The Journal of surgical research
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Informed consent is important for limited English proficient (LEP) patients undergoing surgery, as many surgical procedures are complicated, making patient comprehension difficult even without language barriers. The study objectives were to (1) understand surgeons' preoperative consenting process with LEP patients, (2) examine how surgeons self assess their non-English language proficiency levels using a standardized scale, and (3) identify the relationship between self assessed non-English language proficiency and surgeons' self-reported use of interpreters during preoperative informed consent. ⋯ Surgeons reported relying on their own non-English language skills, bilingual staff, and family and friends of patients to obtain informed consent from LEP patients, suggesting that further understanding of barriers to professional interpreter use is needed.
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Comparative Study
Suture, synthetic, or biologic in contaminated ventral hernia repair.
Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). ⋯ Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair.
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Health care disparities are a well-documented phenomenon. Despite the development and implementation of multiple interventions, disparities in surgery have proven persistent. Thought to arise from a combination of patient, provider, and system-level factors, the objective of this study was to identify what is currently known about factors that influence surgical disparities and elucidate possible interventions to address them across four intervention-based themes: (1) condition-specific targeted interventions; (2) increased reliance on quantitative factors; (3) doctor-patient communication; and (4) cultural humility. ⋯ There are various forms of interventions to address surgical disparities, spanning knowledge from disparate fields. Promising efforts have emerged towards the successful alleviation of disparities. In order to move the field of surgery from understanding of disparities towards actions to mitigate them, continued development of meaningful quality improvement initiatives are needed.
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The aim of this study was to determine the functional and biochemical changes at the neuromuscular junction (NMJ) induced by sepsis. ⋯ Chronic sepsis has a denervation-like effect on the NMJ, which was indicated by upregulation of heterogeneous nAChRs, the increased area of end plates, and demyelination of the motoneuron axon.
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Little is known regarding the effects of caseload volume of other relevant members of the "surgical team." The present study sought to report variations in health care utilization and outcomes relative to surgeon and anesthesiologist volume among patients undergoing pancreatic surgery. ⋯ Although variability exists in health care practices among providers at the surgeon level, less is observed among anesthesiologists. Although a proportion of this variability can be explained by provider volumes, a significant proportion remains unexplained possibly due to nonmodifiable factors such as patient case mix.