Journal of the American College of Surgeons
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Comparative Study
Who pays for poor surgical quality? Building a business case for quality improvement.
Both providers and payors bear the financial risk associated with complications of poor quality care. But the stakeholder who bears the largest burden of this risk has a strong incentive to support quality improvement activities. The goal of the present study was to determine whether hospitals or payors incur a larger burden of increased hospital costs associated with complications. ⋯ Hospitals and payors both suffer financial consequences from poor-quality health care, but the greater burden falls on health-care payors. Strong incentives exist for health-care payors to become more involved in supporting quality improvement activities.
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Comparative Study
Effect of fluid resuscitation on acute skeletal muscle ischemia-reperfusion injury after hemorrhagic shock in rats.
Severe extremity wounds with vascular injury are common in military trauma, and tourniquets are commonly used for hemorrhage control. The complications of tourniquet use in the setting of trauma are not well studied. This study investigated the combined effect of hemorrhagic shock and fluid resuscitation with Hextend (HX; BioTime, Inc) or lactated Ringer's (LR) on skeletal muscle subjected to tourniquet-induced ischemia-reperfusion injury. ⋯ Resuscitation with HX or lactated Ringer's does not adversely affect muscle viability in ischemia-reperfusion injury. HX may be a better clinical choice when skeletal muscle ischemia-reperfusion injury is a risk, despite greater edema.