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  • 11
    Online-Ressource
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    Cefoxitin versus piperacillin–tazobactam as surgical antibiotic prophylaxis in patients undergoing pancreatoduodenectomy: protocol for a randomised controlled trial
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 3 ( 2021-03), p. e048398-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 3 ( 2021-03), p. e048398-
    Kurzfassung: Although antibiotic prophylaxis is established in reducing postoperative surgical site infections (SSIs), the optimal antibiotic for prophylaxis in pancreatoduodenectomy (PD) remains unclear. The study objective is to evaluate if administration of piperacillin–tazobactam as antibiotic prophylaxis results in decreased 30-day SSI rate compared with cefoxitin in patients undergoing elective PD. Methods and analysis This study will be a multi-institution, double-arm, non-blinded randomised controlled superiority trial. Adults ≥18 years consented to undergo PD for all indications who present to institutions participating in the National Surgical Quality Improvement Program Hepato-Pancreato-Biliary (NSQIP HPB) Collaborative will be included. Data collection will use the NSQIP HPB Collaborative Surgical Clinical Reviewers. Patients will be randomised to either 1–2 g intravenous cefoxitin or 3.375–4.5 g intravenous piperacillin–tazobactam within 60 min of surgical incision. The primary outcome will be 30-day postoperative SSI rate following PD. Secondary outcomes will include 30-day postoperative mortality; specific postoperative complication rate; and unplanned reoperation, length of stay, and hospital readmission. A subset of patients will have bacterial isolates and sensitivities of intraoperative bile cultures and SSIs. Postoperative SSIs and secondary outcomes will be analysed using logistic regression models with the primary predictor as the randomised treatment group. Additional adjustment will be made for preoperative biliary stent presence. Additionally, bacterial cultures and isolates will be summarised by presence of bacterial species and antibiotic sensitivities. Ethics and dissemination This study is approved by the Institutional Review Board at Memorial Sloan Kettering Cancer Center. This trial will evaluate the effect of piperacillin–tazobactam compared with cefoxitin as antibiotic prophylaxis on the hazard of postoperative SSIs. The results will be disseminated regardless of the effect of the intervention on study outcomes. The manuscript describing the effect of the intervention will be submitted to a peer-reviewed journal when data collection and analyses are complete. Trial registration number NCT03269994 .
    Materialart: Online-Ressource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-048398
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2021
    ZDB Id: 2599832-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 12
    Online-Ressource
    Online-Ressource
    Consistency of pressure injury documentation across interfacility transfers
    BMJ ; 2018
    In:  BMJ Quality & Safety Vol. 27, No. 3 ( 2018-03), p. 182-189
    Details
    In: BMJ Quality & Safety, BMJ, Vol. 27, No. 3 ( 2018-03), p. 182-189
    Kurzfassung: Hospital-acquired pressure injuries (HAPIs) are publicly reported in the USA and used to adjust Medicare payment to acute inpatient facilities. Current methods used to identify HAPIs in administrative claims rely on hospital-reported present-on-admission (POA) data instead of prior patient health information. Objective To study the reliability of claims data for HAPIs and pressure injury (PI) stage by evaluating diagnostic coding agreement across interfacility transfers. Methods Using the 2012 100% Medicare Provider and Analysis Review file, we identified all fee-for-service acute inpatient discharge records with a PI diagnosis among Medicare patients 65 years and older. We then identified additional facility claims (eg, acute inpatient, long-stay inpatient or skilled nursing facility) belonging to the same patient who had either (1) admission within 1day of hospital discharge or (2) discharge within 1day of hospital admission. Multivariable logistic regression and stratified kappa statistics were used to measure coding agreement between transferring and receiving facilities in the presence or absence of a PI diagnosis at the time of patient transfer and PI stage category (early vs advanced). Results In our comparison of claims data between transferring and receiving facilities, we observed poor agreement in the presence or absence of a PI diagnosis at the time of transfer (36.3%, kappa=0.03) and poor agreement in PI stage category (74.3%, kappa=0.17). Among transfers with a POA PI reported by the receiving hospital, only 34.0% had a PI documented at the prior transferring facility. Conclusions The observed discordance in PI documentation and staging between transferring and receiving facilities may indicate inaccuracy of HAPI identification in claims data. Future research should evaluate the accuracy of hospital-reported POA data and its impact on PI quality measurement.
