World journal of surgery
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World journal of surgery · Oct 2011
Outcomes of severely injured adult trauma patients in an Australian health service: does trauma center level make a difference?
Trauma centers are designated to provide systematized multidisciplinary care to injured patients. Effective trauma systems reduce patient mortality by facilitating the treatment of injured patients at appropriately resourced hospitals. Several U.S. studies report reduced mortality among patients admitted directly to a level I trauma center compared with those admitted to hospitals with less resources. It has yet to be shown whether there is an outcome benefit associated with the "level of hospital" initially treating severely injured trauma patients in Australia. This study was designed to determine whether the level of trauma center providing treatment impacts mortality and/or hospital length of stay. ⋯ Severely injured patients treated at a level III center had a higher mortality rate than those treated at a level I center. Most problems identified occurred in the emergency department and were related to delays in care provision. This research highlights the importance of efficient prehospital, in-hospital, and regional trauma systems, performance monitoring, peer review, and adherence to protocols and guidelines.
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World journal of surgery · Sep 2011
Comparative StudyOutcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis.
The role of laparoscopy in the management of diverticular disease is evolving. Concerns were raised in the past because laparoscopic resection for diverticulitis is often difficult and occasionally hazardous. This study was undertaken to evaluate the difference in overall outcomes between elective open and laparoscopic surgery with or without anastomosis for diverticulitis. ⋯ The laparoscopic operation was associated with lower morbidity, lower mortality, shorter hospital stay, and lower hospital charges compared to the open operation for diverticulitis. Elective laparoscopic surgery for diverticulitis is safe and can be considered the preferred operative option.
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World journal of surgery · Sep 2011
Comparative StudyIn-hospital death following inpatient surgical procedures in the United States, 1996-2006.
Over the past decade, improvements in perioperative care have been widely introduced throughout the United States, yet there is no clear indication that the death rate following surgery has improved. We sought to evaluate the number of deaths after surgery in the United States over a 10-year period and to evaluate trends in postoperative mortality. ⋯ The death rate following surgery is substantial but appears to have improved. Such mortality statistics provide an essential measure of the public health impact of surgical care. Incorporating mortality statistics following therapeutic intervention is an essential strategy for regional and national surveillance of care delivery.
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World journal of surgery · Sep 2011
Randomized Controlled Trial Comparative StudyProspective randomized trial of laparoscopic Nissen fundoplication with anterior versus posterior hiatal repair: late outcomes.
The technique used for hiatal closure in laparoscopic Nissen fundoplication might have an impact on the risk of postfundoplication dysphagia and hiatal herniation. In 1997, we commenced a randomized trial to evaluate the impact of anterior versus posterior hiatal repair techniques on these outcomes. In the present study, we evaluated the 10-year outcomes from this trial. ⋯ At the 10-year follow-up, the outcomes for the two groups were similar. Anterior hiatal repair is an acceptable technique for hiatal closure during laparoscopic Nissen fundoplication.
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World journal of surgery · Sep 2011
Comparative StudyLiver resection of colorectal liver metastases in elderly patients.
The percentage of elderly patients with colorectal liver metastases (CLM) has increased. Liver resection remains the only curative therapy; data evaluating the outcome in this age group is limited. Aim of the present study was to determine if postoperative morbidity, mortality, and other independent predictors influence survival in patients ≥ 70 years undergoing liver resection for CLM. ⋯ Resection of CLM at older age is feasible with morbidity and mortality rates similar to those in younger patients. Although age ≥ 70 was shown to be associated with poorer overall outcome, reasonable 5-year survival was observed.