Claude Laflamme | University of Toronto (original) (raw)

Papers by Claude Laflamme

Healthcare quarterly, Feb 3, 2020

Patients undergoing surgery today experience longer hospital stays and more complications because... more Patients undergoing surgery today experience longer hospital stays and more complications because evidence-based practices in the areas of nutrition, activity, opioid-sparing analgesia, hydration and overall best practices are not consistently applied or used. There is also emerging evidence that supporting patients and families to become engaged in their perioperative care improves outcomes. Enhanced Recovery After Surgery (ERAS) helps patients be more prepared for surgery and recover more quickly by bringing patients, healthcare providers and health systems together and creating tools and resources that are based on the most up-to-date evidence. The goal of Enhanced Recovery Canada is to support the uptake of these best practices across Canada, improving patient outcomes and experiences. M rs. Lee awaits colon cancer surgery. Her healthcare/surgery team works with her to identify her concerns and to tailor support through evidencebased pathways to help her prepare mentally and physically (e.g., optimizing her diet, activity and medical conditions), which help ease her worry. She uses a customized tablet-based Enhanced Recovery app to track her symptoms and to know when to eat and drink at all times on her surgical journey. After surgery, she knows what to expect and is ready to move and eat the very same day. She has less nausea and pain than she expected. Mrs. Lee is discharged from hospital only 4 days post-surgery. She continues to use her Enhanced Recovery app and has regular follow-ups, which alleviate her anxiety. Six weeks later, she says she feels ready to start chemotherapy. The surgery team tracks her symptoms, uses appropriate pain and symptom control to optimize her recovery and encourages her to move, avoiding the muscle wasting, weakness and frailty that are a consequence of immobilization. This scenario is a far cry from the present state in Canada. In reality, Mrs. Lee suffered terribly from anxiety and a lack of empowerment. Her pre-surgical period was rife with inconsistent patient information and optimization strategies. She stayed 10 days in hospital and waited 4 weeks for results. Her doctor was equally upset by the gaps in care and unnecessary costs that she felt she was unable to change. The health authority recognized the value of adopting evidence-based practices but had difficulty spreading the implementation of best practices and scaling them up without first addressing buy-in among stakeholders.

Mathematical Logic Quarterly, 1994

Let G be a finite group. We prove that the theory af abelian-by-G groups is decidable if and only... more Let G be a finite group. We prove that the theory af abelian-by-G groups is decidable if and only if the theory of modules over the group ring Z[G] is decidable. Then we study some model theoretic questions about abelian-by-C groups, in particular we show that their class is elementary when the order of G is squarefree.

The Journal of the Acoustical Society of America, 1996

Journal of the American College of Surgeons, 2012

Canadian Journal of Surgery

Canadian Journal of Surgery

Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collabo... more Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration C olorectal surgery may be associated with undesirable outcomes, including long length of stay in hospital, high rates of surgical site infection, perioperative nausea and vomiting, high readmission rates, and increased costs. Enhanced Recovery After Surgery (ERAS) has emerged worldwide as the new standard of care for patients undergoing elective colorectal surgery. The goal of ERAS is to reduce the patient's surgical stress response, optimize their physiologic function, and facilitate recovery by incorporating evidence-based interventions into patient management. A metaanalysis published in 2014 including 16 randomized controlled trials comparing the ERAS pathway to conventional perioperative care showed that the ERAS pathway reduced overall morbidity rates and shortened length of stay by 2.28 days, without increasing readmission rates. 1 A significant reduction in nonsurgical complications was noted, while the effect on surgical complications was less pronounced. An economic evaluation of the ERAS multisite implementation program for colorectal surgery in Alberta estimated the net health system savings to be 1768perpatient.2Intermsofreturnoninvestment,forevery1768 per patient. 2 In terms of return on investment, for every 1768perpatient.2Intermsofreturnoninvestment,forevery1 invested in ERAS, $3.80 could be expected in return. 2 Yet, despite the compelling evidence in support of ERAS, it has not been adopted widely. Results from a Canadian qualitative study suggest that although clinicians see the value in implementing an ERAS program, lack of nursing staff, lack of financial resources, resistance to change, and poor communication and collaboration are perceived as barriers to its adoption. 3 Enhanced Recovery Canada (ERC) is a project-based committee of the Canadian Patient Safety Institute (CPSI) that was formed as part of CPSI's commitment to influence improved surgical safety across the country. In 2017, ERC set out to develop a clinical pathway for elective colorectal surgery based on the key clinical elements of ERAS identified through implementation research, 4 including patient and family engagement, nutrition management, fluid and hydration management, mobility and physical activity, surgical

