Annals of surgery
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Efforts to implement quality improvements in surgery are notoriously problematic. One needs to look no farther than recent attempts to implement checklists, team training, and surgical briefings. These interventions have been empirically shown to improve team communication and performance. ⋯ The model highlights important variables associated with implementation success. It also provides a tool for diagnosing why certain interventions may not have worked as intended so that improvements in the implementation process can be made. Finally, the model offers a general framework for guiding future implementation or "how to" research.
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Editorial Comment
Best Practices: Targeting Surgeon Communication at the End of Life.
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Multicenter Study Comparative Study Clinical Trial
Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma.
To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. ⋯ The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.
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To study the association between ketorolac use and postoperative complications. ⋯ Use of intravenous ketorolac was associated with greater odds of reintervention, ED visit, and readmission in both colorectal and noncolorectal GI surgery. Given this confirmatory evaluation of other reports of a negative association and the large size of this cohort, clinicians should exercise caution when using ketorolac in patients undergoing GI surgery.
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Randomized Controlled Trial
Structured Training to Improve Nontechnical Performance of Junior Surgical Residents in the Operating Room: A Randomized Controlled Trial.
The objective of the study was to evaluate the effectiveness of structured training on junior trainees' nontechnical performance in an operating room (OR) environment. ⋯ The results demonstrate the effectiveness of structured curricular training in improving nontechnical performance in the first year of surgical residency, supporting routine implementation of nontechnical components in postgraduate surgical curricula.