Journal of the American College of Surgeons
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Organ donation serves a public health function but is also an important part of end-of-life care. Nearly 40% of organ donors are the victims of traumatic brain injury (TBI). We report on a series of patients with nonsurvivable TBI and severe coagulopathy or active hemorrhage who went on to successful organ donation with the use of recombinant factor VIIa (rFVIIa). ⋯ Use of rFVIIa facilitated donation in patients with multisystem injuries who otherwise might have been ineligible for organ donation. Use of rFVIIa did not affect early graft function, although longterm outcomes are unknown. Recombinant factor VIIa is expensive, but its use is justified if the donor organ supply can be increased.
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The concept of a team-based model for delivery of care has been critical at our institution for improving efficiency and safety. Despite these measures, difficulties continue to occur during lengthy operating room procedures. Using a novel team-based practice model, a multidisciplinary team was organized to improve efficiency in microsurgical breast reconstruction. We describe development of an intraoperative pathway for deep inferior epigastric perforator (DIEP) flap breast reconstruction and its impact on various outcomes. ⋯ Implementation of an intraoperative pathway led to improvements in operative time, cost, quality measures, and staff satisfaction. Refinement of the pathway with team resolution of variances might continue to improve outcomes. Complex, multi-team procedures can derive benefits from standardization and intraoperative pathway development.
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Length of stay (LOS) is important, particularly as a marker for medical resource consumption. Determining which factors increase LOS can provide information on reducing costs and improving delivery of care. The objective of the current study was to identify patient preoperative and intraoperative risk factors for prolonged LOS after common urologic procedures. ⋯ In this sample of urologic patients, prolonged LOS is associated with both preoperative and intraoperative factors. Preoperative factors, such as previous cardiac surgery and abnormal creatinine and hematocrit, were independently associated with a prolonged LOS and interoperative processes, such as length of operation and intraoperative transfusion. To help reduce costs and improve the quality of urologic care, efforts should be made to improve intraoperative processes and to minimize preoperative risk factors.
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The goal of our study was to determine the temporal trends in provider volume for liver resection procedures. ⋯ Regionalization of liver resections is occurring at both the level of the individual surgeon and the hospitals where these procedures are performed. These trends in provider volume might be associated with increasing discrepancies in outcomes and patient demographics among different volume categories of hospitals.