Journal of the American College of Surgeons
-
Multicenter Study Comparative Study
Differences in hospital performance for noncancer vs cancer colorectal surgery.
Considerable hospital-to-hospital variations in surgical outcomes have been reported across surgical procedures. However, it is unclear whether hospital quality rankings are consistent for noncancer and cancer operations. We investigated the differences in hospital performance for noncancer and cancer colorectal resections at 52 hospitals participating in the Michigan Surgical Quality Collaborative (MSQC). ⋯ A hospital's performance ranking in risk-adjusted outcomes after noncancer colorectal resections does not correlate to its performance for cancer-related colorectal resections. Indication for operation should be considered when leveraging risk-adjusted hospital outcomes for quality improvement efforts.
-
Randomized Controlled Trial
Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial.
Postoperative pain is an unavoidable consequence of open abdominal surgery. Although cryotherapy, the application of ice to a surgical wound site, has been shown to be effective in reducing postoperative pain in orthopaedic, gynecologic, and hernia operations, it has not been assessed in patients who undergo major open abdominal operations. We hypothesized that patients who receive cryotherapy would report lower pain scores as a primary outcomes measure. ⋯ Ice packs are a simple, cost-effective adjuvant for decreasing postoperative pain and narcotic use in patients undergoing major abdominal operations.
-
Nonmetastatic, noninflammatory, invasive breast cancers with skin involvement (SI) are classified as T4b, regardless of size. This study evaluated disease-specific survival (DSS) to determine whether size should be considered for these lesions rather than grouping them all into stage III. ⋯ Noninflammatory SI breast cancers have widely varied DSS that differs by tumor size and nodal involvement and therefore should not all be stage III. Skin involvement should be subordinate to T and N groupings to classify SI with non-SI lesions having similar prognoses.
-
Hospital readmissions are under intense scrutiny as a measure of health care quality. The Center for Medicare and Medicaid Services (CMS) has proposed using readmission rates as a benchmark for improving care, including targeting them as nonreimbursable events. Our study aim was to describe potentially preventable readmissions after surgery and to identify targets for improvement. ⋯ A minority of readmissions may potentially be preventable. Targets for reducing readmissions include addressing the clinical issues of infection and dehydration as well as improving discharge planning to limit both early and short readmissions. Policies aimed at penalizing reimbursements based on readmission rates should use clinical data to focus on inappropriate hospitalization in order to promote high quality patient care.