Journal of the American College of Surgeons
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Patient safety is a national priority. Patient Safety Indicators (PSIs) monitor potential adverse events during hospital stays. Surgical specialty PSI benchmarks do not exist, and are needed to account for differences in the range of procedures performed, reasons for the procedure, and differences in patient characteristics. A comprehensive profile of adverse events in vascular surgery was created. ⋯ Patient safety events in vascular surgery were high and varied by procedure, with amputations and open abdominal aortic aneurysm repair having considerably more potential adverse events. PSIs were associated with black race, public payer, and procedure indication. It is important to note the overall higher rates of PSIs occurring in vascular patients and to adjust benchmarks for this surgical specialty appropriately.
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The measurement of hospital quality based on outcomes requires risk adjustment. The c-statistic is a popular tool used to judge model performance, but can be limited, particularly when evaluating specific operations in focused populations. Our objectives were to examine the interpretation and relevance of the c-statistic when used in models with increasingly similar case mix and to consider an alternative perspective on model calibration based on a graphical depiction of model fit. ⋯ In the present study, we demonstrate how the c-statistic can become less informative and, in certain circumstances, can lead to incorrect model-based conclusions, as case mix is restricted and patients become more homogenous. Although it remains an important tool, caution is advised when the c-statistic is advanced as the sole measure of a model performance.
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We sought to identify variables associated with American Board of Medical Specialties (ABMS)-member board certification and lack thereof among US medical graduates who planned at medical school graduation to become certified in surgery and entered graduate medical education in general surgery. ⋯ Demographic and professional development variables were associated with ABMS-member BC status among US medical graduates who had intended at medical school graduation to become certified in surgery.
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Comparative Study
What are the real rates of postoperative complications: elucidating inconsistencies between administrative and clinical data sources.
Comparison of quality outcomes generated from administrative and clinical datasets have shown inconsistencies. Understanding this is important because data designed to drive performance improvement are used for public reporting of performance. We examined administrative and clinical data and 2 clinical data sources in 4 surgical morbidity outcomes. ⋯ We demonstrate considerable discordance between data sources measuring the same postoperative events. The main contributor was difference in definitions, with additional contribution from data collection and management methods. Although any of these sources can be used for their original intent of performance improvement, this study emphasizes the shortcomings of using these sources for grading performance without standardizing definitions, data collection, and management.
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Multicenter Study Controlled Clinical Trial
Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma.
Our aim was to determine the prevalence of platelet dysfunction using an end point of assembly into a stable thrombus after severe injury. Although the current debate on acute traumatic coagulopathy has focused on the consumption or inhibition of coagulation factors, the question of early platelet dysfunction in this setting remains unclear. ⋯ In this study, we show that platelet dysfunction is manifest after major trauma and before substantial fluid or blood administration. These data suggest a potential role for early platelet transfusion in severely injured patients at risk for postinjury coagulopathy.