Enterocutaneous fistula formation after cardiac transplantation due to injury from LVAD driveline migration.

A man in his early 20s with heart failure with reduced ejection fraction secondary to non-compaction cardiomyopathy (Titin (TTN) gene mutation positive) was transitioned from left ventricular assist device (LVAD) mechanical support to heart transplantation. Transplantation was successful; however, LVAD explantation resulted in innumerable complications secondary to penetration of the driveline into the peritoneal cavity. He developed an enterocutaneous fistula which led to concurrent malnutrition, poor wound healing, systemic infection, and allograft rejection in a patient less than 1 month after heart transplantation on immunosuppression.

Multivariable Cost Frontiers-Qualitative Financial Analyses Using Operational Metrics From the Implementation of a Surgery Fellowship.

Objective: We expand the application of cost frontiers and introduce a novel approach using qualitative multivariable financial analyses.

Summary Background Data: With the creation of a 5 + 2-year fellowship program in July 2016, the Division of Vascular Surgery at the University of Vermont Medical Center altered the underlying operational structure of its inpatient services.

Method: Using WiseOR (Palo Alto, CA), a web-based OR management data system, we extracted the operating room metrics before and after August 1, 2016 service for each 4-week period spanning from September 2015 to July 2017.

OR Management and Metrics: How It All Fits Together for the Healthcare System.

Increased healthcare costs and diminishing returns have prompted healthcare administrators to address budget allocations to alleviate institutional costs. Current economic constraints, such as limited Medicaid and Medicare insurance payments, limit our patients' ability to receive urgent surgical interventions as well as access preventative diagnostic tools. Rather than downsizing the workforce, future sustainability must be derived upon effective cost structures supported by improved quality control measures and increased patient accessibility.