Proposal for Standardized Tabular Reporting of Observational Surgical Studies Illustrated in a Study on Primary Repair of Bile Duct Injuries.

Background: A standard format for reporting observational surgical studies does not exist. This creates difficulties in comparing studies and in performing synthesis through systematic reviews and meta-analyses. This article proposes a method called "standard tabular reporting" and illustrates its use in a case series of bile duct reconstructions for biliary injuries occurring during cholecystectomy.

Comparison between clinical registry and medicare claims data on the classification of hospital quality of surgical care.

Objective: To compare the classification of hospital statistical outlier status as better or worse performance than expected for postoperative complications using Medicare claims versus clinical registry data.

Background: Controversy remains as to the most favorable data source for measuring postoperative complications for pay-for-performance and public reporting polices.

Methods: Patient-level records (2005-2008) were linked between the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Medicare inpatient claims.

Identification of modifiable factors for reducing readmission after colectomy: a national analysis.

Background: Rates of hospital readmission are currently used for public reporting and pay for performance. Colectomy procedures account for a large number of readmissions among operative procedures. Our objective was to compare the importance of 3 groups of clinical variables (demographics, preoperative risk factors, and postoperative complications) in predicting readmission after colectomy procedures.

A simple effective method for generation of a permanent record of the Critical View of Safety during laparoscopic cholecystectomy by intraoperative "doublet" photography.

Background: The Critical View of Safety (CVS) is an established method for identifying the cystic duct during laparoscopic cholecystectomy. Its goal is to prevent misidentification of the bile ducts and avoid biliary injury. However, a visual record of CVS is not usually made.

Hypoglycemia-associated autonomic failure in diabetes.

The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent antecedent hypoglycemia, as well as sleep or prior exercise, causes both defective glucose counterregulation (by attenuating the adrenomedullary epinephrine response, in the setting of absent insulin and glucagon responses) and hypoglycemia unawareness (by attenuating the sympathoadrenal, largely the sympathetic neural, response) and thus a vicious cycle of recurrent hypoglycemia. Albeit with different time courses, the pathophysiology of defense against hypoglycemia - no decrease in therapeutic insulin, no increase in glucagon and an attenuated increase in sympathoadrenal activity - is the same in type 1 diabetes and advanced type 2 diabetes. Hypoglycemia unawareness is reversible by 2-3 weeks of scrupulous avoidance of hypoglycemia in most affected patients.

Anonymous group peer review in surgery morbidity and mortality conference.

Background: Surgical peer review might be characterized by assessment heterogeneity.

Methods: We performed a prospective, anonymous, peer review of surgeon and system performance during a morbidity and mortality conference.

Results: Twenty-two cases were reviewed by a mean of 48.

Unique site- and time-specific patterns of recurrence following resection of colorectal carcinoma hepatic metastases in patients staged by FDG-PET.

Background/purpose: We recently reported that patients staged by positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) prior to liver resection for metastatic colorectal cancer had an excellent 5-year survival. In this study, the site- and time-specific patterns of recurrence were examined in patients staged by FDG-PET and the results compared to historical literature control data.

Methods: From March 1995 to June 2002, all patients having hepatic resection for colorectal cancer metastases had preoperative FDG-PET.