Journal of the American College of Surgeons
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Length of stay (LOS) is important, particularly as a marker for medical resource consumption. Determining which factors increase LOS can provide information on reducing costs and improving delivery of care. The objective of the current study was to identify patient preoperative and intraoperative risk factors for prolonged LOS after common urologic procedures. ⋯ In this sample of urologic patients, prolonged LOS is associated with both preoperative and intraoperative factors. Preoperative factors, such as previous cardiac surgery and abnormal creatinine and hematocrit, were independently associated with a prolonged LOS and interoperative processes, such as length of operation and intraoperative transfusion. To help reduce costs and improve the quality of urologic care, efforts should be made to improve intraoperative processes and to minimize preoperative risk factors.
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Surgical site infections (SSI) continue to be a significant problem in surgery. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Best Practices Initiative compared process and structural characteristics among 117 private sector hospitals in an effort to define best practices aimed at preventing SSI. ⋯ Our findings suggest that evidence-based SSI prevention practices do not easily distinguish well from poorly performing hospitals. But structural and process of care characteristics of hospitals were found to have a significant association with good results.
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Hypertension, diabetes, and dyslipidemia are common conditions associated with obesity. This study provides current estimates of the prevalence of hypertension, diabetes, dyslipidemia, and metabolic syndrome according to the severity of obesity in men and women participating in the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). ⋯ The prevalence of hypertension, diabetes, dyslipidemia, and metabolic syndrome substantially increases with increasing body mass index. These findings have important public health implications for the prevention and treatments (surgical and nonsurgical) of obesity.
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Individuals greater than 60 years old donate an important portion of the organs available for orthotopic liver transplantation (OLT), but use of donors in this age group remains controversial. We hypothesized that proper selection of donors older than age 60 would not disadvantage recipients in terms of patient and graft survival. ⋯ Our data suggest that age alone does not adversely affect recipient outcomes. When properly selected, donors older than 60 represent an important and safe increase in the liver donor pool.