The American surgeon
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The American surgeon · Apr 2016
The Triage of Injured Patients: Mechanism of Injury, Regardless of Injury Severity, Determines Hospital Destination.
The target rate for trauma undertriage is <5 per cent, but rates are as high as 30 to 40 per cent in many trauma systems. We hypothesized that high undertriage rates were due to the tendency to undertriage injured elderly patients and a growing elderly population. We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database over a 5-year period. ⋯ High rates of undertriage are largely due to the undertriage of fall-related injuries, which occurs in both younger and older adults. Patients injured after MVCs and penetrating trauma victims are brought to trauma centers regardless of injury severity, resulting in high rates of overtriage. These findings suggest an opportunity to improve trauma system performance.
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The American surgeon · Apr 2016
Comparative StudyImproving Outcomes in Elective Colorectal Surgery: A Single-institution Retrospective Review.
Our hospital, a Tennessee Surgical Quality Collaborative (TSQC) member, adopted a statewide colorectal care bundle intended to reduce surgical site infections (SSI) in elective colorectal cases. The bundle includes proper antibiotics/dosing, normoglycemia, normothermia, supplemental oxygen six hours postoperatively, and early enteral nutrition. A single-institution retrospective study of our National Surgical Quality Improvement Program (NSQIP) database for the rates of SSI before and after the colorectal bundle. ⋯ After adopting a colorectal bundle aimed at reducing SSIs, we did not improve our SSI rates in NSQIP; however, our NHSN data demonstrated considerable improvement. Differences in data collection may affect SSI rates, and ultimately "quality" based reimbursement. Implementation of the bundle did improve outcomes in colorectal surgery.
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The American surgeon · Apr 2016
Clinical TrialA Prospective Blinded Study Evaluating the Role of Endoscopic Ultrasound before Endoscopic Retrograde Cholangiopancreatography in the Setting of "Positive" Intraoperative Cholangiogram during Cholecystectomy.
During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is used to identify common bile duct (CBD) stones. In patients whose IOC is suspicious for stones, endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice for stone removal. However, IOC has a false positive rate of 30 to 60 per cent, and ERCP adverse events may occur in 11 per cent of patients. ⋯ IOC with single or multiple filling defects more often correlated to the presence of CBD stones. At ERCP, choledocholithiasis was present in 65 per cent of patients who had an IOC suspicious for CBD stones. EUS should be used as a noninvasive method to correctly identify retained CBD stones in low-to-moderate risk patients with a positive IOC.
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The American surgeon · Apr 2016
Obesity and the Risk for Surgical Site Infection in Abdominal Surgery.
Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. ⋯ Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.