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At least 343 records · Page 19Linked to original sources
PubMed1994

Risk management in cardiac anesthesia: the ASA Closed Claims Project perspective.

The ASA Closed Claims Project has generated a standardized collection of case summaries of adverse anesthetic outcomes, with the objectives of identifying major areas of anesthesiologist liability and the contribution of substandard care to anesthetic injury. Seventy-six (3%) of the files in the project's current database of over 2,400 case summaries are for anesthesia-related injuries sustained during cardiac surgery. The most common adverse outcomes in the cardiac surgical group were death (36%), brain damage (16%), stroke (13%), and nerve damage (11%). Equipment malfunction or misuse was responsible for 37% of the adverse outcomes in the cardiac group, compared with only 9% in the noncardiac group (P = < 0.01). Conversely, respiratory-related damaging events were responsible for only 9% of adverse outcomes in the cardiac group, compared with 32% of adverse outcomes in the noncardiac claims (P = < 0.01); incidences of damaging events related to the cardiovascular system and those events related to inadequate or inappropriate fluid therapy were similar in both groups. Although there are several important limitations intrinsic to closed-claims analysis, data from the Closed Claims Project suggest that careful attention to IV catheter management and cardiopulmonary bypass equipment will reduce the risk of injury to patients.

Anesthesia↗
PubMed1987

The future of major ambulatory surgery.

Major ambulatory surgery has grown steadily in its availability and use for the past two decades. This growth and expansion have come about because of three facts: major ambulatory surgery has become a totally accepted modality for delivery of surgical care; it benefits all participants; and it is cost-effective. Public interest and demand, surgeon satisfaction and participation, and payor encouragement and mandate will ensure its continued growth.

Ambulatory Surgical Procedures↗
PubMed2001

Coronary artery bypass grafting in Native Americans: a higher risk of death compared to other ethnic groups?

BACKGROUND: While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials, little is known about its outcomes in Native Americans. MEASUREMENTS AND MAIN RESULTS: We assessed clinical outcomes associated with CABG in 155 Native Americans using a national database of 18,061 patients from 25 nongovernmental, not-for-profit U.S. health care facilities. Patients were classified into five groups: 1) Native American, 2) white, 3) African American, 4) Hispanic, and 5) Asian. We evaluated for ethnic differences in in-hospital mortality and length of stay, and after adjusting for age, gender, surgical priority, case-mix severity, insurance status, and facility characteristics (volume, location, and teaching status). Overall, we found the adjusted risk for in-hospital death to be higher in Native Americans when compared to whites (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5 to 9.8), African Americans (OR, 3.4; 95% CI, 1.1 to 9.9), Hispanics (OR, 7.1; 95% CI, 2.5 to 20.3), and Asians (OR, 2.8; 95% CI, 1.1 to 7.0). No significant differences were found in length of stay after adjustment across ethnic groups. CONCLUSIONS: The risk of in-hospital death following CABG may be higher in Native Americans than in other ethnic groups. Given the small number of Native Americans in the database (n = 155), however, further research will be needed to confirm these findings.

Black or African American↗
PubMed2005

Knee surgery costs in football, floor ball, European team handball and ice hockey.

UNLABELLED: The purpose of this study was first, to identify the health costs of knee surgery related to different sports (football, floor ball, European team handball and ice hockey) among players at competitive level in Stockholm 1997. Information was retrieved from three different databases, one containing information on all players in different sports, another one containing information on all surgery performed at S:t Gorans Hospital, Stockholm, and a third one containing information on all surgery performed in Stockholm. The National Registration Number (NRN) was used to identify the patients. The NRN is a unique personal identifier assigned to all Swedish residents, which allows linkage between different registers and databases. In Stockholm in 1997, 6781 surgical procedures related to the knee were performed at a cost of SEK (Swedish Crowns) 39,026,657. On players in all studied sports, 762 knee surgical procedures were performed on 657 patients in Stockholm at a cost of SEK 4,884,076. At S:t Gorans Hospital, 319 knee surgical procedures were performed on 288 patients, and 293 (92%) of these were directly related to sport participation. It was also found that only 74% of anterior cruciate ligament injuries that resulted in a surgical intervention were reported to the insurance company. CONCLUSION: The average cost for knee surgery in the studied sports was low. Knee surgery costs for European team handball players were the highest compared with other sports studied.

Adolescent↗
PubMed1983

Perirenal pancreatic pseudocysts: diagnostic management.

Three cases of pancreatic pseudocysts involving the kidney are presented in which clinical findings or diagnostic imaging favored intrinsic renal disease. Correct diagnosis was established in all cases by sonographically guided cyst aspiration with amylase determinations on the cyst fluid. In addition, laboratory studies ruled out infection, a well known complication of pancreatic pseudocysts. The findings were instrumental in guiding clinical management and insuring correctly timed and properly guided surgical intervention. It is concluded that any patient with a fluid collection in the kidney region may have a pancreatic pseudocyst even without a clear-cut history of pancreatitis or trauma. Fine-needle aspiration is safe and efficacious, and laboratory analysis of cyst fluid should always include amylase determination, in addition to bacteriologic and cytologic evaluation, even if serum amylase is normal.

Adult↗
PubMed1993

Out of apathy.

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Attitude of Health Personnel↗
PubMed1978

Too much surgery?

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Blue Cross Blue Shield Insurance Plans↗