Journal of the American College of Surgeons
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Randomized Controlled Trial
Utilization and Underlying Reasons of Duty Hour Flexibility in the Flexibility in Duty hour Requirement for Surgical Trainees (FIRST) Trial.
The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial randomly assigned surgical residency programs to either standard duty hour policies or flexible policies that eliminated caps on shift lengths and time off between shifts. Our objectives were to assess adherence to duty hour requirements in the Standard Policy arm and examine how often and why duty hour flexibility was used in the Flexible Policy arm. ⋯ There were differences in duty hours worked by residents in the Flexible vs Standard Policy arms of the FIRST trial, but it appeared that residents generally used the flexibility for patient care and educational opportunities selectively.
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Observational Study
Assessment of Progress in Early Trauma Care in Japan over the Past Decade: Achievements and Areas for Future Improvement.
Strategies to optimize early trauma care have been introduced in Japan; however, detailed evaluation of the progress achieved has not been reported. ⋯ Although early trauma care has generally improved, specific progress was variable. Focused panel review of patients with severe head injury or undergoing thoracotomy may be an efficient strategy for further improvement.
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True aneurysms of the gastroduodenal (GDA) and pancreaticoduodenal (PDA) arteries have been attributed to increased collateral flow due to tandem celiac artery stenosis or occlusion. Although GDA and PDA aneurysm exclusion is recommended because of the high reported risk of rupture, it remains uncertain whether simultaneous celiac artery reconstruction is necessary to preserve end-organ flow. ⋯ Gastroduodenal artery and PDA aneurysms present most commonly with pain or bleeding, and all should be considered for repair, regardless of size. Aneurysm exclusion is safely and effectively achieved with endovascular coiling. Although associated celiac artery stenosis is found in the majority of cases, celiac revascularization might not be necessary.
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Ventral hernia repair (VHR) is a commonly performed surgical procedure. Unfortunately, long-term prospective information about quality of life and outcomes after VHR has been challenging to obtain. Decoupling follow-up from clinical visits via patient-reported outcomes (PROs) has been proposed as a means of achieving better long-term assessments after VHR. The Americas Hernia Society Quality Collaborative (AHSQC) is a national quality improvement (QI) effort in hernia repair that uses PROs to obtain long-term follow-up. However, the modality of PRO engagement to maximize participation has not been well established. A formal QI initiative was undertaken to determine if long-term PRO follow-up could be increased at a single AHSQC site by adding telephone communication to email communication for long-term postoperative VHR assessment. ⋯ A telephone-based approach markedly improved long-term PRO participation rates in postoperative VHR patients. Ultimately, a combination of email and telephone communication may be necessary to achieve higher levels of PRO follow-up in the VHR population.
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Observational Study
Intraoperative Hypothermia and Surgical Site Infections in Patients with Class 1/Clean Wounds: A Case-Control Study.
Numerous surgical quality metrics focus on prevention of unintentional perioperative hypothermia due, in part, to the association between hypothermia and surgical site infections (SSI). However, few studies have comprehensively evaluated the relationship between these metrics and SSI. In this study, we evaluated individual components of 1 set of hypothermia metrics to determine their association with SSI. ⋯ Intraoperative hypothermia was not significantly associated with SSI. These results suggest that development of compliance metrics may not be an effective strategy for SSI reduction in class I surgical wounds.