Journal of the American College of Surgeons
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Quality of acute surgical care in the US is threatened by a shortage of surgeons performing emergency procedures because of rising costs of uncompensated care, liability concerns, declining reimbursement, and lifestyle considerations. In July 2005, we restructured the general surgery service at our medical center into a hospitalist model to improve patient access to surgical care. ⋯ The surgical hospitalist model provides a cost-effective way for general surgeons to provide timely and high-quality emergency surgical care and enhance patient and referring provider satisfaction.
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Comparative Study
Is a minor clinical anastomotic leak clinically significant after resection of colorectal cancer?
There are few reports comparing the variety and frequency of postoperative complications between patients with a major clinical leak requiring emergency abdominal reoperation and those with a minor leak diagnosed from clinical signs and managed expectantly without reoperation. This study examined the association between severity of leakage and 18 other postoperative complications, postoperative mortality, and length of postoperative hospital stay. ⋯ A minor leak is not trivial. Apart from the fact that major clinical leakage necessitates urgent reoperation, there were few other differences between major and minor clinical leaks in the frequency of other complications.
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Because the hospitals in Norway are mostly rural community hospitals that see life-threatening trauma only infrequently, we developed a course in damage control surgery based on a live porcine model in 1999. The course also focuses on teamwork and leadership training based on crew resource management principles. The aim of this study was to evaluate the direct educational benefit from the course and whether participants had used the damage control techniques in their subsequent daily practice. ⋯ This study shows that a team-oriented operative trauma course is not only beneficial in the short term, but the principles and techniques learned are subsequently applied by the graduates in their daily practice. Course content and structure, particularly the emphasis on integral operating room teams working together, is especially suitable for the rural setting.