Journal of the American College of Surgeons
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Hypertension, diabetes, and dyslipidemia are common conditions associated with obesity. This study provides current estimates of the prevalence of hypertension, diabetes, dyslipidemia, and metabolic syndrome according to the severity of obesity in men and women participating in the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). ⋯ The prevalence of hypertension, diabetes, dyslipidemia, and metabolic syndrome substantially increases with increasing body mass index. These findings have important public health implications for the prevention and treatments (surgical and nonsurgical) of obesity.
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The concept of a team-based model for delivery of care has been critical at our institution for improving efficiency and safety. Despite these measures, difficulties continue to occur during lengthy operating room procedures. Using a novel team-based practice model, a multidisciplinary team was organized to improve efficiency in microsurgical breast reconstruction. We describe development of an intraoperative pathway for deep inferior epigastric perforator (DIEP) flap breast reconstruction and its impact on various outcomes. ⋯ Implementation of an intraoperative pathway led to improvements in operative time, cost, quality measures, and staff satisfaction. Refinement of the pathway with team resolution of variances might continue to improve outcomes. Complex, multi-team procedures can derive benefits from standardization and intraoperative pathway development.
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Length of stay (LOS) is important, particularly as a marker for medical resource consumption. Determining which factors increase LOS can provide information on reducing costs and improving delivery of care. The objective of the current study was to identify patient preoperative and intraoperative risk factors for prolonged LOS after common urologic procedures. ⋯ In this sample of urologic patients, prolonged LOS is associated with both preoperative and intraoperative factors. Preoperative factors, such as previous cardiac surgery and abnormal creatinine and hematocrit, were independently associated with a prolonged LOS and interoperative processes, such as length of operation and intraoperative transfusion. To help reduce costs and improve the quality of urologic care, efforts should be made to improve intraoperative processes and to minimize preoperative risk factors.
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The goal of our study was to determine the temporal trends in provider volume for liver resection procedures. ⋯ Regionalization of liver resections is occurring at both the level of the individual surgeon and the hospitals where these procedures are performed. These trends in provider volume might be associated with increasing discrepancies in outcomes and patient demographics among different volume categories of hospitals.