Annals of surgery
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To develop a method of evaluating trauma center mortality that addresses the limitations of currently available methodology-Standardized Mortality Ratios (SMRs) based on the Trauma and Injury Severity Score. ⋯ The proposed method of trauma center profiling offers comprehensive adjustment for patient-level risk factors and consideration of transfer status, is based on comparisons to an internal standard, accounts for inter- and intrahospital variation, and replaces SMRs with estimates of regression-adjusted mortality that are comparable across hospitals. TRAM-adjusted mortality estimates can be used to describe institutional outcome performance and to identify institutional outliers. Such information is the key to identifying ways to improve the quality of modern trauma care.
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Randomized Controlled Trial Comparative Study
Renal function and abdominal aortic aneurysm (AAA): the impact of different management strategies on long-term renal function in the UK EndoVascular Aneurysm Repair (EVAR) Trials.
To investigate the impact of different management policies on renal function in patients with abdominal aortic aneurysm. ⋯ In these patients deterioration in renal function was slow, with little evidence to suggest any long-term difference between treatment with EVAR or open repair in fit patients or between EVAR and no intervention in unfit patients. Graft complications and larger neck diameters appear to be associated with faster renal function decline.
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Review Meta Analysis
Elective midline laparotomy closure: the INLINE systematic review and meta-analysis.
To evaluate the optimal technique and material for abdominal fascia closure after midline laparotomy, first by means of a precisely defined study population and follow-up period and second by the surgically driven aspects. ⋯ No further trials should be conducted for evaluation of technique and available materials for elective midline abdominal fascial closure, according to the results of our cumulative meta-analysis. Future trials will have to define the optimal closure strategy in the emergency setting and relevance of new suture materials and other strategies such as the use of prophylactic mesh in targeted subpopulations.
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Multicenter Study
Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.
To assess whether implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent surgical cases would improve compliance with basic standards of care and reduce rates of deaths and complications. ⋯ Implementation of the checklist was associated with a greater than one-third reduction in complications among adult patients undergoing urgent noncardiac surgery in a diverse group of hospitals. Use of the WHO Surgical Safety Checklist in urgent operations is feasible and should be considered.
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This systematic review was designed to determine postoperative complication rates of radical surgery for rectal cancer (abdominal perineal resection and anterior resection). ⋯ Benchmark complication rates for radical rectal cancer surgery were obtained for use in sample size calculations in future studies and for quality control purposes. Postoperative death rates showed improvement in recent years.