Surgery
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Rates of many surgical procedures vary widely across both large and small geographic regions. Although variation in health care use has long been described, few studies have systematically compared variation profiles across surgical procedures. The goal of this study was to examine current patterns of regional variation in the rates of common surgical procedures. ⋯ Although the use of many surgical procedures varies widely across geographic areas, rates of "discretionary" procedures are most variable. To avoid potential overuse or underuse, efforts to increase consensus in clinical decision making should focus on these high variation procedures.
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Since Aubaniac's first description in 1952, the use of central venous catheters has increased dramatically; they are now considered commonplace. Placement of these catheters, however, has an associated risk of morbidity and mortality. In most cases, this risk is outweighted by the benefit gained, especially when long-term access to the central venous system is needed for multiple transfusions, chemotherapy, antibiotics, or parenteral nutrition. A large number of central venous catheters are placed in children at our institution, usually by interns and residents. ⋯ Central venous catheterization in children is relatively safe, with only a 3.2% complication rate and no mortality in our series.