Articles: cations.
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Comparative Study
Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective.
Enhanced Recovery After Surgery (ERAS) pathways are known to decrease complications and duration of stay in colorectal surgery patients. However, it is unclear whether an ERAS pathway would be feasible and effective at a safety-net hospital. The aim of this study was to identify local barriers and facilitators before the adoption of an ERAS pathway for patients undergoing colorectal operations at a safety-net hospital. ⋯ Although limited hospital resources are perceived as a barrier to ERAS implementation at a safety-net hospital, there is strong support for such pathways and multiple factors were identified that may facilitate change. Inclusion of patient perspectives is critical to identifying challenges and facilitators to implementing ERAS changes focused on optimizing patient perioperative health and outcomes.
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Randomized Controlled Trial
Improving Escalation of Care: A Double-blinded Randomized Controlled Trial.
This study aimed to determine whether an intervention could improve the escalation of care skills of junior surgeons. ⋯ Teaching junior surgeons a systematic approach to escalation of care improved multiple core skills required to maintain patient safety and avoid preventable harm.
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Comparative Study
The effect of anesthesia type on major lower extremity amputation in functionally impaired elderly patients.
Patients undergoing major lower extremity amputations are at risk for a wide variety of perioperative complications. Elderly patients with any functional impairment have been shown to be at high risk for these adverse events. Our goal was to determine the association between the type of anesthesia-general anesthesia (GA) and regional/spinal anesthesia (RA)-on perioperative outcomes after lower extremity amputation in these elderly and functionally impaired patients. ⋯ The mode of anesthesia, GA vs RA, did not have significant effect on perioperative outcomes after major lower extremity amputation in the functionally impaired geriatric population. These findings provide an evidence base that will allow surgeons, anesthesiologists, and patients to make an informed decision about anesthesia type for their procedure.
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Hospital readmissions after surgical operations are considered serious complications and have an impact on health care-associated costs. The Centers for Medicare and Medicaid Services strongly encourage identification and ramification of factors associated with hospital readmissions after operations. Despite advances in endovascular surgery, lower extremity arterial bypass remains the "gold standard" treatment for severe, symptomatic peripheral arterial disease. The purpose of this study was to retrospectively review the factors associated with hospital readmission after lower extremity bypass surgery. ⋯ Readmission after lower extremity bypass surgery is a serious complication. Various factors put a patient at high risk for readmission. Return to the operating room, wound infection, amputation, deep venous thrombosis, and major reintervention on bypass are independent risk factors for hospital readmission. Return to the operating room is associated with a 5.95-fold increase in hospital readmission.
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To determine the prognostic significance of histologic type/subtype in a large series of patients with primary resected retroperitoneal sarcoma. ⋯ Histologic type/subtype is the most important independent predictor of DSD, LR, and DR in primary retroperitoneal sarcoma. Histology predicts the pattern and incidence of LR and DR and will aid in more accurate patient counseling and selection of patients for adjuvant therapy trials.