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PubMed1979

What is unnecessary surgery?

The definition of "unnecessary surgery" has never been made very precise. A useful definition might be provided by the economist's notion of patient costs and benefits as they would be calculated by a fully informed patient-consumer. Combining both clinical information and consumer preferences, it is impossible to demonstrate unnecessary surgery for most diagnoses. Conclusions in recent Congressional reports on unnecessary surgery are not supported by evidence likely to benefit either individual physicians or patients.

Adenoidectomy↗
PubMedDate not supplied

Quality of evaluation and management of children requiring timely orthopaedic surgery before admission to a tertiary pediatric facility.

The purpose of this study was to investigate the quality of evaluation and management of children requiring timely orthopaedic surgery before admission to a tertiary pediatric facility. A retrospective chart review was performed on 372 consecutive children who underwent orthopaedic surgery for a diagnosis of fracture, infection, slipped capital femoral epiphysis (SCFE), or compartment syndrome during a 22-month period at the authors' facility. Of the 372 children, 142 children (38%) first received medical care elsewhere; these are the subjects of this study. Before being seen at the authors' institution, 27 children (19%) had a problem in treatment or diagnosis and 18 (13%) had a delay in diagnosis or treatment of greater than 48 hours. Problems in diagnosis included five children with unrecognized open fractures, four of whom did not receive antibiotics; six children with missed SCFE, five of whom were not made non-weight-bearing; and six missed closed fractures. Delay in treatment occurred for 15 fractures, with a mean delay of >7 days until surgical treatment. Insurance status and primary language of the family were not associated with problems or delays in treatment. Overall, 32% of children undergoing time-sensitive orthopaedic surgery at a tertiary pediatric center had problems or delays in the medical care they received before transfer.

California↗