Journal of the American College of Surgeons
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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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During the past decade, the field of bariatric surgery has changed dramatically. This study was intended to determine trends in the use of bariatric surgery in the United States. Data used were from the Nationwide Inpatient Sample from 2003 through 2008. ⋯ In the United States, the number of bariatric operations peaked in 2004 and plateaued thereafter. Use of the laparoscopic approach to bariatric surgery has increased to >90% of bariatric operations. In-hospital mortality continually decreased throughout the 6-year period.