Archives of surgery (Chicago, Ill. : 1960)
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Randomized Controlled Trial Comparative Study
Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial.
To determine if an evidence-based practice bundle would result in a significantly lower rate of surgical site infections (SSIs) when compared with standard practice. ⋯ An evidence-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.
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Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients. ⋯ Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.
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To determine whether timing of clopidogrel bisulfate cessation influences outcome after abdominal operations. ⋯ While clopidogrel use within 7 days of an operation significantly increased the risk of postoperative bleeding, most bleeding episodes were successfully managed by transfusion without an increase in bleeding-related mortality or necessity for reoperation. After controlling for operative urgency, no significant difference in mortality or intensive care unit admission was demonstrated in patients undergoing elective procedures. High-risk patients undergoing elective operations may not require preoperative clopidogrel cessation. When clopidogrel cessation is warranted, 7 days before the procedure is recommended. Perioperative risk does not vary by timing of cessation within 7 days of an operation.
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Comparative Study
Airway pressure release ventilation and successful lung donation.
Donor management with airway pressure release ventilation (APRV) improves oxygenation and increases lung donation while maintaining equivalent graft survival. ⋯ The use of APRV prior to procurement may increase the rate of successful lung donation.
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Robotic-assisted pancreatic resection and reconstruction are safe and can reproduce perioperative results seen in open surgery. ⋯ Robotic-assisted complex pancreatic surgery can be performed safely in a high-volume pancreatic tertiary care center with perioperative outcomes comparable to those of open surgery. Advances in robotic technology and increasing experience may improve long operative times.