Langenbeck's archives of surgery
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Langenbecks Arch Surg · Aug 2012
Randomized Controlled Trial Comparative StudyEarly tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study.
Long-term ventilation in intensive care units (ICUs) is associated with several problems such as increased mortality, increased rates of ventilator-associated pneumonia (VAP), and prolonged time of hospitalization, and thus leads to enormous healthcare expenditure. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalization has already been analyzed in several studies, the timing of the tracheostomy procedure on patient's mortality is still controversial. The aim of our study was to investigate whether early tracheostomy improved outcome in critically ill patients. ⋯ Despite many advantages like reduced time of ventilation and hospitalization, early tracheostomy is not associated with decreased mortality in critically ill patients.
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Langenbecks Arch Surg · Aug 2012
Comparative StudyOutcome in patients with long-term treatment in a surgical intensive care unit.
This study aimed to evaluate the outcome of patients with abdominal, thoracic or vascular operations and long-term intensive care unit (ICU) treatment. ⋯ Patients with long-term ICU stay showed decreased survival than patients who are treated less than 5 days but similar survival as patients which stayed between 5 and 19 days. Malignant disease is not associated with an unfavourable 12-month survival while older age, higher SAPS index at discharge and longer stay at ICU are. Long-term ICU survivors have no increased risk to succumb after discharge from ICU.
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Langenbecks Arch Surg · Aug 2012
Comparative StudyCan the new RCP R0/R1 classification predict the clinical outcome in ductal adenocarcinoma of the pancreatic head?
According to the International Union Against Cancer (UICC), R1 is defined as the microscopic presence of tumor cells at the surface of the resection margin (RM). In contrast, the Royal College of Pathologists (RCP) suggested to declare R1 already when tumor cells are found within 1 mm of the RM. The aim of this study was to determine the significance of the RM concerning the prognosis of pancreatic ductal adenocarcinoma (PDAC). ⋯ Our study has shown that the RCP suggestion for R status has no impact on the prognosis of PDAC. In contrast, our data confirmed the UICC R classification of RM as well as N category, grading, and lymph node ratio as significant prognostic factors.
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Langenbecks Arch Surg · Aug 2012
Comparative StudyImproving quality of medical treatment and care: are surgeons' working conditions and job satisfaction associated to patient satisfaction?
Over the last decades, surgeons, researchers, and health administrators have been working hard to define standards for high-quality treatment and care in Surgery departments. However, it is unclear whether patients' perceptions of medical treatment and care are related and affected by surgeons' perceptions of their working conditions and job satisfaction. The aim of this study was to evaluate patients' satisfaction in relation to surgeons' working conditions. ⋯ This study demonstrates strong associations between surgeons' working conditions and patient satisfaction. Based on these findings, hospital managements should improve work organization, workload, and job resources to not only improve surgeons' job satisfaction but also quality of medical treatment and patient satisfaction in Surgery departments.
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Langenbecks Arch Surg · Jun 2012
Comparative StudySafe management of anastomotic leakage after gastric cancer surgery with enteral nutrition via a nasointestinal tube.
Anastomotic leakage is a serious complication after gastric cancer surgery. Despite the superiority of enteral nutrition (EN), total parenteral nutrition (PN) remains the standard therapy for anastomotic leakage. After introduction of EN via a nasointestinal tube for patients with anastomotic leakage in our institution in 2006, standard nutritional therapy was shifted gradually from PN to EN. The present preliminary study evaluates the safety and feasibility of EN via a nasointestinal tube for anastomotic leakage after gastric cancer surgery. ⋯ Nasointestinal tube insertion with EN can be performed safely for patients with anastomotic leakage. A major advantage of EN is fewer infectious complications. Because EN was not inferior to PN in terms of clinical outcome, we recommended that it is used in patients with anastomotic leakage after gastric cancer surgery.