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Journal of the American College of Surgeons

Jamie E Anderson, Garth H Utter, Patrick S Romano, Gregory J Jurkovich
BACKGROUND: Traditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, whereas the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. While both methods are used to identify adverse events and inform quality improvement efforts, these two methods may not overlap. STUDY DESIGN: This is a retrospective observational study of all hospitalizations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event (PSIs 03, 05-15) identified by: (1) surgery faculty and residents for review by departmental M&M conference; or (2) administrative data (according to AHRQ version 6...
July 5, 2018: Journal of the American College of Surgeons
Brett L Ecker, Matthew T McMillan, Laura Maggino, Charles M Vollmer
BACKGROUND: Improvements in surgical outcomes are predicated on recognizing effective practices with subsequent adaptation. It is unknown whether risk assessment for pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) translates to improved patient outcomes at the practice level. METHODS: A prospectively collected, single-surgeon career experience (2003-2018) of 455 consecutive pancreatectomies (303 PDs and 152 distal pancreatectomies) was examined...
July 5, 2018: Journal of the American College of Surgeons
Michael J Valliere, Piper L Wall, Charisse M Buising
BACKGROUND: Limb tourniquet pressures >100mmHg prior to tightening system use eases achieving arterial occlusion, minimizes tightening system problems, and probably minimizes discomfort. This study examined effects of buckle and strap features on converting pulling force to strap pressure. STUDY DESIGN: Twenty-two buckle and strap combinations were evaluated using a thigh-diameter, ballistic gel cylinder and three thighs. Weights of 14.11, 27.60, and 41.11kg provided pulling force...
June 29, 2018: Journal of the American College of Surgeons
Christopher M Quinn, Karl Y Bilimoria, Jeanette W Chung, Clifford Y Ko, Mark E Cohen, Jonah J Stulberg
BACKGROUND: Surgeon performance profiling is of great interest to surgeons, hospitals, health plans and the public, yet efforts to date have been contested, with stakeholders at odds over the selection and reliability and validity of metrics used. We sought to create surgeon-level comparative assessments within the Illinois Surgical Quality Improvement Collaborative. STUDY DESIGN: American College of Surgeons National Surgical Quality Improvement Program data were obtained for 51 Illinois hospitals covering a 30-month period from 2014-2016...
June 22, 2018: Journal of the American College of Surgeons
Daniel M Morgan, Neil Kamdar, Scott E Regenbogen, Greta Krapohl, Carolyn Swenson, Mark Pearlman, Darrel A Campbell, Samantha Hendren
BACKGROUND: The Hospital Acquired Condition Reduction Program (HACRP) is a national pay-for-performance program that includes a measure of surgical site infection (SSI) after hysterectomy and colectomy. This study compares the HACRP SSI measure with other published methods. STUDY DESIGN: This was a retrospective cohort study from the Michigan Surgical Quality Collaborative (MSQC). The outcome was 30-day, adjusted deep and organ space SSI ("complex SSI")...
June 21, 2018: Journal of the American College of Surgeons
Aileen C Johnson, Cecilia G Ethun, Yuan Liu, Alexandra G Lopez-Aguiar, Thuy B Tran, George Poultsides, Valerie Grignol, J Harrison Howard, Meena Bedi, T Clark Gamblin, Jennifer Tseng, Kevin K Roggin, Konstantinos Chouliaras, Konstantinos Votanopoulos, Darren Cullinan, Ryan C Fields, Keith A Delman, William C Wood, Kenneth Cardona, Shishir K Maithel
BACKGROUND: Multi-institutional collaborations provide granularity lacking in epidemiologic data sets to enable in-depth study of rare diseases. For patients with superficial, high-grade soft tissue sarcomas of the trunk and extremity, the value of radiation therapy (RT) is not clear. We aimed to use the 7-institution US Sarcoma Collaborative (USSC) and the National Cancer Database (NCDB) to investigate this issue. STUDY DESIGN: All adult patients with superficial truncal and extremity high-grade soft tissue sarcomas who underwent primary curative-intent resection from 2000 to 2016 at USSC institutions or were included in the NCDB from 2004 to 2013 were analyzed...
