Journal of the American College of Surgeons
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Surgical crises represent unrecognized opportunities for improving patient safety and adding value in healthcare. The first step in a crisis response is to contain and mitigate harm. While the principles of damage control are well established in surgery, methods of containing harm on broader clinical and organizational levels are not clearly defined. ⋯ Crisis containment can be achieved by controlling operators' startle response, applying prioritization tools, and deploying drills against specific failures. The application of this model may extend to healthcare areas outside surgery.
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Review Meta Analysis
Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis.
The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. ⋯ The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
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Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs). ⋯ SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination.
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Randomized Controlled Trial Comparative Study
Long-Term Quality of Life after Minimally Invasive vs Open Distal Pancreatectomy in the LEOPARD Randomized Trial.
Minimally invasive distal pancreatectomy (MIDP) shortens time to functional recovery and improves 30-day quality of life (QoL), as compared with open distal pancreatectomy (ODP) for nonmalignant disease. The impact of MIDP on QoL, cosmetic satisfaction, and overall major complications beyond 1-year follow-up is currently unknown. ⋯ More than 3 years after distal pancreatectomy, no improvement in QALYs and overall QoL was seen after MIDP, whereas cosmetic satisfaction was higher after MIDP as compared with ODP.