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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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.
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Multicenter Study
Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database.
To construct a risk model for total gastrectomy outcomes using a nationwide Internet-based database. ⋯ We have performed the first reported risk stratification study for total gastrectomy, using a nationwide Internet-based database. The total gastrectomy outcomes in the nationwide population were satisfactory. The risk models that we have created will help improve the quality of surgical practice.