International journal of surgery
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Preoperative anaemia is a risk factor for poorer postoperative outcomes and many colorectal cancer patients have iron-deficiency anaemia. The aim of this study was to assess if a preoperative iron-deficiency anaemia management protocol for elective colorectal surgery patients helps improve detection and treatment of iron-deficiency, and improve patient outcomes. ⋯ Introduction of an iron-deficiency anaemia management pathway has resulted in improved perioperative haemoglobin levels, with a reduction in perioperative transfusion, in elective colorectal patients. Implementation of this pathway could result in similar outcomes across other categories of surgical patients.
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Liberal emergency department (ED) resuscitation after trauma may lead to uncontrolled hemorrhage, reduced organ perfusion, and compartment syndrome. Recent guidelines reduced the standard starting point for crystalloid resuscitation from 2 L to 1 L and emphasized "balanced" resuscitation. The purpose of this study was to characterize how an urban, Level 1 trauma center has responded to changes in crystalloid resuscitation practices over time and to describe associated patient outcomes. ⋯ The observed decrease in high-volume crystalloid resuscitations in the ED paralleled a reduction in mortality over the ten-year period. In addition, adjusted mortality was higher in those receiving high-volume resuscitation.
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The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool (RAPT) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement, spine fusion and cardiac valve surgery patients. ⋯ The RAPT tool has shown the ability to predict discharge disposition for total joint and spine surgery patients, but not cardiac valve surgery patients, where the majority of patients in all categories were discharged home, at an institution participating in a bundled payment program. The ability to identify discharge disposition pre-operatively is valuable for improving care coordination, directing care resources and establishing and maintaining patient and family expectations.
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Intraoperative electrophysiological monitoring is used to determine whether decompression is sufficient during microvascular decompression (MVD) for hemifacial spasm (HFS). However, the real offending vessel is sometimes neglected by the neurosurgeons. Here, we reported our experience in using optimized abnormal muscle response (AMR) monitoring and continuous intraoperative monitoring for MVD. ⋯ Our findings demonstrated that the optimized method could improve the positive detection rate of AMR and accuracy of decompression effect prediction. The evaluation for the decompression effect by optimized intraoperative monitoring can increase the immediate remission rate and reduce the delayed recovery rate.
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The aim of this study was to describe short-time effect of Roux-en-Y gastric bypass (RYGB) on insulin sensitivity (IS) of Chinese diabetes patients with body mass index (BMI) <35 kg/m2 by hyperinsulinemic euglycemic clamp. ⋯ Peripheral and hepatic IS improved remarkably at 3 months following RYGB, as an important mechanism for early improvement in T2DM patients with low BMI. And the time to reach euglycemia at the hyperinsulinemic euglycemic clamp may be an useful index of assessing insulin sensitivity. It is more reasonal to combine the time to reach euglycemia with M value for assessing IS.