The American surgeon
-
The American surgeon · Jan 2016
Delineation of Criteria for Admission to Step Down in the Mild Traumatic Brain Injury Patient.
Patients that suffer a mild traumatic brain injury (TBI) with intracranial hemorrhage are commonly admitted to an intensive care unit with repeat imaging in 12 to 24 hours. This is costly to the health-care system. This study aimed to evaluate this practice and to identify criteria to triage patients to lower levels of monitored care. ⋯ These include age, GCS < 15, and warfarin use. Patients aged <55 with GCS 15, posed minimal risk for deterioration. Patients aged <55 and with a GCS of 15 can be admitted to a monitored step-down bed with less frequent neurological checks.
-
The American surgeon · Jan 2016
Implementation of an Acute Care Surgery Service in a Community Hospital: Impact on Hospital Efficiency and Patient Outcomes.
A service led by acute care surgeons managing trauma, critically ill surgical, and emergency general surgery patients via an acute care surgery model of patient care improves hospital efficiency and patient outcomes at university-affiliated hospitals and American College of Surgeons-verified trauma centers. Our goal was to determine whether an acute care surgeon led service, entitled the Surgical Trauma and Acute Resuscitative Service (STARS) that implemented an acute care surgery model of patient care, could improve hospital efficiency and patient outcomes at a community hospital. A total of 492 patient charts were reviewed, which included 230 before the implementation of the STARS [pre-STARS (control)] and 262 after the implementation of the STARS [post-STARS (study)]. ⋯ Average decreases in ED-LOS (9.7 + 9.6 hours, pre-STARS versus 6.6 + 4.5 hours, post-STARS), SICU-LOS (5.3 + 9.6 days, pre-STARS versus 3.5 + 4.8 days, post-STARS), H-LOS (12.4 + 12.7 days, pre-STARS versus 11.4 + 11.3 days, post-STARS), and total in hospital charges ($419,602.6 + $519,523.0 pre-STARS to $374,816.7 + $411,935.8 post-STARS) post-STARS. Regression analysis revealed decreased ED-LOS-2.9 hours [P = 0.17; 95% confidence interval (CI): -7.0, 1.2], SICU-LOS-6.3 days (P < 0.001; 95% CI: -9.3, -3.2), H-LOS-7.6 days (P = 0.001; 95% CI: -12.1, -3.1), and 3.4 times greater odds of survival (P = 0.04; 95% CI: 1.1, 10.7) post-STARS. In conclusion, implementation of the STARS improved hospital efficiency and patient outcomes at a community hospital.
-
The American surgeon · Jan 2016
The Charlson Comorbidity Index (CCI) as a Mortality Predictor after Surgery in Elderly Patients.
The increasing range of surgery in elderly patients reflects the changing demography where in the next 10 years one quarter of the population will be 65 years of age or older. There is presently no consensus concerning the optimal predictive markers for postoperative morbidity and mortality after surgery in older patients with an appreciation that physical frailty is more important than chronological age. ⋯ A higher mean CCI was noted in both age groups in early nonsurvivors after both elective and emergency surgery with a more significant effect of the preoperative CCI than chronological age for the prediction of late postoperative death for both groups after elective and emergency operations. Although the CCI was not designed to predict perioperative mortality in surgical cohorts, it correlates with a greater risk than age for perioperative death in the elderly.
-
Controversy surrounds appendectomy timings and their effects on postoperative outcomes. This study evaluated the influence of hospital delays on perforation rates and complications in patients with acute appendicitis. From January 2008 to December 2013, the cases of 4148 consecutive patients who had undergone appendectomies for suspected appendicitis were reviewed. ⋯ Hospital delays were not associated with significantly increased risks of perforation and complications. However, patients with perforated appendicitis had higher risks of developing postoperative ileus if hospital delays were >18 hours. Therefore, hospital delays of ≤18 hours are safe, but caution is required if delays are >18 hours.
-
The American surgeon · Jan 2016
Comparative StudyOutcomes of 157 V-Patch(TM) Implants in the Repair of Umbilical, Epigastric, and Incisional Hernias.
Umbilical, epigastric, and incisional hernias have traditionally been repaired using a Mayo or tensioned suture technique, with recurrence rates of approximately 50 per cent. Recent studies have shown that a tension-free repair using mesh can drastically decrease recurrence rates. Reinforced deployment prostheses are preferred because they enable retrofascial placement through a small incision, thus avoiding the potential morbidity of a larger incision and the costs associated with a laparoscopic approach. ⋯ Complications included three patients (1.9%) with mesh infection, one with an enterocutaneous fistula (0.6%), and one patient with a postoperative small bowel obstruction (0.6%). Four patients required patch explantation (2.5%). The V-Patch reinforced deployment prosthesis is effective in the treatment of umbilical, epigastric, and incisional hernias, and has a low rate of complications.