Journal of the American College of Surgeons
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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.
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Evidence suggests that patient outcomes can be associated with the quality of surgical training. To raise the standards of surgical training, a tool to measure training quality is needed. The objective of this study was to define the elements of high-quality surgical training and methods to measure them. ⋯ International expert consensus was achieved on defining and measuring high-quality surgical training. This has been translated into the (S-QAT) to evaluate surgical training programs. Competition created by comparing training quality might raise the standards of surgical education.
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Historical Article
Scudder Oration on Trauma. A century of evolution in trauma resuscitation.
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Pneumonectomy for benign disease is often complicated by inflammatory processes that obscure operative planes. We reviewed our experience to evaluate the impact of requiring urgent or emergent pneumonectomy on outcomes. ⋯ Pneumonectomy for benign disease has significant risk for mortality, particularly when not performed electively. Although surgery cannot be planned in the setting of trauma or some situations of acute infection, patients known to have conditions that are likely to require pneumonectomy should be considered for surgery earlier in their disease course, before developing an acute problem that requires urgent or emergent resection.