Journal of the American College of Surgeons
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Comparative Study Observational Study
Standardizing a control group for comparing open with laparoscopic major liver resection in observational studies: reducing the need for correction of clinical heterogeneity.
The results of comparative observational trials of liver resections can be problematic because of the large number of covariates that need to be balanced by complex statistical methods. Our purpose was to examine a cohort of patients whose outcomes were specifically representative of a major open hepatectomy, therefore reducing the number of covariates requiring statistical correction in future comparative observational trials. ⋯ This study displays results for a cohort of patients who are specifically reflective of a major open liver resection. Use of NSQIP data allows rigorous collection of complication data in a quantifiable manner. This methodology should facilitate comparative observational trials using laparoscopic techniques by reducing the need for statistical correction of unbalanced covariates.
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Quality improvement in colorectal surgery (CRS) requires implementation of tools to improve patient and financial outcomes, and assessment of results. Our objective was to evaluate the durability of transversus abdominis plane (TAP) blocks and a standardized enhanced recovery protocol (ERP) on a large series of laparoscopic colorectal resections. ⋯ Adding TAP blocks to an ERP facilitated shorter LOS with low readmission and reoperation rates when compared to previously published series. The effect appears durable and consistent in a large case series. Transversus abdominis plane blocks may be an efficient, cost-effective method for improving laparoscopic CRS results.