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Purposeful response to verbal or tactile stimulation Purposeful response following repeated or pa... more Purposeful response to verbal or tactile stimulation Purposeful response following repeated or painful stimulation Unarousable even with repeated or painful stimulation Airway Unaffected No intervention required Intervention may be required Intervention often required Spontaneous ventilation Unaffected Adequate May be inadequate Frequently inadequate Cardiovascular function Unaffected Usually maintained Usually maintained May be impaired

Rev Argent Anestesiol, 2012

Circulation, Oct 31, 2007

Critical care (London, England), Jan 20, 2016

Hypothermia is present in up to two-thirds of patients with severe injury, although it is often d... more Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and...

Canadian journal of anaesthesia = Journal canadien d'anesthésie, 2006

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

Annals of Pharmacotherapy, 2002

To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior p... more To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior pain control after cardiac surgery compared with patient-controlled analgesia (PCA) or nurse-administered SC injections. Sixty-two patients undergoing elective cardiac surgery participated in this prospective, randomized, partly-blinded study. Perioperative care was standardized, and patients were assigned to receive IT morphine (ITM group) followed by PCA, IT placebo (ITP group) followed by PCA, or SC injections of morphine every 4 hours as needed (SC group). Rating scales and questionnaires were used to assess clinical outcomes. ITM did not favor earlier extubation, and there was even a tendency for longer extubation times in the ITM group compared with the ITP and SC groups. Pain scores, adverse effects, postoperative recovery, and patient satisfaction were also comparable in the 3 groups. Considering that the administration of IT morphine is more costly and can be riskier than conventional analgesic regimens, we conclude that its use is not indicated in patients undergoing cardiac surgery if early extubation is planned.

Journal of the American College of Surgeons, 2009

Objective: To appraise the available evidence for patient monitoring, perioperative active warmin... more Objective: To appraise the available evidence for patient monitoring, perioperative active warming methods, outcomes supporting the prevention of perioperative hypothermia, and implementation strategies for the prevention of perioperative hypothermia.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2006

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2008

The maintenance of intraoperative normothermia has been identified as an important factor in the ... more The maintenance of intraoperative normothermia has been identified as an important factor in the reduction of surgical site infections, intraoperative blood loss, postoperative cardiac complications and PACU recovery time. The impact of prewarming and intraoperative warming on the temperature of patients under general anesthesia has been demonstrated in previous studies. However, the value of these interventions in cases performed under regional anesthesia in the clinical setting has not been clearly determined. This randomized controlled trial was conducted to determine whether preoperative and intraoperative warming of patients under neuraxial anesthesia will result in improved patient temperature during the perioperative period. Methods: Following research ethics board approval, consent was obtained from 120 patients presenting for primary total hip arthroplasty (N=60) or primary total knee arthroplasty (N=60). Subjects were randomized to: (1) active prewarming through a forced-air blanket in the block room for 30-60 minutes as well as intraoperative warming, (2) passive warming through cotton blankets in the block room but active forced-air warming in the OR, or (3) passive cotton blanket warming pre-and intraoperatively. Surgery was performed under spinal anesthesia with sedation. Intraoperative temperatures were monitored at 15 minute intervals through a tympanic infrared thermometer. Preoperative and early postoperative temperatures were also recorded. Recovery room admission and discharge times and incidence of shivering were noted. Four subjects were excluded from the data analysis due to failure of the neuraxial block and administration of general anesthesia. Data are described as mean ± standard deviation. Statistical analysis was conducted by ANOVA on temperature data and chisquared analysis on shivering data. Results: Passively warmed patients were found to have consistently low perioperative temperatures. Only the prewarmed patients had a significantly higher postoperative temperature (35.6°C ±0.63) compared to those who were passively warmed (35.1°C ±0.48, p<0.01). Preoperative warming resulted in normothermic conditions at the start of surgery (36.2°C ±0.57) while patients who were not prewarmed experienced a more precipitous temperature drop (35.8°C ±0.63, p<0.01 and 35.9°C ±0.41, p<0.05 for groups 2 and 3 respectively). Average intraoperative temperature was significantly lower in patients who were passively warmed (35.1°C ±0.51) compared to those who were actively warmed (35.5°C ±0.62, p<0.05 and 35.8°C ±0.60, p<0.001 for groups 2 and 1 respectively). No difference was found in recovery room length of stay or the incidence of postoperative shivering. Discussion: Patients undergoing primary total hip or knee arthroplasty under neuraxial anesthesia are at risk of developing mild perioperative hypothermia. Active pre-and intraoperative warming of these patients with a forced-air blanket results in higher

The Annals of Thoracic Surgery, 1997

Methods. Fourteen dogs were subjected to mobilization of the internal mammary artery and anastomo... more Methods. Fourteen dogs were subjected to mobilization of the internal mammary artery and anastomosis of it to the left anterior descending coronary artery over an angiographic catheter inserted into the internal mammary artery under fluoroscopy. The anastomosis was completed over the ...

Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for blee... more Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for bleeding that must be balanced with risk of ongoing ischemia if coronary artery bypass grafting is delayed. This study aimed to evaluate the impact of clopidogrel on mortality and major bleeding in patients undergoing urgent coronary bypass surgery. We reviewed 451 consecutive patients who underwent urgent isolated coronary bypass surgery; 262 had not received clopidogrel, whereas 189 received clopidogrel &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 5 days preoperative. The primary endpoint was in-hospital death, massive transfusion or massive blood loss. Patient characteristics were almost similar between groups. There was no difference in in-hospital death or massive bleeding indices between groups (clopidogrel: 7% vs. no clopidogrel: 6%, P = 0.9). No difference was observed even after adjusting for the date of stopping clopidogrel preoperatively. Multivariate regression analysis showed that clopidogrel or the duration it was stopped preoperatively, did not predict adverse outcomes. Significant independent predictors included preoperative renal dysfunction, hemoglobin level and peripheral vascular disease. clopidogrel, or the time it was stopped prior to surgery, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent coronary artery bypass surgery.

Journal of the American College of Surgeons, 2012

BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care cost... more BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care costs, so prevention of SSI has garnered much attention worldwide. Surgical site infection is recognized as an important quality indicator of patient care and safety. The purpose of this study was to use qualitative research methods to evaluate staff perceptions of the utility and impact of individualized audit and feedback (AF) data on SSI-related process metrics for their individual practice, as well as on overall communication and teamwork as they relate to SSI prevention. STUDY DESIGN: This study was performed in a tertiary care center, based on patients treated in the colorectal and hepatic-pancreatic-biliary surgical oncology services. Eighteen clinicians were interviewed. Analysis of interviews via comparative analysis techniques and coding strategies were used to identify themes.

Healthcare quarterly, Feb 3, 2020

Patients undergoing surgery today experience longer hospital stays and more complications because... more Patients undergoing surgery today experience longer hospital stays and more complications because evidence-based practices in the areas of nutrition, activity, opioid-sparing analgesia, hydration and overall best practices are not consistently applied or used. There is also emerging evidence that supporting patients and families to become engaged in their perioperative care improves outcomes. Enhanced Recovery After Surgery (ERAS) helps patients be more prepared for surgery and recover more quickly by bringing patients, healthcare providers and health systems together and creating tools and resources that are based on the most up-to-date evidence. The goal of Enhanced Recovery Canada is to support the uptake of these best practices across Canada, improving patient outcomes and experiences. M rs. Lee awaits colon cancer surgery. Her healthcare/surgery team works with her to identify her concerns and to tailor support through evidencebased pathways to help her prepare mentally and physically (e.g., optimizing her diet, activity and medical conditions), which help ease her worry. She uses a customized tablet-based Enhanced Recovery app to track her symptoms and to know when to eat and drink at all times on her surgical journey. After surgery, she knows what to expect and is ready to move and eat the very same day. She has less nausea and pain than she expected. Mrs. Lee is discharged from hospital only 4 days post-surgery. She continues to use her Enhanced Recovery app and has regular follow-ups, which alleviate her anxiety. Six weeks later, she says she feels ready to start chemotherapy. The surgery team tracks her symptoms, uses appropriate pain and symptom control to optimize her recovery and encourages her to move, avoiding the muscle wasting, weakness and frailty that are a consequence of immobilization. This scenario is a far cry from the present state in Canada. In reality, Mrs. Lee suffered terribly from anxiety and a lack of empowerment. Her pre-surgical period was rife with inconsistent patient information and optimization strategies. She stayed 10 days in hospital and waited 4 weeks for results. Her doctor was equally upset by the gaps in care and unnecessary costs that she felt she was unable to change. The health authority recognized the value of adopting evidence-based practices but had difficulty spreading the implementation of best practices and scaling them up without first addressing buy-in among stakeholders.

