Annals of surgery
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We aimed to evaluate variations in patient experience measures across different surgical specialties and to assess the impact of further case-mix adjustment. ⋯ HCAHPS case-mix adjustment does not include adjustment for specialty or diagnosis, which may result in artificially lower scores for centers that provide a high level of complex care. Further research is needed to ensure that the HCAHPS is an unbiased comparison tool.
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The aim of this study is to examine, by a prospective randomized controlled trial, the influence of liberal (LIB) vs restricted (RES) perioperative fluid administration on morbidity following pancreatectomy. ⋯ In a high volume institution, major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6-fold.
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To determine factors affecting cognition and identify predictors of long-term cognitive impairment following carotid revascularization procedures. ⋯ Carotid interventions affect cognitive function. Systemic biomarkers can be used to identify patients at risk of significant cognitive decline postprocedures that benefit from targeted cognitive training.
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The aim of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery. ⋯ Most postoperative myocardial injury is asymptomatic and may only be detected by routine troponin screening. Elevated troponin concentrations after colorectal surgery may facilitate identifying patients at postoperative risk and prompt appropriate testing. Early intervention in select patients may lead to potential reduction of mortality after major colorectal surgery.
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The ProPublica Surgeon Scorecard is the first nationwide, multispecialty public reporting of individual surgeon outcomes. However, ProPublica's use of a previously undescribed outcome measure (composite of in-hospital mortality or 30-day related readmission) and inclusion of only inpatients have been questioned. Our objectives were to (1) determine the proportion of cases excluded by ProPublica's specifications, (2) assess the proportion of inpatient complications excluded from ProPublica's measure, and (3) examine the validity of ProPublica's outcome measure by comparing performance on the measure to well-established postoperative outcome measures. ⋯ ProPublica's outcome measure specifications exclude 82% of cases, miss 84% of postoperative complications, and correlate poorly with well-established postoperative outcomes. Thus, the validity of the ProPublica Surgeon Scorecard is questionable.