Articles: cations.
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Although influence of technical complications in association to hospital length of stay has been studied extensively in esophageal resection, nontechnical factors responsible for prolonged length of stay have not been reported. Using the NSQIP dataset, we hypothesized that we would be able to identify factors associated with prolonged length of stay after esophagectomy. ⋯ Urinary tract infection and pneumonia after esophagectomy are associated with longer hospital stays. Although meticulous surgical technique remains paramount, our study demonstrates that postoperative nontechnical complications factor into prolonged hospital stays. Focus on such factors can lead to reductions in hospital stays.
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The aim of this study was to develop and internally validate a triage score that can identify trauma patients at the scene who would potentially benefit from helicopter emergency medical services (HEMS). ⋯ The AMPT score identifies patients with improved survival following HEMS transport and should be considered in air medical triage protocols.
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Randomized Controlled Trial Comparative Study
Successful Completion of the Pilot Phase of a Randomized Controlled Trial Comparing Sentinel Lymph Node Biopsy to No Further Axillary Staging in Patients with Clinical T1-T2 N0 Breast Cancer and Normal Axillary Ultrasound.
Axillary surgery is not considered therapeutic in patients with clinical T1-T2 N0 breast cancer. The importance of axillary staging is eroding in an era in which tumor biology, as defined by biomarker and gene expression profile, is increasingly important in medical decision making. We hypothesized that axillary ultrasound (AUS) is a noninvasive alternative to sentinel lymph node biopsy (SLNB), and AUS could replace SLNB without compromising patient care. ⋯ Successful completion of the pilot phase of the randomized controlled trial confirms the feasibility of the study design, and provides prospective evidence supporting the ability of AUS to exclude clinically significant disease in the axilla. The results provide strong support for a phase 2 randomized controlled trial.
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Comparative Study
Comparison of 30-Day Postoperative Outcomes after Laparoscopic vs Robotic Colectomy.
The robotic platform has been used increasingly to perform colorectal surgery. The benefits of robotic colectomy when compared with laparoscopic colectomy have not been definitively established. ⋯ In this head-to-head comparison of laparoscopic colectomy and robotic colectomy, the majority of postoperative outcomes were equivalent, except for an increase in operative time and shorter length of stay in the robotic group. Robotic colectomy appears to be a safe option for minimally invasive colectomy, but additional studies are needed to elucidate whether it is cost-effective when compared with laparoscopic colectomy.
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Comparative Study Observational Study
Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy.
In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed by surgery type. ⋯ The protective effects of PEEP are procedure specific with meaningful effects observed in patients undergoing major abdominal surgery. Our data suggest that default mechanical ventilator settings should include PEEP of 5-10 cmH2O during major abdominal surgery.