Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis.

Background: Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established.

Patient and procedure-related risk factors for adverse events after infrainguinal bypass.

Background: Current medical practice urges individual health care facilities and medical professionals to obtain and provide detailed insight in quality of care with the possibility of comparing data between institutions. Adverse event (AE) analysis serves as a mainstay in quality assessment in vascular surgery, but the comparison of AE data between facilities can be complex. The aim of the present study was to assess independent risk factors for AE occurrence: patient, disease and operation characteristics besides general differences between health care facilities.

Standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain.

Background: The aim of the present study was to investigate the efficacy and safety of standard outpatient re-evaluation for patients who are not admitted to the hospital after emergency department surgical consultation for acute abdominal pain.

Methods: All patients seen at the emergency department between June 2005 and July 2006 for acute abdominal pain were included in a prospective study using a structured diagnosis and management flowchart. Patients not admitted to the hospital were given appointments for re-evaluation at the outpatient clinic within 24 h.

Assessment of incidence, cause, and consequences of pressure ulcers to evaluate quality of provided care.

Background: Pressure ulcers are one of the most frequently registered complications in general surgery.

Objective: To obtain insight into the incidence, cause, and consequences of pressure ulcers and to evaluate the value of pressure ulcer registration to assess quality of care.

Results: During the 9-year study period, 275 pressure ulcers were registered (5.

Wound complications at the groin after peripheral arterial surgery sparing the lymphatic tissue: a double-blind randomized clinical trial.

Background: The groin incision after arterial reconstructive surgery is most likely at risk for infectious or lymphatic wound complications. Theoretically; sparing lymphatic tissue by a lateral approach to the femoral artery should minimize these. The aim of this study was to assess the incidence of wound complications after the lateral versus the direct approach of the common femoral artery.

A prospective study of incidence of saphenous nerve injury after total great saphenous vein stripping.

Background And Objectives: Total stripping of the great saphenous vein (GSV) is a validated surgical strategy of treating patients with primary varicose veins (PVV). An often cited, but not well documented and studied, complication of total stripping is postoperative damage of the saphenous nerve (SN).

Objective: The objective was to evaluate the incidence of SN damage and to assess the therapeutic efficacy after total stripping of the GSV.

The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery.

Background: The long-term patency of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) suffers from a high incidence of primary failure due to early thrombosis, myointimal hyperplasia at the venous access site, or failure to mature. A multidisciplinary meeting in vascular access surgery was initiated to optimize the timing, indication, type of intervention, and the logistics of AVFs/AVGs during the preoperative and postoperative period. This study evaluated the influence of the new optimized care protocol on the incidence of revisions (surgical and endovascular) and patency rates.

The incidence of unplanned returns to the operating room after peripheral arterial bypass surgery and its value as indicator of quality of care.

Background: In recent years, a growing need has arisen to define possible indicators of quality of care.

Methods: To examine whether unplanned return to the operating room within 30 days after the initial procedure could serve as an indicator to assess quality of care in peripheral arterial bypass surgery, all bypass procedures performed between January 1996 and January 2004 were evaluated. Data were obtained from a prospectively kept hospital registration system.

Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery?

The incidence of unplanned reoperations could potentially be used as an indicator of quality of care. This study provided insight into the incidence of unplanned reoperations in a surgical department and added to the discussion of the value of unplanned reoperations as an indicator of quality of care. Between January 1996 and December 2003, all unplanned reoperations were entered prospectively into a complication registration system.

Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital? Results from two teaching hospitals.

In order to document the incidence of perioperative complications in patients with infantile hypertrophic pyloric stenosis, a descriptive cohort study was performed in two teaching hospitals in the Netherlands. One hospital specialized in pediatric surgery and the other was a general surgery teaching hospital. All consecutive infants who underwent pyloromyotomy for the diagnosis hypertrophic pyloric stenosis in both hospitals between 1998 and 2002 were included.

Computed tomography severity index is an early prognostic tool for acute pancreatitis.

Background: Acute pancreatitis is a severe disease with unpredictable course and outcomes. It is especially hard to identify early those patients who will have a fulminant course. In a prospective observational study, we tested the hypothesis that the CT Severity Index (CTSI), established within 48hours after admission, is prognostic for morbidity and mortality and can predict the necessity for admission to an ICU.

Short versus long-term postoperative drainage of the axilla after axillary lymph node dissection. A prospective randomized study.

Background: Axillary lymph node dissection (ALND) is a standard procedure in the treatment of breast cancer. Current practice following ALND involves several days of drainage of the axilla to reduce the formation of seroma. The aim of this study is to investigate the feasibility of 24 h drainage.

Quality control of colorectal surgery with an extensive complication registration system.

Background/aims: Since 1996, a standard registration is used to obtain a clear understanding of the complications that occur after colorectal surgery. In our registration system the cause of a complication and the detrimental effect to the patient's health are coded.

Methods: The treatment of colorectal diseases was evaluated to analyze the quality of medical care.

Mortality after peripheral bypass surgery: value of a mortality scoring system in evaluating the quality of care.

The objective of this study was to determine the role of a mortality registration in the quality control of patients who died after peripheral bypass surgery. We developed a mortality registration to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between pre- and postmortem findings. In a 10-year period, 28 of the 1,022 patients (2.

The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life.

Objective: To evaluate the effect of a prophylactic gastrojejunostomy on the development of gastric outlet obstruction and quality of life in patients with unresectable periampullary cancer found during explorative laparotomy.

Summary Background Data: Several studies, including one randomized trial, propagate to perform a prophylactic gastrojejunostomy routinely in patients with periampullary cancer found to be unresectable during laparotomy. Others suggest an increase of postoperative complications.

Value of keeping records of mortality.

Objective: To evaluate treatment and complications which is essential for good medical practice.

Design: Prospective audit.

Setting: City hospital, The Netherlands.

Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial.

Objective: Controversy still exists whether polytetrafluoroethylene is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Therefore, a prospective randomized trial was performed to compare vein with polytetrafluoroethylene for femoropopliteal bypasses with the distal anastomosis above the knee.

Methods: Between January 1993 and December 1996, 151 above-knee femoropopliteal bypasses were performed.

Factors associated with perioperative complications and long-term results after pulmonary resection for primary carcinoma of the lung.

Objective: The aim of this study was to describe perioperative morbidity and mortality of patients presenting with resectable lung cancer and to investigate the long-term survival.

Methods: We reviewed the records of 344 patients who underwent lung resection for bronchogenic carcinoma. Follow-up information was obtained from visits to the outpatient clinic.