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Surgical Volume (surgical + volume)
Selected AbstractsSurgical volume and clinical outcomeBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2007S. Paterson-Brown Centralise to survive [source] Association between unplanned readmission rate and volume of breast cancer operation casesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2006H-S Ahn Summary This study was conducted to investigate the relationship between unplanned readmission and breast cancer operation cases, with the assumption that the rate of unplanned readmission within 30 days of surgery was solely due to postsurgical complications. We divided hospitals into three categories based on breast cancer operation cases: low-volume hospitals (,50 annual procedures), medium-volume hospitals (51,99 annual procedures) and high-volume hospitals (,100 annual procedures). The medical records of 1351 subjects in 24 hospitals were investigated. We found unplanned readmission rates were significantly higher in hospitals with a lower surgical volume. From these three groups, a sample consisting of 1351 patients was created and 17 unplanned readmission cases (1.2%) were reported. Of these 17 cases, 12 (70.59%) cases were from low-volume hospitals. The present results indicate that unplanned readmission within 30 days following discharge is an important adverse outcome in breast cancer surgery. [source] Atrial Remodeling After Mitral Valve Surgery in Patients with Permanent Atrial FibrillationJOURNAL OF CARDIAC SURGERY, Issue 5 2004Fernando Hornero M.D., Ph.D. Mitral surgery allows an immediate surgical auricular remodeling and besides in those cases in which sinus rhythm is reached, it is followed by a late remodeling. The aim of this study is to investigate the process of postoperative auricular remodeling in patients with permanent atrial fibrillation undergoing mitral surgery. Methods: In a prospective randomized trial, 50 patients with permanent atrial fibrillation and dilated left atrium, submitted to surgical mitral repair, were divided into two groups: Group I contained 25 patients with left auricular reduction and mitral surgery, and Group II contained 25 patients with isolated valve surgery. Both groups were considered homogeneous in the preoperative assessment. Results: After a mean follow-up of 31 months, 46% of patients included in Group I versus 18% of patients included in Group II restarted sinus rhythm (p = 0.06). An auricular remodeling with size regression occurred in those patients who recovered from sinus rhythm, worthy of remark in Group II (,10.8% of left auricular volume reduction in Group I compared to ,21.5% in Group II; p < 0.05). A new atrial enlargement took place in those patients who remained with atrial fibrillation (+16.8% left auricular volume in Group I vs. +8.4% in Group II; p < 0.05). Conclusions: Mitral surgery produces an atrial postoperative volume that decrease especially when reduction techniques are employed. Late left atrial remodeling depended on the type of atrial rhythm and postoperative surgical volume. [source] Systematic review of the impact of volume of oesophagectomy on patient outcomeANZ JOURNAL OF SURGERY, Issue 5 2010Christopher I. W. Lauder Abstract Purpose:, This systematic review aims to assess whether overall survival, mortality, morbidity, length of stay and cost of performing oesophagectomy are related to surgical volume. Methods:, A systematic search strategy from 1997 until December 2006 was used to retrieve relevant studies. Inclusion of articles was established through application of a predetermined protocol, independent assessment by two reviewers and a final consensus decision. Results:, A total of 55 studies were identified of which 27 studies, representing 68 882 patients, met the inclusion criteria. Twenty-one of these solely examined hospital volume, 5 examined both hospital and surgeon volume, and 1 examined surgeon volume in isolation. All but one of the studies were retrospective in nature, and because of the heterogeneity of the literature, no meta-analysis could be performed. Of the studies exploring the relationship between hospital volume and mortality, 20 reported a statistically significant benefit to large volume centres. Five of six included studies showed significant evidence for a reduced mortality risk with greater surgeon volume. Conclusions:, Based on the evidence from these retrospective studies, oesophagectomy performed in high volume centres would appear to be associated with better outcome compared with low volume centres. [source] Recent Changes in the Workforce and Practice of Dermatologic SurgeryDERMATOLOGIC SURGERY, Issue 3 2009EMILY P. TIERNEY MD BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29,39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29,39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [source] Screened individuals' preferences in the delivery of abdominal aortic aneurysm repairBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2010P. J. E. Holt Background: This study aimed to determine preferences for service attributes in a population screened for abdominal aortic aneurysm. Methods: A questionnaire was designed to encompass various aspects of service provision. Questions were calibrated against the time an individual was willing to travel to access specific attributes. Subjects attending an aneurysm screening programme were asked to complete a questionnaire before their screening ultrasound scan. Statistical analysis was through pairwise analysis of the median travel times with the signed rank test. The Wilcoxon rank sum, analysed by the Kruskal,Wallis test, was used to compare preference ratings. Results: A total of 262 individuals were asked to complete the questionnaire; the response rate was 98·5 per cent. Approximately 92 per cent of individuals stated a willingness to travel for at least 1 h beyond their nearest hospital in order to access services with a 5 per cent lower perioperative mortality rate, a 2 per cent lower amputation or stroke rate, a high annual caseload of aneurysm repairs, and routine availability of endovascular repair. Conclusion: Patients attending aneurysm screening were willing to travel beyond their nearest hospital to access a service with better outcomes, higher surgical volumes and endovascular surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Benchmarks and control charts for surgical site infectionsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000T. L. Gustafson Background Although benchmarks and control charts are basic quality improvement tools, few surgeons use them to monitor surgical site infection (SSI). Obstacles to widespread acceptance include: (1) small denominators, (2) complexities of adjusting for patient risk and (3) scepticism about their true purpose (cost cutting, surgical privilege determination or improving outcomes). Methods The application of benchmark charts (using US national SSI rates as limits) and control charts (using facility rates as limits) was studied in 51 hospitals submitting data to the AICE National Database Initiative. SSI rates were risk adjusted by calculating a new statistic, the standardized infection ratio (SIR), based on the risk index suggested by the Centers for Disease Control National Nosocomial Infection Surveillance Study. Fourteen different types of control chart were examined and 115 suspiciously high or low monthly rates were flagged. Participating hospital epidemiologists investigated and classified each flag as ,a real problem' (potentially preventable) or ,not a problem' (beyond the control of personnel at this facility). Results None of the standard, widely recommended, control charts studied showed practical value for identifying either preventable rate increases or outbreaks (clusters due to a single organism). On the other hand, several types of risk-adjusted control chart based on the SIR correctly identified most true opportunities for improvement. Sensitivity, specificity and receiver,operator characteristic (ROC) analysis revealed that the XmR chart of monthly SIRs would be useful in hospitals with smaller surgical volumes (ROC area = 0·732, P = 0·001). For larger hospitals, the most sensitive and robust SIR chart for real-time monitoring of surgical infections was the mXmR chart (ROC area = 0·753, P = 0·0005). © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||