Annals of surgery
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Observational Study
Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When and How Well?
To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. ⋯ Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.
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This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio=1.54; 95% CI: 1.12-2.11). ⋯ The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).
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We assessed the Modification of Diet in Renal Disease (MDRD) performance to predict serum creatinine (SCr) in severe trauma population and determined the best theoretical glomerular filtration rate (GFR) to use in this estimation. ⋯ The eSCr75-MDRD equation systematically overestimates oSCr of severe trauma patients. The eSCrTRAUMA-MDRD equation determined was statistically superior allowing more accurate qualification of acute kidney injury.
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The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality. ⋯ Mortality after resections for esophageal, gastric, and pancreatic cancer falls as surgeon volume rises up to 30 cases. Within this range, we did not demonstrate any statistical threshold that could be recommended as a minimum volume target.
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To determine the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare beneficiaries. ⋯ Although several hospital characteristics are associated with lower failure to rescue rates, these macrosystem factors explain a small proportion of the variability between hospitals. This suggests that microsystem characteristics, such as hospital culture and safety climate, may play a larger role in improving a hospital's ability to manage postoperative complications.