Archives of surgery (Chicago, Ill. : 1960)
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Multicenter Study Comparative Study Observational Study
Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program hospitals: effect of operative approach and hospital-level variation.
When assessing the effect of operative approach on outcomes, it may be less relevant whether a transhiatal or an Ivor Lewis esophagectomy was performed and may be more important to focus on patient selection and the quality of the hospital performing the operation. ⋯ Compared with transhiatal dissection, Ivor Lewis esophagectomy did not result in worse postoperative complications. After controlling for case-mix, hospital performance varied widely for all outcomes assessed, indicating that reductions in short-term outcomes will likely result from expanding other aspects of hospital quality beyond a focus on specific technical maneuvers.
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Multicenter Study
Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief.
To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP). ⋯ The timing of surgery is an important risk factor for clinical outcome in CP. Surgery may need to be considered at an earlier phase than it is now, preferably within 3 years of symptomatic CP. Likelihood of postoperative pain relief can be calculated on an individual basis using the presented nomogram.
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Multicenter Study
Improving outcomes after gastroesophageal cancer resection: can Japanese results be reproduced in Western centers?
Extended lymphadenectomy in gastroesphageal cancer leads to improved long-term survival without compromising postoperative outcomes in Western patients to attain the standard achieved in Japanese centers. ⋯ This study demonstrates that postoperative outcomes and long-term survival after gastroesophageal cancer resection can be improved in Western patients to the highest standard achieved in Japan.
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Randomized Controlled Trial Multicenter Study
Influence of rescrubbing before laparotomy closure on abdominal wound infection after colorectal cancer surgery: results of a multicenter randomized clinical trial.
To test the hypothesis that strict asepsis in closing wounds following laparotomy reduces the risk for surgical wound infection in elective colorectal cancer surgery. ⋯ This study does not support the use of rescrubbing to reduce the incidence of incisional surgical site infection.
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Multicenter Study Comparative Study
Comparison of hospital performance in trauma vs emergency and elective general surgery: implications for acute care surgery quality improvement.
As emergency general surgery (EMGS) and trauma care are increasingly being provided by the same personnel with overlapping resources, we postulated that the quality of care provided to EMGS and trauma patients would be similar. We also evaluated the relationship between trauma and elective general surgery (ELGS) care, believing that performance would be similar across these services as it reflects institutional culture. ⋯ Trauma performance improvement programs are well established compared with those for EMGS. Although EMGS patients use similar structures and processes as trauma patients, there is a lack of correlation between the quality of care provided to trauma and EMGS patients; EMGS should be incorporated into trauma performance improvement programs.