The Surgical Care Improvement Project (SCIP) was formed by a partnership of national organizations with the goal of reducing surgical complications by 25% by 2010. The focus of the SCIP initiative includes four key components that perioperative health care workers can address in reducing the morbidity and mortality of surgical patients. By implementing SCIP quality measures, hospitals could prevent an estimated 13,000 patient deaths and 271,000 surgical complications each year.

IN RESPONSE TO RECENT REPORTS from several major US medical centers regarding possible exposure of surgical patients to transmissible spongiform encephalopathies (TSEs), one institution developed guidelines to care for surgical patients with the preoperative diagnosis of "rule out TSE." BASED ON CURRENT sterilization technology, using disposable surgical instruments may be the safest way to eliminate concerns of iatrogenic transmission of TSE and reduce the number of hospital staff members who could be exposed to the TSE contagion. PERIOPERATIVE PRECAUTIONS that can be taken when patients are undergoing brain biopsy procedures to rule out TSE are detailed.

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Total pancreatectomy may be the only treatment option that relieves pain and tissue destruction for patients with chronic pancreatitis, but this procedure causes surgically induced diabetes, which is difficult to manage because of the absence of insulin-producing beta cells. Some patients may benefit from autologous islet cell reimplantation, a procedure that involves collecting and purifying the islets of Langerhans from the patient's own resected pancreas and reinfusing them into the patient via the portal vein. Typically, candidates for this procedure are younger adults with nondilated pancreatitis that has yet to develop into glucose intolerance. Islet cell transplantation success varies and is directly related to the quality and quantity of the patient's pancreas and the damage caused by the chronic pancreatitis.