The American surgeon
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The American surgeon · Aug 2010
ReviewRib fracture fixation: controversies and technical challenges.
Rib fractures are a common injury affecting more than 350,000 people each year in the United States and are associated with respiratory complications, prolonged hospitalization, prolonged pain, long-term disability, and mortality. The social and economic costs that rib fractures contribute to the health care burden of the United States are therefore significant. ⋯ Recently, however, several reports from American centers support an increased application of operative fixation. With this resurgent interest of American surgeons in mind, we review the clinical presentations, potential indications, controversies, and technical challenges unique to rib fracture fixation.
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The American surgeon · Aug 2010
Comparative StudySurgical intensive care unit mobility is increased after institution of a computerized mobility order set and intensive care unit mobility protocol: a prospective cohort analysis.
In some populations, intensive care unit (ICU) mobility has been shown to be safe and beneficial. We gathered data on 50 nonintubated surgical patients in a 10-bed surgical ICU (SICU) who met physiologic inclusion criteria beginning in May 2008 (A group). In January 2009, we began mandatory entry of computerized mobility orders as part of a standardized ICU order set. ⋯ In the A group, 11 patients (22%) were mobilized; in the B group, 40 patients (80%) were mobilized, P < 0.05. In our SICU patient population, mandatory entry of computerized mobility orders as part of a standard SICU order set and establishment of an ICU mobility nursing protocol was associated with an increase in number of mobility orders entered as well as an increase in SICU patient activity. Further studies should focus on measurement of the effect of mobility interventions on patient outcomes.
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The American surgeon · Aug 2010
Analysis of Centers for Medicaid and Medicare Services 'never events' in elderly patients undergoing bowel operations.
Since October 2008, the Centers for Medicare and Medicaid Services (CMS) has denied reimbursement for 10 hospital-acquired "never events," which were deemed reasonably preventable. This study compares the frequency and costs of CMS "never events" in patients undergoing bowel operations between ages 65 to 79 years and 80 years or older. Patients aged 65 years or older who underwent small or large bowel operations, from January 2008 to March 2009, were identified by a retrospective review of inpatient charts and the Greenville Hospital System electronic coding database. ⋯ Patients 80 years of age or older had a statistically higher incidence when compared with the age 65- to 79-year-old age group of catheter-related urinary tract infections (UTIs) (36 vs 12%), vascular catheter infections (15 vs 4%), hospital LOS (11 vs 6 days) as well as a greater median hospital cost ($28,300 vs $15,300). It is unclear whether these "never events" are the reason for higher costs or an indicator of more severely ill patients. Nevertheless, it is clear that the additional financial burden of caring for these high-risk, high-cost, elderly patients is clearly borne by the hospital.
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The American surgeon · Aug 2010
Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury.
Blunt trauma patients with rib fractures were studied to determine whether the number of rib fractures or their patterns were more predictive of abdominal solid organ injury and/or other thoracic trauma. Rib fractures were characterized as upper zone (ribs 1 to 4), midzone (ribs 5 to 8), and lower zone (ribs 9 to 12). Findings of sternal and scapular fractures, pulmonary contusions, and solid organ injures (liver, spleen, kidney) were characterized by the total number and predominant zone of ribs fractured. ⋯ Scapular and sternal fractures were more common with upper zone fractures and pulmonary contusions increased with the number of fractured ribs. Multiple rib fractures involving the lower ribs have a high association with solid organ injury, 51 per cent in this series. The increasing number of rib fractures enhanced the likelihood of other chest wall and pulmonary injuries but did not affect the incidence of solid organ injury.