Annals of surgery
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Randomized Controlled Trial Multicenter Study
Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressings versus coverage with a sterile circular polyethylene drape for prevention of surgical site infections: a CHIR-Net trial (BaFO; NCT01181206).
To determine whether circular plastic wound edge protectors (CWEPs) significantly reduce the rate of surgical site infections (SSIs) in comparison to standard surgical towels in patients undergoing laparotomy. ⋯ Our trial shows that CWEPs are effective at reducing the incidence of SSIs in elective and clean or clean-contaminated open abdominal surgery.
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Multicenter Study Comparative Study
A partnership model between high- and low-volume hospitals to improve results in hepatobiliary pancreatic surgery.
To optimize the results of low-volume (LV) centers for hepatopancreaticobiliary (HPB) surgery. ⋯ Our partnership model helped improve postoperative outcomes at the LV center. Results at the LV hospital were comparable with the HV centers, although 2 years of partnership were required to achieve this in pancreatic surgery.
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Synthesize the findings from individual qualitative studies about surgeons' account of their practice. ⋯ Surgeons' emphasis on technical aspects, individuality, and performance seems to impede a modern patient-centered approach to care and to act as a barrier to well-being. Our findings suggest that taking into account the relational and emotional dimensions of surgical practice (both with patients and within the institution) might improve surgical innovation, surgeons' well-being, and the attractiveness of this specialty.
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To study new-onset postoperative atrial fibrillation in patients with esophageal and junctional cancer. ⋯ A total of 473 patients (mean age: 63 years; 73% male) underwent resection, 51% 2-stage, 18% 3-stage, 12% transhiatal, and 19% extended total gastrectomy. Ninety-six (20%) patients developed new-onset AF, in 18%, 27%, 29%, and 14% of 2-, 3-, transhiatal, and extended total gastrectomy cohorts, respectively (P=0.05). Age, diabetes, neoadjuvant therapy, and cardiac history predisposed (P<0.05) to AF, and AF was significantly (P<0.0001) associated with pneumonia, pleural effusions requiring drainage, and maximum postoperative C-reactive protein (CRP) (P<0.05) but not with anastomotic leak/conduit necrosis or mortality. Amiodarone was the primary treatment in 63% of cases, 1% underwent cardioversion, and 92% were in sinus rhythm on discharge. At a median follow-up of 40 months (7-109 months), the median survival was 40 months versus 53 months in the AF and non-AF cohorts, respectively (P=0.353) CONCLUSIONS: New-onset AF is common, linked to age, diabetes, cardiac disease, and neoadjuvant therapy. It is strongly associated with complications, principally respiratory sepsis, and systemic inflammation. For most, it resolves, with no impact on oncologic outcomes.
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Randomized Controlled Trial Multicenter Study
Effectiveness of regional hyperthermia with chemotherapy for high-risk retroperitoneal and abdominal soft-tissue sarcoma after complete surgical resection: a subgroup analysis of a randomized phase-III multicenter study.
To determine whether regional hyperthermia (RHT) in addition to chemotherapy improves local tumor control after macroscopically complete resection of abdominal or retroperitoneal high-risk sarcomas. ⋯ In patients with macroscopically complete tumor resection, RHT in addition to chemotherapy resulted in significantly improved local tumor control and DFS without increasing surgical complications. Within a multimodal therapeutic concept for abdominal and retroperitoneal high-risk sarcomas, RHT is a treatment option beside radical surgery and should be further evaluated in future trials.