Surgery
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Therapeutic anticoagulation in the geriatric trauma population is increasingly common. Fresh frozen plasma, while the criterion standard for correction, has limited availability and associated transfusion risks. We examined our use of prothrombin complex concentrate for immediate reversal of therapeutically anticoagulated geriatric trauma patients. ⋯ Prothrombin complex may be used safely and effectively to reverse emergently anticoagulation in geriatric trauma patients.
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In the current environment, pressure is ever increasing to maximize financial performance in surgery departments. Factors such as physician extenders, billing and collection, payor mix, contracting, incentives from the Centers for Medicare and Medicaid Services, and administrative incentives may greatly influence financial performance. However, despite a plethora of information from the University HealthSystem Consortium and the Association of American Medical Colleges, best-practice information for business infrastructure is lacking. To obtain a sampling of current practices, we conducted a survey of departments of surgery. ⋯ Our results indicate that the physician extender, clinical support staff, and business staff environment can impact surgeon productivity, and there is opportunity for improvement. Determining best practices for ratios of support staff/MD and optimizing the role of electronic medical record in workflow and billing/collections are critical in the current environment. Our pilot study requires extension across more institutions for validation.
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Septic wound complications are known to limit the ability of surgeons to perform primary fascial closure after damage control laparotomy (DCL) in patients with trauma. Factors preventing primary fascial closure after DCL in nontrauma patients, however, are unknown. We aim to identify these risk factors. ⋯ The development of septic complications such as intra-abdominal abscess and enterocutaneous fistulae were associated with inability to primarily close the fascia after DCL. In addition, longer duration of open abdomen management, greater number of serial abdominal explorations, and worse base deficits were negatively associated with primary fascial closure.
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The storage lesion of packed red blood cells (PRBCs) consists of biochemical changes associated with increased inflammatory mediators and decreased oxygen-carrying capacity. The effect of storage on the coagulation system is less well studied. The purpose of this study is to determine how PRBC storage time affects the activated coagulation time (ACT), using an in vitro model. ⋯ In an isolated in vitro model, the storage lesion of PRBCs is associated with decreased coagulation. This may have relevance for transfusion practices in coagulation-sensitive circumstances such as trauma.