Journal of the American College of Surgeons
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The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has become an important surgical quality program in the United States, yet few studies describe their methods for handling missing data. Our study examines the impact of missing data on predictive models for short-term operative outcomes after cancer surgery in the ACS NSQIP database. ⋯ Missing data present challenges to interpreting predictors of short-term operative outcomes after cancer surgery at ACS NSQIP hospitals. Similar to best practices for other data sets, this study highlights the importance of using missing values carefully when using ACS NSQIP. Given its potential to introduce bias, the approach to handling missing values should be detailed in future ACS NSQIP studies.
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This investigation sought to evaluate risk factors for morbidity and mortality from a large series of below-knee amputees prospectively entered in a national database. ⋯ Renal disease, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age were identified as predictors of mortality after below-knee amputation. Renal disease, cardiac issues, history of sepsis, steroid use, contaminated/infected wounds, and alcohol use were also found to be predictors of postoperative complications.
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Obesity is a known risk factor for surgical site infection (SSI). Our hypothesis is that morphometric measures of midline subcutaneous fat will be associated with increased risk of SSI and will predict SSI better than conventional measures of obesity. ⋯ Abdominal subcutaneous fat is an independent predictor of superficial incisional SSI after midline laparotomy. Novel morphometric measures may improve risk stratification and help elucidate the pathophysiology of surgical complications.
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Because operating room crises are rare events, failure to adhere to critical management steps is common. We sought to develop and pilot a tool to improve adherence to lifesaving measures during operating room crises. ⋯ Checklist use can improve safety and management in operating room crises. These findings warrant broader evaluation, including in clinical settings.