June 12, 2018: Journal of the American College of Surgeons
Luke R Johnston, Matthew J Bradley, Carlos J Rodriguez, Michael P McNally, Eric A Elster, James E Duncan
BACKGROUND: During the past decade of conflict, numerous casualties sustained injuries requiring the formation of an ostomy. However, outcomes in those casualties undergoing ostomy reversal have yet to be analyzed. We review the experience and identify risk factors for complications after ostomy reversal in a series of combat casualties at our military treatment facility. STUDY DESIGN: A retrospective review of combat casualties managed with a diverting ostomy who underwent ostomy reversal at our military treatment facility over a 13 year period...
June 12, 2018: Journal of the American College of Surgeons
Samuel Wade Ross, A Britton Christmas, Peter E Fischer, Haley Holway, Rachel Seymour, Ciara R Huntington, B Todd Heniford, Ronald F Sing
BACKGROUND: The concept of hemodilution after blood loss and crystalloid infusion is a surgical maxim that remains unproven in humans. We sought to quantify the effect of hemodilution after crystalloid administration in voluntary blood donors as a model for acute hemorrhage. STUDY DESIGN: A prospective, randomized control trial was conducted in conjunction with community blood drives. Donors were randomized to receive no IV fluid(noIVF), two liters normal saline(NS), or two liters lactated ringers(LR) after blood donation...
June 4, 2018: Journal of the American College of Surgeons
Sarah E Tevis, Andrew P Rogers, Evie H Carchman, Eugene F Foley, Bruce A Harms
BACKGROUND: While the costs of medical training continue to increase, surgeon income and personal financial decisions may be challenged to manage this expanding debt burden. We sought to characterize the financial liability, assets, income, and debt of surgical residents, and evaluate the necessity for additional financial training. STUDY DESIGN: All surgical trainees at a single academic center completed a detailed survey. Questions focused on issues related to debt, equity, cash flow, financial education, and fiscal parameters...
May 31, 2018: Journal of the American College of Surgeons
Carl L Dambkowski, Luis Garcia, Natalia Leva, John M Morton
BACKGROUND: One of the world's highest volume chemicals is bisphenol-A (BPA), an organic compound with a high solubility in fat. An emerging body of literature has suggested a link between BPA, obesity, and insulin resistance. The study aim was to determine if surgical weight loss is associated with changes in BPA levels. STUDY DESIGN: Demographic, preoperative, and 3-, 6-, and 12-month postoperative urine and laboratory data were prospectively collected on 22 bariatric surgery patients at a single academic institution...
May 26, 2018: Journal of the American College of Surgeons
M Margaret Knudson, Eric A Elster, Jeffery A Bailey, Jay A Johannigman, Patrick V Bailey, C William Schwab, Garrett G Kirk, Jonathan A Woodson
No abstract text is available yet for this article.
May 23, 2018: Journal of the American College of Surgeons
Della M Lin, Kathryn A Carson, Lisa H Lubomski, Elizabeth C Wick, Julius Cuong Pham
BACKGROUND: Surgical site infections (SSIs) after colorectal surgery are common, lead to patient harm, and are costly to the healthcare system. This study's purpose was to evaluate the effectiveness of the AHRQ Safety Program for Surgery in Hawaii. STUDY DESIGN: This pre-post cohort study involved 100% of 15 hospitals in Hawaii from January 2013 through June 2015. The intervention was a statewide implementation of the Comprehensive Unit-Based Safety Program and individualized bundles of interventions to reduce SSIs...
