Surgery
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Global parameters, such as wound class, the American Society of Anesthesiologists' physical classification score, and prolonged operative time, have been associated with the risk of surgical site infection (SSI). We hypothesized that additional risk factors for SSI would be identified by controlling for these parameters and that deep and organ/space SSI may have different risk factors for occurrence. ⋯ These results demonstrate additional factors that increase the risk of developing SSI. Deep and organ/space infections have a different risk profile. This information should guide clinicians in their assessment of SSI risk and should identify targets for intervention to decrease the incidence of SSI.
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Venous thromboembolism (VTE) is a recognized cause of morbidity and mortality in hospitalized patients and is reported to account for 250,000 deaths annually. Recent shifts in prophylaxis administration are occurring among surgical specialty groups after observing a lower rate of VTE among patients undergoing elective operation. We report the incidence of VTE from 3 sources to provide an estimate of the true risk of the complication in elective surgery. ⋯ VTE and associated mortality rates are extremely low in these 3 large data sources. We believe patients will benefit from an ongoing assessment of real need and complications of carefully risk-adjusted VTE prophylaxis.
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This study prospectively assesses the underlying errors contributing to surgical complications over a 12-month period in a complex academic department of surgery using a validated scoring template. ⋯ After surgical technique, most surgical error was caused by human factors: judgment, inattention to detail, and incomplete understanding, and not to organizational/system errors or breaks in communication. Training efforts to minimize error and enhance patient safety must address human factor causes of error.
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Recent studies have demonstrated a significant role for factor(s) present in mesenteric lymph following hemorrhagic shock in the etiology of post-hemorrhagic shock acute lung injury (ALI). Earlier studies have shown that ischemia-reperfusion insults to systemic tissue beds can also result in ALI. We therefore hypothesized that factors in systemic lymph may cause lung injury after hemorrhagic shock; this was studied in vitro. ⋯ Pulmonary microvascular endothelial dysfunction is evident after exposure to lymph obtained from systemic sites after hemorrhagic shock. The "unique" properties ascribed to post-hemorrhagic shock mesenteric lymph in causing ALI seem to be shared by lymph from systemic sites as well.