JAMA surgery
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Multicenter Study Comparative Study Clinical Trial
Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction.
Previous outcome studies comparing implant and autologous breast reconstruction techniques have been limited by short-term follow-up, single-center design, and a lack of rigorous patient-reported outcome data. An understanding of the expected satisfaction and breast-related quality of life associated with each type of procedure is central to the decision-making process. ⋯ At 2 years, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial well-being and sexual well-being than did those who underwent implant reconstruction. These findings can inform patients and their clinicians about expected satisfaction and quality of life outcomes of autologous vs implant-based procedures and further support the adoption of shared decision making in clinical practice.
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Multicenter Study Observational Study
Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery.
Patterns of preoperative opioid use are not well characterized across different surgical services, and studies in this patient population have lacked important self-reported data of pain and affect. ⋯ In this large study of preoperative opioid use that includes patient-reported outcome measures, more than 1 in 4 patients presenting for surgery reported opioid use. These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.
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Multicenter Study
Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry.
Increasing evidence supports the role of red blood cells (RBCs) in physiological hemostasis and pathologic thrombosis. Red blood cells are commonly transfused in the perioperative period; however, their association with postoperative thrombotic events remains unclear. ⋯ The results of this study suggest that perioperative RBC transfusions may be significantly associated with the development of new or progressive postoperative VTE, independent of several putative confounders. These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices.
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Multicenter Study
Association Between Preoperative Proteinuria and Postoperative Acute Kidney Injury and Readmission.
Proteinuria indicates renal dysfunction and is a risk factor for morbidity among medical patients, but less is understood among surgical populations. There is a paucity of studies investigating how preoperative proteinuria is associated with surgical outcomes, including postoperative acute kidney injury (AKI) and readmission. ⋯ Proteinuria was associated with postoperative AKI and 30-day unplanned readmission independent of preoperative eGFR. Simple urine assessment for proteinuria may identify patients at higher risk of AKI and readmission to guide perioperative management.
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Multicenter Study
Association of Hospital Participation in a Regional Trauma Quality Improvement Collaborative With Patient Outcomes.
The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma Quality Improvement Program (MTQIP) goes beyond the provision of feedback alone, focusing on collaborative quality improvement. It is unknown whether the addition of a collaborative approach to benchmark reporting improves outcomes. ⋯ This study demonstrates that hospital participation in a regional collaborative quality improvement program is associated with improved patient outcomes beyond benchmark reporting alone while promoting compliance with processes of care.