Archives of surgery (Chicago, Ill. : 1960)
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Review Meta Analysis Comparative Study
Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis.
To determine whether interventional radiology (IR) or laparotomy (LAP) is the best management of delayed postoperative hemorrhage (DPH) after pancreaticoduodenectomy. Data Source We undertook an electronic search of MEDLINE and selected for analysis only original articles published between January 1, 1990, and December 31, 2007. ⋯ This meta-analysis, although based on data from small case series, is unable to demonstrate any significant difference between LAP and IR in the management of DPH after pancreaticoduodenectomy. The management of this life-threatening complication is difficult, and the appropriate treatment pathway ultimately will be decided by the clinical status of the patient and the institution preference.
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Randomized Controlled Trial Comparative Study
Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial.
To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. ⋯ The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. Trial Registration trialregister.nl Identifier: 56264738.
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Review Meta Analysis
Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis.
To review the impact of epidural vs systemic analgesia on postoperative pulmonary complications. ⋯ Epidural analgesia protects against pneumonia following abdominal or thoracic surgery, although this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.
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Comparative Study
Race and insurance status as risk factors for trauma mortality.
To determine the effect of race and insurance status on trauma mortality. ⋯ Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.
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Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage. ⋯ The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.