Journal of the American College of Surgeons
-
Adherence to bundled interventions can reduce surgical site infection (SSI) rates; however, predictors of successful implementation are poorly characterized. We studied the association of patient and hospital characteristics with adherence to a colorectal SSI reduction bundle across a statewide surgical collaborative. ⋯ Adherence to an SSI reduction bundle is associated with patient BMI and hospital safety net status. Quality improvement groups should consider institutional traits for optimal implementation of SSI bundles. Safety net hospitals may require additional focus to overcome unique implementation barriers.
-
Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT. ⋯ FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.
-
The impact of chronic kidney disease (CKD) on surgery is still not well defined. We sought to characterize the association of preoperative CKD with 30-day mortality after hepatic resection. ⋯ The degree of CKD was related to the risk of complications and 30-day mortality after hepatectomy. CKD classification should be strongly considered in the preoperative risk estimation of these patients.
-
A subset of Entrustable Professional Activities (EPAs) has been developed for general surgery. We aim to contribute validity evidence for EPAs as an assessment framework for general surgery residents, including concurrent validity compared to ACGME milestones, the current gold standard for evaluating competency. ⋯ The influence of PGY level and operative phase on entrustment scoring supports the validity of EPAs as a formative evaluation framework for general surgery resident performance. In addition, evident correlations between EPA scores and respective milestone ratings provide concurrent validity evidence.
-
This landmark paper traces anti-LGBT discrimination in surgery from history to present with particular analysis of discrimination against patients, providers, and within faith-based and military While research alone will not end healthcare iniquity, the work cannot begin until the “Don’t Ask Don’t Tell” era of scholarship on ends. institutions. Discrimination against marginalized individuals is an epidemic in American Healthcare. Research regarding gender- and race- based discrimination in healthcare and surgery is robust; scholarship on anti-LGBT (Lesbian, Gay, Bisexual, and Transgender; see Table 1 for explanations of commonly used terms) discrimination is woefully lacking. ⋯ Delineating all these changes is beyond the scope of any one paper. However, improving and sustaining LGBT equity cannot begin without first providing a common background to create change upon. This paper seeks to correct the discursive gap.