Abstract：
BACKGROUND:Surgeons in academic medical centers have traditionally taken a siloed approach to reducing postoperative complications. We initiated a project focusing on transparency and sharing of data to engage surgeons in collaborative quality improvement. Its key features were the development of a comprehensive department quality dashboard and the creation of the Clinical Operations Council that oversaw quality. The purpose of this study was to assess the impact of those efforts. STUDY DESIGN:We compared inpatient outcomes before and after our intervention, allowing one quarter as the diffusion period. The outcomes analyzed were: risk-adjusted length of stay, mortality, direct cost and unadjusted incidence of complications, and 30-day all-cause readmissions, as determined by the Vizient Clinical Database. We examined the outcomes of three groups: group 1 (surgery); group 2, all other surgical departments (other surgery); and group 3, all other patients (non-surgery). Two-tailed Student's t-test was used for analysis and p < 0.05 was considered statistically significant. RESULTS:Group 1 demonstrated statistically significant improvements in mortality (p = 0.01), length of stay (p = 0.002), cost (p = 0.0001), and complications (p = 0.02), and the all-cause readmission rate was unchanged, resulting in mean decrease of 0.55 length of stay days and direct cost savings of $2,300 per surgical admission. The comparison groups had only modest decreases in some of the analyzed outcomes and an increase in complication rates. CONCLUSIONS:These data suggest that a collaborative, data-driven, and transparent approach to assessing the quality of surgical care can yield significant improvements in patient outcomes.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Birdas TJ,Rozycki GF,Dunnington GL,Stevens L,Liali V,Schmidt CMdoi
10.1016/j.jamcollsurg.2018.12.013subject
Has Abstractpub_date
2019-04-01 00:00:00pages
368-373issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(19)30010-9journal_volume
228pub_type
杂志文章abstract：BACKGROUND:In the novel coronavirus disease 2019 (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, medical practices have limited access to in-person visits. This poses a challenge to maintain appropriate patient care while preventing a substantial backlog of p...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2020.04.030
更新日期：2020-08-01 00:00:00
abstract：BACKGROUND:Cecal leak or disruption after appendectomy for complicated appendicitis is a consequence of severity of disease and is related to residual abscess cavity, inflammation, phlegmon, and nonviable intestine. In an attempt to improve results, we have begun to resect the cecum and other localized infected tissue ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1994-08-01 00:00:00
abstract：BACKGROUND:The incidence of thyroid cancer in patients treated operatively for thyroid disease has been historically low (<5%). Previous series have not specifically addressed cancer rates in both euthyroid and hyperthyroid patients. This study examined cancer frequency in patients referred for removal of benign thyroi...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2012.12.022
更新日期：2013-04-01 00:00:00
abstract：BACKGROUND:Frailty is an objective method of quantifying a patient's fitness for surgery. Its clinical use is limited by the time needed to complete, as well as a lack of evidence-based interventions to improve outcomes in identified frail patients. The purpose of this study was to critically analyze the components of ...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章
doi：10.1016/j.jamcollsurg.2015.01.053
更新日期：2015-05-01 00:00:00
abstract：BACKGROUND:Afterbirth or placenta is normally discarded. But placental cord blood, because of its rich mix of fetal and adult hemoglobin, plasma, and high platelet count has the potential to be a safe alternative to adult blood. STUDY DESIGN:We transfused 413 U (range 50 mL to 146 mL; mean 86 mL+/-7.6 mL SD; median 80...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2004.12.007
更新日期：2005-04-01 00:00:00
abstract：BACKGROUND:Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and ma...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.12.046
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:Effective teamwork in the operating room (OR) is often undermined by the "silo mentality" of the differing professions. Such thinking is formed early in one's professional experience and is fostered by undergraduate medical and nursing curricula lacking interprofessional education. We investigated the immedi...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章
doi：10.1016/j.jamcollsurg.2013.09.006
更新日期：2014-01-01 00:00:00
abstract：BACKGROUND:Given the questionable long-term durability of biologic meshes, additional prosthetic options for ventral hernia repairs (VHR) in contaminated fields are necessary. Recent evidence suggests improved bacterial resistance of reduced-weight, large-pore synthetics, giving a potential mesh alternative for repair ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2013.07.382
更新日期：2013-12-01 00:00:00
abstract：:One hundred and seventy consecutive patients undergoing parathyroid gland exploration and bilateral thyroidectomy received, postoperatively, routine oral calcium supplementation, close monitoring of total serum calcium, and addition of vitamin D for specific criteria, all to accomplish a postoperative course free of s...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1994-01-01 00:00:00
abstract：BACKGROUND:Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamcollsurg.2012.12.024
更新日期：2013-05-01 00:00:00
abstract：BACKGROUND:Although RBC transfusions can be lifesaving, recent evidence suggests that their use is associated with added morbidity and mortality and that a lower transfusion threshold is safe. It is unclear if this new evidence has translated into decreased RBC use among surgical patients. The purpose of this study is ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2008.04.002
更新日期：2008-09-01 00:00:00
abstract：BACKGROUND:In changing our technique to performing needle localization breast biopsies (NLBB) using local anesthesia in an outpatient setting, we investigated whether or not our complication rates with local anesthesia were acceptable when compared with complications from a cohort of biopsies of the breast performed fo...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1994-09-01 00:00:00
