Archives of surgery (Chicago, Ill. : 1960)
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There exist predictors of mortality and the need for colectomy among patients with fulminant Clostridium difficile colitis. ⋯ Despite awareness and treatment, fulminant C difficile colitis remains a highly lethal disease. Reliable predictors of mortality exist and should be used to prompt aggressive surgical intervention. Survival rates are higher in patients who were cared for by surgical vs nonsurgical departments, possibly because of more frequent and earlier operations.
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To identify and quantify surgical outcomes as possible quality measures of initial breast cancer surgery and to assess variation among surgeons. ⋯ Quality indicators for breast cancer surgery can be identified and readily monitored. Outcome variation exists at a high-volume breast center. Further study into the causes and effects of this variation on short- and long-term patient outcomes as well as health care costs is needed.
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To determine the efficacy of extracorporeal membrane oxygenation (ECMO) for nonneonatal acute respiratory failure. ⋯ Therapy with ECMO may provide a survival benefit in carefully selected patients with nonneonatal acute respiratory failure who have failed maximal ventilator support. Nonneonatal survival with ECMO therapy is strongly dependent on diagnosis, with the highest survival seen in those with viral or bacterial pneumonia. Older age, multiple organ failure, prolonged ventilation prior to ECMO initiation, and long ECMO runs are associated with decreased survival.
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To compare outcomes of patients undergoing bariatric procedures in hospitals designated as centers of excellence compared with nondesignated hospitals. ⋯ Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volume. Extra expenses associated with center of excellence designation may not be warranted.
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To determine the extent to which the Injury Severity Score (ISS) and Trauma Mortality Probability Model (T-MPM), a new trauma injury score based on empirical injury severity estimates, agree on hospital quality. ⋯ The choice of expert-based or empirical Abbreviated Injury Score severity scores for individual injuries does not seem to have a significant effect on hospital quality measurement when physiologic information is included in the prediction model. This finding should help to convince all stakeholders that the quality of trauma care can be accurately measured and has face validity.