Surgical Care (surgical + care)

Distribution by Scientific Domains

Selected Abstracts

Surgical care , how can new evidence be applied to clinical practice?

Henrik Kehlet
No abstract is available for this article. [source]

Relevance of Cosmeceuticals to the Dermatologic Surgeon

Harold J. Brody MD
Background. The dermatologic surgeon is the dermatologist with special expertise in the surgical care of the health and beauty of the skin. Objectives, Methods, Results. There is no better arena for the use of topical regimens to preserve skin quality than in the time interval devoted to before and after care with respect to surgical procedures. Conclusion. Many of these regimens can be tailor devised with topical drugs and cosmeceuticals together in proper balance in the patient's best interest for affordable health care. HAROLD J. BRODY, MD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

The Relationship between Patients' Perception of Care and Measures of Hospital Quality and Safety

Thomas Isaac
Background. The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. Methods. We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates. Results. The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations ,0.17 to ,0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care. Conclusions. Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care. [source]

Improving outcomes for operable pancreatic cancer: Is access to safer surgery the problem?

David K Chang
Abstract Despite advances in the understanding and treatment of pancreatic cancer in the last two decades, there is a persisting nihilistic attitude among clinicians. An alarmingly high rate of under-utilization of surgical management for operable pancreatic cancer was recently reported in the USA, where more than half of patients with stage 1 operable disease and no other contraindications were not offered surgery as therapy, denying this group of patients a 20% chance of long-term survival. These data indicate that a nihilistic attitude among clinicians may be a significant and reversible cause of the persisting high mortality of patients with pancreatic cancer. This article examines the modern management of pancreatic cancer, in particular, the advances in surgical care that have reduced the mortality of pancreatectomy to almost that of colonic resection, and outlines a strategy for improving outcomes for patients with pancreatic cancer now and in the future. [source]

Itinerant Surgical and Medical Specialist Care in Kansas: Report of a Survey of Rural Hospital Administrators

Rick Kellerman M.D
ABSTRACT In most rural areas, specialist nonprimary care, when available, is provided by "itinerant" physicians and surgeons who periodically visit from a distant home base. Little is known about current usage and acceptability of itinerant specialists in rural communities. Administrators of hospitals in rural and frontier Kansas counties were asked to report the frequency of itinerant care in their facilities, the home base of each specialist and a listing of procedures performed during specialist visits. Administrators were also asked to respond on a Likert scale to six questions inviting their assessment of itinerant care. Responses were received from 53 of 56 hospitals. All offered at least one monthly session of itinerant medical or surgical care. The most common specialties represented were cardiology (in 87 percent of hospitals), urology (68 percent), orthopedics (68 percent) and radiology (60 percent). General surgeons consulted in over 80 percent of responding hospitals. Psychiatrists, dermatologists and neurologists were rarely available in the hospitals surveyed. Administrators generally rated itinerant care highly, though some expressed concern about revenue lost when specialists performed procedures in their home-base office or hospital. No associations were found between amount of care offered and potential explanatory variables such as hospital size, distance from subregional centers, or percentage of patients hospitalized locally. Furttier study is needed to better understand differences in itinerant specialist utilization and acceptance among rural Kansas hospitals. Because Kansas demographics are similar to those of many other American rural areas, such study may offer insights applicable to other regions. [source]

Case Mix, Quality and High-Cost Kidney Transplant Patients

M. J. Englesbe
A better understanding of high-cost kidney transplant patients would be useful for informing value-based purchasing strategies by payers. This retrospective cohort study was based on the Medicare Provider Analysis and Review (MEDPAR) files from 2003 to 2006. The focus of this analysis was high-cost kidney transplant patients (patients that qualified for Medicare outlier payments and 30-day readmission payments). Using regression techniques, we explored relationships between high-cost kidney transplant patients, center-specific case mix, and center quality. Among 43 393 kidney transplants in Medicare recipients, 35.2% were categorized as high-cost patients. These payments represented 20% of total Medicare payments for kidney transplantation and exceeded $200 million over the study period. Case mix was associated with these payments and was an important factor underlying variation in hospital payments high-cost patients. Hospital quality was also a strong determinant of future Medicare payments for high-cost patients. Compared to high-quality centers, low-quality centers cost Medicare an additional $1185 per kidney transplant. Payments for high-cost patients represent a significant proportion of the total costs of kidney transplant surgical care. Quality improvement may be an important strategy for reducing the costs of kidney transplantation. [source]

Surgical workforce in New Zealand: characteristics, activities and limitations

Antony Raymont
Planning the future surgical workforce is a vitally important activity in which the Royal Australasian College of Surgeons is actively engaged. This paper reports on a survey, undertaken in late 2005, of all vocationally registered New Zealand surgeons. It describes their age and gender distribution, their workload, the distribution of their work hours and limitations on their activities. It is hoped that this will contribute to planning of surgical services for the future. Of surgeons surveyed, 452 (73%) responded. Their mean age was 51 years and 7% were female. Recruitment has been stable at approximately 20 per year since 1990. New Zealand surgeons worked, on average, 48 h per week and could accommodate additional work. Seventy-seven per cent of surgeons took after-hours calls and reported a 55% chance of returning to the hospital each week (30% in the main population centres and 70% in other districts). Overall, surgeons spent 50% of their clinical time in private practice. Most surgeons experienced significant resource constraints in providing surgical care. The current workload of surgeons in New Zealand is acceptable but after-hours duties, especially in secondary hospitals, may be unattractive. Surgical services are currently limited by institutional resources. If there is a substantial increase in the need for surgery in the future, surgical recruitment, which has been stable, should be increased. [source]

