Journal of the American College of Surgeons
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Traumatic injury remains the leading cause of preventable morbidity and mortality worldwide, with a large economic burden. One fourth of annual Medicare expenditures result from readmissions, including trauma. The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) has elevated care for >200 trauma programs worldwide. We use ACS TQIP, which does not include 30-day outcomes featured in the ACS NSQIP, affecting observed readmission rates. ⋯ We hypothesized that our observed and actual readmission rates differed. We discovered a significant difference in reported rates. Incorporating an NSQIP-like postdischarge feedback process can improve the accuracy of hospitals' readmission data and complication reporting, and thereby improve the value of the information TQIP uses as benchmarks.
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Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care-readmission to a hospital different from the location of the operation-and evaluates its causes and consequences among patients readmitted after major cancer surgery. ⋯ Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.
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Comparative Study
Does Performance Vary Within the Same Hospital When Separately Examining Different Patient Subgroups?
Surgical quality programs, such as the American College of Surgeons NSQIP, provide reports based on specialty or procedure, with patients aggregated together. It is unknown whether hospital performance differs by patient subgroup (eg cancer vs noncancer patients), masking opportunities for improvement. Our objectives were to determine whether performance differs within a given hospital for 6 contrasting patient subgroups and to identify the percentage of hospitals with greater than chance differences in performance. ⋯ Hospital performance within a given hospital varies by patient subgroup. Quality programs can consider separate reports for these subgroups to identify opportunities for quality improvement.
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Training of foreign medical graduates in surgical oncology is an undervalued intervention for improving global cancer care. The aim of this work was to describe the design and results of a clinical training program for international surgeons from a single comprehensive cancer center. ⋯ The International General Surgical Oncology Fellowship has successfully trained foreign surgeons for academic practice in surgical oncology. Most of the graduates have returned to their country of origin and contributed to education and research there.
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Multivisceral transplantation (transplantation of the stomach, intestine, liver, and pancreas) is usually undertaken as a semi-elective procedure after thorough assessment in patients who have intestinal failure with cirrhosis, cirrhosis with portomesenteric venous thrombosis, or tumors such as desmoids involving the liver and mesentery. ⋯ Treatment options for patients presenting with widespread splanchnic ischemia with hepatic and intestinal failure/infarction were previously limited to salvage surgery and attempted revascularization. In situations in which these failed, the only previous option would have been palliation. In selected cases, we propose that urgent multivisceral transplantation should be considered as a life-saving treatment. This represents a previously unreported indication for MVT.