Independent Operating by General Surgery Residents: An ACS-NSQIP Analysis

2021 ◽  
Author(s):  
Karen J Dickinson ◽  
Barbara L Bass ◽  
Edward A Graviss ◽  
Duc T Nguyen ◽  
Kevin Y Pei
Keyword(s):  
General Surgery ◽  
Acs Nsqip

Sustaining Improvement: Implementation and Spread of a Surgical Site Infection Bundle

2018 ◽  
Vol 84 (10) ◽  
pp. 1665-1669 ◽  
Author(s):  
Tara A. Russell ◽  
Hallie Chung ◽  
Christina Riad ◽  
Sarah Reardon ◽  
Kevork Kazanjian ◽  
...  
Keyword(s):  
General Surgery ◽  
Odds Ratio ◽  
Surgical Site Infections ◽  
Surgical Patients ◽  
Infection Rates ◽  
Process Measures ◽  
Quality Metric ◽  
Effective Implementation ◽  
Acs Nsqip ◽  
Significant Challenge

Surgical site infections (SSIs) are considered a quality metric across surgical specialties and are a major cause of increased readmissions and overall costs to surgical patients. Bundled interventions have demonstrated efficacy in reducing SSIs in various surgical fields, yet the ability to sustain and spread interventions while continuing to reduce infection rates is a significant challenge. This study assessed the implementation and sustainability of an SSI bundle, which was initially piloted within the colorectal surgery division and then spread to additional general surgery services. Outcomes (risk-adjusted ACS-NSQIP odds ratio and observed to expected (O:E) SSI rates) and process measures were monitored on run charts throughout the course of the intervention. By the end of the study period, ACS-NSQIP risk-adjusted odds ratios for SSIs decreased from 1.22 to 0.95 for colorectal procedure targeted and 1.32 to 1.04 for all general surgery procedures ( P < 0.05). O:E ratios showed similar reductions. SSI reductions were associated with process measure compliance. This study demonstrates that effective implementation within a single surgical division provides the foundation for spread of a SSI bundle, which results in continued and sustained reductions in SSI rates.

Evaluation of the Performance of ACS NSQIP Surgical Risk Calculator in Emergency General Surgery Patients

2020 ◽  
Vol 86 (2) ◽  
pp. 83-89
Author(s):  
Andrea M. Long ◽  
Amy N. Hildreth ◽  
Patrick T. Davis ◽  
Rebecca Ur ◽  
Ashley T. Badger ◽  
...  
Keyword(s):  
General Surgery ◽  
Outcome Expectations ◽  
Poor Correlation ◽  
Risk Calculator ◽  
Inclusion Criteria ◽  
Emergency General Surgery ◽  
Surgical Risk ◽  
Acs Nsqip ◽  
Risk Of Mortality ◽  
Predicted Risk

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.

Surgery for the Very Old: Are Nonagenarians Different?

2020 ◽  
Vol 86 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Tanner I. Kim ◽  
Anand Brahmandam ◽  
Laura Skrip ◽  
Timur Sarac ◽  
Alan Dardik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
General Surgery ◽  
Postoperative Hospital Stay ◽  
Surgical Patients ◽  
Perioperative Mortality ◽  
Very Old ◽  
Acs Nsqip ◽  
Acs Nsqip Database ◽  
The Impact

Octogenarians and nonagenarians are considered the “very old” and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9 per cent of the population to 4.3 per cent in 2050. This study aimed to underscore the differences in surgical trends, demographics, and outcomes between octogenarians and nonagenarians. The ACS-NSQIP database (2007–2012) was used to derive the type of surgeries, demographics, and outcomes of octogenarian and nonagenarians undergoing nonemergent vascular, orthopedic, and general surgery procedures. Between 2007 and 2012, nonagenarians accounted for an increasing percentage of surgeries (85 to 121 per 10,000 surgeries, relative risk = 1.42; 95% CI: 1.30–1.54) across surgical specialties, including vascular, general, and orthopedic surgery, whereas the percentage of octogenarians undergoing surgery remained unchanged. Nonagenarians had a higher 30-day perioperative mortality and a longer hospital stay than octogenarians after vascular, orthopedic, and general surgery procedures. Nonagenarians are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of nonagenarians needs to be studied to justify the increasing healthcare costs.

Risk Prediction Accuracy Differs for Transferred and Nontransferred Emergency General Surgery Cases in the ACS-NSQIP

2020 ◽  
Vol 247 ◽  
pp. 364-371 ◽  
Author(s):  
Manuel Castillo-Angeles ◽  
Molly P. Jarman ◽  
Tarsicio Uribe-Leitz ◽  
Ginger Jin ◽  
Ali Salim ◽  
...  
Keyword(s):  
Risk Prediction ◽  
General Surgery ◽  
Prediction Accuracy ◽  
Emergency General Surgery ◽  
Acs Nsqip

Identification and classification of flow disruptions in the operating room during two types of general surgery procedures

2010 ◽  
Author(s):  
Sacha N. Duff ◽  
T. Christopher Windham ◽  
Douglas A. Wiegmann ◽  
Jason Kring ◽  
Jennifer D. Schaus ◽  
...  
Keyword(s):  
Operating Room ◽  
General Surgery ◽  
Flow Disruptions

Robots Advance Gyn, General Surgery Techniques

2006 ◽  
Vol 36 (10) ◽  
pp. 63
Author(s):  
BETSY BATES
Keyword(s):  
General Surgery

Congenital Intercostal Hernia: A Rare Entity

JMS SKIMS ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 48
Author(s):  
Syed Muzamil Andrabi ◽  
Mohd Yousuf Dar ◽  
Javid Ahmad Bhat
Keyword(s):  
Male Patient ◽  
General Surgery ◽  
Rare Entity ◽  
Intercostal Hernia ◽  
History Of ◽  
Lateral Chest ◽  
Patient Department

A 35-year-old male patient presented to the General Surgery Out Patient Department with a history of swelling on the left lateral chest since birth. The swelling appeared during inspiration and disappeared during expiration. JMS 2018;21(1):48 

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