Journal of the American College of Surgeons
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Clinical Trial
Perioperative Bundle to Reduce Surgical Site Infection after Pancreaticoduodenectomy: A Prospective Cohort Study.
Pancreaticoduodenectomy is historically associated with incisional surgical site infection (iSSI) rates between 15% and 20%. Prospective studies have been mixed with respect to the benefit of individual interventions directed at decreasing iSSI. We hypothesized that the application of a perioperative bundle during pancreaticoduodenectomy would decrease the rate of iSSIs significantly. ⋯ In this cohort study of 300 consecutive patients who underwent pancreaticoduodenectomy, the implementation of a 4-part bundle decreased iSSI rate from 22% to 11%.
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In 2017, our hospital was identified as a high outlier for postoperative Clostridium difficile infections (CDIs) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated a CDI task force with representation from Surgery, Infectious Disease, Pharmacy, and Performance Services to analyze available data, identify opportunities for improvement, and implement strategies to reduce CDIs. ⋯ Our multidisciplinary CDI reduction program has demonstrated significant reductions in CDIs. It is effective, straightforward to implement and monitor, and can be generalized to high-outlier institutions.
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For many surgeons, focused parathyroidectomy has become the preferred approach for management of sporadic primary hyperparathyroidism (HPT). This study describes use patterns of bilateral neck exploration (BE) by endocrine surgeons participating in the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP). ⋯ This is the first analysis of parathyroidectomy use trends by high-volume endocrine surgeons in CESQIP. Bilateral neck exploration is a commonly used approach (40%), and conversion from focused to BE was observed in 11% of cases, despite highly localized glands. Bilateral neck exploration remains a complex and frequently used procedure, and surgeons intending to perform parathyroid surgery should be adequately trained and adept at BE.
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Optimal pain control post pancreaticoduodenectomy is a challenge. Epidural analgesia (EDA) is used increasingly, despite inherent risks and unclear effects on outcomes. ⋯ Based on the largest single-institution series published to date, our data support the use of EDA for optimization of pain control. More importantly, our data document that EDA improved infectious and pulmonary complications significantly.
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Biography Historical Article
W Dean Warren, MD: Iron Hand and Principles of Steel.