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Rapolti DI, Kisa P, Situma M, Nico E, Lobe T, Sims T, Ozgediz D, Klazura G. The creation of a pediatric surgical checklist for adult providers. BMC Health Serv Res 2024; 24:1029. [PMID: 39232756 PMCID: PMC11375845 DOI: 10.1186/s12913-024-11405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/06/2024] [Indexed: 09/06/2024] Open
Abstract
PURPOSE To address the need for a pediatric surgical checklist for adult providers. BACKGROUND Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications. METHODS Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2023 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias. RESULTS Forty-two papers with 8,529,061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies. CONCLUSION The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes. FUNDING Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540.
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Affiliation(s)
| | - Phyllis Kisa
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Martin Situma
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elsa Nico
- University of Illinois, Chicago, IL, USA
| | - Thom Lobe
- University of Illinois, Chicago, IL, USA
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Í Soylu L, Hansen JB, Kvist M, Burcharth J, Kokotovic D. Health-related quality of life is a predictor of readmission following emergency laparotomy. World J Surg 2024; 48:1863-1872. [PMID: 38898564 DOI: 10.1002/wjs.12260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is a multidimensional concept used to examine the impact of patient-perceived health status on quality of life. Patients' perception of illness affects outcomes in both medical and elective surgical patients; however, not much is known about how HRQoL effects outcomes in the emergency surgical setting. This study aimed to examine if patient-reported HRQoL was a predictor of unplanned readmission after emergency laparotomy. METHODS This study included 215 patients who underwent emergency laparotomy at the Copenhagen University Hospital, Herlev, between August 1, 2021, and July 31, 2022. Patient-reported HRQoL was assessed with the EuroQol group EQ5D index (EQ5D5L descriptive system and EQ-VAS). The population was followed from 0 to 180 days after discharge, and readmissions and days alive and out of hospital were registered. A Cox proportional hazard model was used to examine HRQoL and the risk of readmission within 30 and 180 days. RESULTS Within 30 days, 28.4% of patients were readmitted; within 180 days, the number accumulated to 45.1%. Low self-evaluated HRQoL predicted 180-day readmission and was significantly associated with fewer days out of hospital within both 90 and 180 days. Low HRQoL and discharge with rehabilitation were independent risk factors for short- (30-day) and long-term (180-day) emergency readmission. CONCLUSION Patient-perceived quality of life is an independent predictor of 180-day readmission, and the number of days out of hospital was correlated to self-reported HRQoL.
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Affiliation(s)
- Lív Í Soylu
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Jannick Brander Hansen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Madeline Kvist
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Dunja Kokotovic
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
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Rapolti D, Kisa P, Situma M, Nico E, Lobe T, Sims T, Ozgediz D, Klazura G. The Creation of a Pediatric Surgical Checklist for Adult Providers. RESEARCH SQUARE 2023:rs.3.rs-3269257. [PMID: 37790469 PMCID: PMC10543282 DOI: 10.21203/rs.3.rs-3269257/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Purpose To address the need for a pediatric surgical checklist for adult providers. Background Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications. Methods Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2022 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias. Results 42 papers with 8529061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies. Conclusion The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes. Funding Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540.
