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Self-Reported Compliance and Infection Rates
Helmick and coauthors determine whether mandated reporting for ventilator and catheter bundle compliance is correlated with decreased infection rates, and they determine whether labor-intensive audits are correlated with compliance. They find that current mandated self-reported compliance and audit measures are poorly correlated with decreased ventilator-associated pneumonia or catheter-related bloodstream infection.
Clearing Common Bile Duct Stones
The optimal strategy for common bile duct stones encountered during cholecystectomy is not known. Möller and coworkers evaluated data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography, including 3828 patients who had bile duct stones that were encountered intraoperatively. The study revealed a significant lower risk of “unfavorable” outcome when efforts were made to clear the ducts compared with when no effort was made. This was also true for small stones (<4 mm).
Continuing Medical Education
Continuing Perioperative β-Blockade
The Surgical Care Improvement Project perioperative β-blocker (BB) (SCIP-BB) continuation measure was revised in 2012 to incorporate inpatient BB continuation after discharge from the postanesthesia care unit. Richman et al determine whether adherence to the original or revised SCIP-BB measure is associated with decreased adverse events. They find that adherence to the original SCIP-BB measure was associated with increased cerebrovascular events but not improved cardiovascular event outcomes. β-Blocker continuation consistent with the revised SCIP-BB measure is associated with reduced major adverse cardiovascular or cerebrovascular events, cardiovascular events, and 30-day mortality.
Nonagenarian and Centenarian Trauma Patients
With the dramatic growth in the very old population and their concomitant heightened exposure to traumatic injury, the trauma burden among this patient population is estimated to be exponentially increasing. Hwabejire and colleagues determine the clinical outcomes and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients (NCTPs). Despite low in-hospital mortality, they find that the cumulative mortality rate among NCTPs at 1 year after discharge is significant, particularly in the presence of head injury, spine injury, mechanical ventilation, high injury severity, or prolonged length of hospital stay.
Neoadjuvant Chemotherapy and Morbidity
Neoadjuvant chemotherapy (NC) is increasingly being used in patients with breast cancer, and evidence-based reports related to its independent effects on morbidity after mastectomy with immediate breast reconstruction are limited. Abt et al sought to determine the effect of NC on 30-day postoperative morbidity in women undergoing mastectomy with or without immediate breast reconstruction. Their study supports the safety of NC in women undergoing mastectomy with or without immediate breast reconstruction. Neoadjuvant chemotherapy is associated with lower overall morbidity in the patients undergoing mastectomy without breast reconstruction and in those undergoing tissue expander breast reconstruction.
Highlights. JAMA Surg. 2014;149(10):997. doi:10.1001/jamasurg.2013.3504
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