abstract：BACKGROUND:The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has become an important surgical quality program in the United States, yet few studies describe their methods for handling missing data. Our study examines the impact of missing data on predictive models for short-term...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.05.010
更新日期：2011-09-01 00:00:00
abstract：BACKGROUND:Obese patients are more prone to post-injury multiple organ failure (MOF). Obesity pathophysiology includes an adipose-tissue-derived, renin-angiotensin-aldosterone system affecting inflammatory responses via leukocyte angiotensin receptors. We hypothesized that obese patients receiving pre-injury angiotensi...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2015.03.051
更新日期：2015-08-01 00:00:00
abstract：BACKGROUND:The Tennessee Surgical Quality Collaborative analyzes NSQIP data from 21 participating hospitals. The Tennessee Surgical Quality Collaborative has reduced surgical complications, but causative factors are unclear. We sought to correlate surgical duration with complications to reveal mitigating strategies. S...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2014.12.040
更新日期：2015-04-01 00:00:00
abstract：BACKGROUND:Peripheral ports represent a new option for central venous access that have a low complication rate while providing long duration. This study provides five years of evaluation of this device. STUDY DESIGN:All patients had follow-up evaluation concurrently, with detailed information collected for the first 7...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1995-04-01 00:00:00
abstract：BACKGROUND:Outcome improvement is a major goal of pancreatic surgery. Such efforts include decreasing perioperative narcotic use to optimize care and reduce potential contributions to the opioid crisis. Ketorolac, a frequent component of opioid-minimizing recovery pathways, has not been universally adopted over concern...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2020.02.024
更新日期：2020-06-01 00:00:00
abstract：BACKGROUND:Computed tomography angiography (CTA) has been increasingly used in traumatic brain injury (TBI) patients to uncover vascular lesions that might have preceded the trauma and caused the bleed. This study aims to evaluate the usefulness of head CTA in the initial care of blunt TBI patients. STUDY DESIGN:We co...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2015.03.002
更新日期：2015-06-01 00:00:00
abstract：BACKGROUND:Transcutaneous techniques to measure serum bilirubin have been validated in neonates but not in adult patients. We evaluated transcutaneous bilirubinometry (TcB) in adults at risk for or diagnosed with hepatic dysfunction to determine if this technology has clinical use in quantifying the presence and magnit...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2008.01.014
更新日期：2008-06-01 00:00:00
abstract：UNLABELLED:Some of the concepts contained here have been discussed and incorporated in another publication, but the data are entirely unique to this manuscript. (See: Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause." Backster A, Teo A, Swift M, MD, Polk HC Jr, MD, FACS, Harken AH, MD, FACS....
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.01.009
更新日期：2007-04-01 00:00:00
abstract：BACKGROUND:Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment fail...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章
doi：10.1016/j.jamcollsurg.2016.08.004
更新日期：2016-11-01 00:00:00
abstract：BACKGROUND:The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum. STUDY DESIGN:Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experien...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/j.jamcollsurg.2005.02.021
更新日期：2005-07-01 00:00:00
abstract：BACKGROUND:With the general acceptance of lumpectomy, axillary staging, and radiotherapy as local treatment for infiltrating breast cancer, an appreciation is evolving for the spectrum of vascular lesions that occur in the mammary skin after this treatment. Most of these lesions develop within the prior radiation field...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(01)00863-8
更新日期：2001-07-01 00:00:00
abstract：BACKGROUND:Laparoscopic liver resection is a procedure in evolution. In the last decade it has evolved from a novel procedure to a standard part of the hepatic surgeon's armamentarium. Few data exist on the development of a laparoscopic resection program. STUDY DESIGN:With IRB approval, a retrospective review of 300 c...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.04.032
更新日期：2011-10-01 00:00:00
abstract：BACKGROUND:The only possible curative treatment in gastric carcinoma is surgery, and there is still controversy surrounding the value of extended lymph node dissection. STUDY DESIGN:A retrospective cohort study was conducted in patients who underwent curative D1 or D2 resection for operable gastric carcinoma. Survival...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(00)00779-1
更新日期：2001-01-01 00:00:00
abstract：BACKGROUND:Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma. STUDY DESIGN:The trauma records for gunshot victims and their insurance status were reviewed at o...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2009.12.002
更新日期：2010-03-01 00:00:00
abstract：BACKGROUND:Type or lack of insurance may affect access to care, treatment, and outcomes. We evaluated trends for surgical management of all peripheral arterial disease (PAD) in-hospital admissions by insurer status in New York State. STUDY DESIGN:Statewide Planning and Research Cooperative System (SPARCS) data were ob...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.05.033
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:Treatment of early gastric cancer may be an ideal application for laparoscopic surgery. But laparoscopic surgery has various limitations derived from the lack of tactile feedback and a two-dimensional display of the operative field. So, laparoscopic surgery is technically challenging and requires a more deta...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2003.07.021
更新日期：2003-12-01 00:00:00
abstract：BACKGROUND:Ablation is increasingly used to treat primary and secondary liver cancer. Ablation near portal pedicles and hepatic veins is challenging. Irreversible electroporation (IRE) is a new ablation technique that does not rely on heat and, in animals, appears to be safe and effective when applied near hepatic vein...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.04.029
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on pre...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.08.013
更新日期：2007-12-01 00:00:00
