Annals of surgery
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Multicenter Study
Derivation and validation of a quality indicator of acute care length of stay to evaluate trauma care.
To derive and internally validate a quality indicator (QI) for acute care length of stay (LOS) after admission for injury. ⋯ We have developed a QI on the basis of risk-adjusted LOS to evaluate trauma care that can be implemented with routinely collected data. The QI is based on a robust risk adjustment model with good internal and temporal validity, and demonstrates good properties in terms of discrimination, construct validity, and forecasting. This QI can be used to target interventions to reduce LOS, which will lead to more efficient resource use and may improve patient outcomes after injury.
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Multicenter Study
Splenectomy and the risk of sepsis: a population-based cohort study.
We sought to estimate the long-term risk of sepsis in patients who underwent splenectomy before, during, and after implementation of vaccination. ⋯ The risk of hospitalization or death from sepsis is high in patients who previously underwent splenectomy and depends on the indication for splenectomy. The effectiveness of current vaccination practices warrants further evaluation.
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Multicenter Study
The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster.
We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions. ⋯ Adequate preparation, rapid logistical response, short transport times, immediate access to operating rooms, methodical multidisciplinary care delivery, and good fortune contributed to excellent outcomes.
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The leadership of the surgical community is actively engaged in improving the preparation of incoming residents to assume responsibility and accountability for key elements of care and stewardship. To better prepare for this transition, it is essential that all matriculants to surgery residency successfully complete a preparatory course of blended learning that specifically addresses essential components of quality care and patient safety before the start of their training. ⋯ We strongly endorse this effort and encourage medical schools to adopt this or a similar program. We stand ready to assist medical schools and medical students in implementation of this important initiative.
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Multicenter Study
Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry.
To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients. ⋯ Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.