Journal of the American College of Surgeons
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Multicenter Study Comparative Study
Comparison of hospital performance in emergency versus elective general surgery operations at 198 hospitals.
Surgical quality improvement has focused on elective general surgery (ELGS) outcomes despite the substantial risk associated with emergency general surgery (EMGS) procedures. Furthermore, any differences in the quality of care provided to EMGS versus ELGS patients are not well described. We compared risk factors and risk-adjusted outcomes associated with EMGS and ELGS procedures to assess whether hospitals have comparable outcomes across these procedures. ⋯ EMGS patients are at substantially greater risk than ELGS patients for adverse events. Hospitals do not appear to have highly consistent performance across EMGS and ELGS outcomes. Processes of care that afford improved outcomes to EMGS patients need to be identified and disseminated.
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Multicenter Study
Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients.
The Venous Thromboembolism Prevention Study (VTEPS) Network is a consortium of 5 tertiary referral centers established to examine venous thromboembolism (VTE) in plastic surgery patients. We report our midterm analyses of the study's control group to evaluate the incidence of VTE in patients who receive no chemoprophylaxis, and validate the Caprini Risk Assessment Model (RAM) in plastic surgery patients. ⋯ The Caprini RAM effectively risk-stratifies plastic and reconstructive surgery patients for VTE risk. Among patients with Caprini score >8, 11.3% have a postoperative VTE when chemoprophylaxis is not provided. In higher risk patients, there was no evidence that VTE risk is limited to the immediate postoperative period.
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Multicenter Study
American College of Surgeons National Surgical Quality Improvement Program Pediatric: a phase 1 report.
There has been a long-standing desire to implement a multi-institutional, multispecialty program to address surgical quality improvement for children. This report documents results of the initial phase of the American College of Surgeons National Surgical Quality Improvement Program Pediatric. ⋯ Based on this initial phase of development, the highly anticipated American College of Surgeons National Surgical Quality Improvement Program Pediatric has the potential to identify outcomes of children's surgical care that can be targeted for quality improvement efforts.
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Data regarding pre-existing comorbidities is often poorly recorded in trauma registries, and reports of their impact on outcomes are conflicting. Additionally, many previous reports, when conducting data analysis, do not reliably account for differences in case and control cohorts. Our objective was to identify a subset of patients with reliable comorbidity and complication data in the National Trauma Data Bank (NTDB) in order to determine the impact of select chronic organ system dysfunction on morbidity and mortality using case-control methodology. ⋯ Chronic hepatic failure, end-stage renal disease, immunodeficiency, and acquired coagulopathy are associated with higher resource use, complication rates, and mortality in a refined subset of NTDB patients.