The Journal of surgical research
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Most literature regarding fireworks injuries are from outside the United States, whereas US-based reports focus primarily on children and are based on datasets which cannot provide accurate estimates for subgroups of the US population. ⋯ Emergency department visits for fireworks injuries are concentrated around major national holidays and are more prevalent in certain parts of the country and among young males. This suggests that targeted interventions may be effective in combating this public health problem.
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Racial disparities have been shown to be associated with increasing health-care costs. We sought to identify racial disparities in 30-d graft failure rates after infrainguinal bypass in an effort to define targets for improved health care among minorities. ⋯ More blacks and Hispanics present with critical limb ischemia, requiring distal revascularization. Even when controlling for anatomic differences and degree of peripheral arterial disease, black race remained independently associated with early graft failure after infrainguinal bypass. These results identify a target for improved outcomes.
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Surgical site infections (SSIs) after thyroidectomy are rare but can have significant consequences. Thyroidectomy is a clean case, and the patterns for use of prophylactic antibiotics vary. We hypothesized that patient and operative characteristics may predict a higher risk of SSI, and that SSI are associated with other complications leading to increased resource utilization. ⋯ Although rare, SSI after thyroidectomy are associated with other postoperative complications. We have identified preoperative and intraoperative factors that are associated with SSI, and this may help identify high-risk patients who may benefit from selective use of antibiotics.
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High-quality teamwork among operating room (OR) professionals is a key to efficient and safe practice. Quantification of teamwork facilitates feedback, assessment, and improvement. Several valid and reliable instruments are available for assessing separate OR disciplines and teams. We sought to determine the most feasible approach for routine documentation of teamwork in in-situ OR simulations. We compared rater agreement, hypothetical training costs, and feasibility ratings from five clinicians and two nonclinicians with instruments for assessment of separate OR groups and teams. ⋯ Additional training is needed to achieve higher levels of agreement; however, costs may be prohibitive. The most cost-effective model for real-time OR teamwork assessment may be to use a simulation technician combined with one clinical rater to allow complete documentation of all participants.
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The practice of ambulatory surgery has expanded greatly as a result of advances in surgical technology and rising financial pressures. We sought to characterize the utilization of ambulatory surgical practices for common general surgical procedures in Michigan. ⋯ Despite wide variation in ambulatory surgery utilization for general surgical procedures, we were unable to explain observed differences by patient comorbidities, case mix, or hospital characteristics. These data suggest that understanding factors associated with ambulatory surgery utilization may represent a novel avenue for quality improvement within our statewide surgical collaborative.