The British journal of surgery
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Review Meta Analysis
Systematic review and meta-analysis of enhanced recovery programmes in surgical patients.
Enhanced recovery programmes (ERPs) have been developed over the past 10 years to improve patient outcomes and to accelerate recovery after surgery. The existing literature focuses on specific specialties, mainly colorectal surgery. The aim of this review was to investigate whether the effect of ERPs on patient outcomes varies across surgical specialties or with the design of individual programmes. ⋯ ERPs are effective in reducing length of hospital stay and overall complication rates across surgical specialties. It was not possible to identify individual components that improved outcome. Qualitative synthesis may be more appropriate to investigate the determinants of success.
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Comparative Study
Quality of life and other patient-reported outcomes following exenteration for pelvic malignancy.
Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant patient-reported outcomes over 12 months for patients who did and those who did not undergo pelvic exenteration. ⋯ Quality of life and related patient-reported outcomes improve rapidly after pelvic exenteration surgery. For 9 months after surgery, these outcomes are comparable with those of similar do patients who do not have surgery; thereafter, there is a decline in patients who do not have exenteration. Pelvic exenteration can be performed with acceptable quality of life and patient-reported outcomes.
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The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a well validated model for the prediction of perioperative mortality and morbidity with application to surgery and intensive care medicine. The outcome measure calculations are time-consuming, complex and potentially error-prone. Nomograms are low-cost easy-to-use graphic devices that can be used to make repeated calculations to an acceptable level of accuracy for most clinical purposes. This paper describes a nomogram to aid calculation of POSSUM scores. ⋯ The nomogram provides a rapid, accurate, low-cost means of performing, visualizing and cross-checking POSSUM calculations.
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Hyaluronic acid (HA) probably plays a critical role in tumorigenesis. The clinical significance of serum HA concentration in patients with hepatocellular carcinoma (HCC) remains to be elucidated. This study analysed the relationship between preoperative serum HA levels and prognosis after hepatic resection in patients with HCC. ⋯ High preoperative serum HA levels predict poor prognosis in patients with HCC after hepatic resection, and may serve as a future biomarker.