Archives of surgery (Chicago, Ill. : 1960)
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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.
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Comparative Study
Analysis of compliance and outcomes in a trauma system with a 2-hour transfer rule.
Minimizing time to definitive care in an effort to optimize outcomes is the goal of trauma systems. Toward this end, some systems have imposed standards on time to interfacility transfer. This study evaluates compliance and outcome in a system with a 2-hour transfer rule. ⋯ While the majority of transfers occur at greater than the mandated 2-hour interval, the most seriously injured patients are reaching definitive care within 2 hours. Markers of acuity for patients transferred at greater than 2 hours parallel those of the general trauma patient population. These data suggest that, in this system, provider-determined transfer time that exceeds 2 hours has no adverse effect on patient outcome. It appears to accomplish recognition and rapid transport of the most seriously ill. This may obviate the need for onerous system mandates that are not feasible or have poor compliance.