Annals of surgery
-
Meta Analysis
Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients.
To assess the predictive value of C-reactive protein (CRP) level for postoperative infectious complications after colorectal surgery. ⋯ This diagnostic meta-analysis of 1832 patients--the first in the literature--provides compelling evidence that C-reactive protein on postoperative day 4 has a high negative predictive value for infectious complications of 89%. Therefore, CRP measurement allows safe and early discharge of selected patients after colorectal surgery.
-
To understand the etiology and resolution of unanticipated events in the operating room (OR). ⋯ Unanticipated events are common in the OR. Deviations result from poor organizational/environmental design and suboptimal team dynamics, with caregivers compensating to avoid patient harm. Although recognized in other high-risk domains, such human resilience has not yet been described in surgery and has major implications for the design of safety interventions.
-
To evaluate the prognostic and predictive relevance of pretreatment serum C-reactive protein (CRP) in malignant pleural mesothelioma (MPM) patients. ⋯ Our results suggest that multimodality regimens including radical resection increase survival selectively in MPM patients with normal pretreatment serum CRP levels.
-
Randomized Controlled Trial
Prospective, randomized assessment of the acquisition, maintenance, and loss of laparoscopic skills.
Laparoscopic skills are difficult to learn. We, therefore, assessed the factors involved in skill acquisition, maintenance, and loss in 2 prospective, randomized studies. ⋯ Laparoscopic skills are optimally acquired on an Interval training schedule. They significantly decline with 2 weeks of nonuse.
-
To establish the incidence and predictive factors of enterotomy made during adhesiolysis in abdominal wall repair and to assess the impact of enterotomies and long-lasting adhesiolysis on postoperative morbidity such as sepsis, wound infection, abdominal complications and pneumonia, and socioeconomic costs. ⋯ One in 8 patients undergoing abdominal wall repair suffer inadvertent enterotomy following adhesiolysis. Adhesiolysis time predicts enterotomy. Morbidity in patients with extensive adhesiolysis and adhesiolysis complicated by enterotomy is high, inducing longer hospital stay and increased health care utilization.