Journal of the American College of Surgeons
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Multicenter Study
American College of Surgeons National Surgical Quality Improvement Program Pediatric: a phase 1 report.
There has been a long-standing desire to implement a multi-institutional, multispecialty program to address surgical quality improvement for children. This report documents results of the initial phase of the American College of Surgeons National Surgical Quality Improvement Program Pediatric. ⋯ Based on this initial phase of development, the highly anticipated American College of Surgeons National Surgical Quality Improvement Program Pediatric has the potential to identify outcomes of children's surgical care that can be targeted for quality improvement efforts.
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Randomized Controlled Trial Multicenter Study Comparative Study
A moderated journal club is more effective than an Internet journal club in teaching critical appraisal skills: results of a multicenter randomized controlled trial.
Evidence Based Reviews in Surgery (EBRS) is an Internet journal club that is effective in teaching critical appraisal skills to practicing surgeons. The objective of this randomized controlled trial was to determine whether teaching critical appraisal skills to surgical residents through the Internet is as effective as a moderated in-person journal club. ⋯ A moderated journal club is considerably better in teaching critical appraisal skills to surgical residents. This is likely because of the low participation in the Internet journal club.
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Multicenter Study
Detection of postoperative respiratory failure: how predictive is the Agency for Healthcare Research and Quality's Patient Safety Indicator?
Patient Safety Indicator (PSI) 11, or postoperative respiratory failure, was developed by the US Agency for Healthcare Research and Quality to detect incident cases of respiratory failure after elective operations through use of ICD-9-CM diagnosis and procedure codes. We sought to determine the positive predictive value (PPV) of this indicator. ⋯ Although PSI 11 predicts true postoperative respiratory failure with relatively high frequency, the indicator does not limit detection to preventable cases. The PPV of PSI 11 might be increased by excluding cases with a principal diagnosis suggestive of a nonelective hospitalization and those with head or neck procedures. Removing the diagnosis code criterion from the indicator might also increase PPV, but would decrease the number of true positive cases detected by 20%.
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Multicenter Study
Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis.
Use of prosthetic grafts for reconstruction after portal vein (PV) resection during pancreaticoduodenectomy is controversial. We examined outcomes in patients who underwent vein reconstruction using polytetrafluoroethylene (PTFE). ⋯ With careful patient selection, PTFE graft reconstruction of resected PV/SMV during pancreaticoduodenectomy is possible with minimal risk of hepatic necrosis or graft infection. Comparison studies to primary anastomosis and autologous vein reconstruction are necessary.
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Multicenter Study
A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate?
As compared with open distal pancreatectomy (ODP), laparoscopic distal pancreatectomy (LDP) affords improved perioperative outcomes. The role of LDP for patients with pancreatic ductal adenocarcinoma (PDAC) is not defined. ⋯ LDP provides similar short- and long-term oncologic outcomes as compared with OD, with potentially shorter hospital stay. These results suggest that LDP is an acceptable approach for resection of PDAC of the left pancreas in selected patients.