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https://www.readbyqxmd.com/read/28979986/geographic-diffusion-and-implementation-of-acute-care-surgery-an-uneven-solution-to-the-national-emergency-general-surgery-crisis
#1
Jasmine A Khubchandani, Angela M Ingraham, Vijaya T Daniel, Didem Ayturk, Catarina I Kiefe, Heena P Santry
Importance: Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. Objective: To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging...
October 4, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28958272/inclusion-of-the-acute-care-surgeon-in-the-difficult-airway-protocol-a-nine-year-experience
#2
Seong K Lee, Andrew A Rosenthal, Dafney L Davare, Chauniqua Kiffin, Rafael Sanchez, Michael Hurtado, Eddy H Carrillo
An emergency surgical airway is a lifesaving intervention required in the event of airway loss or respiratory failure when conventional endotracheal intubation cannot be performed. The Acute Care Surgery/Trauma Service is a critical component in the angioedema/difficult airway protocol at our institution. We conducted a retrospective review (2007-2016) to analyze the role our service has in managing patients requiring an emergency surgical airway. Cases were analyzed for preexisting conditions, hospital location of procedure, techniques, complications, and mortality...
September 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28930946/evaluating-the-traditional-day-and-night-shift-in-an-acute-care-surgery-fellowship-is-the-swing-shift-a-better-choice
#3
Paul J Chestovich, Christopher F McNicoll, Nichole K Ingalls, Deborah A Kuhls, Douglas R Fraser, Shawna L Morrissey, John J Fildes
BACKGROUND: Fellowship trainees in Acute Care Surgery require experience in the management of complex and operative trauma cases. Trauma center staffing usually follows standard 12 or 24 hour shifts, with resident and fellow trainees following a similar schedule. Although trauma admissions can be generally unpredictable, we analyzed temporal trends of trauma patient arrival times to determine the best time frame to maximize trainee experience during each day. METHODS: We reviewed ten years (2007-2016) of trauma registry data for blunt and penetrating trauma activations...
September 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28930045/antibiotic-use-among-older-adults-on-an-acute-care-general-surgery-service
#4
André S Pollmann, Jon G Bailey, Philip J B Davis, Paul M Johnson
BACKGROUND: Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgical service at a tertiary care teaching hospital. METHODS: Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgical service...
October 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28929283/expanding-the-field-of-acute-care-surgery-a-systematic-review-of-the-use-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa-in-cases-of-morbidly-adherent-placenta
#5
R Manzano-Nunez, M F Escobar-Vidarte, M P Naranjo, F Rodriguez, P Ferrada, J D Casallas, C A Ordoñez
PURPOSE: Prophylactic placement of endovascular balloon occlusion catheters has grown to be part of the surgical plans to control intraoperative hemorrhage in cases of abnormal placentation. We performed a systematic literature review to investigate the safety and effectiveness of the use of REBOA during cesarean delivery in pregnant woman with morbidly adherent placenta. METHODS: A systematic review was performed. Relevant case reports and nonrandomized studies were identified by the literature search in MEDLINE...
September 19, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28918345/meta-analysis-on-the-impact-of-the-acute-care-surgery-model-of-disease-and-patient-specific-outcomes-in-appendicitis-and-biliary-disease
#6
Patrick B Murphy, Kristin DeGirolamo, Theunis Jean Van Zyl, Laura Allen, Elliott Haut, W Robert Leeper, Ken Leslie, Neil Parry, Morad Hameed, Kelly N Vogt
BACKGROUND: The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured emergency general surgery patient population, however, there are variations in the design of ACS service models. This meta-analysis analyzes the impact of implementation of different ACS models on the outcomes for appendicitis and biliary disease. STUDY DESIGN: A systematic, English-language search of major databases was conducted. From 1,827 papers, 2 independent reviewers identified 25 studies that reported on outcomes for patients with appendicitis (n = 13), biliary disease (n = 7), or both (n = 5), before and after implementation of an ACS service...
