JAMA surgery
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Multicenter Study
Epidural analgesia in laparoscopic colorectal surgery: a nationwide analysis of use and outcomes.
The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes. ⋯ The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.
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Multicenter Study
Processes of care in the multidisciplinary treatment of gastric cancer: results of a RAND/UCLA expert panel.
There is growing interest in reducing the variations and deficiencies in the multidisciplinary management of gastric cancer. ⋯ Patients with GC being treated with curative intent should be considered for multimodal treatment. For patients with incurable disease, surgical interventions should be considered only for the management of major bleeding or obstruction.
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The optimal approach for profiling hospital performance with bariatric surgery is unclear. ⋯ Composite measures are much better at explaining hospital-level variation in serious complications and predicting future performance than other approaches. In this preliminary study, it appears that such composite measures may be better than existing alternatives for profiling hospital performance with bariatric surgery.