Langenbeck's archives of surgery
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Langenbecks Arch Surg · Feb 2013
Multicenter StudySurgeons' work ability and performance in surgical care: relations between organisational predictors, work engagement and work ability.
The aim of this study was to examine relations and influences between work-related factors, personal resources, work engagement and work ability of surgeons working in German hospitals. ⋯ The study results reflect the positive effect of supportive working conditions and work engagement on the preservation of work ability, indicating their importance in promoting surgeons' work ability. Due to the elderly population and the continuing development of health care in Germany, the demand for surgeons increases. These circumstances give reasons for a strong need to preserve and restore surgeons' work ability. New strategies for training and improving the capacity and performance of surgeons are necessary.
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Langenbecks Arch Surg · Feb 2013
Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice.
In cases with periampullary tumors, the practice of preoperative biliary drainage (PBD) is still debated without clear uniform indications. Our study focused on resectable cases with an obstructive jaundice candidate for curative surgery. Main endpoints were overall complication and mortality rates between patients treated with and without PBD. ⋯ PBD did not significantly increase the risk of overall postoperative complications, although it was associated to higher rate of biliary infections. PBD was not associated with any advantages in patients with a resectable periampullary lesion by reducing operative morbidity. PBD should be considered in selected patients when surgery has to be delayed.
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Langenbecks Arch Surg · Feb 2013
Clinical practice guidelines (CPGs) reduce costs in the management of isolated splenic injuries at pediatric trauma centers.
The American Pediatric Surgical Association Trauma Committee proposed the use of a clinical practice guideline (CPG) for the non-operative management of isolated splenic injuries in 1998. An analysis was conducted to determine the financial impact of CPGs on the management of these injuries. ⋯ Utilization of a CPG to manage children with isolated splenic injuries at a pediatric trauma center results in significantly reduced imaging, laboratory, and total hospital costs independent of patient age, gender, grade, and LOS.
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Langenbecks Arch Surg · Jan 2013
ReviewFast-track surgery: procedure-specific aspects and future direction.
Fast-track (FT) surgery can be defined as a coordinated perioperative approach aimed at reducing surgical stress and facilitating postoperative recovery. The objective of this review was to examine the literature on the procedure-specific application of FT surgery. ⋯ The concept of FT rehabilitation has been applied mainly in colorectal surgery, but positive data have appeared also in other areas such as orthopedic, hepatopancreaticobiliary, urological, upper gastrointestinal, gynecological, thoracic, vascular, endocrine, breast, and pediatric surgeries. There is very little experience with comprehensive FT programs in cardiac surgery or trauma. Quantitative analysis from randomized trials and cohort studies suggest that FT is effective in reducing hospital stay without increased adverse events. Other benefits of the FT approach include a reduction in complications, ileus, fatigue, pain, and hospital expenses. However, despite clear benefits of FT care, implementation in daily practice has been slow. Further efforts must be undertaken to secure implementation in routine clinical practice. Standardized FT protocols should be provided on a procedure-specific basis.
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Langenbecks Arch Surg · Dec 2012
Deficiency of the oxygen sensor PHD1 augments liver regeneration after partial hepatectomy.
Liver regeneration after partial hepatectomy (PH) occurs in conditions of reduced oxygen supply. HIF prolyl hydroxylase enzymes (PHD1, PHD2, and PHD3) are oxygen sensors involved in adaptive response to hypoxia. Specific functions of these PHD enzymes in liver regeneration have, however, remained enigmatic. Here, we investigated the significance of PHD1 in liver regeneration following hepatectomy. ⋯ Loss of PHD1 enhances liver regeneration by boosting hepatocyte proliferation in a c-Myc-dependent fashion. PHD1 might, therefore, represent a potential target to facilitate liver regeneration after surgical resection.