Journal of the American College of Surgeons
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Comparative Study
Wound classification in pediatric general surgery: significant variation exists among providers.
Risk-adjusted rates of surgical site infections (SSI) are used as a quality metric to facilitate improvement within a hospital system and allow comparison across institutions. The NSQIP-Pediatric, among others, uses surgical wound classification as a variable in models designed to predict risk-adjusted postoperative morbidity, including SSI rates. The purpose of this study was to measure the level of agreement in wound classification assignment among 3 providers: surgeons, operating room (OR) nurses, and NSQIP surgical clinical reviewers (SCR). ⋯ There is significant variation in assigning surgical wound classification among health care providers. For future SSI comparative analyses, it will be critical to improve uniformity and understanding of wound class assignment among providers and institutions.
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We examined the relationship between morbid obesity, clinical presentation, and perioperative outcomes in patients offered surgery for diverticulitis. ⋯ Morbidly obese patients undergoing surgery for diverticulitis are nearly 10 years younger than NL patients and are more likely to require ES, ostomy creation, open surgery, and to undergo procedures without an anastomosis. Morbidly obese patients undergoing ES also have more preoperative systemic inflammatory response syndrome/sepsis/septic shock.
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As new technology is developed and scientific evidence demonstrates strategies to improve the quality of care, it is essential that surgeons keep current with their skills. Rural surgeons need efficient and targeted continuing medical education that matches their broader scope of practice. Developing such a program begins with an assessment of the learning needs of the rural surgeon. The aim of this study was to assess the learning needs considered most important to surgeons practicing in rural areas. ⋯ Our results demonstrated that surgeons practicing in rural areas have a strong interest in acquiring additional skills in a variety of general and subspecialty surgical procedures. The information obtained in this study may be used to guide curriculum development of further postgraduate skills courses targeted to rural surgeons.
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Patterns of care of physician specialists may differ for patients with hepatocellular carcinoma (HCC). Reasons underlying variations are poorly understood. One source of variation may be disparate referral rates to specialists, leading to differences in cancer-directed treatments. ⋯ After HCC diagnosis, referral to a specialist varied considerably. Both clinical and nonclinical factors were associated with consultation. Disparities in referral to a specialist and subsequent therapy need to be better understood to ensure all HCC patients receive appropriate care.