A seroma is the most frequent complication of breast cancer surgery, the etiology of which remains obscure. We reviewed our data to determine the factors related to the incidence of seroma formation in our patients. A retrospective analysis of the records of 359 consecutive patients (334 Hispanic; 93%) who underwent primary surgical therapy from January 1, 1996 to December 31, 2000, with either modified radical mastectomy (MRM) or wide local excision (WLE) and axillary lymph node dissection (ALND) was performed. In all cases, removal of the breast was performed using electrocoagulation, and sharp dissection was used in the axilla. One-eighth inch closed suction round drains were used. Early arm motion was encouraged. The seroma rate was compared to the age of the patient, the presence and number of positive axillary lymph nodes, the total number of axillary lymph nodes removed, tumor size, weight of the patient, the use of neoadjuvant chemotherapy, and the type of surgery performed. The overall seroma rate was 15.8%. Seromas occurred in 19.9% of patients undergoing MRM and in 9.2% of patients undergoing breast-conserving surgery (p=0.01). The seroma rate was not influenced by any other tested variables. All seromas were easily managed with aspiration and pressure; this technical maneuver allowed seroma resolution in all patients except one following one to six aspirations. A seroma did not delay initiation of chemotherapy. No patient developed a capsule requiring excision. In our experience, a seroma is a "necessary evil;" it will occur unpredictably in a predictable number of patients.

Objective: To determine whether faculty triage (FT) activities can shorten emergency department (ED) length of stay (LOS). Methods: This was a comparison study measuring the impact of faculty triage vs no faculty triage on ED LOS. It was set in an urban county teaching hospital. Subjects were patients presenting to the registration desk between 9 AM and 9 PM on 16 consecutive Mondays (August 2 to November 15, 1999). On eight Mondays, an additional faculty member was stationed at the triage desk. He or she was asked to expedite care by rapid evaluation orders for diagnostic studies and basic therapeutic interventions, and by moving serious patients to the patient care areas. He or she was not provided with detailed instructions or protocols. The ED LOS, time of registration (TIMEREG), inpatient admission status (ADMIT), x-ray utilization (XRAY), total patients registered each day between 9 AM and 9 PM (TOTREG), and patients who left without being seen (LWBS) were determined using an ED information system. The LOS was analyzed in relation to FT, ADMIT, and XRAY by the Mann-Whitney U test. The LOS was related to TIMEREG and TOTREG by simple linear regression. Stepwise multiple linear regression models to predict LOS were generated using all the variables. Results: Patients without FT (n = 814) had a mean LOS of 445 minutes. Patients with FT (n = 920) had a mean LOS of 363 minutes. Mean difference in LOS was 82 minutes (95% CI = 111 to 53), a reduction of 18%. The LOS was also related to: ADMIT 203 minutes (95% CI = 168 to 238), TOTREG 2.7 min/additional patient registered (95% CI = 1.15 to 4.3), and TIMEREG 0.14 min/min since 9 AM (95% CI = 0.07 to 0.21). The LWBS was reduced by 46% with FT. In multiple regression analysis , ADMIT, FT, TIMEREG, and XRAY were all related to LOS, but the model explained only a small part of variance (adjusted R 2 = 0.093). The faculty cost is estimated to be $11.98/patient. Conclusions: Faculty triage offers a moderate increase in efficiency at this ED, albeit with relatively high cost. A CCORDING to the American College of Emergency Physicians, between 1988 and 1999, emergency department (ED) patient visits escalated from 81.3 million to 100 million. 1 During the same period, the total number of the nation's EDs decreased 10%. These trends, coupled with other factors such as nursing shortages, lack of in-patient beds, and laboratory delays, to name a few, have precipitated overcrowding that has only worsened by the increasing numbers of uninsured individuals who use the ED for primary care. Concurrent with these stressors, managed care and government payers have demanded greater ED efficiency and lower costs. Institutions have proposed numerous solutions to improve ED efficiency and alleviate overcrowding such as creating triage protocols, fast tracks, From Texas Tech University Health Sciences Center, El Paso, TX (SNP, BKN, EDB, MJW).

N THE COURSE of analyzing data, one often I attempts to show statistical relationships between 2 2 variables. For example, one might wish to know whether the systolic blood pressure (BPI on admission predicts the likelihood of survival in patients with acute myocardial infarction. One could develop a prediction model from a series of patients. The tools for demonstrating such relationships are generally related to analysis of variance (ANOVA) and regression. As with all statistical methods, these techniques rely on underlying assumptions about the nature of the data being analyzed. If the assumptions are violated, the results of the analysis are suspect. Regression techniques generally assume that error terms or residuals (the difference between the actual value and that predicted by the regression model) are uncorrelated; that is, knowledge of the deviation from the predicted value in one case should not give information about the deviation from the predicted value in another. This assumption is frequently violated in practice. Often, when data points are arranged in the order in which they were obtained, the errors in 2 points close to each other are likely to be in the same direction. One can easily see why this is true. As time passes, a treatment team may become more experienced, leading to better out-