Surgery
-
A relationship between higher volume providers and improved outcomes has been suggested by some studies and has been used to construct guidelines for many diseases. For gastric cancer (GC), however, optimal volume cutoffs are not clear. ⋯ Appropriate and inappropriate provider volumes for a variety of gastric procedures have been defined by an international expert panel.
-
Multicenter Study
Detecting postoperative hemorrhage or hematoma from administrative data: the performance of the AHRQ Patient Safety Indicator.
Patient Safety Indicator (PSI) 9, "postoperative hemorrhage or hematoma" (PHH), of the US Agency for Healthcare Research and Quality has been considered for public quality of care reporting. We sought to evaluate its performance in detecting true complications. ⋯ PSI 9 holds promise in detecting serious, possibly preventable complications. The indicator might be improved by specification of the 998.11 hemorrhage code to exclude purely intraoperative events and addition of procedure codes to the indicator's numerator criteria.
-
Analysis and modeling of data monitoring vital signs and waveforms in patients in a surgical/trauma intensive care unit (STICU) may allow for early identification and treatment of patients with evolving respiratory failure. ⋯ Among STICU patients, a multivariate model predicted increases in risk of intubation in the following 24 hours based on vital sign data available currently on bedside monitors. Further refinement could allow for earlier detection of respiratory decompensation and intervention to decrease preventable morbidity and mortality in surgical/trauma patients.
-
Despite reports of randomized, control trials and cohort studies that do not support the use of drains, most surgeons routinely place prophylactic, intraperitoneal drains at the time of pancreatic resections. We sought to evaluate the outcome of elective pancreatic resection with or without prophylactic peripancreatic drainage. The primary outcome was the rate of postoperative complications. Total pancreatectomy and pancreatectomy for chronic pancreatitis were excluded. ⋯ In a tertiary, high-volume, Hepatobiliary and pancreatic (HBP) surgery center, the routine prophylactic draining of the abdominal cavity after pancreatic resection did not decrease the frequency or severity of postoperative complications. Prophylactic peripancreatic drainage also did not decrease the requirement for interventional procedures. Interventional radiology and transgastric endoscopic drainage of the post-pancreatectomy collection are feasible and improve patients' outcomes. Malnutrition and the type of operation were independent factors for postoperative complications.
-
Controversy persists as to whether positive operative margins are an independent prognostic factor for resected pancreatic cancer. This study evaluated the impact of the resection margin status on the patterns of recurrence and prognosis after resection for pancreatic cancer. ⋯ In the setting of pancreatectomy, when we evaluated the definitions of R0 resection, the margin status influenced the local recurrence rate but had no impact on the patients' survival.