Annals of surgery
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The aim of this study was to assess the reduction in the incidence of parastomal hernia (PH) after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed. ⋯ Placement of a prosthetic mesh by the laparoscopic approach following the modified Sugarbaker technique is safe and effective in the prevention of PH, reducing significantly the incidence of PH.
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The present study was aimed to identify mechanisms linked to complicated courses and adverse events after severe trauma by a systems biology approach. ⋯ These findings indicate that the heme degradation pathway is associated with increased susceptibility to septic complications after trauma, which is indicated by HP expression in particular.
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Comparative Study
On-demand Reporting of Risk-adjusted and Smoothed Rates for Quality Profiling in ACS NSQIP.
Surgical quality improvement depends on hospitals having accurate and timely information about comparative performance. Profiling accuracy is improved by risk adjustment and shrinkage adjustment to stabilize estimates. These adjustments are included in ACS NSQIP reports, where hospital odds ratios (OR) are estimated using hierarchical models built on contemporaneous data. However, the timeliness of feedback remains an issue. ⋯ The on-demand, nonhierarchical approach provides results similar to the traditional hierarchical method and offers immediacy, an "over-time" perspective, application to a broader range of models and data subsets, and reporting of more easily understood rates. Although the nonhierarchical method results are now available "on-demand" in a web-based application, the hierarchical approach has advantages, which support its continued periodic publication as the gold standard for hospital profiling in the program.
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To assess how informed patients are about breast reconstruction, and how involved they are in decision making. ⋯ Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages.
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The purpose of this study was to describe variations in blood-based resuscitation in an injured cohort. We hypothesize that distinct transfusion trajectories are present. ⋯ Traditional definitions of massive transfusion are broad and imprecise. In cohorts of severely injured patients, there are distinct, identifiable transfusion trajectories. Identification of subgroups is important in understanding clinical course and to anticipate resuscitative and therapeutic needs.