Journal of the American College of Surgeons
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Comparative Study
Implementation of evidence-based practices for surgical site infection prophylaxis: results of a pre- and postintervention study.
Although evidence-based guidelines for best practices pertaining to surgical site infection (SSI) prophylaxis exist, the feasibility of implementing such practices remains to be demonstrated outside of a controlled clinical trial. This study was designed to assess the safety and feasibility of implementing evidence-based care practices to prevent SSIs. ⋯ Implementation of evidence-based care practices to prevent SSI is both safe and practical outside the setting of a randomized, controlled trial. Sustained compliance remains to be demonstrated, although practice audits at our institution suggest ongoing success is possible.
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Although RBC transfusions can be lifesaving, recent evidence suggests that their use is associated with added morbidity and mortality and that a lower transfusion threshold is safe. It is unclear if this new evidence has translated into decreased RBC use among surgical patients. The purpose of this study is to measure the change in use of RBCs during the last decade. ⋯ Despite evidence supporting more restrictive use of RBC transfusions, RBC use among surgical patients has increased during the last decade.
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Older participants are often excluded from clinical trials, precluding a representative sample. ⋯ Strategies, albeit unstudied, could assist investigators in planning surgical trials that successfully enroll and retain older women.
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It is a widely held belief that detailed risk-adjustment is always necessary in comparative reports of surgical performance. We sought to evaluate the importance of risk-adjustment for two cardiac surgery report cards in New York and Pennsylvania. ⋯ Based on data from two prominent state registries, risk-adjusted and unadjusted mortality rates provide nearly identical estimates of hospital performance with coronary artery bypass. Risk-adjustment may not always be important for identifying high quality hospitals.