Journal of the American College of Surgeons
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Anastomotic leak, a potentially deadly postoperative occurrence, particularly interests surgeons performing gastrointestinal procedures. We investigated incidence, cost, and impact on survival of anastomotic leak in gastrointestinal surgical procedures at an academic center. ⋯ Significant morbidity, mortality, and cost accompany gastrointestinal anastomotic leaks. Patients who experience an anastomotic leak have lower rates of survival at 30 days and long term.
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Comparative Study
A comparative study of laparoscopic vs. open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis.
Although laparoscopic surgery has many advantages, its application in pancreatic ductal adenocarcinoma has not been sufficiently studied. The objective of this study was to compare the surgical outcomes of laparoscopic distal pancreatectomy (LDP) to those of open distal pancreatectomy (ODP) for left-sided ductal adenocarcinoma. ⋯ This large single-center study of laparoscopic surgery for left-sided pancreatic ductal adenocarcinoma indicated that LDP was safe and more efficacious than OPD after propensity score adjustment for presurgical variables of return to diet and length of stay.
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Hospital readmissions are an increasing focus of health care policy. This study explores the association between 30-day readmissions and 30-day mortality for surgical procedures. ⋯ Hospital readmission rate alone is a limited measure of quality given the poor correlation between hospital readmission and mortality rates. In this study, 85% of hospital outliers were "discordant" for readmission and mortality. Furthermore, almost a quarter of these discordant hospitals had "expected" or "low" readmission but "high" mortality rates. Quality metrics that focus exclusively on readmission rates overlook these discrepancies.
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Cardiac surgical procedures are complex and require the coordinated action of many. This creates the potential for small failures that could be the substrate for subsequent morbidity or mortality. High-reliability science suggests that preoccupation with small failures can lead to improved outcomes. ⋯ Preoccupation with all failures in the operating room can reveal important information about the operating room and perioperative microenvironment that can prompt substantive process changes both locally and within the larger health system.