Archives of surgery (Chicago, Ill. : 1960)
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Comparative Study
Provider density and health system facility factors and their relationship to rates of pediatric perforated appendicitis in US counties.
To examine whether density of providers or health care facility factors have a significant effect on the rates of perforated appendicitis in the pediatric population. ⋯ Increasing geographic density of pediatricians was associated with a decreasing trend in the odds ratio of perforated appendicitis, with a statistically significant protective effect observed in the highest-density quartile of pediatricians. The density of all other provider and health care facility factors analyzed did not demonstrate a significant association with the rates of perforated appendicitis.
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Comparative Study
Working with a fixed operating room team on consecutive similar cases and the effect on case duration and turnover time.
If variation in procedure times could be controlled or better predicted, the cost of surgeries could be reduced through improved scheduling of surgical resources. This study on the impact of similar consecutive cases on the turnover, surgical, and procedure times tests the perception that repeating the same manual tasks reduces the duration of these tasks. We hypothesize that when a fixed team works on similar consecutive cases the result will be shorter turnover and procedure duration as well as less variation as compared with the situation without a fixed team. ⋯ Scheduling similar consecutive cases and performing with a fixed team results in lower turnover times and preparation times. The procedure time of the inguinal hernia repair decreased significantly and has practical scheduling implications. For more complex surgery, like laparoscopic cholecystectomy, there is no effect on procedure time.
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Randomized Controlled Trial Comparative Study
Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial.
To compare the influence of 2 volumes of fluid, integrated with goal-directed fluid therapy, on hypovolemia (a key trigger of tissue hypoperfusion) and central venous oxygen saturation (Scvo₂) and to assess their relationships with postoperative morbidity. ⋯ Excessive fluid restriction increased the level of hypovolemia, leading to reduced Scvo₂ and thereby increased incidence of postoperative complications. Excessive fluid restriction should be applied cautiously in surgical patients.
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Comparative Study
Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma.
To determine whether controlling for differences in the use of invasive therapy affects racial/ethnic differences in survival of early-stage hepatocellular carcinoma (HCC). ⋯ For early-stage HCC, racial/ethnic disparities in survival between minority and white patients are notable. After accounting for differences in stage, use of invasive therapy, and treatment benefit, no racial/ethnic survival disparity is evident between Hispanics and whites, but blacks have persistently poor survival.