The Journal of surgical research
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Postoperative pulmonary complications (PPCs) after major abdominal surgery are common and associated with significant morbidity and high cost of care. The objective of this study was to identify the risk factors for PPCs after major abdominal surgery. ⋯ PPCs after abdominal procedures are associated with a number of clinical variables. Esophageal operations and American Society of Anesthesiology Classification System were the strongest predictors. These results provide a framework for identifying patients at risk for developing pulmonary complications after major abdominal surgery.
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State-supported trauma systems have a proven association with improved mortality, but to date, there are no data reported on what mechanism leads to this benefit. Our hypothesis is that trauma systems with funding support are associated with increased number of trauma centers (TCs). ⋯ Our study shows that the number of level 3 TCs significantly and independently correlated with the presence of a funded trauma system. The number of level 1 and 2 centers showed no such correlation. Further study will determine if increased number of level 3 centers leads to improved clinical outcome.
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Prevention of retained surgical items (RSIs) is the main objective of the World Health Organization "Guidelines for Safe Surgery" (WHO/GSS) 2008 to improve patient safety. ⋯ RSI rates have decreased overall after the introduction of the WHO/GSS. The largest reductions have occurred in public or nonteaching hospitals. Only private (nonprofit) hospitals reported increases in RSI since 2008. Higher rates of RSI are associated with fundoplications and other gastric procedures.
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Controversy exists over optimal timing of tracheostomy in patients with respiratory failure after blunt trauma. The study aimed to determine whether the timing of tracheostomy affects mortality in this population. ⋯ Among non-head injured blunt trauma patients with prolonged respiratory failure, tracheostomy placement within 10 d of admission may result in increased mortality compared with later time points.