Journal of the American College of Surgeons
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Although rates of superficial surgical site infection (SSI) are increasingly used as measures of hospital quality, the statistical reliability of using SSI rates in this context is uncertain. We used the American College of Surgeons National Surgical Quality Improvement Program data to determine the reliability of SSI rates as a measure of hospital performance and to evaluate the effect of hospital caseload on reliability. ⋯ SSI rates are a reliable measure of hospital quality when an adequate number of cases have been reported. For hospitals with inadequate caseloads, the National Surgical Quality Improvement Program sampling strategy could be altered to provide enough cases to ensure reliability.
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This study evaluated how implementation of an acute care emergency surgery service (ACCESS) affected key determinants of emergency department (ED) length of stay, and particularly, surgical decision time. Also, we analyzed how ACCESS affected ED overcrowding. ⋯ ACCESS reduced surgical decision time for surgical patients. Also, ACCESS improved overall ED crowding, as measured by time-to-stretcher for ED patients. Further improvements could be made by improving time to imaging. Patients referred for nonperforated appendicitis with a fecalith on CT should have expedited surgery.
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Postsurgical functional decline is common in older patients and can lead to frailty and increased mortality. Comprehensive interventions such as the Hospital Elder Life Program (HELP) have been shown to be effective, but modifying the HELP to include only 3 key interventions might prove cost-effective for surgical patients. ⋯ The modified HELP intervention effectively reduced older surgical patients' functional decline and delirium rates by hospital discharge. This program, conducted by a trained nurse, was not costly but did require commitment and ongoing cooperation between physician and nursing leadership to achieve compliance with the protocols.
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Obesity is a known risk factor for surgical site infection (SSI). Our hypothesis is that morphometric measures of midline subcutaneous fat will be associated with increased risk of SSI and will predict SSI better than conventional measures of obesity. ⋯ Abdominal subcutaneous fat is an independent predictor of superficial incisional SSI after midline laparotomy. Novel morphometric measures may improve risk stratification and help elucidate the pathophysiology of surgical complications.
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Because operating room crises are rare events, failure to adhere to critical management steps is common. We sought to develop and pilot a tool to improve adherence to lifesaving measures during operating room crises. ⋯ Checklist use can improve safety and management in operating room crises. These findings warrant broader evaluation, including in clinical settings.