Surgery
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Observational Study
Adherence to surgical antibiotic prophylaxis remains a challenge despite multifaceted interventions.
Adherence to prophylactic antibiotics guidelines is challenging and poorly documented. We hypothesized that a multiphase, multifaceted quality improvement initiative would engage relevant stakeholders, address known barriers to adoption, and improve overall adherence. ⋯ Despite multiple interventions to improve antibiotic prophylaxis, overall adherence did not improve. Most interventions were directed at the point of administration in the operating room; future implementation strategies should focus on the perioperative setting.
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Although evidence to support the use of laparoscopic and robotic approaches for the treatment of rectal cancer is limited, these approaches are being adopted broadly. We sought to investigate national practice patterns and compare short-term oncologic outcomes of different approaches for rectal cancer resections. ⋯ An open approach is often used in rectal cancers with higher pathologic stages. Matched patient analysis suggests minimally invasive approaches are associated with improved R0 resections.
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Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined. ⋯ Although resident participation resulted in slightly longer operative times and a modest increase in overall complications after liver and pancreatic resection, other metrics such as duration of stay, major morbidity, and mortality were unaffected. These data have important implications for educating patients regarding resident participation in these complex cases.
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Multicenter Study
When is it safe to forgo abdominal CT in blunt-injured children?
CT is the standard modality to diagnose solid organ injury after blunt trauma; however, the associated radiation carries a risk of cancer. We hypothesized that there are patient-specific factors that can identify those children who require abdominal CT. ⋯ Children who present to the emergency department after blunt abdominal trauma by a nonmotorized force with a normal GCS and SIPA are unlikely to have a solid organ injury that will require intervention.
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Comparative Study
Hospital-level resource use by the oldest-old for pancreaticoduodenectomy at high-volume hospitals.
Owing to limited data on hospital resources consumed in caring for the oldest-old, we examined the use of pancreaticoduodenectomy (PD)-relevant hospital resources in patients of increasing age treated in high-volume hospitals participating in the University HealthSystem Consortium. ⋯ Our findings suggest the ability to deliver quality pancreatic surgical care to an aging population without strong associations to increased resource utilization. As the number of octogenarians undergoing PD continues to grow, the impact of this technically complex procedure on other important cancer care metrics, including patient-reported outcomes and quality of life, requires further assessment.