Mathematical Logic Quarterly, 1994

Let G be a finite group. We prove that the theory af abelian-by-G groups is decidable if and only... more Let G be a finite group. We prove that the theory af abelian-by-G groups is decidable if and only if the theory of modules over the group ring Z[G] is decidable. Then we study some model theoretic questions about abelian-by-C groups, in particular we show that their class is elementary when the order of G is squarefree.

The Journal of the Acoustical Society of America, 1996

Journal of the American College of Surgeons, 2012

Canadian Journal of Surgery

Canadian Journal of Surgery

Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collabo... more Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration C olorectal surgery may be associated with undesirable outcomes, including long length of stay in hospital, high rates of surgical site infection, perioperative nausea and vomiting, high readmission rates, and increased costs. Enhanced Recovery After Surgery (ERAS) has emerged worldwide as the new standard of care for patients undergoing elective colorectal surgery. The goal of ERAS is to reduce the patient's surgical stress response, optimize their physiologic function, and facilitate recovery by incorporating evidence-based interventions into patient management. A metaanalysis published in 2014 including 16 randomized controlled trials comparing the ERAS pathway to conventional perioperative care showed that the ERAS pathway reduced overall morbidity rates and shortened length of stay by 2.28 days, without increasing readmission rates. 1 A significant reduction in nonsurgical complications was noted, while the effect on surgical complications was less pronounced. An economic evaluation of the ERAS multisite implementation program for colorectal surgery in Alberta estimated the net health system savings to be 1768perpatient.2Intermsofreturnoninvestment,forevery1768 per patient. 2 In terms of return on investment, for every 1768perpatient.2Intermsofreturnoninvestment,forevery1 invested in ERAS, $3.80 could be expected in return. 2 Yet, despite the compelling evidence in support of ERAS, it has not been adopted widely. Results from a Canadian qualitative study suggest that although clinicians see the value in implementing an ERAS program, lack of nursing staff, lack of financial resources, resistance to change, and poor communication and collaboration are perceived as barriers to its adoption. 3 Enhanced Recovery Canada (ERC) is a project-based committee of the Canadian Patient Safety Institute (CPSI) that was formed as part of CPSI's commitment to influence improved surgical safety across the country. In 2017, ERC set out to develop a clinical pathway for elective colorectal surgery based on the key clinical elements of ERAS identified through implementation research, 4 including patient and family engagement, nutrition management, fluid and hydration management, mobility and physical activity, surgical

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Purposeful response to verbal or tactile stimulation Purposeful response following repeated or pa... more Purposeful response to verbal or tactile stimulation Purposeful response following repeated or painful stimulation Unarousable even with repeated or painful stimulation Airway Unaffected No intervention required Intervention may be required Intervention often required Spontaneous ventilation Unaffected Adequate May be inadequate Frequently inadequate Cardiovascular function Unaffected Usually maintained Usually maintained May be impaired

Rev Argent Anestesiol, 2012

Circulation, Oct 31, 2007

Critical care (London, England), Jan 20, 2016

Hypothermia is present in up to two-thirds of patients with severe injury, although it is often d... more Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and...

Canadian journal of anaesthesia = Journal canadien d'anesthésie, 2006

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

Annals of Pharmacotherapy, 2002

To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior p... more To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior pain control after cardiac surgery compared with patient-controlled analgesia (PCA) or nurse-administered SC injections. Sixty-two patients undergoing elective cardiac surgery participated in this prospective, randomized, partly-blinded study. Perioperative care was standardized, and patients were assigned to receive IT morphine (ITM group) followed by PCA, IT placebo (ITP group) followed by PCA, or SC injections of morphine every 4 hours as needed (SC group). Rating scales and questionnaires were used to assess clinical outcomes. ITM did not favor earlier extubation, and there was even a tendency for longer extubation times in the ITM group compared with the ITP and SC groups. Pain scores, adverse effects, postoperative recovery, and patient satisfaction were also comparable in the 3 groups. Considering that the administration of IT morphine is more costly and can be riskier than conventional analgesic regimens, we conclude that its use is not indicated in patients undergoing cardiac surgery if early extubation is planned.