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Affiliation(s)
- Diana Rapolti
- University of Illinois Hospital and Health Sciences System
| | | | | | - Elsa Nico
- University of Illinois Hospital and Health Sciences System
| | - Thom Lobe
- University of Illinois Hospital and Health Sciences System
| | - Thomas Sims
- University of Illinois Hospital and Health Sciences System
| | | | - Greg Klazura
- University of Illinois Hospital and Health Sciences System
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Boyle L, Lumley T, Cumin D, Campbell D, Merry AF. Using days alive and out of hospital to measure surgical outcomes in New Zealand: a cross-sectional study. BMJ Open 2023; 13:e063787. [PMID: 37491100 PMCID: PMC10373692 DOI: 10.1136/bmjopen-2022-063787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES To measure differences at various deciles in days alive and out of hospital to 90 days (DAOH90) and explore its utility for identifying outliers of performance among district health boards (DHBs). METHODS Days in hospital and mortality within 90 days of surgery were extracted by linking data from the New Zealand National Minimum Data Set and the births and deaths registry between 1 January 2011 and 31 December 2021 for all adults in New Zealand undergoing acute laparotomy (AL-a relatively high-risk group), elective total hip replacement (THR-a medium risk group) or lower segment caesarean section (LSCS-a low-risk group). DAOH90 was calculated without censoring to zero in cases of mortality. For each DHB, direct risk standardisation was used to adjust for potential confounders and presented in deciles according to baseline patient risk. The Mann-Whitney U test assessed overall DAOH90 differences between DHBs, and comparisons are presented between selected deciles of DAOH90 for each operation. RESULTS We obtained national data for 35 175, 52 032 and 117 695 patients undergoing AL, THR and LSCS procedures, respectively. We have demonstrated that calculating DAOH without censoring zero allows for differences between procedures and DHBs to be identified. Risk-adjusted national mean DAOH90 Scores were 64.0 days, 79.0 days and 82.0 days at the 0.1 decile and 75.0 days, 82.0 days and 84.0 days at the 0.2 decile for AL, THR and LSCS, respectively, matching to their expected risk profiles. Differences between procedures and DHBs were most marked at lower deciles of the DAOH90 distribution, and outlier DHBs were detectable. Corresponding 90-day mortality rates were 5.45%, 0.78% and 0.01%. CONCLUSION In New Zealand after direct risk adjustment, differences in DAOH90 between three types of surgical procedure reflected their respective risk levels and associated mortality rates. Outlier DHBs were identified for each procedure. Thus, our approach to analysing DAOH90 appears to have considerable face validity and potential utility for contributing to the measurement of perioperative outcomes in an audit or quality improvement setting.
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Affiliation(s)
- Luke Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - David Cumin
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Doug Campbell
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Alan Forbes Merry
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Batista J, Cruz EDDEA, Silva DPDA, Nazário SDAS, Antunes BCS. Impact of surgical checklists on the time of surgical processes: a cross-sectional study. Rev Col Bras Cir 2023; 50:e20233425. [PMID: 36790228 PMCID: PMC10519694 DOI: 10.1590/0100-6991e-20233425-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. METHOD cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. RESULTS there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. CONCLUSION the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.
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Affiliation(s)
- Josemar Batista
- - Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem - Curitiba - PR - Brasil
| | | | | | - Saimon DA Silva Nazário
- - Universidade Federal do Paraná, Programa de Pós-graduação em Enfermagem - Curitiba - PR - Brasil
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Charlesworth M, Carlisle J. How to design and interpret a randomised controlled trial using Bayesian statistics. Anaesthesia 2023; 78:119-124. [PMID: 35793093 DOI: 10.1111/anae.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 12/13/2022]
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - J Carlisle
- Department of Anaesthesia, Peri-operative Medicine and Intensive Care, Torbay Hospital, Devon, UK
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BATISTA JOSEMAR, CRUZ ELAINEDREHMERDEALMEIDA, SILVA DANIELIPARREIRADA, NAZÁRIO SAIMONDASILVA, ANTUNES BÁRBARACRISSKORA. Impacto de checklists cirúrgicos no tempo dos processos operatórios: um estudo transversal. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
RESUMO Objetivo: analisar o impacto do uso de checklists no tempo médio dos processos operatórios de pacientes submetidos a artroplastias de quadril e joelho. Método: pesquisa transversal e analítica realizada entre novembro/2020 e março/2022 com consulta retrospectiva em amostra aleatória simples de 291 prontuários, distribuídos em três períodos (2010/2013/2016). Utilizou-se estatística descritiva e inferencial para análise dos dados; valores de p=0,05 indicaram significância. Resultados: houve redução do tempo de entrada-saída da sala cirúrgica (p=0,002), de cirurgia (p<0,001) e entre o início-anestesia e início-incisão (p=0,021). Não houve diferença no tempo entre os pacientes com e sem o uso dos checklists (p=0,05) com relação às variáveis início-anestesia, início-incisão, tempo de anestesia e de cirurgia. Conclusão: a implantação de checklists potencialmente contribuiu para reduzir o tempo de uso da sala cirúrgica. A não associação de seu uso ao aumento do tempo médio dos processos no centro cirúrgico mostra que sua aplicação não interfere negativamente nesse indicador.
