Journal of the American College of Surgeons
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The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. ⋯ Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment.
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Chronic kidney disease (CKD) is known to adversely affect cardiac and vascular surgery outcomes. We examined the effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection. ⋯ Few patients with significant renal insufficiency are candidates for pancreatic resection. Severe CKD (stages 4-5) is associated with increased risk of complication and respiratory failure. Serum creatinine ≥ 1.8 mg/dL may serve as a useful marker of renal insufficiency and identifies patients at significantly increased risk of any complication, major complication, and respiratory failure after pancreatic resection.
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The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program. ⋯ The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years.