September 14, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28899559/emergency-general-surgery-and-trauma-outcomes-from-the-first-consultant-led-service-in-singapore
#7
Sachin Mathur, Woan Wui Lim, Tiong Thye Goo
INTRODUCTION: There is a significant burden on public health systems from emergency surgical and trauma (ESAT) patients. In Western countries, the response has been to separate acute and elective surgery with the creation of a new sub-specialty: acute care surgery. Dedicated acute units have shown improvements in efficiency and clinical outcomes for patients. The aim of this study was to assess the results of the first such unit in Singapore. MATERIALS AND METHODS: A retrospective analysis was performed of a 12-month period of acute admissions between May 2014 and April 2015, with comparison of 6-months before and after the creation of the ESAT service...
September 5, 2017: Injury
https://www.readbyqxmd.com/read/28892324/2016-acs-governors-survey-will-acute-care-surgery-change-the-surgical-landscape
#8
Juan C Paramo, Mark W Puls, David J Welsh, Peter Andreone
No abstract text is available yet for this article.
May 2017: Bulletin of the American College of Surgeons
https://www.readbyqxmd.com/read/28882357/evaluation-of-negative-pressure-wound-therapy-to-closed-laparotomy-incisions-in-acute-care-surgery
#9
Elleson Schurtz, Jerome Differding, Eric Jacobson, Christopher Maki, Mentor Ahmeti
BACKGROUND: Surgical site complications in the form of wound infections are a major burden to the healthcare system. Negative pressure wound therapy (NPWT) as delivered by a surgical incision management system (SIMS) is a novel approach to improve wound healing when applied to closed incisions. However, data is limited in its application to laparotomy incisions in the acute care surgery setting. METHODS: A retrospective case-control study was performed to evaluate the outcomes of SIMS with regard to surgical site infections in a series of 48 consecutive patients in which SIMS was applied to closed laparotomy incisions in the acute care surgery setting...
August 23, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28851486/geriatric-rescue-after-surgery-gras-score-to-predict-failure-to-rescue-in-geriatric-emergency-general-surgery-patients
#10
Muhammad Khan, Asad Azim, Terence O'Keeffe, Faisal Jehan, Narong Kulvatunyou, Chelsey Santino, Andrew Tang, Gary Vercruysse, Lynn Gries, Bellal Joseph
BACKGROUND: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. METHODS: 3-year(2013-15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor...
August 15, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28838270/surgical-outcome-evaluation-of-perforated-gastric-cancer-from-the-aspects-of-both-acute-care-surgery-and-surgical-oncology
#11
Shang-Yu Wang, Chih-Ho Hsu, Chien-Hung Liao, Chih-Yuan Fu, Chun-Hsiang Ouyang, Chi-Tung Cheng, Jun-Te Hsu, Ta-Sen Yeh, Chun-Nan Yeh
BACKGROUND: Perforated gastric cancer (PGC) is a rare condition of gastric cancer (GC). In this study, we sought to assess the outcome of PGC from the aspects of both acute care surgery and surgical oncology at a single institute, Chang Gung Memorial Hospital (CGMH). METHODS: From 1997 to 2013, 6864 patients were diagnosed with GC and 2738 were diagnosed with gastroduodenal perforation at CGMH. In total, 29 patients with PGC were identified. Immediate surgical and long-term oncologic outcomes were evaluated after an appropriate matching process was performed...
August 24, 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/28807202/do-acute-care-surgeons-follow-best-practices-for-breast-abscess-management-a-single-institution-analysis-of-325-consecutive-cases
#12
Alison Unzeitig Barron, Stephen Luk, Herb A Phelan, Brian H Williams
BACKGROUND: The breast surgery community has adopted needle aspiration as the standard of care for breast abscesses, which have a size less than 5 cm on ultrasound, no skin changes, and fewer than 5 days of symptoms. Our acute-care surgery (ACS) service manages all breast abscess consults at our urban safety-net hospital. We undertook this descriptive study to identify the rate of operative incisions and drainage performed by ACS surgeons which were not compatible with best practices for breast abscess management...
August 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28756821/acute-care-surgery-an-evolving-paradigm
#13
Gregory J Jurkovich, Kimberly A Davis, Clay Cothren Burlew, Christopher J Dente, Joseph M Galante, Joel S Goodwin, Bellal Joseph, Marc de Moya, Robert D Becher, Viraj Pandit
No abstract text is available yet for this article.
