• Quality Improvement
  • Errors
  • Most effective means to decrease rate of hospital admissions is to increase rates of correct helmet use in children
    • Helmet laws and bicycle safety programs increase helmet use
  • Surgical site infection (SSI)

    • ERAS and fast track surgery (FTS)

      • Protocols work best when all components are practiced together
      • Improvement with exchanging of gloves, gowns, and instrument trays prior to wound closure
      • Benefit with mechanical prep + oral abx ppx

    • ERAS Practice Guidelines + Recommendations

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    • Smoking

      • Best when quit 2-4 wks prior to surgery
  • DVT ppx

    • Otherwise healthy pt, able to ambulate → no DVT ppx

    • High risk of bleeding → mechanical methods (SCDs)

    • 1 risk factor for VTE → DVT ppx

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    • Rivaroxaban and betrixaban approved for VTE ppx. Betrixaban > LMWH

  • GCS is a poor predictor of individual outcome
    • Elderly pts should be re-evaluated at 72 hr mark to determine subsequent care
  • Bariatric weight loss
    • Weight loss of excess body weight
    • Sleeve - 50-60%
    • Roux-n-Y - 70-80%
    • No surgery exists that would result in 100+% loss of excess body weight
  • Splenectomy
    • Leukocytosis
      • Plt:WBC ratio > 20 is normal physiology
    • Thrombocytosis - transiet
      • 500,000 - 1,000,000 → observe
  • Ventral hernias
    • Lap vs Open
      • No difference in post-op pain, recurrence at 35 mo, operative time, mortality
      • Lap better: post-op infection