The American surgeon
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The American surgeon · Aug 2005
Comparative StudyProspective, blinded evaluation of accuracy of operative reports dictated by surgical residents.
Incomplete or inaccurate operative notes result in delayed, reduced, or denied reimbursement. Deficient reports may be more common when dictated by the surgical residents. We performed a blinded study to assess the accuracy of residents' dictations and their effect on the appropriate level of coding for reimbursement. ⋯ Dictations of complex, multicode, or laparoscopic surgeries, especially if delayed beyond 24 hours, are likely to contain significant deficiencies that affect billing. Attending surgeons may be better equipped to dictate complex cases. Formal housestaff education, mentorship by the attending faculty, and ongoing quality control may be paramount to minimize documentation errors to ensure appropriate coding for the services rendered.
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The American surgeon · Aug 2005
Comparative StudyThe general surgery model: a more appealing and sustainable alternative for the care of trauma patients.
The contemporary model of trauma care where dedicated trauma/critical care surgeons exclusively manage trauma patients has become progressively unsustainable. Little objective data, however, is available documenting that a better model exists. From September 2002 through August 2003, the trauma model at a 735-bed level I trauma teaching hospital was changed from the contemporary model to a new one where selected general surgeons with Advanced Trauma Life Support (ATLS) certification covered in-house trauma and emergency surgery call on a rotational basis. ⋯ Differences (trauma/critical care vs general surgery, % increase/P value) included average daily census (24 vs 54, 225%), cases/attending (262 vs 543, 207%), cases/resident (54 vs 262, 485%), charges/attending (353,811 dollars vs 471,725 dollars, 133%), collections/attending (106,143 dollars vs 165,103 dollars, 156%), number of trauma patients (643 vs 748, 116%), trauma mortality (7.3% vs 4.0%; P = 0.007), trauma mortality with ISS >15 (21.7% vs 12.0%; P = 0.035), trauma complications (33.1% vs 17%; P < 0.001), and ICU morbidity (66.8% vs 43.9%; P < .001). The new general surgery model produced superior financial results and better quantitative surgical experience while exceeding trauma and ICU quality outcomes compared to the former trauma/critical care model. These data objectively support a model such as ours--one that is financially sustainable and more professionally attractive.
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The American surgeon · Aug 2005
A needs assessment for regionalization of trauma care in a rural state.
Systems of trauma care in urban areas have a demonstrated survival benefit. Little is known of the benefit of trauma system organization in rural areas. We hypothesized that examination of all trauma deaths during a 1-year period would provide opportunities to improve care in our rural state. ⋯ Suicide accounted for a significant number of the overall trauma deaths at 32 per cent. Rural trauma system design should focus on discovery, as that is where the majority of deaths occur. Suicide is a significant problem in this rural state that should be aggressively targeted with prevention programs.
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The American surgeon · Jul 2005
Comparative StudyComponents separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair.
When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. ⋯ The LR may have a short-term advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community.
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The American surgeon · Jul 2005
Monetary lessons from litigation involving laparoscopic cholecystectomy.
Limited information exists on the relationship between adverse events associated with laparoscopic cholecystectomy (LC) and subsequent litigation. Out of 104 suits concerning LC, 18 cases were settled for 628,138 dollars; 48 cases resulted in a plaintiff's verdict with the plaintiff receiving 2,891,421 dollars; and 18 cases resulted in a surgeon's verdict. ⋯ Given the minimal monetary differences between a settlement and a plaintiff's verdict, when a surgeon is the sole defendant in a malpractice case concerning LC, the surgeon should encourage their carriers not to settle before trial; as only a trial will exonerate the surgeon. However, this encouragement should be tempered when there are "red flags" that favor the plaintiff, including multiple defendants (especially a hospital), male plaintiffs, bile duct injuries, knowledgeable and well-financed plaintiff's attorneys, and certain plaintiff's venues.