July 2017: Current Problems in Surgery
https://www.readbyqxmd.com/read/28738944/predicting-postoperative-complications-for-acute-care-surgery-patients-using-the-acs-nsqip-surgical-risk-calculator
#14
Jessica R Burgess, Benjamin Smith, Rebecca Britt, Leonard Weireter, Travis Polk
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator has been used to assist surgeons in predicting the risk of postoperative complications. This study aims to determine if the risk calculator accurately predicts complications in acute care surgical patients undergoing laparotomy. A retrospective review was performed on all patients on the acute care surgery service at a tertiary hospital who underwent laparotomy between 2011 and 2012. The preoperative risk factors were used to calculate the estimated risks of postoperative complications in both the original ACS NSQIP calculator and updated calculator (June 2016)...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738931/management-of-appendicitis-with-the-implementation-of-an-acute-care-surgery-service-in-a-community-teaching-hospital
#15
Michael Farrell, Emily Murphy, Richard Caplan, Kevin Bradley, Matthew Rubino, Mark Cipolle
No abstract text is available yet for this article.
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28736059/anti-factor-xa-measurements-in-acute-care-surgery-patients-to-examine-enoxaparin-dose
#16
Vanessa Wall, Kory I Fleming, Joseph E Tonna, Jade Nunez, Nick Lonardo, R Wayne Shipley, Ram Nirula, Christopher J Pannucci
BACKGROUND: The purpose of this study was to determine if fixed dose enoxaparin prophylaxis provided effective anticoagulation for acute care surgery patients and to examine whether a real-time enoxaparin dose adjustment algorithm optimized anticoagulation. METHODS: Acute care surgical patients placed on enoxaparin prophylaxis 30 mg twice daily were recruited prospectively. Peak steady state aFXa levels were drawn with a goal peak aFXa range of 0.2-0.4 IU/ml. A real time dose adjustment algorithm was implemented for patients with out-of-range levels...
July 18, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28662926/defining-the-burden-scope-and-future-of-vascular-acute-care-surgery
#17
Donald G Harris, Anthony Herrera, Charles B Drucker, Richa Kalsi, Nandakumar Menon, Shahab Toursavadkohi, Jose J Diaz, Robert S Crawford
OBJECTIVE: The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland. METHODS: A retrospective analysis of a statewide inpatient database was performed to identify patients undergoing noncardiac vascular procedures in Maryland from 2009 to 2013...
June 26, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28640780/challenges-in-acute-care-surgery-shootout-at-the-o-k-corral-history-revisited
#18
Gary A Vercruysse, Zachary M Bauman, Jordan Roman, Peter M Rhee, Ernest E Moore
No abstract text is available yet for this article.
June 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28465716/acute-care-surgery-a-means-for-providing-cost-effective-quality-care-for-gallstone-pancreatitis
#19
Patrick B Murphy, Dave Paskar, Richard Hilsden, Jennifer Koichopolos, Tina S Mele
BACKGROUND: Modern practice guidelines recommend index cholecystectomy (IC) for patients admitted with gallstone pancreatitis (GSP). However, this benchmark has been difficult to widely achieve. Previous work has demonstrated that dedicated acute care surgery (ACS) services can facilitate IC. However, the associated financial costs and economic effectiveness of this intervention are unknown and represent potential barriers to ACS adoption. We investigated the impact of an ACS service at two hospitals before and after implementation on cost effectiveness, patient quality-adjusted life years (QALY) and impact on rates of IC...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28452889/surgical-management-of-pancreatic-necrosis-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#20
COMPARATIVE STUDY
Nathan T Mowery, Brandon R Bruns, Heather G MacNew, Suresh Agarwal, Toby M Enniss, Mansoor Khan, Weidun Alan Guo, Jeremy W Cannon, Matthew E Lissauer, Therese M Duane, Amy N Hildreth, Peter A Pappas, Lynn M Gries, Meghann Kaiser, Bryce R H Robinson
BACKGROUND: Pancreatic or peripancreatic tissue necrosis confers substantial morbidity and mortality. New modalities have created a wide variation in approaches and timing of interventions for necrotizing pancreatitis. As acute care surgery evolves, its practitioners are increasingly being called upon to manage these complex patients. METHODS: A systematic review of the MEDLINE database using PubMed was performed. English language articles regarding pancreatic necrosis from 1980 to 2014 were included...
August 2017: Journal of Trauma and Acute Care Surgery
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