Journal of the American College of Surgeons
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Comparative Study
Are procedures codes in claims data a reliable indicator of intraoperative splenic injury compared with clinical registry data?
Identifying iatrogenic injuries using existing data sources is important for improved transparency in the occurrence of intraoperative events. There is evidence that procedure codes are reliably recorded in claims data. The objective of this study was to assess whether concurrent splenic procedure codes in patients undergoing colectomy procedures are reliably coded in claims data as compared with clinical registry data. ⋯ It is feasible to use Medicare claims data to identify splenic injuries occurring during colectomy procedures, as claims data have moderate sensitivity and excellent specificity for capturing concurrent splenic procedure codes compared with ACS NSQIP.
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Although surgical repair is universally recognized as the gold standard for treatment of paraesophageal hernia (PEH), the optimal surgical approach is still the subject of debate. To determine which surgical technique is safest, we compared the outcomes of laparoscopic (lap), open transabdominal (TA), and open transthoracic (TT) PEH repair using the NSQIP database. ⋯ In the absence of published data indicating improved long-term outcomes after open TA or TT approach, our findings support the use of laparoscopy, whenever technically feasible, because it yields improved short-term outcomes.
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Whether high-ratio resuscitation (HRR) provides patients with survival advantage remains controversial. We hypothesized a direct correlation between HRR infusion rates in the first 180 minutes of resuscitation and survival. ⋯ This is the first study to examine effects of MIRs on survival. Further studies on the effects of narrow time-interval analysis for blood product resuscitation are warranted.
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The national pass rate for the American Board of Surgery Certifying Examination has decreased in the past 5 years. An individual's ability to pass might be as dependent on his or her handling of the psychology of the examination-the "examanship" -because it is about clinical knowledge and judgment. To assess this, we implemented the Advanced Certifying Examination Simulation (ACES) program. The ACES was created as a novel method to simulate the stress of the Certifying Examination and focuses on the examanship of the test. ⋯ The ACES program provides feedback on the qualities of examanship: controlling anxiety, expressing a positive attitude, and maintaining a strong and confident voice. By providing a structured, simulated venue where residents can safely gain experience, we believe that ACES might lead to increased first-time passage rates on the American Board of Surgery Certifying Examination.