Journal of the American College of Surgeons
-
Type or lack of insurance may affect access to care, treatment, and outcomes. We evaluated trends for surgical management of all peripheral arterial disease (PAD) in-hospital admissions by insurer status in New York State. ⋯ EVI increased tremendously and was used without disparity across insurer status. Amputation declined steadily and may have been related to increased EVI or to decreased admission for gangrene. Advanced age, low socioeconomic class or minority status, and lack of insurance negatively affect presentation and limb salvage. Universal health care may be beneficial in improving outcomes but must address root causes for delayed presentation.
-
Comparative Study
Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers?
Within organized trauma systems, both Level I and Level II trauma centers are expected to have the resources to treat patients with major multisystem trauma. The evidence supporting separate designations for Level I and Level II trauma centers is inconclusive. The objective of this study was to compare mortality and complications for injured patients admitted to Level I and Level II trauma centers. ⋯ Severely injured patients admitted to Level I trauma centers have a lower risk of mortality compared with patients admitted to Level II centers. These findings support the continuation of a 2-tiered designation system for trauma.
-
The American College of Surgeons (ACS) Case Log represents a data system that satisfies the American Board of Surgery (ABS) Maintenance of Certification (MOC) program, yet has broad data fields for surgical subspecialties. Using the ACS Case Log, we have developed a method of data capture, categorization, and reporting of acute care surgery fellows' experiences. ⋯ Using the ACS Case Log satisfies the ABS MOC program requirements and provides a method for monitoring and reporting acute care surgery fellow experiences. This system is flexible to accommodate the needs of surgical subspecialties and their training programs. As documentation requirements expand, efficient clinical documentation is a must for the busy surgeon. Although, our data entry and processing method has the immediate capacity for acute care surgery fellowships nationwide, multiple larger decisions regarding national case log systems should be encouraged.