Surgery
-
To assess differences in hospital costs for inpatients with Clostridium difficile (CD) colitis based on hospital size, rural or urban hospital setting, and hospital designation as a teaching institution. ⋯ Costs for inpatient CD colitis in Pennsylvania have been increasing. Teaching and urban hospitals treat the group of patients with CD colitis with the greatest comorbidity, accounting for their greater cost of care. The cost of treating CD colitis is comparable among different sizes of teaching hospitals, which may reflect a more standardized approach toward treatment choices.
-
This study was conducted to determine if team training using a federally sponsored team training program improves operating room (OR) performance and culture. ⋯ These data confirm that team training improves OR performance, but continued team training is required to provide sustained improved OR culture.
-
Review Meta Analysis
Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis.
The use of antibiotics alone in the treatment of uncomplicated acute appendicitis has been controversial. The present report is based on a systematic review and meta-analysis of existing studies that compared antibiotics treatment to appendectomy in patients with uncomplicated acute appendicitis. ⋯ In some cases, antibiotic treatment may fail, and there is a risk of recurrence. However, surgically treated patients, including those with the potential for spontaneous resolution and those with a normal appendix, are subjected to the risks of operative morbidity and mortality. Antibiotic therapy incurs significantly fewer complications. Prospective randomized studies are urgently needed to conclusively define the roles of appendectomy and antibiotic treatment in the management of uncomplicated acute appendicitis.
-
Patients presenting with acute mesenteric ischemia (AMI) sufficiently advanced to require bowel resection have a high morbidity and mortality. The objective of this study was to analyze these patients to determine if certain pre- or intraoperative variables are predictive of death or complications which could then be used to develop a predictive model to aid in surgical decision-making. ⋯ Mortality and morbidity rates after bowel resection for AMI are high. A risk calculator for prediction of postoperative mortality and morbidity has been developed and awaits validation in subsequent studies.
-
Comparative Study
In-house direct supervision by an attending is associated with differences in the care of patients with a blunt splenic injury.
There continues to be controversy over the added value of direct supervision of residents, particularly its effect on patient outcomes. The purpose of this study was to compare direct and indirect resident supervision for the management of blunt spleen injuries and to evaluate differences in patient care. ⋯ This study shows that there were significant differences in the management of blunt splenic injury depending on the type of supervision. Indirect supervision was associated with less compliance with a management protocol, fewer patients undergoing initial operation, more ICU use, increased hospital charges, and a greater use of splenic artery embolization without indication. These results emphasize the value of direct supervision in the management of a select group of trauma patients.