Advances in surgery
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Advances in surgery · Jan 2014
ReviewDoes close temperature regulation affect surgical site infection rates?
The argument for close temperature control, to which regulatory bodies have held health systems in an effort to reduce the burden of hospital-acquired infections, is not fully supported by current evidence. The literature is complex on the topic, and overinterpretation of historical data supporting close temperature regulation does not preclude an important recognition of these early works' contribution to high-quality surgical care. Avoidance of hypothermia through the regular use of active rewarming should be a routine part of safe surgical care. ⋯ Clinicians, researchers, and policymakers must be careful in how they apply these well-supported findings to process metrics in an era of limited resources with increasingly stringent quality guidelines and outcomes measures. Discrete temperature targets in current measures are not supported by the existing literature. Not only do these targets artificially anchor clinicians to temperature values with an inadequate scientific basis but they demand intensive resources from health institutions that could potentially be better used on quality requirements with stronger evidence of their ultimate effect on patient care.
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Laparoscopic cholecystectomy is widely established as the standard operation in acute cholecystectomy. Valid data from several prospective studies, including a recent large randomized multicenter trial, are available, demonstrating that early cholecystectomy is associated with less morbidity, a shorter length of hospital stay, and lower total hospital costs compared with delayed cholecystectomy after a conservative treatment period with antibiotics. Early cholecystectomy within 24 hours of hospital admission is the therapy of choice in patients fit for surgery and should be implemented as the standard treatment algorithm for this condition.
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Advances in surgery · Jan 2013
ReviewReadmission after abdominal aortic aneurysm repair: what does it mean?
Thirty-day readmission is common after AAA repair, an d postoperative events are strong predictors of readmission after adjusting for comorbidity. In addition, readmission is strongly associated with 1-year mortality. Considering the current evidence for readmission after AAA repair, improved coordination of care across the inpatient, transitional care, and outpatient settings, with active surveillance for procedure-specific (EVAR vs open) postoperative complications, may prevent some early readmissions. Given the pending financial implications and the striking association with 1-year mortality, developing interventions that target readmission after AAA repair is of paramount importance in the landscape of vascular surgery practice.