Journal of the American College of Surgeons
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Multicenter Study Clinical Trial
Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study.
Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion. ⋯ PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.
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Multicenter Study Observational Study
Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study.
Full implementation of safety checklists in surgery has been linked to improved outcomes and team effectiveness; however, reliable and standardized tools for assessing the quality of their use, which is likely to moderate their impact, are required. ⋯ We found large variation in WHO checklist use in a representative sample of English ORs. Measures sensitive to checklist practice quality, like CUT, will help identify areas for improvement in implementation and enable provision of comprehensive feedback to OR teams.
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Comparative Study Clinical Trial
Transforming hemoglobin measurement in trauma patients: noninvasive spot check hemoglobin.
Technological advances now allow for noninvasive Hbg measurements. Previous studies have reported on the efficacy of continuous noninvasive Hgb devices. Recently, a new device, Pronto-7, a spot check pulse CO-oximeter has become available. The aim of our study was to assess noninvasive Hgb measurement in trauma patients. ⋯ Spot check Hgb monitoring had excellent correlation with invasive Hgb measurements. Application of spot check has more clinical use as compared with previous continuous Hgb monitoring. This novel technology allows immediate and accurate Hgb measurements in trauma patients.
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The American College of Surgeons Committee on Trauma (ACS-COT) is dedicated to improving the quality of care for severely injured patients. The ACS-COT charges designated centers with providing feedback to referring hospitals. There are no guidelines or recommendations as to what should be included in the feedback or how it should be used. ⋯ There is significant interest on the part of referring hospitals to receive feedback from a designated level 1 trauma/burn center to improve quality of care. A system like U-link can allow secure access to review patient charts for quality improvement and feedback purposes, in a manner that is efficient for the referring and receiving hospitals.