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Alexander H, Moore M, Hannam J, Poole G, Bartlett A, Merry A. Days alive and out of hospital after laparoscopic cholecystectomy. ANZ J Surg 2022; 92:2889-2895. [PMID: 36250953 PMCID: PMC9828827 DOI: 10.1111/ans.18099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Days alive and out of hospital (DAOH) is a metric that incorporates several outcomes into a single, standardized measure. This study aimed to explore the utility of DAOH in assessing the outcomes of a retrospective cohort of patients undergoing laparoscopic cholecystectomy (LC). METHODS Patients undergoing LC at Auckland City Hospital between 1 January 2010 and 31 August 2015 were included. DAOH values were calculated for the 90 days from the date of surgery (DAOH90 ) and described using median and interquartile ranges (IQR). DAOH90 distributions were compared using a two-tailed (non-parametric) Wilcoxon-Mann-Whitney test. RESULTS 1652 patients undergoing LC were studied. Patients experiencing complications (n = 70, 4.2%) had fewer DAOH90 (median 83, IQR 79, 86) than patients who underwent uncomplicated LC (median 88, IQR 86, 88), P < 0.001. Patients who were converted to open cholecystectomy (n = 70, 4.2%) also had fewer DAOH90 (median 82.5, IQR 79, 84) than patients who underwent uncomplicated LC, P < 0.001. Post-operative complications and conversion had a statistically significant effect on DAOH90 at each of the tested quantiles, except for conversion at the 0.1 quantile. CONCLUSION DAOH90 is readily calculable from existing New Zealand administrative data sources and is sensitive to the occurrence of complications after LC.
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Affiliation(s)
- Harry Alexander
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Matthew Moore
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Jacqueline Hannam
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Garth Poole
- Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Adam Bartlett
- Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Alan Merry
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
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Fuchs A, Frick S, Huber M, Riva T, Theiler L, Kleine-Brueggeney M, Pedersen TH, Berger-Estilita J, Greif R. Five-year audit of adherence to an anaesthesia pre-induction checklist. Anaesthesia 2022; 77:751-762. [PMID: 35302235 PMCID: PMC9314793 DOI: 10.1111/anae.15704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although patient safety related to airway management has improved substantially over the last few decades, life‐threatening events still occur. Technical skills, clinical expertise and human factors contribute to successful airway management. Checklists aim to improve safety by providing a structured approach to equipment, personnel and decision‐making. This audit investigates adherence to our institution's airway checklist from 1 June 2016 to 31 May 2021. Inclusion criteria were procedures requiring airway management and we excluded all procedures performed solely under regional anaesthesia, sedation without airway management or paediatric and cardiovascular surgery. The primary outcome was the proportion of wholly performed pre‐induction checklists. Secondary outcomes were the pattern of adherence over the 5 years well as details of airway management, including: airway management difficulties; time and location of induction; anaesthesia teams in operating theatres (including teams for different surgical specialities); non‐operating theatre and emergency procedures; type of anaesthesia (general or combined); and urgency of the procedure. In total, 95,946 procedures were included. In 57.3%, anaesthesia pre‐induction checklists were completed. Over the 5 years after implementation, adherence improved from 48.3% to 66.7% (p < 0.001). Anticipated and unanticipated airway management difficulties (e.g. facemask ventilation, supraglottic airway device or intubation) defined by the handling anaesthetist were encountered in 4.2% of all procedures. Completion of the checklist differed depending on the time of day (61.3% during the day vs. 35.0% during the night, p < 0.001). Completion also differed depending on location (66.8% in operating theatres vs. 41.0% for non‐operating theatre anaesthesia, p < 0.001) and urgency of procedure (65.4% in non‐emergencies vs. 35.4% in emergencies, p < 0.001). A mixed‐effect model indicated that urgency of procedure is a strong predictor for adherence, with emergency cases having lower adherence (OR 0.58, 95%CI 0.49–0.68, p < 0.001). In conclusion, over 5 years, a significant increase in adherence to an anaesthesia pre‐induction checklist was found, and areas for further improvement (e.g. emergencies, non‐operating room procedures, night‐time procedures) were identified.
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Affiliation(s)
- A Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S Frick
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,Unit for Research and Innovation in Anaesthesia, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - L Theiler
- Department of Anaesthesia, Cantonal Hospital Aarau, Aarau, Switzerland
| | - M Kleine-Brueggeney
- Department of Anaesthesia, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland
| | - T H Pedersen
- Department of Anaesthesiology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - J Berger-Estilita
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,Centre for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
| | - R Greif
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,School of Medicine, Sigmund Freud Private University Vienna, Vienna, Austria
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Molina G, Haynes AB, Brindle ME. Where do we go now? Evolution of the surgical safety checklist in the era of high-performing programmes. Anaesthesia 2021; 77:135-138. [PMID: 34643939 DOI: 10.1111/anae.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- G Molina
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - A B Haynes
- Department of Surgery and Peri-operative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - M E Brindle
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Alberta Children's Hospital, Calgary, AB, Canada
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