Download Complications in Surgery, 5th edition by Michael W Mulholland, Gerard A Doherty PDF

By Michael W Mulholland, Gerard A Doherty

This quantity deals authoritative, evidence-based techniques for fighting and coping with problems in all present normal surgical procedure techniques. the outlet sections speak about institutional hazard administration matters and hazards universal to all operations, resembling wound therapeutic difficulties, an infection, surprise, and problems in immunosuppressed sufferers. next sections specialize in problems of particular methods in thoracic, vascular, gastric, endocrine, breast, and oncologic surgical procedure, in addition to organ transplantation and pediatric surgical procedure. for every approach, the authors talk about surgical objectives, anticipated results, preoperative id of hazard elements, intraoperative process, and postoperative threat. a number of decision-making algorithms, drawings of concepts, and tables supplement the textual content.

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With the notable exception of CABG, few procedures meet both criteria. Of course, sample size and thus precision can be improved if morbidity and mortality rates are assessed after aggregating all major surgical procedures performed in a given hospitalâ the approach taken by NSQIP. However, performance measures that are not procedure-specific are considerably less useful for either evidence-based referral or targeting quality improvement efforts. For this reason, it is important to consider surgical quality in two other domains: structure and process (6).

They are also more likely to practice in higher-volume tertiary care centers, which might also have better patient outcomes. However, several studies suggest that subspecialty training might be an independent predictor of favorable outcomes. For example, Goodney et al. studied operative mortality in US Medicare patients undergoing resection for lung cancer (38). 6%). These specialty-related differences were partly attenuated by surgeon volume, hospital volume, and other characteristics, but did not disappear after controlling for these other variables.

With this goal in mind, for example, the National Surgical Quality Improvement Program (NSQIP) has been tracking surgical morbidity and mortality rates for all hospitals of the Department of Veterans Affairs (3). Although evidence-based referral and quality improvement strategies differ in many important respects, the success of both strategies depends on reliable, provider-specific measures of surgical quality. The most direct measures of surgical quality are risk-adjusted morbidity and mortality rates.

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