Journal of the American College of Surgeons
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Multicenter Study Comparative Study
Comparing outcomes after transthoracic and transhiatal esophagectomy: a 5-year prospective cohort of 17,395 patients.
Debate continues over whether transhiatal esophagectomy (THE) offers decreased morbidity and mortality compared with transthoracic esophagectomy (TTE). To definitively answer this question, we used the Nationwide Inpatient Sample database to compare morbidity and mortality after THE and TTE. ⋯ This large-volume, multicenter study constitutes the largest cohort in the literature to compare outcomes after THE and TTE. These findings indicate the outcomes after THE and TTE for esophageal disease are equivalent, although higher-volume centers will have lower morbidity and mortality.
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There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on preexisting administrative records and one based on chart reviews. ⋯ Risk-adjusted mortality estimates were comparable using administrative or clinical data. Minor performance differences might still have implications. Because of the potential lower cost of using administrative data, this type of algorithm can be an efficient alternative and should continue to be investigated.
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Anastomotic leakage in colorectal surgery remains a major challenge because of its early and late consequences. ⋯ In right colectomy for cancer, preoperative nutritive support leading to regain of lost weight could reduce postoperative morbidity. Concerning left colectomy, if colonic cleanliness is poor, intraoperative colonic lavage should be done. When poor colonic cleanliness is associated with palliative resection and low distal rectal anastomosis, a protective stoma should be considered.
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Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality. ⋯ Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.
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The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes. ⋯ In patients with mild to moderate gallstone pancreatitis, a policy of early cholecystectomy resulted in a significantly reduced length of hospital stay with no increase in complications or mortality.