Journal of the American College of Surgeons
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Understanding surgical site infection (SSI) risk factors after breast operation is essential to develop infection-prevention strategies and improve surgical outcomes. ⋯ Suboptimal prophylactic antibiotic dosing is a potentially modifiable risk factor for SSI after breast operation. SSI risk was increased in patients undergoing mastectomy and in patients who had an implant or tissue expander placed during operation. This information can be used to develop a specific risk stratification index to predict SSI and infection-preventive strategies tailored for breast surgery patients.
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Comparative Study
Surgery for gallbladder cancer: a population-based analysis.
Gallbladder cancer is an aggressive neoplasm, and resection is the only curative modality. Single institutional studies report an aggressive surgical approach improves survival. This analysis was performed to examine the components of surgical resection and resultant survival. ⋯ Very few patients underwent aggressive surgery. En bloc resection and lymphadenectomy may have stage-specific effects on survival. Additional studies should explore the underuse of aggressive operations, verify survival advantages, and define stage-specific resection strategies.
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Comparative Study
Conservative management of postoperative Fever in gynecologic patients undergoing major abdominal or vaginal operations.
To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics. ⋯ Although postoperative fever is common in gynecologic patients, the incidence of infection is low (3%). A standardized postoperative fever protocol in low-risk gynecology patients decreases use of empiric antibiotics without compromising morbidity.
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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.