May 18, 2018: Journal of the American College of Surgeons
May C Tee, Adam C Krajewski, Ryan T Groeschl, Michael B Farnell, David M Nagorney, Michael L Kendrick, Sean P Cleary, Rory L Smoot, Kristopher P Croome, Mark J Truty
BACKGROUND: Pancreatectomy with arterial resection (AR) is performed infrequently. As indications evolve, we evaluated indications, outcomes, and predictors of mortality, morbidity, and survival after AR. STUDY DESIGN: We performed a single-institution review of elective pancreatectomies with AR (from July1990 to July 2017). Univariate and multivariate analyses were performed for predictors of outcomes and survival. RESULTS: A total of 111 patients underwent pancreatectomy with AR including any hepatic (54%), any celiac (44%), any superior mesenteric (14%), or multiple ARs (14%), with revascularization in 55%...
May 9, 2018: Journal of the American College of Surgeons
Wen Hui Tan, Jennifer Yu, Sara Feaman, Jared M McAllister, Lindsey G Kahan, Mary A Quasebarth, Jeffrey A Blatnik, J Christopher Eagon, Michael M Awad, L Michael Brunt
BACKGROUND: With the epidemic of prescription opioid abuse in the US, rates of opioid-related unintentional deaths have risen dramatically. However, few data exist comparing postoperative opioid prescriptions with patient use. We sought to better elucidate this relationship in surgical patients. STUDY DESIGN: A prospective cohort study was conducted of narcotic-naïve patients undergoing open and laparoscopic abdominal procedures on a minimally invasive surgery service...
May 7, 2018: Journal of the American College of Surgeons
Colin F Mackenzie, Mark W Bowyer, Sharon Henry, Samuel A Tisherman, Adam Puche, Hegang Chen, Valerie Shalin, Kristy Pugh, Evan Garofalo, Stacy A Shackelford
BACKGROUND: Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome...
May 4, 2018: Journal of the American College of Surgeons
Shanu N Kothari, Madeline J Anderson, Andrew J Borgert, Kara J Kallies, Todd J Kowalski
BACKGROUND: The American College of Surgeons guidelines indicate that skull caps are acceptable, and the Association of Perioperative Registered Nurses recommends bouffant caps. However, no scientific evidence has shown a significant advantage in surgical site infection (SSI) reduction with either cap. The objective of this study was to determine the influence of surgical cap choice on SSIs. STUDY DESIGN: Data from a previously published prospective randomized trial on the impact of hair clipping on SSIs were analyzed...
May 4, 2018: Journal of the American College of Surgeons
Bruno C Odisio, Eve Simoneau, Alex A Holmes, Claudius H Conrad, Jean-Nicolas Vauthey
No abstract text is available yet for this article.
May 4, 2018: Journal of the American College of Surgeons
Matthew Torgeson, Joel Kileny, Christopher Pfeifer, Lawrence Narkiewicz, Shawn Obi
BACKGROUND: Colorectal surgery is a focus of enhanced recovery protocols (ERP). The use of transversus abdominis plane (TAP) block for abdominal surgery has demonstrated effectiveness in ERP, however, no direct comparison of epidural vs TAP for nonanalgesic clinical factors has been published to date. The primary aim of this study was to compare epidural with TAP for length of stay in colorectal surgery. STUDY DESIGN: Patients undergoing open and laparoscopic colorectal surgery were prospectively randomized into epidural (n = 39) or TAP (n = 44) groups preoperatively...
May 1, 2018: Journal of the American College of Surgeons
Zaher Lakkis, Maxime Laydi, Brice Paquette, Célia Turco, Nicolas Bouviez, Simone Manfredelli, Alexandre Doussot, Julien Pauchot
No abstract text is available yet for this article.
April 30, 2018: Journal of the American College of Surgeons
Marcus D Darrabie, Chasen A Croft, Scott C Brakenridge, Alicia M Mohr, Martin A Rosenthal, Nicole R Mercier, Frederick A Moore, R Stephen Smith
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel method of controlling subdiaphragmatic hemorrhage while improving hemodynamic stability. This procedure achieves many of the goals of resuscitative thoracotomy (RT), but is less invasive. Here, we present the initial experience with REBOA at a level 1 academic trauma center. STUDY DESIGN: We performed a retrospective review. Orientation of surgeons and residents to REBOA was accomplished by an educational program including a hands-on simulation session (1...
April 27, 2018: Journal of the American College of Surgeons
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