Journal of the American College of Surgeons
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Risk-adjusted evaluation is a key component of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The purpose of this study was to improve standard ACS NSQIP risk adjustment using a novel procedure risk score. ⋯ Information from focused, clinically meaningful CPT procedure groups improves the risk estimation of ACS NSQIP models.
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Randomized Controlled Trial Multicenter Study Comparative Study
A moderated journal club is more effective than an Internet journal club in teaching critical appraisal skills: results of a multicenter randomized controlled trial.
Evidence Based Reviews in Surgery (EBRS) is an Internet journal club that is effective in teaching critical appraisal skills to practicing surgeons. The objective of this randomized controlled trial was to determine whether teaching critical appraisal skills to surgical residents through the Internet is as effective as a moderated in-person journal club. ⋯ A moderated journal club is considerably better in teaching critical appraisal skills to surgical residents. This is likely because of the low participation in the Internet journal club.
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Injured patients cared for in trauma centers have a lower risk of death than those cared for in nontrauma centers. However, many patients are transported to a non-trauma center after injury (undertriaged) and require transfer to trauma center care. Previous analyses of undertriage focused only on survivors to trauma center care and were potentially subject to survivor bias. Using a novel population-based design, we evaluated the true mortality cost of undertriage. ⋯ Undertriage after major trauma is associated with substantial mortality. These data suggest a need to design strategies to improve triage to trauma center.
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Development of infectious complications after high volume elective surgical procedures imposes a significant clinical burden to the United States population. This study evaluated the association of in-hospital delay of elective procedures and the subsequent impact on infectious complications after coronary artery bypass graft (CABG) surgery, colon resection, and lung resection. ⋯ In-hospital delay of elective surgery from the day of admission was associated with a significant increase in infectious complications and mortality. This delay was also associated with a significant increase in hospital cost. Future policy directed toward preventing in-hospital delay of elective surgery may offer significant cost savings and decrease infectious complications after elective surgery.