Journal of the American College of Surgeons
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The reasons why some patients with benign esophageal diseases require esophagectomy remain poorly understood. In this study we sought to define the rate of progression to esophagectomy and the postesophagectomy outcomes of patients with benign esophageal conditions in whom 1 or more previous interventions failed. ⋯ These findings highlight the importance of increased awareness of the potential progression to esophagectomy during repeated procedural interventions for benign esophageal disease. A subset of the patients who progress more rapidly, including adult patients and those with acquired disease and/or previous fundoplication, may benefit from counseling about potential esophagectomy.
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Despite studies reporting successful interventions to increase antibiotic prophylaxis compliance, surgical site infections remain a significant problem. The reasons for this lack of improvement are unknown. This review evaluates the internal and external validity of quality improvement studies of interventions to increase surgical antibiotic prophylaxis compliance. ⋯ The methodology and reporting of quality improvement studies on perioperative antibiotic prophylaxis is suboptimal, and factors that would improve generalizability of successful intervention implementation are infrequently reported. Clinicians should use caution in applying the results of these studies to their general practice.
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The Surgical Care Improvement Program endorses mandatory compliance with approved intravenous prophylactic antibiotics; however, oral antibiotics are optional. We hypothesized that surgical site infection (SSI) rates may vary depending on the choice of antibiotic prophylaxis. ⋯ The choice of IV antibiotic was related to the SSI rate; however, oral antibiotics were associated with reduced SSI rate for every antibiotic class.
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The ability to measure surgical quality of care is important and can lead to improvements in patient safety. As such, processes should be carried out in an identical fashion for all patients, regardless of how vulnerable or complex they are. Our objectives were to assess quality of surgical care delivered to elderly patients and to determine the association between patient characteristics and quality of care. ⋯ Quality of care delivered to elderly patients undergoing major surgery at our institution was generally poor and independent of patient characteristics. Although quality appears to be uniform across different patients, these results provide targets for quality improvement initiatives.