Bone banking. A cost effective method for establishing a community hospital bone bank

Both cost effectiveness and safety can be realized in the operation of a community bone bank by adoption of the following measures: deep freezing, rather than freeze drying; allogenic bone is collected from femoral heads excised from total hip arthroplasties; and careful donor and graft selection controls ensure an allograft free of disease which can be transmitted to the recipient. Two-year follow-up data reveal no complications or infections from implantation of 101 allografts.     

Bone banking in Canada: a review

Transplantation of human tissues has become increasingly popular, and associated with this increase are reports of the transmission of diseases including acquired immune deficiency syndrome. To reduce the risk of transmitting disease through transplantation, careful scrutiny of current tissue transplantation procedures is necessary. Bone banking in Canada was evaluated by questionnaire, sent to the head operating room nurse of every Canadian hospital listed in the 1986 Canadian Medical Directory as having 100 or more beds. From this questionnaire, the authors identified 60 bone banks in Canada, many of which failed to meet recommended guidelines. The authors review the literature relating to bone banking procedures and present in detail the results of their survey.     

Cholecystectomy in a community hospital

Modern elective cholecystectomy, when distinguished from emergency operations and those complicated by choledocholithiasis, should be a safe procedure with a brief hospital stay. In a community hospital, 100 consecutive patients underwent cholecystectomy, with minor complications in 7 percent. The postoperative hospital stay averaged less than 4 days, and the cost was just over $2,000. Elective cholecystectomy in the community can have minimal risk and will likely remain cost-effective even when medical therapies become available.     

Blood banking in the small hospital.

This represents an attempt to briefly outline the type of blood bank and transfusion service we at Montrose Memorial Hospital have developed and utilized to supply our blood needs. Basically it is a system based on a fairly large list of known, pretested, and available donors who can be contacted quickly to supply blood upon demand. Only bare minimum stock supplies are maintained. The major problem is waste of blood, but Montrose experience continues to fall below the average for rural areas. Although the starting and maintaining of this walking blood bank was and is a complicated involved, and somewhat tedious process, we have been happy with the results and have been able to supply in an adequate fashion the blood requirements of an isolated yet extremely active population with a sophisticated medical community.     

Survival in a community hospital dialysis center

The survival experience of 213 patients with end-stage renal disease treated over a 10-year period in a community hospital dialysis center is the focus of the study. Statistical assessments of the effects of risk factors and alternative treatment modalities on patient survival are made using survival functions and proportional hazards regression models. Comparisons of the data base and the main results with those of previous published reports are presented. A key result is our finding of improved survival since the introduction of a continuous ambulatory peritoneal dialysis program in 1980. This result is discussed in some detail.     

Surgical pulmonary embolectomy in a community hospital

Background

Surgical pulmonary embolectomy (SPE) is indicated for a pulmonary embolism associated with hemodynamic instability. A review of the literature demonstrates that most studies of SPE are conducted at large academic medical centers. This series is from a 325-bed community hospital.

Methods

A retrospective chart review was performed of patients undergoing SPE from January 2008 to December 2012. All patients aged >18 years were reviewed for 30-day mortality, length of hospital stay, comorbidities, and preoperative hemodynamic parameters.

Results

Fifteen patients (7 men and 8 women; median age, 55.5 years; range, 20–72 years) underwent SPE. There were 2 deaths (13.3%). Four of the patients underwent catheter-directed interventions before SPE. The mean length of hospital stay was 12 days.

Conclusions

These data suggest that SPE is associated with favorable outcomes in the appropriate community setting, and the mortality rate seen in this study compares favorably with the nationwide average of 27.2%.     

Carotid endarterectomy in a small community hospital

Over a 10 year period carotid endarterectomy was performed in a total of 177 operations in 145 patients at a small community hospital. Mortality and morbidity rates were similar to those reported from larger medical centers. The use and comparison of intracerebral protective techniques of hypercarbia and shunting are discussed. Routine use of the Silastic shunt appears preferable to more elaborate means of cerebral protection. The noninvasive Dopscan and periorbital Doppler examination are effective tools in the selection of patients for surgery and follow-up of patients with asymptomatic bruits, contralateral stenoses or both. These noninvasive studies often add valuable information when the angiographie findings are uncertain. The treatment of asymptomatic carotid lesions remains controversial. Significant carotid stenosis or ulcerated plaque can be treated prophylactically by endarterectomy if the operator can show no hospital mortality and a reversible neurologic deficit of about 2 percent in his series.     

Pelvic fractures at a community hospital

One hundred twenty-eight pelvic fractures were reviewed. Of the 128 patients with pelvic fractures, there were seven deaths. Pelvic fractures associated with the greatest blood loss and complications were those which occurred in crush-type injuries secondary to automobile accidents or other heavy impact injuries. Unless fractures were of a crush-type with massive fractures, the amount of blood loss correlated more closely with the history of injury than it did with the x-ray appearance of pelvic fracture. A single patient in this series had greater than 45 units blood loss and exhibited many of the basic problems encountered when dealing with patients with major pelvic fractures. The case of this patient is reviewed in detail, including component therapy for massive blood loss. The prophylactic use of caval filtration or an umbrella device might be warranted in patients with massive pelvic fractures.     

Hepatic resection at a community hospital

Hepatic resection remains the “gold standard” in the primary management of primary and metastatic tumors to the liver. Advanced surgical techniques along with more modern and sophisticated equipment have led to an increasing number of hepatic resections being performed with a concomitant decrease in morbidity and mortality. We followed prospectively 18 consecutive hepatic resections performed over a period of approximately 2.5 years. The setting was a community teaching hospital with a low volume of referrals for hepatic resection. Sixteen (88%) had metastatic disease and two had primary liver disease. There were four trisegmentectomies, four lobectomies, four segmentectomies, and six large wedge resections. Average estimated blood loss was 608 ml. Seven patients required transfusions. Complications occurred in five patients (27%). In-hospital mortality was 0%. Our experience suggests that liver resections in a low-volume community hospital can be performed safely provided an experienced surgical team with familiarity of advanced surgical techniques and sophisticated equipment used in hepatic resection is readily available. Presented at the Annual Meeting of the American College of Surgeons, Orlando, Fla., October 1998.