ABSTRACT
BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
Subject(s)
General Surgery , Surgical Procedures, Operative , Adult , Aged , Benchmarking , Cohort Studies , Emergencies , Female , Hospital Mortality , Humans , Middle Aged , Postoperative Complications , Prospective Studies , Quality Improvement , Retrospective StudiesABSTRACT
The purpose of this analysis was to prospectively evaluate two biocollectors designed for ecto and endocervix Accelon and spatula, for with two gynecologists-obstetricians taken double cervical sample, simultaneous, in 100 patients going to Outpatient Department. The pathologist did not know which slides were taken with which biocollector, Collectors as well as biocollectors were evaluated by formula Kappa and Contingency tables. Variable nominal of study was quality sample following Bethesda's criteria. Cytological findings observed in slides taken with accellon and spatula respectively were squamous cells 100% a 96%. although proportionally spatula captures greater cellularity of squamous epithelium. From metaplasic cells 17 and 8%. From cylindric epithelium cells, 81 and 65%; and here accellon aptures proportionally greater amount of cylindric cels, 10 or more Leukocytes in presence of cylindric cells at 1X1000 in immersion; 4 y 0% hematies, 18 and 14% without impeding cytological interpretation. And microorganisms. 3 and 10%. As to conclusions: There was concordance for the two collectors; and it was not so for biocollectors, which detect neoplastic epithelial lesions, being a better collector of endocervical component, the Accellon an it favors objective criteria for the cytologic diagnostic of endocervicitis. As to spatula it captures more squamous component and it favors cytologic diagnosis of microorganism that affect this area. Both biocollectors are needed to compensate limitations, and so, improve the specimens that permit to lower false negatives.
