Journal of the American College of Surgeons
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Comparative Study
Surgical site infection prevention: a qualitative analysis of an individualized audit and feedback model.
Surgical site infection (SSI) adversely affects patient outcomes and health care costs, so prevention of SSI has garnered much attention worldwide. Surgical site infection is recognized as an important quality indicator of patient care and safety. The purpose of this study was to use qualitative research methods to evaluate staff perceptions of the utility and impact of individualized audit and feedback (AF) data on SSI-related process metrics for their individual practice, as well as on overall communication and teamwork as they relate to SSI prevention. ⋯ Provision of individualized AF data had a significant impact on promoting individual practice change. Despite this, we concluded that practice change is a shared responsibility, requiring a team leader. So, AF had little bearing on establishing a necessary multidisciplinary team approach to SSI prevention, to create more effective and sustainable practice change among an entire team.
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Multicenter Study Comparative Study
Hazard regression models of early mortality in trauma centers.
Factors affecting early hospital deaths after trauma can be different from factors affecting later hospital deaths, and the distribution of short and long prehospital times can vary among hospitals. Hazard regression (HR) models might therefore be more useful than logistic regression (LR) models for analysis of trauma mortality, especially when treatment effects at different time points are of interest. ⋯ Hazard regression models with time-varying hazard ratios reveal inconsistencies in treatment effects, data quality, and/or timing of early death among trauma centers. Hazard regression models are generally more flexible than LR models, can be adapted for censored data, and potentially offer a better tool for analysis of factors affecting early death after injury.
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Multicenter Study Comparative Study
Hospital surgical volume and cost of inpatient surgery in the elderly.
Strong relationships between hospital volume and quality with inpatient surgery have prompted calls for volume-based referral. However, many are concerned that such policies would steer patients toward higher-cost hospitals. ⋯ Volume-based referral policies would not steer patients toward hospitals with high mean costs around episodes of inpatient surgery in the elderly. Minimizing the use of very low-volume hospitals has the potential to reduce costs as well as improve outcomes, particularly for operations with strong volume-outcomes associations.
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Multicenter Study
The road to curative surgery in gastric cancer treatment: a different path in the elderly?
The aim of this study was to evaluate the possibility of a different path to achieve curative surgery in patients older than age 70 years and affected by resectable gastric cancer. ⋯ Age should not be considered as a factor in the selection of treatment for gastric cancer patients. Curative surgery can be performed as safely in elderly patients as in younger patients, with comparable postoperative results and long-term survival rates, although the life expectancy of elderly patients is shorter.