Journal of the American College of Surgeons
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Residents are often required to balance whether to adhere to duty hour policies or violate them to care for patients and obtain educational experiences. Little is known about why residents violate duty hour policies and whether there is a relationship between how often residents violate duty hours and concerns about patient safety. Our objective was to assess the association between resident duty hour violations and resident concerns about patient safety. ⋯ Trainees who reported perceiving negative effects of duty hour policies on patient safety were more likely to report frequent duty hour violations.
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Ventral hernia repair (VHR) is a commonly performed surgical procedure. Unfortunately, long-term prospective information about quality of life and outcomes after VHR has been challenging to obtain. Decoupling follow-up from clinical visits via patient-reported outcomes (PROs) has been proposed as a means of achieving better long-term assessments after VHR. The Americas Hernia Society Quality Collaborative (AHSQC) is a national quality improvement (QI) effort in hernia repair that uses PROs to obtain long-term follow-up. However, the modality of PRO engagement to maximize participation has not been well established. A formal QI initiative was undertaken to determine if long-term PRO follow-up could be increased at a single AHSQC site by adding telephone communication to email communication for long-term postoperative VHR assessment. ⋯ A telephone-based approach markedly improved long-term PRO participation rates in postoperative VHR patients. Ultimately, a combination of email and telephone communication may be necessary to achieve higher levels of PRO follow-up in the VHR population.
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Observational Study
Intraoperative Hypothermia and Surgical Site Infections in Patients with Class 1/Clean Wounds: A Case-Control Study.
Numerous surgical quality metrics focus on prevention of unintentional perioperative hypothermia due, in part, to the association between hypothermia and surgical site infections (SSI). However, few studies have comprehensively evaluated the relationship between these metrics and SSI. In this study, we evaluated individual components of 1 set of hypothermia metrics to determine their association with SSI. ⋯ Intraoperative hypothermia was not significantly associated with SSI. These results suggest that development of compliance metrics may not be an effective strategy for SSI reduction in class I surgical wounds.
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Massive localized lymphedema (MLL) is an area of skin and subcutaneous overgrowth associated with obesity. The purpose of this study was to determine whether MLL results from obesity-induced lymphedema (OIL) and to characterize the prevalence and risk factors for the condition. ⋯ Massive localized lymphedema is a consequence of OIL and affects approximately 60% of obese patients with lower-extremity dysfunction; a BMI >56 kg/m(2) significantly increases the risk. Obese individuals should be referred to a bariatric weight-loss center before their BMI reaches a threshold for OIL and MLL to develop.