    Materialart: Online-Ressource
    ISSN: 2044-5415 , 2044-5423
    URL: Article
    URL: Article
    DOI: 10.1136/bmjqs-2017-006726
    DOI: 10.1136/bmjqs-2017-006726.supp1
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2018
    ZDB Id: 2592912-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 13
    Online-Ressource
    Online-Ressource
    How Well Is Surgical Improvement Being Conducted? Evaluation of 50 Local Surgery-Related Improvement Efforts
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American College of Surgeons Vol. 235, No. 4 ( 2022-10), p. 573-580
    Details
    In: Journal of the American College of Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 235, No. 4 ( 2022-10), p. 573-580
    Kurzfassung: Delivering high-quality care is paramount; however, evaluations show mixed results. Studies assessing improvement efforts in nonsurgical disciplines show suboptimal conduct, yet little is known about how well improvement efforts in surgery are conducted. This study evaluates local surgical improvement efforts to determine whether opportunities exist to improve their conduct. STUDY DESIGN: Fifty consecutive improvement efforts were collected from hospitals participating in 1 of 5 American College of Surgeons Quality Accreditation/Verification Programs. Conduct of these efforts was evaluated using a quality framework (with 39 criteria grouped into 8 components). Descriptive, paired, and 1-way ANOVA analyses were undertaken. RESULTS: The mean percentage of 39 criteria fulfilled for the 50 improvement efforts was 36% (range 0% to 72%). Individual criterion scores ranged from 0% to 82%. The 2 highest scoring criteria were improvement planning and problem documentation; the 2 lowest scoring were value assessments and stakeholder value perspective. The highest scoring framework component addressed End-of-Project Decision-Making (47%); the lowest was Cost Evaluation (3%). Twenty-four percent of 50 improvement efforts reported full achievement of project goals, 32% reported partial achievement, and 44% reported no achievement. Higher scores were associated with projects having full/partial achievement of stated project goals vs projects not achieving project goals (p 〈 0.05). Higher scores were not associated with hospital characteristics (eg bed size, teaching status) or improvement characteristics (eg improvement strategy). CONCLUSIONS: Evaluation of local surgical improvement efforts shows opportunities for improvement. Better-conducted improvement efforts were associated with more effective improvement. To support better surgical quality of care, improvement efforts need to improve.
    Materialart: Online-Ressource
    ISSN: 1072-7515
    URL: Article
    DOI: 10.1097/XCS.0000000000000341
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 14
    Online-Ressource
    Online-Ressource
    Multisite Implementation of an American College of Surgeons Geriatric Surgery Quality Improvement Initiative
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American College of Surgeons Vol. 237, No. 2 ( 2023-08), p. 171-181
    Details
    In: Journal of the American College of Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 237, No. 2 ( 2023-08), p. 171-181
    Kurzfassung: The American College of Surgeons (ACS) Coalition for Quality in Geriatric Surgery (CQGS) identified standards of surgical care for the growing, vulnerable population of aging adults in the US. The aims of this study were to determine implementation feasibility for 30 selected standards, identify barriers and best practices in their implementation, and further refine these geriatric standards and verification process. STUDY DESIGN: The CQGS requested participation from hospitals involved in the ACS NSQIP Geriatric Surgery Pilot Project, previous CQGS feasibility analyses, and hospitals affiliated with a core development team member. Thirty standards were selected for implementation. After implementation, site visits were conducted, and postvisit surveys were distributed. RESULTS: Eight hospitals were chosen to participate. Program management (55%), immediate preoperative and intraoperative clinical care (62.5%), and postoperative clinical care (58%) had the highest mean percentage of “fully compliant” standards. Goals and decision-making (30%), preoperative optimization (28%), and transitions of care (12.5%) had the lowest mean percentage of fully compliant standards. Best practices and barriers to implementation were identified across 13 of the 30 standards. More than 80% of the institutions reported that participation changed the surgical care provided for older adults. CONCLUSIONS: This study represents the first national implementation assessment undertaken by the ACS for one of its quality programs. The CQGS pilot testing was able to demonstrate implementation feasibility for 30 standards, identify challenges and best practices, and further inform dissemination of the ACS Geriatric Surgery Verification Program.
    Materialart: Online-Ressource
    ISSN: 1072-7515
    URL: Article
    DOI: 10.1097/XCS.0000000000000723
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2023
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 15
    Online-Ressource
    Online-Ressource
    Familial-Environmental Effects Shifting our Understanding of Diverticular Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American College of Surgeons
    Details
    In: Journal of the American College of Surgeons, Ovid Technologies (Wolters Kluwer Health)
    Materialart: Online-Ressource
    ISSN: 1072-7515
    URL: Article
    DOI: 10.1097/XCS.0000000000000860
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2023
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 16
    Online-Ressource
    Online-Ressource
    Preoperative Nutritional Optimization of the Oncology Patient: A Scoping Review
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American College of Surgeons Vol. 234, No. 3 ( 2022-03), p. 384-394
    Details
    In: Journal of the American College of Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 234, No. 3 ( 2022-03), p. 384-394
    Kurzfassung: Malnutrition is common among patients with cancer and is a known risk factor for poor postoperative outcomes; however, preoperative nutritional optimization guidelines are lacking in this high-risk population. The objective of this study was to review the evidence regarding preoperative nutritional optimization of patients undergoing general surgical operations for the treatment of cancer. METHODS A literature search was performed across the Ovid (MEDLINE), Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCOhost), and Web of Science (Clarivate) databases. Eligible studies included randomized clinical trials, observational studies, reviews, and meta-analyses published between 2010 and 2020. Included studies evaluated clinical outcomes after preoperative nutritional interventions among adult patients undergoing surgery for gastrointestinal cancer. Data extraction was performed using a template developed and tested by the study team. RESULTS A total of 5,505 publications were identified, of which 69 studies were included for data synthesis after screening and full text review. These studies evaluated preoperative nutritional counseling, protein-calorie supplementation, immunonutrition supplementation, and probiotic or symbiotic supplementation. CONCLUSIONS Preoperative nutritional counseling and immunonutrition supplementation should be considered for patients undergoing surgical treatment of gastrointestinal malignancy. For malnourished patients, protein-calorie supplementation should be considered, and for patients undergoing colorectal cancer surgery, probiotics or symbiotic supplementation should be considered.
