Journal of the American College of Surgeons
-
The Accreditation Council for Graduate Medical Education (ACGME) duty-hour requirements prompted program directors to rethink the organizational structure of their residency programs. Many surgical educators have expressed concerns that duty-hour restrictions would negatively affect quality of resident education. This article summarizes evaluation research results collected to study the impact of our reengineered residency program designed to preserve important educational activities while meeting duty-hour accreditation requirements. ⋯ Duty-hour restrictions produce new challenges and might require additional resources but need not cause a deterioration of surgical residents' educational experience.
-
We reported previously a 26% incidence of surgical site infection (SSI) in patients undergoing elective colorectal resection. Multiple risk factors have been identified, including obesity, improper administration of prophylactic antibiotics, hypothermia, and poor glycemic control. We hypothesized that implementation of a multidisciplinary wound management protocol targeting these risk factors would reduce the incidence of SSI. ⋯ After implementation of a multidisciplinary wound-management protocol, incidence of SSI improved 39%. These results demonstrate that compliance with a prospectively designed protocol for perioperative care can effectively reduce operative morbidity in patients undergoing colorectal operations.
-
Pilonidal disease is a common condition among young people. Complicated pilonidal surgical wounds are associated with considerable morbidity, including chronic sacral wound, loss of work time, and lifestyle limitation. The aim of our study is to report our experience with Karydakis procedure and explore the risk factors associated with infection and poor healing in pilonidal operation. ⋯ Excision and primary closure is an acceptable modality of treatment in nonobese and nonsmoker patients with pilonidal sinus disease. Infection rate in obese patients and smokers is unacceptably high, and active preoperative weight loss and smoking cessation or simple laid open procedure is recommended in these patients.
-
Comment Biography Historical Article
Invited commentary: Ira A Ferguson Sr, MD, FACS and the other Tuskegee experiment.