Journal of the American College of Surgeons
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Multicenter Study
Early Clinical Outcomes of a Novel Antibiotic-Coated, Non-Crosslinked Porcine Acellular Dermal Graft after Complex Abdominal Wall Reconstruction.
Non-crosslinked porcine acellular dermal grafts (NCPADG) are currently the mainstay biomaterial for abdominal wall reconstruction (AWR) in complex hernia patients. We report early clinical outcomes using a novel rifampin/minocycline-coated NCPADG for AWR. ⋯ Data suggest that use of a novel rifampin/minocycline-coated NCPADG was associated with a low rate of postoperative surgical site occurrences/postoperative complications during the first 30 days of follow-up in complex AWR patients. In addition, data suggest a low rate of hernia recurrence at 6-month follow-up. Additional study is warranted to determine whether early antimicrobial protection of the device translates into longer-term protection of the repair.
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Comparative Study Observational Study
Timing of Pharmacologic Venous Thromboembolism Prophylaxis in Severe Traumatic Brain Injury: a Propensity-Matched Cohort Study.
Patients with severe traumatic brain injury (sTBI) are at high risk for developing venous thromboembolism (VTE). Nonetheless, pharmacologic VTE prophylaxis is often delayed out of concern for precipitating extension of intracranial hemorrhage (ICH). The purpose of this study was to compare the effectiveness of early vs late VTE prophylaxis in patients with sTBI, and to characterize the risk of subsequent ICH-related complication. ⋯ In this observational study of patients with sTBI, early initiation of VTE prophylaxis was associated with decreased risk of pulmonary embolism and deep vein thrombosis, but no increase in risk of late neurosurgical intervention or death. Early prophylaxis may be safe and should be the goal for each patient in the context of appropriate risk stratification.
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Income inequality in the United States has been increasing in recent decades. It is unclear whether income inequality has an independent effect on health outcomes, or whether it simply correlates with increasing levels of poverty. The goal of this study was to evaluate whether income inequality is significantly associated with US county health care expenditures and health care use. ⋯ Income inequality is independently associated with higher health care expenditures and more health care use, with increases in both potentially discretionary procedures and in potentially preventable admissions.
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The University HealthSystem Consortium (UHC) administrative database has been used increasingly as a quality indicator for hospitals and even individual surgeons. We aimed to determine the accuracy of cardiac surgical data in the administrative UHC database vs data in the clinical Society of Thoracic Surgeons database. ⋯ In comparing the 2 databases, we found similarity in patient demographic information and percentage of patients with comorbidities. The small difference in volumes of each operation type and the larger disparity in postoperative complications between the databases were related to differences in data definition, data collection, and coding errors.