    Materialart: Online-Ressource
    ISSN: 1072-7515
    URL: Article
    DOI: 10.1097/XCS.0000000000000055
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 17
    Online-Ressource
    Online-Ressource
    Using Volume Criteria: Do California Hospitals Measure Up?
    Elsevier BV ; 2003
    In:  Journal of Surgical Research Vol. 113, No. 1 ( 2003-7), p. 96-101
    Details
    In: Journal of Surgical Research, Elsevier BV, Vol. 113, No. 1 ( 2003-7), p. 96-101
    Materialart: Online-Ressource
    ISSN: 0022-4804
    URL: Article
    DOI: 10.1016/S0022-4804(03)00145-8
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2003
    ZDB Id: 1470806-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 18
    Online-Ressource
    Online-Ressource
    Evaluating health utility in patients with melanoma, breast cancer, colon cancer, and lung cancer: a nationwide, population-based assessment
    Elsevier BV ; 2003
    In:  Journal of Surgical Research Vol. 114, No. 1 ( 2003-9), p. 1-5
    Details
    In: Journal of Surgical Research, Elsevier BV, Vol. 114, No. 1 ( 2003-9), p. 1-5
    Materialart: Online-Ressource
    ISSN: 0022-4804
    URL: Article
    DOI: 10.1016/S0022-4804(03)00167-7
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2003
    ZDB Id: 1470806-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 19
    Online-Ressource
    Online-Ressource
    Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture
    BMJ ; 2015
    In:  BMJ Quality & Safety Vol. 24, No. 7 ( 2015-07), p. 458-467
    Details
    In: BMJ Quality & Safety, BMJ, Vol. 24, No. 7 ( 2015-07), p. 458-467
    Kurzfassung: To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. Background Healthcare systems are investing considerable resources in improving workplace culture. It remains unclear whether these interventions, when aimed at surgical care, are successful and whether they are associated with changes in patient outcomes. Methods PubMed, Cochrane, Web of Science and Scopus databases were searched from January 1980 to January 2015. We included studies on interventions that aimed to improve surgical culture, defined as the interpersonal, social and organisational factors that affect the healthcare environment and patient care. The quality of studies was assessed using an adapted tool to focus the review on higher-quality studies. Due to study heterogeneity, findings were narratively reviewed. Findings The 47 studies meeting inclusion criteria (4 randomised trials and 10 moderate-quality observational studies) reported on interventions that targeted three domains of culture: teamwork (n=28), communication (n=26) and safety climate (n=19); several targeted more than one domain. All moderate-quality studies showed improvements in at least one of these domains. Two studies also demonstrated improvements in patient outcomes, such as reduced postoperative complications and even reduced postoperative mortality (absolute risk reduction 1.7%). Two studies reported improvements in healthcare efficiency, including fewer operating room delays. These findings were supported by similar results from low-quality studies. Conclusions The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including better patient outcomes and enhanced healthcare efficiency. Trial registration number CRD42013005987.
    Materialart: Online-Ressource
    ISSN: 2044-5415 , 2044-5423
    URL: Article
    DOI: 10.1136/bmjqs-2014-003764
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2015
    ZDB Id: 2592912-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 20
    Online-Ressource
    Online-Ressource
    Palliative care for colorectal cancer
    Elsevier BV ; 2004
    In:  Surgical Oncology Clinics of North America Vol. 13, No. 3 ( 2004-7), p. 467-477
    Details
    In: Surgical Oncology Clinics of North America, Elsevier BV, Vol. 13, No. 3 ( 2004-7), p. 467-477
    Materialart: Online-Ressource
    ISSN: 1055-3207
    URL: Article
    DOI: 10.1016/j.soc.2004.03.002
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2004
    Standort Signatur Einschränkungen Verfügbarkeit
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