Journal of the American College of Surgeons
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We prospectively evaluated the safety and efficacy of adding preoperative chemoprophylaxis to our institution's operative venous thromboembolism (VTE) prophylaxis policy as part of a physician-led quality improvement initiative. ⋯ In patients undergoing major cancer surgery, institution of a single dose of preoperative chemoprophylaxis, as part of a physician-led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates.
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Methods to assess a surgeon's individual performance based on clinically meaningful outcomes have not been fully developed, due to small numbers of adverse outcomes and wide variation in case volumes. The Achievable Benchmark of Care (ABC) method addresses these issues by identifying benchmark-setting surgeons with high levels of performance and greater case volumes. This method was used to help surgeons compare their surgical practice to that of their peers by using merged National Surgical Quality Improvement Program (NSQIP) and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data to generate surgeon-specific reports. ⋯ The ABC method appears to be a sound and useful approach to identifying benchmark-setting surgeons within a single institution. Such surgeons may be able to help their peers improve their performance.
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Multicenter Study
Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons.
The national field trauma triage guidelines have been widely implemented in US trauma systems, but never prospectively validated. We sought to prospectively validate the guidelines, as applied by out-of-hospital providers, for identifying high-risk trauma patients. ⋯ The national field triage guidelines are relatively insensitive for identifying seriously injured patients and patients requiring early critical interventions, particularly among older adults.
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Although recent reports have suggested the potential advantages of laparoscopy in patients undergoing major hepatectomy, the benefits of this approach in elderly patients remain unclear. This study aimed to compare the short-term outcomes of laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients. ⋯ The current study supports the benefits of laparoscopy in decreasing postoperative complications in elderly patients requiring major hepatectomy.
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Comparative Study
Abdominal Wall Reconstruction: A Comparison of Totally Extraperitoneal and Transabdominal Preperitoneal Approaches.
Abdominal wall reconstruction for complex ventral and incisional hernias is associated with significant complications. Commonly, the peritoneal cavity is opened and adhesiolysis is performed with the potential for enterotomy. A totally extraperitoneal (TE) approach to abdominal wall reconstruction is feasible in many ventral hernia repairs and can reduce visceral injuries without impacting other outcomes. This study compares outcomes after retro-rectus ventral hernia repairs with TE and transabdominal (TA) preperitoneal approaches. ⋯ Abdominal wall reconstruction can be performed safely in a TE fashion. The extraperitoneal approach results in shorter operative duration, but had similar complications when compared with TA preperitoneal approach.