Uncommon cause of liver abscess

Preparing a high-performance surgical team: lessons from 11,000 surgeries

INTRODUCTION

In the future, surgery will be centralized in hospitals with the best value (excellent results with reduced cost). High-performance teams will be required; however, available data concerning the specific abilities necessary to build and manage them are poor.

OBJECTIVES

Share the set of competencies and skills established to build and lead a high-performance general surgery team.

METHODS

In November 2012, a general surgery team started its activities at a tertiary hospital in Sao Paulo, Brasil. The model consisted of high volume performed by a small team. Experienced surgeons, motivated, and with technical and moral excellence were selected. A sense of unity was created and goals were shared. Complex cases were discussed daily and a prospective database to follow outcomes was established. The payment value was above the market.

RESULTS

In 6 years and 4 months, 11,006 surgical procedures were performed (8,597 electives and 2,409 in an urgent setting). Cholecystectomy was the most common procedure (4,101; being 3,676 electives), followed by inguinal hernioplasty (n: 1,827) and appendectomy (n: 925). A total of 449 elective oncologic procedures were performed. The surgical site infection rate in clean procedures was 0.12%, 80 patients required re-do surgery (2.4% in an urgent setting and 0.2% of the electives). There were 22 postoperative deaths (0.66% for urgent and 0.07% for electives), 5 of the 6 deaths in elective patients were in oncologic cases.

CONCLUSION

A competent surgical team, inserted in a model that favors performance and values the individual can deliver high volume with exceptional results.

Retained Foreign Body Causing a Liver Abscess

Introduction

A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department.

Case Report

We report a case of a middle-aged female who presented to the Emergency Department with nonspecific symptoms. Computed tomography showed a liver abscess that had formed secondary to a fishbone. The patient was treated conservatively initially and subsequently with percutaneous drainage and finally with open drainage. Her condition improved and she was discharged from the hospital with the foreign body still in-situ.

Conclusion

This case is one of six cases in literature where the patient has been discharged successfully from the hospital with a retained fishbone. It also demonstrates the difficulty of diagnosing a foreign body causing a liver abscess and the multiple treatment modalities used to treat a liver abscess caused by fishbone.