Journal of the American College of Surgeons
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Multicenter Study
Outcomes of synthetic mesh in contaminated ventral hernia repairs.
Given the questionable long-term durability of biologic meshes, additional prosthetic options for ventral hernia repairs (VHR) in contaminated fields are necessary. Recent evidence suggests improved bacterial resistance of reduced-weight, large-pore synthetics, giving a potential mesh alternative for repair of contaminated hernias. We aimed to evaluate the clinical outcomes of 2 institutions' experience implanting lightweight polypropylene synthetic mesh in clean-contaminated and contaminated fields. ⋯ Although perhaps not yet considered standard of care in the United States, we have demonstrated favorable infection, recurrence, and mesh removal rates associated with the use of synthetic mesh in contaminated VHR.
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Multicenter Study Comparative Study
The "hidden curriculum" and residents' attitudes about medical error disclosure: comparison of surgical and nonsurgical residents.
The "hidden curriculum" and role models for responding to medical errors might play a central role in influencing residents' attitudes about disclosure. We sought to compare surgical and nonsurgical residents' exposure to role modeling for responding to medical errors and their attitudes about error disclosure. ⋯ The punitive response to error by senior members of the health care team might be an impediment to the transparent disclosure of errors among residents that might disproportionally affect surgical training programs.
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Multicenter Study
Experience with an enteral-based nutritional support regimen in critically ill trauma patients.
Assuring adequate enteral nutritional support in critically ill patients is challenging. By describing our experience, we sought to characterize the challenges, benefits, and complications of an approach that stresses enteral nutrition. ⋯ Enteral caloric intake during the first week was related to the pattern and severity of injury and was associated with important infectious outcomes. Our observations support moderating enteral intake during the first week after injury and avoiding parenteral nutrition.
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Comparative Study
Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair.
Current risk-assessment tools for surgical site occurrence (SSO) and surgical site infection (SSI) are based on expert opinion or are not specific to open ventral hernia repairs. We aimed to develop a risk-assessment tool for SSO and SSI and compare its performance against existing risk-assessment tools in patients with open ventral hernia repair. ⋯ The VHRS identified patients at increased risk for SSO/SSI more accurately than the National Nosocomial Infection Surveillance scores and VHWG grade, and can be used to guide clinical decisions and patient counseling.
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Comparative Study
Hospital readmissions after colectomy: a population-based study.
Surgical readmissions will be targeted for reimbursement cuts in the near future. We sought to understand differences between hospitals with high and low readmission rates in a statewide surgical collaborative to identify potential quality improvement targets. ⋯ There is wide variation in hospital readmission rates after colectomy that correlates with overall complication rates. However, the wide variation in complication rates among hospitals with similar readmission rates suggests that hospital complication rates explain little about their readmission rates. Preventing readmissions after colectomy in hospitals with high readmission rates will require more attention to different care processes currently unmeasured in many clinical registries as well as complication prevention.