David R. Flum

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Surgery and other invasive therapies are complex interventions, the assessment of which is challenged by factors that depend on operator, team, and setting, such as learning curves, quality variations, and perception of equipoise. We propose recommendations for the assessment of surgery based on a five-stage description of the surgical development process.(More)
CONTEXT Intraoperative cholangiography (IOC) may decrease the risk of common bile duct (CBD) injury during cholecystectomy by helping to avoid misidentification of the CBD. OBJECTIVE To characterize the relationship of IOC use and CBD injury while controlling for patient and surgeon characteristics. DESIGN, SETTING, AND PATIENTS Retrospective nationwide(More)
PURPOSE This systematic literature review was designed to summarize and compare the reported outcomes of one-stage and two-stage operations for the treatment of perforated diverticulitis with peritonitis. METHODS This review identified 98 published studies (1957-2003) dealing with the surgical management of perforated diverticulitis with peritonitis,(More)
CONTEXT Common bile duct (CBD) injury during cholecystectomy is a significant source of patient morbidity, but its impact on survival is unclear. OBJECTIVE To demonstrate the relation between CBD injury and survival and to identify the factors associated with improved survival among Medicare beneficiaries. DESIGN, SETTING, AND PATIENTS Retrospective(More)
Research on surgical interventions is associated with several methodological and practical challenges of which few, if any, apply only to surgery. However, surgical evaluation is especially demanding because many of these challenges coincide. In this report, the second of three on surgical innovation and evaluation, we discuss obstacles related to the study(More)
OBJECTIVE To determine if certain outcomes of incisional hernia repair have improved in recent eras. SUMMARY BACKGROUND DATA Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias. METHODS This retrospective, population-based cohort study was conducted using a 1987 to 1999 Washington hospital(More)
BACKGROUND Negative appendectomy (NA)--the nonincidental removal of a normal appendix--occurs commonly but the associated clinical- and system-level costs are not well studied. HYPOTHESIS The frequency of adverse clinical outcomes and associated financial burden of hospitalizations during which NA is performed is greater than previously recognized and(More)
CONTEXT Misdiagnosis of presumed appendicitis is an adverse outcome that leads to unnecessary surgery. Computed tomography, ultrasonography, and laparoscopy have been suggested for use in patients with equivocal signs of appendicitis to decrease unnecessary surgery. OBJECTIVE To determine if frequency of misdiagnosis preceding appendectomy has decreased(More)
BACKGROUND To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization. METHODS We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005(More)
Surgical innovation is an important part of surgical practice. Its assessment is complex because of idiosyncrasies related to surgical practice, but necessary so that introduction and adoption of surgical innovations can derive from evidence-based principles rather than trial and error. A regulatory framework is also desirable to protect patients against(More)