasses, 1928-31