Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Nighttime intensivist staffing: is there evidence for a need?
Postoperative critical care provided by critical care specialists, or intensivists, improves outcomes after surgery. Although there are data supporting daytime intensivist coverage in the intensive care unit, it is not clear how nighttime specialist coverage impacts the quality of care or outcomes. Many surgical intensive care units have adopted continuous 24-hour critical care coverage. Here, we highlight an important study by Wallace and colleagues that reports the impact of nighttime intensivist staffing on outcomes in critically ill patients.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Cerebral protection for aortic arch surgery: mild hypothermia with selective cerebral perfusion.
Historically, reconstruction of the aortic arch has been exclusively performed during deep hypothermic circulatory arrest. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of perfusion and extending the safe limits for arch repair. ⋯ To our best knowledge we have been one of the pioneering centers to start such an aggressive temperature management in aortic arch surgery back in 2000. To date 426 patients underwent aortic arch replacement in our unit employing the standardized surgical protocol described herein.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
What is the optimal interval between chemoradiation and esophagectomy?
Locally advanced esophageal cancer requires multimodality therapy-most commonly induction chemoradiation followed by esophagectomy. There is a paucity of literature on the optimal time interval between induction treatment and resection. Patient readiness and healthy tissue, as well as tumor responses to radiation, are factors to consider. Two recent retrospective large-center studies on this topic are reviewed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
ReviewLung cancer resection volume: is procedure volume really an indicator of quality?
The majority of lung cancer resection studies indicate that hospital and surgeon procedure volume are inversely associated with mortality. It makes intuitive sense that performing large numbers of these procedures leads to better outcomes. ⋯ This review will examine the methodology used in the volume-outcome relationship literature and highlight important areas of concern. Careful examination of the literature demonstrates that lung cancer resection volume is not strongly associated with mortality and should not be used as a proxy measure for quality.