Acute-care surgical service: a change in culture

Andrew D. Parasyn
The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency. [source]


Morgan P. McMonagle
Background: Time to definitive trauma care directly influences patient survival. Patient transport (retrieval) services are essential for the transportation of remotely located trauma patients to a major trauma centre. Trauma surgical expertise can potentially be combined with the usual retrieval response (surgically supported response) and delivered to the patient before patient transportation. We identified the frequency and circumstances of such surgically supported retrievals. Methods: Retrospective review of trauma patients transported by the NRMA CareFlight, New South Wales Medical Retrieval Service, Australia, from 1999 to 2003, identifying patients who had a surgically supported retrieval response and an urgent surgical procedure carried out before patient transportation to an major trauma centre. Results: Seven hundred and forty-nine trauma interhospital patient transfers were identified of which 511 (68%) were categorized as urgent and 64% of which were rural based. Three (0.4%) patients had a surgically supported retrieval response and had an urgent surgical procedure carried out before patient transportation. All patients benefited from that early surgical intervention. Conclusion: A surgically supported retrieval response allows for the more timely delivery of urgent surgical care. Patients can potentially benefit from such a response. There are, however, important operational considerations in providing a surgically supported retrieval response. [source]


B. T. Collopy
Background: In 1997 a set of 53 clinical indicators developed by the Royal Australasian College of Surgeons (RACS) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Programme (CEP), was introduced into the ACHS Evaluation and Quality Improvement Programme (EQuIP). The clinical indicators covered 20 different conditions or procedures for eight specialty groups and were designed to act as flags to possible problems in surgical care. Methods: The development process took several years and included a literature review, field testing, and revision of the indicators prior to approval by the College council. In their first year 155 health-care organizations (HCO) addressed the indicators and this rose to 210 in 1998. Data were received from all states and both public and private facilities. Results: The collected data for 1997 and 1998 for some of the indicators revealed rates which were comparable with those reported in the international literature. For example, the rates of bile duct injury in laparoscopic cholecystectomy were 0.7 and 0.53%, respectively; the mortality rates for coronary artery graft surgery were 2.5 and 2.1%, respectively; the mortality rates after elective abdominal aortic aneurysm repair were 2.5 and 3.7%, respectively; and the post-tonsillectomy reactionary haemorrhage rates were 0.9 and 1.3%, respectively. Results for some indicators differed appreciably from other reports, flagging the need for further investigation; for example, the negative histology rates for appendectomy in children were 18.6 and 21.2%, respectively, and the rates for completeness of excision of malignant skin tumours were 90.7 and 90%, respectively. The significance of these figures, however, depends upon validation of the data and their reliability and reproducibility. Because reliability can be finally determined only at the hospital level they are of limited value for broader comparison. Conclusion: The process of review established for the indicator set has led to refinement of some indicators through improvement of definitions, and to a considerable reduction in the number of indicators to 29 (covering 18 procedures), for the second version of the indicators (which was introduced for use from January 1999). The clinical indicator programme, as it has with other disciplines, hopefully will provide a stimulus to the modification and improvement of surgical practice. Clinician ownership should enhance the collection of reliable data and hence their usefulness. [source]

Public hospital admissions for treating complications of clinical care: incidence, costs and funding strategy

Peter McNair
Abstract Objective: To quantify the frequency of, and the costs and payments associated with, admissions for treatment of injuries and illnesses that are consequences of care. Data sources: Routinely-coded 2005/06 public hospital inpatient data from Victoria, Australia (1.25 million admissions) and corresponding patient-level cost data (1.04 million admissions). Payments reflected DRG-based prospective rates. Study design: Retrospective analysis of admissions with principal diagnoses that specify adverse events arising as a direct consequence of healthcare. Results: 1.5% (15,336) of the costed admissions specifically treat an injury or illness arising from medical or surgical care, consuming 2.74% of hospital prospective payments and representing $89.3 m (2.84%) of total reported costs. 1.4% (17,429) of all public hospital admissions and 2.82% of hospital prospective payments (estimated cost-$101.5 m per year) are committed to treating complications of care. Private residences or aged care facilities are the source of 84.9% (14,804) of these admissions. Inpatient death was the outcome in 0.7% (118) of these admissions. Implications: Admissions for treating complications of care represent a small, relatively expensive, proportion of hospital admissions, which account for disproportionate levels of hospital costs and funding. A policy option providing incentives to reduce the incidence and costs of complications arising from care includes allocating all costs arising from transferred (re)admissions back to the original episode of care and developing a suite of specific DRGs to fund admissions for treatment of complications. [source]

Letter: Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection (Br J Surg 2005; 92: 1354-1362)

G. Tornero-Campello
No abstract is available for this article. [source]

Authors' reply: Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection (Br J Surg 2005; 92: 1354-1362)

M. Gatt
No abstract is available for this article. [source]