Journal of the American College of Surgeons
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Multicenter Study Comparative Study
Does preoperative anemia adversely affect colon and rectal surgery outcomes?
Complications associated with blood transfusions have resulted in widespread acceptance of low hematocrit levels in surgical patients. However, preoperative anemia seems to be a risk factor for adverse postoperative outcomes in certain surgical patients. This study investigated the National Surgical Quality Improvement Program (NSQIP) database to determine if preoperative anemia in patients undergoing open and laparoscopic colectomies is an independent predictor for an adverse composite outcome (CO) consisting of myocardial infarction, stroke, progressive renal insufficiency or death within 30 days of operation, or for an increased hospital length of stay (LOS). ⋯ This large multicenter database analysis suggests that the presence of severe and moderate and even mild preoperative anemia is an independent risk factor for complications and a longer hospital stay after colon surgery.
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Bedside percutaneous tracheostomy (BPT) is a cost-effective alternative to open tracheostomy. Small series have consistently documented minimal morbidity, but BPT has yet to be embraced as the standard of care. Because this has been our preferred technique in the surgical ICU for more than 20 years, we reviewed our experience to ascertain its safety. We hypothesize that BPT has acceptably minimal morbidity, even in high-risk patients. ⋯ BPT in the surgical intensive care unit is a safe procedure, even in high-risk patients. We believe BPT is the new gold standard for patients requiring tracheostomy for mechanical ventilation.
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Effective teamwork is crucial for safe surgery. Failures in nontechnical and teamwork skills are frequently implicated in adverse events. The Observational Teamwork Assessment for Surgery (OTAS) tool assesses teamwork of the entire team in the operating room. Empirical testing of OTAS has yet to explore the content validity of the tool. ⋯ The exemplars of OTAS demonstrated very good content validity. Taken together with recent evidence on the construct validity of the tool, these findings demonstrate that OTAS is psychometrically robust for capturing teamwork in the operating room.