Factors Influencing Length of Stay in Cholecystectomy Patients in a Community Hospital.

Context: Gallstone disease is a major health problem addressed by general surgeons, with approximate incidence of 10-15% in the Western world. With increasing focus in the healthcare literature on cost containment, controlling excess lengths of hospital stay (LOS) in this population is paramount. The aim of this study was to determine the factors that influence LOS in cholecystectomy patients to examine whether results would indicate a possible improvement in perioperative patient care and decrease costs at our community hospital in a suburban setting.

Use of a mock deposition program to improve resident understanding of the importance of documentation.

Introduction: It has been estimated that the probability of a physician being involved in a medical litigation by 65 years of age ranges from 76 to 98% depending on specialty. We hypothesized that a mock deposition held by a medico-legal expert attorney could effectively increase awareness of the importance of accurate and complete medical documentation.

Methods: Pre and post-lecture and mock deposition surveys were analyzed and the contents evaluated.

Video review using a reliable evaluation metric improves team function in high-fidelity simulated trauma resuscitation.

Objective: To demonstrate that instruction of proper team function can occur using high-fidelity simulated trauma resuscitation with video-assisted debriefing and that this process can be integrated rapidly into a standard general surgery curriculum.

Design: The rater reliability of our team metric was assessed by having physicians and nonphysicians rate the same video-recorded trauma simulations at intervals in time. To assess the effectiveness of video debriefing, subjects participated in a 3-week trauma team training course that consisted of 2 video-recorded simulation sessions, each approximately 2 hours in length separated by a 90-minute debriefing session.

Retained drains causing a bronchoperitoneal fistula: a case report.

Introduction: Bronchoperitoneal fistulas are extremely rare. We present a case where retained surgical drains from a previous surgery resulted in erosion and fistula formation. This condition required an extensive surgical procedure and advanced ventilator techniques.

Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis.

Objective: Prehospital intravenous (IV) fluid administration is common in trauma patients, although little evidence supports this practice. We hypothesized that trauma patients who received prehospital IV fluids have higher mortality than trauma patients who did not receive IV fluids in the prehospital setting.

Methods: We performed a retrospective cohort study of patients from the National Trauma Data Bank.

Spine immobilization in penetrating trauma: more harm than good?

Background: Previous studies have suggested that prehospital spine immobilization provides minimal benefit to penetrating trauma patients but takes valuable time, potentially delaying definitive trauma care. We hypothesized that penetrating trauma patients who are spine immobilized before transport have higher mortality than nonimmobilized patients.

Methods: We performed a retrospective analysis of penetrating trauma patients in the National Trauma Data Bank (version 6.

Females have fewer complications and lower mortality following trauma than similarly injured males: a risk adjusted analysis of adults in the National Trauma Data Bank.

Background: Studies of sexual dimorphism in trauma outcomes suggest that women have a survival advantage compared to equivalently injured men. It is unknown if this gender disparity is mediated by potentially life-threatening complications.

Objective: To determine (1) if there is a sex-based differences in the odds of developing inpatient complications after trauma, and (2) if are these complications associated with death among trauma patients.

Hospital-acquired pneumonia: pathophysiology, diagnosis, and treatment.

Hospital-acquired pneumonia (HAP) is one of the most common causes of nosocomial infection, morbidity, and mortality in hospitalized patients. Many patient- and disease-specific factors contribute to the pathophysiology of HAP, particularly in the surgical population. Risk-factor modification and inpatient prevention strategies can have a significant impact on the incidence of HAP.

Positron-emission tomography as a prognostic tool for early-stage lung cancer.

Background: Positron-emission tomography (PET) shows tissue metabolic activity in the form of the standard uptake value (SUV). This study examines the prognostic value of the SUV for early-stage lung cancer.

Methods: A retrospective review of 187 patients undergoing PET for potential lung cancer.

Epidural versus intravenous pain control in elderly patients with rib fractures.

Background: Epidural catheters are used in older patients with rib fractures to improve outcome. We reviewed the efficacy of epidural analgesia (EA) compared with intravenous narcotics (IVN) in this population.

Methods: Rib fracture patients >55 years old admitted to our level I trauma center from 1999 through 2002 were reviewed for demographics, Injury Severity Score (ISS), Abbreviated Injury Score for chest, length of stay, cardiopulmonary comorbidities, complications, and type of analgesia.