Archives of surgery (Chicago, Ill. : 1960)
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Multicenter Study Comparative Study Observational Study
Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program hospitals: effect of operative approach and hospital-level variation.
When assessing the effect of operative approach on outcomes, it may be less relevant whether a transhiatal or an Ivor Lewis esophagectomy was performed and may be more important to focus on patient selection and the quality of the hospital performing the operation. ⋯ Compared with transhiatal dissection, Ivor Lewis esophagectomy did not result in worse postoperative complications. After controlling for case-mix, hospital performance varied widely for all outcomes assessed, indicating that reductions in short-term outcomes will likely result from expanding other aspects of hospital quality beyond a focus on specific technical maneuvers.
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Comparative Study
Association of postdischarge complications with reoperation and mortality in general surgery.
To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures. ⋯ The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.
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OBJECTIVE To investigate the relationship between oxygenation and short-term outcomes in patients with traumatic brain injury (TBI). DESIGN Logistic regression analysis was used to determine whether average high (>200 mm Hg) or low (<100 mm Hg) PaO2 levels within the first 24 hours of hospital admission correlated with patient outcomes relative to patients with average PaO2 levels between 100 and 200 mm Hg. SETTING Level 1 trauma center. ⋯ Although the mechanism for this has not been completely elucidated, it may involve hyperoxia-induced oxygen-free radical toxicity with or without vasoconstriction. Hyperoxia and hypoxia were found to be equally detrimental to short-term outcomes in patients with TBI. A narrower therapeutic window for oxygenation may improve mortality and functional outcomes.
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Comparative Study
Assessment of radiofrequency device sensitivity for the detection of retained surgical sponges in patients with morbid obesity.
Retained surgical sponges are serious medical errors that result in negative patient outcomes. A radiofrequency (RF) mat for the operating room bed has recently been introduced to detect the presence of a retained surgical sponge. The study objectives were to evaluate the sensitivity and specificity of the RF mat for the detection of surgical sponges through the torso of individuals with varying body habitus and to compare the sensitivity of the RF mat with that of the RF wand. We hypothesized that the sensitivity and specificity of the RF technology would be comparable to published findings of the manual sponge count by operating room personnel. ⋯ The sensitivity and specificity of RF device technology are much higher than those of surgical sponge counts or published findings on the use of intraoperative radiographs to identify retained surgical sponges. The RF wand is more sensitive than the RF mat in individuals with morbid obesity.