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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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.
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Few studies have investigated the effects of anemia in patients with traumatic brain injury (TBI). The objective of this study was to examine the role of anemia and blood transfusion on outcomes in TBI patients. ⋯ Blood transfusion is associated with significantly worse outcomes in traumatic brain injured patients. In addition, blood transfusion is a major contributing factor to worse outcomes in TBI patients who are anemic. We caution against the liberal use of blood in TBI patients.
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Comparative Study
Racial disparity in surgical mortality after major hepatectomy.
The relationship between surgical mortality and race has not been studied for major hepatectomy. We sought to quantify and explore the nature of racial disparities in surgical mortality after major hepatectomy in a nationally representative cohort of patients. ⋯ In-hospital mortality after major hepatectomy varies substantially by race. After adjustment for potential confounders, African-American patients have two-fold higher population-level odds of surgical mortality than Caucasian patients do. Our analyses suggest that clinical factors, insurance status, and hospital factors do not account for these differences. Additional studies to clarify the nature of this disparity and identify targets for intervention are warranted.