The British journal of surgery
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Multicenter Study Observational Study
Preoperative oral care and effect on postoperative complications after major cancer surgery.
Improving patients' oral hygiene is an option for preventing postoperative pneumonia that may be caused by aspiration of oral and pharyngeal secretions. Whether preoperative oral care by a dentist can decrease postoperative complications remains controversial. A retrospective cohort study was undertaken to assess the association between preoperative oral care and postoperative complications among patients who underwent major cancer surgery. ⋯ Preoperative oral care by a dentist significantly reduced postoperative complications in patients who underwent cancer surgery.
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Multicenter Study
Best-practice care pathway for improving management of mastitis and breast abscess.
Surgical subspecialization has resulted in mastitis and breast abscesses being managed with unnecessary admission to hospital, prolonged inpatient stay, variable antibiotic prescribing, incision and drainage rather than percutaneous aspiration, and loss to specialist follow-up. The objective was to evaluate a best-practice algorithm with the aim of improving management of mastitis and breast abscesses across a multisite NHS Trust. The focus was on uniformity of antibiotic prescribing, ultrasound assessment, admission rates, length of hospital stay, intervention by aspiration or incision and drainage, and specialist follow-up. ⋯ A standardized approach to mastitis and breast abscess reduced undesirable practice variation, with sustained improvements in process and patient outcomes.
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Pragmatic Clinical Trial
Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections.
Surgical-site infection (SSI) is associated with significant healthcare costs. To reduce the high rate of SSI among patients undergoing colorectal surgery at a cancer centre, a comprehensive care bundle was implemented and its efficacy tested. ⋯ Meaningful reductions in SSI can be achieved by implementing a multidisciplinary care bundle at a hospital-wide level.
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Indications for surgical resection of non-colorectal, non-neuroendocrine (NCNNE) liver metastases are unclear. This study analysed the influence of response to neoadjuvant chemotherapy and the presence of extrahepatic disease (EHD) on outcomes. ⋯ The prognosis of patients with NCNNE liver metastases is influenced by preoperative chemotherapy and resectability.
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After neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here. ⋯ Patients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.