World journal of surgery
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World journal of surgery · Aug 2009
Value of MELD and MELD-based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases.
Recent studies have suggested that the Model for End-Stage Liver Disease (MELD) may represent a promising alternative to the Child-Turcotte-Pugh classification as a predictive factor of operative mortality and morbidity. This study was designed to evaluate the value of MELD and four MELD-based indices (iMELD: integrated MELD; MESO: MELD to sodium ratio; MELD-Na: MELD with incorporation of sodium; MELD-XI: MELD excluding the International Normalized Ratio) in the quantification of surgical risk for patients with cirrhosis and compare its prognostic value with the Child-Turcotte-Pugh classification and two derived scores (proposed by Huo and Giannini, respectively). ⋯ In this study, iMELD was a useful predictive parameter of operative mortality for patients with cirrhosis submitted to elective procedures. Further studies are necessary to define the relevance of MELD-based indices in the individual surgical risk evaluation.
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World journal of surgery · Aug 2009
Risk factors for complications after laparoscopic surgery in colorectal cancer patients: experience of 401 cases at a single institution.
Laparoscopic surgery is widely used for the treatment of colorectal cancer, but little is known about perioperative risk factors for complications. ⋯ We identified intraoperative management such as low operative infusion rate is one of the independent significant risk factors for complications after laparoscopic surgery for colorectal cancer in addition to patient characteristics and surgical procedure.
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World journal of surgery · Aug 2009
Randomized Controlled Trial Comparative StudyDiathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial.
This prospective, double-blind, randomized, controlled trial was designed to compare the outcome of diathermy incisions versus scalpel incisions in general surgery. ⋯ Diathermy incision has significant advantages compared with the scalpel because of reduced incision time, less blood loss, & reduced early postoperative pain.
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There is currently no validated measurement system available for quality of care assessment in surgery despite all of the inherent benefits of such an approach. A structured quality framework needs to be developed and incorporate measures that are truly reflective of several important dimensions of care within the entire treatment episode. Presently this has been only partially addressed. ⋯ Combining these measures to create an overall composite quality score can be made feasible only if it is supported by the use of robust statistical methodology. It is important to use appropriate display of performance data to facilitate provider engagement in quality improvement initiatives. This article was designed to present such a structured approach of a quality framework, which is required to appraise the quality of care in surgery to enhance future quality improvement programmes.
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World journal of surgery · Aug 2009
Multicenter StudyMultimodal perioperative rehabilitation for colonic surgery in the elderly.
Traditional perioperative care for colonic surgery in elderly patients is associated with increased morbidity and mortality compared to that of younger patients. Although multimodal perioperative rehabilitation has evolved as a valid concept to improve postoperative outcome, its use has not yet been established for colonic surgery in the elderly. ⋯ Although the overall morbidity did increase with age, it was still less when compared to that of historical groups with traditional care. Therefore, multimodal perioperative rehabilitation should be recommended for the elderly.