Journal of the American College of Surgeons, 2009

Objective: To appraise the available evidence for patient monitoring, perioperative active warmin... more Objective: To appraise the available evidence for patient monitoring, perioperative active warming methods, outcomes supporting the prevention of perioperative hypothermia, and implementation strategies for the prevention of perioperative hypothermia.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2006

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2008

The maintenance of intraoperative normothermia has been identified as an important factor in the ... more The maintenance of intraoperative normothermia has been identified as an important factor in the reduction of surgical site infections, intraoperative blood loss, postoperative cardiac complications and PACU recovery time. The impact of prewarming and intraoperative warming on the temperature of patients under general anesthesia has been demonstrated in previous studies. However, the value of these interventions in cases performed under regional anesthesia in the clinical setting has not been clearly determined. This randomized controlled trial was conducted to determine whether preoperative and intraoperative warming of patients under neuraxial anesthesia will result in improved patient temperature during the perioperative period. Methods: Following research ethics board approval, consent was obtained from 120 patients presenting for primary total hip arthroplasty (N=60) or primary total knee arthroplasty (N=60). Subjects were randomized to: (1) active prewarming through a forced-air blanket in the block room for 30-60 minutes as well as intraoperative warming, (2) passive warming through cotton blankets in the block room but active forced-air warming in the OR, or (3) passive cotton blanket warming pre-and intraoperatively. Surgery was performed under spinal anesthesia with sedation. Intraoperative temperatures were monitored at 15 minute intervals through a tympanic infrared thermometer. Preoperative and early postoperative temperatures were also recorded. Recovery room admission and discharge times and incidence of shivering were noted. Four subjects were excluded from the data analysis due to failure of the neuraxial block and administration of general anesthesia. Data are described as mean ± standard deviation. Statistical analysis was conducted by ANOVA on temperature data and chisquared analysis on shivering data. Results: Passively warmed patients were found to have consistently low perioperative temperatures. Only the prewarmed patients had a significantly higher postoperative temperature (35.6°C ±0.63) compared to those who were passively warmed (35.1°C ±0.48, p<0.01). Preoperative warming resulted in normothermic conditions at the start of surgery (36.2°C ±0.57) while patients who were not prewarmed experienced a more precipitous temperature drop (35.8°C ±0.63, p<0.01 and 35.9°C ±0.41, p<0.05 for groups 2 and 3 respectively). Average intraoperative temperature was significantly lower in patients who were passively warmed (35.1°C ±0.51) compared to those who were actively warmed (35.5°C ±0.62, p<0.05 and 35.8°C ±0.60, p<0.001 for groups 2 and 1 respectively). No difference was found in recovery room length of stay or the incidence of postoperative shivering. Discussion: Patients undergoing primary total hip or knee arthroplasty under neuraxial anesthesia are at risk of developing mild perioperative hypothermia. Active pre-and intraoperative warming of these patients with a forced-air blanket results in higher

The Annals of Thoracic Surgery, 1997

Methods. Fourteen dogs were subjected to mobilization of the internal mammary artery and anastomo... more Methods. Fourteen dogs were subjected to mobilization of the internal mammary artery and anastomosis of it to the left anterior descending coronary artery over an angiographic catheter inserted into the internal mammary artery under fluoroscopy. The anastomosis was completed over the ...

Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for blee... more Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for bleeding that must be balanced with risk of ongoing ischemia if coronary artery bypass grafting is delayed. This study aimed to evaluate the impact of clopidogrel on mortality and major bleeding in patients undergoing urgent coronary bypass surgery. We reviewed 451 consecutive patients who underwent urgent isolated coronary bypass surgery; 262 had not received clopidogrel, whereas 189 received clopidogrel &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 5 days preoperative. The primary endpoint was in-hospital death, massive transfusion or massive blood loss. Patient characteristics were almost similar between groups. There was no difference in in-hospital death or massive bleeding indices between groups (clopidogrel: 7% vs. no clopidogrel: 6%, P = 0.9). No difference was observed even after adjusting for the date of stopping clopidogrel preoperatively. Multivariate regression analysis showed that clopidogrel or the duration it was stopped preoperatively, did not predict adverse outcomes. Significant independent predictors included preoperative renal dysfunction, hemoglobin level and peripheral vascular disease. clopidogrel, or the time it was stopped prior to surgery, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent coronary artery bypass surgery.

Journal of the American College of Surgeons, 2012

BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care cost... more BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care costs, so prevention of SSI has garnered much attention worldwide. Surgical site infection is recognized as an important quality indicator of patient care and safety. The purpose of this study was to use qualitative research methods to evaluate staff perceptions of the utility and impact of individualized audit and feedback (AF) data on SSI-related process metrics for their individual practice, as well as on overall communication and teamwork as they relate to SSI prevention. STUDY DESIGN: This study was performed in a tertiary care center, based on patients treated in the colorectal and hepatic-pancreatic-biliary surgical oncology services. Eighteen clinicians were interviewed. Analysis of interviews via comparative analysis techniques and coding strategies were used to identify themes.