Journal of the American College of Surgeons
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African American women have a higher breast cancer mortality rate than Caucasian women. Estrogen receptor (ER)-negative tumors, which are more aggressive than ER-positive tumors, occur more frequently in African American women than in Caucasian women and may contribute to apparent disparities in outcomes. However, outcome results need to be controlled for socioeconomic status (SES). We evaluated the effect of race and ethnicity on outcomes of patients with ER-negative tumors by determining outcomes in African American and Caucasian women with low SES but similar access to care. ⋯ In a predominantly indigent population, race and ethnicity had no impact on outcomes for ER-negative breast cancer.
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Moving beyond traditional measurement of mortality after injury: evaluation of risks for late death.
The purpose of this study was to evaluate long-term mortality after trauma, and to determine risk factors and possible disparities related to mortality after hospital discharge. ⋯ There is significant mortality attributable to trauma for up to 1 year after hospital discharge. These findings suggest that mortality after trauma needs to be measured beyond hospital discharge in order to assess the complete impact of injury.
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Nonelective colorectal surgery is associated with substantial patient morbidity and mortality. This study sought to describe the practice of emergency colorectal surgery in the United Kingdom during an 11-year period using the Hospital Episode Statistics (HES) database. ⋯ HES data suggest that in everyday practice, postoperative mortality among patients undergoing nonelective admission followed by colorectal resection is high. Additional investigation is required to assess the reliability of HES data for monitoring institutional variation in this context.
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Multicenter Study Comparative Study
Risk adjustment for comparing hospital quality with surgery: how many variables are needed?
The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) will soon be reporting procedure-specific outcomes, and hopes to reduce the burden of data collection by collecting fewer variables. We sought to determine whether these changes threaten the robustness of the risk adjustment of hospital quality comparisons. ⋯ Procedure-specific hospital quality measures can be adequately risk-adjusted with a limited number of variables. In the context of the ACS NSQIP, moving to a more limited model will dramatically reduce the burden of data collection for participating hospitals.
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Comparative Study
Initial laparoscopic basic skills training shortens the learning curve of laparoscopic suturing and is cost-effective.
Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum. ⋯ Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit.