Journal of the American College of Surgeons
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Randomized Controlled Trial Comparative Study
Cluster-Randomized Trial of Opiate-Sparing Analgesia after Discharge from Elective Hip Surgery.
Surgeons have traditionally relied on opiates after hip replacement, despite a growing epidemic of abuse. This study assessed the efficacy of multimodal analgesia and impact of conservative opiate prescribing after discharge from hip surgery. ⋯ Multimodal analgesia with minimal opiates improved pain control while significantly decreasing opiate use and opiate-related adverse effects. It is time to rethink our reliance on opiates after elective operations.
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Multicenter Study
Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest.
Despite increased national attention on misuse of prescription and nonprescription opioids for adolescents and children, little is known about opioid use in a pediatric population during hospitalization for injury. The purpose of this investigation is to describe opioid administration and magnitude of opioid exposure in the first 48 hours of hospitalization in a pediatric trauma population. ⋯ Most pediatric trauma patients received an opioid in the first 48 hours of hospitalization, although prevalence and exposure varied by age, injury, and acuity. Aggressive pain management can be appropriate for injured pediatric patients; however, study results indicate areas for improvement, specifically for children with minor injuries and those receiving excessive opioid amounts.
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Accurate estimation of operative case-time duration is critical for optimizing operating room use. Current estimates are inaccurate and earlier models include data not available at the time of scheduling. Our objective was to develop statistical models in a large retrospective data set to improve estimation of case-time duration relative to current standards. ⋯ Our study is a notable advancement toward statistical modeling of case-time duration across all surgical departments in a large tertiary medical center. Machine learning approaches can improve case duration estimations, enabling improved operating room scheduling, efficiency, and reduced costs.
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Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there might be a select group of patients that could have benefited from prehospital placement of the REBOA. ⋯ Our data suggest that >10% of trauma patients who presented with cardiac arrest could have benefited from prehospital REBOA. Additional prospective studies are warranted to validate the use of field vital signs in selecting candidates.
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Multicenter Study Observational Study
Multicenter Observational Study Examining the Implementation of Enhanced Recovery within the Virginia Surgical Quality Collaborative in Patients Undergoing Elective Colectomy.
The American College of Surgeons (ACS) NSQIP Virginia Surgical Quality Collaborative (VSQC) exists to improve surgical outcomes through multi-institutional collaboration. Enhanced recovery (ER) protocols improve morbidity and reduce length of stay (LOS) after elective surgery. We hypothesized implementation of ER through VSQC would reduce postoperative complications and LOS in patients undergoing elective colectomy. Our objective was to evaluate whether standardization of care based on evidenced-based practices in healthcare settings across multiple institutions improved outcomes. ⋯ Implementation of ER across VSQC was associated with reduction in LOS and complications in patients undergoing elective laparoscopic colectomy.