Evidence-Based Workflows for Thyroid and Parathyroid Surgery.

A need exists to reduce care variations by standardizing the practice of thyroid and parathyroid surgery. During the course of a year, a task force developed algorithms representing decision points and workflows based on American Thyroid Association guidelines and three internal studies of surgical practices in the Northern and Southern California Regions of Kaiser Permanente conducted in collaboration with Health Information Technology Transformation & Analytics (HITTA).

The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year.

Effects of laparoscopic vs laparotomy treatment of E. coli peritonitis on hemodynamic responses in a porcine model.

Background: Laparoscopic surgery is being used now for increasingly diverse clinical applications, including diagnosis and treatment of appendicitis and bacterial peritonitis. However, some concerns and controversies exist regarding the effectiveness of laparoscopic irrigation of the abdominal cavity compared with that achieved during laparotomy. Of no less importance is concern that establishing a CO(2) pneumoperitoneum in patients with cardiopulmonary insufficiency or endotoxemic shock may compromise hemodynamic function.

Entrapment and obstruction of the esophagus from thoracic spine hyperextension-dislocation injury.

We have reported a unique case of esophageal entrapment and obstruction from a thoracic spine hyperextension-dislocation injury after a motor vehicle crash. Because the risk for esophageal injury is not typically associated with thoracic spine injury, a heightened sensitivity for developing symptoms and signs is at least necessary. As with any injury to the gastrointestinal tract, optimal therapy requires resuscitation and prompt operative intervention.

Cardiopulmonary effects of the laparoscopic pneumoperitoneum in a porcine model of adult respiratory distress syndrome.

Background: Increasingly, laparoscopy is being used in critically ill patients in whom there is a question of intra-abdominal sepsis. We examine the cardiopulmonary effects of laparoscopy in a porcine model of adult respiratory distress syndrome (ARDS).

Methods: Domestic pigs (n = 12) underwent saline lung lavage and subsequent surgical abdominal exploration using either laparoscopy or conventional laparotomy.