Journal of the American College of Surgeons
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Parenteral nutrition (PN) is often used in severely injured patients when caloric goals are not achieved enterally. The purpose of this study is to determine whether early administration of parenteral nutrition is associated with an increased risk for infection after severe injury. ⋯ In critically ill trauma patients who are able to tolerate at least some EN, early PN administration can contribute to increased infectious morbidity and worse clinical outcomes.
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Prospective data addressing end-of-life care in the surgical ICU are lacking. We determined factors surrounding life-sustaining therapy discussions (LSTDs) in our surgical ICU as experienced by housestaff. ⋯ Age, acuity, and lack of decision-making capacity were the most important factors involved in the initiation of an LSTD. Housestaff reported that they initiated LSTDs for different reasons and proposed different end-of-life care plans relative to both patients and their surrogates. These disparities can contribute to failed enactment of proposed changes in end-of-life care plans.
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The incidence and risk factors for acute diabetes insipidus after severe head injury and the effect of this complication on outcomes have not been evaluated in any large prospective studies. ⋯ The incidence of acute diabetes insipidus in severe head injury is high, especially in penetrating injuries. Independent risk factors for diabetes insipidus include a Glasgow Coma Scale
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Anastomotic fistula, leak, and abscess are common complications of pancreatectomy. The goal of this study was to describe our current management and outcomes of clinically significant postpancreatectomy fistula, leak, and abscess. ⋯ Although mortality after pancreatectomy has decreased to approximately 2%, the morbidity associated with pancreatic fistula, leak, and abscess remains substantial.
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It is a widely held belief that detailed risk-adjustment is always necessary in comparative reports of surgical performance. We sought to evaluate the importance of risk-adjustment for two cardiac surgery report cards in New York and Pennsylvania. ⋯ Based on data from two prominent state registries, risk-adjusted and unadjusted mortality rates provide nearly identical estimates of hospital performance with coronary artery bypass. Risk-adjustment may not always be important for identifying high quality hospitals.