The British journal of surgery
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There is significant variation in the mortality rates of patients with a ruptured abdominal aortic aneurysm (rAAA) admitted to hospital in England. This study sought to investigate whether modifiable differences in hospital structures and processes were associated with differences in patient outcome. ⋯ The variability in rAAA outcome in English National Health Service hospital Trusts is associated with modifiable hospital resources. Such information should be used to inform any proposed quality improvement programme surrounding rAAA.
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Endocrine therapy alone has been a popular treatment for oestrogen receptor-positive breast cancer in elderly patients, although it may be inadequate in those surviving more than 2-3 years. The aim of this study was to estimate 3-year survival in frail patients with early breast cancer, to inform treatment decisions. ⋯ Detailed assessment can allow prediction of survival probability in frail elderly patients. Good scores indicate good survival prospects and a likely benefit from surgery; poor scores are associated with reduced survival, although with wide variation. CGA is recommended before making decisions on best treatment.
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Review Meta Analysis
Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma.
Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT. ⋯ A significant proportion of patients who undergo lower extremity vascular trauma repair will require secondary amputation. This meta-analysis describes significant prognostic factors needed to inform surgical judgement, risk assessment and patient counselling.
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Randomized Controlled Trial Multicenter Study Comparative Study
Randomized clinical trial of skin closure by subcuticular suture or skin stapling after elective colorectal cancer surgery.
The best suture method to prevent incisional surgical-site infection (SSI) after clean-contaminated surgery has not been clarified. ⋯ UMIN000004001 (http://www.umin.ac.jp/ctr).
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Randomized Controlled Trial Comparative Study
Randomized double-blind trial comparing the cosmetic outcome of cutting diathermy versus scalpel for skin incisions.
Controversy exists about whether cutting diathermy for skin incisions leads to a cosmetically inferior scar. Cosmetic outcomes were compared between skin incisions created with cutting diathermy versus scalpel. Wound infection rates and postoperative incisional pain were also compared. ⋯ NCT01496404 ( http://www.clinicaltrials.gov).