Journal of the American College of Surgeons
-
Multicenter Study
The effect of preoperative renal insufficiency on postoperative outcomes after major hepatectomy: a multi-institutional analysis of 1,170 patients.
Renal insufficiency adversely affects outcomes after cardiac and vascular surgery. The effect of preoperative renal insufficiency on outcomes after major hepatectomy is unknown. ⋯ Preoperative serum creatinine ≥1.8 mg/dL identifies patients at significantly increased risk of postoperative major complications, respiratory failure, and renal failure requiring dialysis. Patients are well selected for major hepatectomy, and few patients with substantial renal insufficiency are deemed operative candidates.
-
Randomized Controlled Trial
Influence of surgeon behavior on trainee willingness to speak up: a randomized controlled trial.
Our aim was to determine if a surgeon's behaviors can encourage or discourage trainees from speaking up when they witness a surgical mistake. ⋯ A discouraging environment decreases the frequency with which trainees speak up when witnessing a surgical error. The senior surgeon plays an important role in improving intraoperative communication between junior and senior clinicians and can enhance patient safety.
-
We sought to determine if discharge home with home health care (HHC) is an independent predictor of increased readmission after pancreatectomy. ⋯ Discharge home with HHC after pancreatectomy is an independent predictor of increased 30-day readmission; specifically, these services are associated with increased nonsevere readmissions, but not severe readmissions.