The American surgeon
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The American College of Surgeons (ACS) recommends trauma overtriage rate (OT) below 50 per cent to maximize efficiency while ensuring optimal care. This retrospective study was undertaken to evaluate OT rates in our Level I trauma center using the most recent criteria and guidelines. OT rates during a 12-month period were measured using six definitions based on combinations of Injury Severity Score (ISS), length of hospital stay (LOS, in days), procedures, and disposition after the emergency department. ⋯ Physiologic assessment criteria and anatomic injury had the lowest OT rates and contained all mortalities. Passenger space intrusion (PSI), pedestrian versus automobile (criterion and guideline), and extrication (guideline) all had consistently high rates of OT. We conclude that PSI should be reduced to a guideline, the pedestrian versus automobile criterion and guideline should be combined, and extrication could be removed from the triage scheme.
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The American surgeon · Oct 2014
Do preoperative β-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines.
Preoperative β-blockers (BBs) are widely administered to reduce morbidity and mortality among surgical patients. In fact, the Society of Thoracic Surgeons uses the administration of preoperative BBs as a quality metric. Recent reports, however, have questioned the benefit and safety of preoperative BB administration. ⋯ BB use was not associated with significant differences in other outcomes such as mortality or postoperative atrial fibrillation. Our study found that preoperative BBs may not be associated with sufficiently improved outcomes to justify their use as a quality metric in this population. Thus, prospective studies are warranted.
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The American surgeon · Oct 2014
Comparative StudyOutcome of abdominal wall hernia repair with biologic mesh: Permacol™ versus Strattice™.
The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. Numerous biologic products are available with virtually no clinical comparison studies. A retrospective study was conducted to compare patients who underwent abdominal wall hernia repair with Permacol™ (crosslinked porcine dermis) and Strattice™ (noncrosslinked porcine dermis). ⋯ Short-term complication and recurrence rates were higher when mesh was used as a fascial bridge: 51 versus 28 per cent for Permacol™, 58 versus 20 per cent for Strattice™. The hernia recurrence was similar in both groups. In this review of patients undergoing abdominal hernia repair with biologic mesh, Strattice™ mesh was associated with a lower short-term complication rate compared with Permacol™, but the hernia recurrence rate was similar.
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The American surgeon · Oct 2014
Management of patients with evisceration after abdominal stab wounds.
In the era of nonoperative management of abdominal stab wounds, the optimal management of patients with evisceration remains unclear. Furthermore, the role of imaging in guiding management of these patients has not been defined. Patients admitted to a Level I trauma center (2005 to 2012) with evisceration after an abdominal stab wound were retrospectively identified. ⋯ In conclusion, the rate of intra-abdominal injury in patients with evisceration remains high. Even in the age of nonoperative management, evisceration continues to be an indication for immediate laparotomy. The diagnostic yield of CT is low and CT should not impact management of these patients.
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Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal. ⋯ A total of 69 cases were reported over a 20-month period: 32 (46%) were plaintiffs' verdicts, whereas 37 (54%) were in favor of the surgeon. Only 10 (31%) of the plaintiff verdicts were by jury trial, whereas the rest were settled by pretrial agreement, mediation, or arbitration. Of cases settled by alternate dispute resolution, the median settlement was $820,000 (n = 22) compared with a median jury trial award of $300,000 (n = 10).