Journal of the American College of Surgeons
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Frailty in the surgical patient has been associated with increased morbidity, mortality, and failure-to-rescue. However, there is little understanding of the economic impact of frailty. ⋯ Although a significant amount of data exists regarding the impact of frailty in the surgical patient, the economic impacts have only limited description in the literature. Here we demonstrate that frailty, independent of age, has a detrimental financial impact on cost and hospital income in elective surgery.
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Adjuvant immunotherapy has improved outcomes in patients with advanced melanoma; however, the potential benefit for patients with pancreatic ductal adenocarcinoma (PDAC) remains unknown. The aim of this study is to determine the impact of adjuvant chemotherapy and immunotherapy (CTx-IT) compared to CTx alone on patient survival following resection of PDAC. ⋯ The addition of adjuvant immunotherapy to chemotherapy is associated with improved survival compared to chemotherapy alone after curative-intent resection of pancreatic adenocarcinoma. Future research is warranted to match specific immunotherapy agents with susceptible patient populations to improve outcomes for this aggressive disease.
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In 2017, our hospital was identified as a "High Outlier" for postoperative Clostridium difficile infections (CDI) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated an CDI Task Force with representation from Surgery, Infectious Disease, Pharmacy, and Performance Services to analyze available data, identify opportunities for improvement, and implement strategies to reduce CDI. ⋯ Our multidisciplinary CDI reduction program has demonstrated significant reduction in CDI. It is effective, straightforward to implement and monitor, and can be generalized to high-outlier.
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Retraction Of Publication
Confusion Instead of Clarity: Publicly Reported Cardiac Surgery Ratings for Coronary Artery Bypass Grafting and Aortic Valve Replacement.
Public reporting of cardiac surgery ratings has been advocated to inform patient selection of hospitals. Although Society of Thoracic Surgeons (STS) ratings are based on audited risk-adjusted patient outcomes, other rating systems rely on administrative databases. In this study, we evaluate correlation among 4 widely used hospital rating systems for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). ⋯ Publicly reported cardiac surgery ratings have significant discrepancy and poor correlation. This might confuse instead of clarify public perception of hospital quality for cardiac surgery.
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Bariatric surgical procedures are an effective and enduring treatment for severe obesity. In addition to improvements in health status, bariatric operations have been noted to potentially decrease postoperative healthcare costs, particularly medication use. ⋯ Total pharmacy use and costs showed a significant and sustained reduction during a 4-year follow-up period among patients undergoing gastric bypass or band operations in comparison with a propensity-matched control group.