Journal of the American College of Surgeons
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Multicenter Study
Correlation of Proposed Surgical Volume Standards for Complex Cancer Surgery with Hospital Mortality.
Minimum case volume thresholds for complex cancer operations have been proposed by the Leapfrog Group. There has been no formal study of how these standards correlate with actual hospital mortality. ⋯ Although proposed minimum VTs are reasonably good at identifying PPHs, they misclassify 3 of 4 hospitals below the minimum VT as PPHs and 1 of 4 PPHs as meeting the minimum VT. Use of case volume cutoffs alone does not correlate well with actual hospital mortality.
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Rib fractures are common among trauma patients and analgesia remains the cornerstone of treatment. Intercostal nerve blocks provide analgesia but are limited by the duration of the anesthetic. This study compares outcomes of epidural analgesia with intercostal nerve block using liposomal bupivacaine for the treatment of traumatic rib fractures. ⋯ Patients who received intercostal nerve blocks with liposomal bupivacaine required intubation less frequently and had shorter ICU and hospital LOS compared with epidural analgesia patients. These results suggest that intercostal nerve blocks with liposomal bupivacaine might be equal or superior to epidural analgesia.
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Graduating surgery residents often feel unprepared to practice autonomously in the current era of surgical training. We implemented an integrated simulation curriculum to improve residents' autonomy and increase their confidence to practice independently. In this study, we chose a laparoscopic ventral hernia repair (LVHR) as our pilot operation to test proof of concept and on which we would construct our integrated curriculum. ⋯ Assessing procedure-specific and global laparoscopic skills through a simulation-based curriculum is feasible and can be used to augment resident training. Our curriculum demonstrated improvement in proficiency and self-confidence while performing an LVHR. Additional study is needed to examine the optimal way to integrate procedure-specific simulation models into training programs.