Annals of surgery
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To determine whether skills acquired by simulation-based training transfer to the operative setting. ⋯ Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs.
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The aim is to discuss the various forms of bias in surgical research, including how it impacts validity and how to recognize and avoid it. ⋯ Familiarity with clinical trials' potential biases helps surgeons assess the believability and applicability of research results. Though these biases may sometimes be ameliorated by randomization, blinding, and intervention standardization, these remedies can present distinctive problems to surgical research. This poses a unique need and opportunity for innovation in surgical research design and evaluation. It necessitates that further research be done on methods to improve not only the internal and external validity of surgical trials but also their assessment.
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Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. ⋯ Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity, and should therefore be more widely adopted. Further improvement is expected by future integration of minimal invasive surgery, pharmacological stress-reduction, and effective multimodal, nonopioid analgesia.
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Comparative Study
Weight loss outcome of revisional bariatric operations varies according to the primary procedure.
Revisional bariatric operations performed for weight loss failure are frequently associated with inconsistent weight reduction and serious perioperative complications. ⋯ Weight loss after revision of pure restrictive operations is significantly better than after revision of operations with malabsorptive components. Improvement of comorbidities in the great majority of patients justifies revision of all types of bariatric operations for unsatisfactory weight loss.
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The Veterans Affairs' (VA) National Surgical Quality Improvement Program (NSQIP) has been associated with significant reductions in postoperative morbidity and mortality. We sought to determine if NSQIP methods and risk models were applicable to private sector (PS) hospitals and if implementation of the NSQIP in the PS would be associated with reductions in adverse postoperative outcomes. ⋯ The VA NSQIP methods and risk models in general and vascular surgery were fully applicable to PS hospitals. Thirty-day postoperative morbidity in PS hospitals was reduced with the implementation of the NSQIP.