Journal of the American College of Surgeons
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Facility-level process measure adherence is being publicly reported. However, the association between measure adherence and surgical outcomes is not well-established. Our objective was to determine the degree to which Surgical Care Improvement Project (SCIP) process measures are associated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk-adjusted outcomes. ⋯ Better adherence to infection-related process measures over the observed range was not significantly associated with better outcomes with one exception. Different measures of quality might be needed for surgical infection.
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Risk-adjusted evaluation is a key component of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The purpose of this study was to improve standard ACS NSQIP risk adjustment using a novel procedure risk score. ⋯ Information from focused, clinically meaningful CPT procedure groups improves the risk estimation of ACS NSQIP models.
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How case volume and quality of care relate to each other and to results of complex cancer surgery is not well-understood. ⋯ Although hospital and surgeon volume were not associated with outcomes, lower overall adherence to quality measures is associated with higher costs, but not improved outcomes. This finding might provide a rationale for improving care systems by maximizing care consistency, even if outcomes are not affected.
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The impact of platelet transfusion in trauma patients undergoing a massive transfusion (MT) was evaluated. ⋯ For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warranted.