Annals of surgery
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Randomized Controlled Trial Multicenter Study
Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus.
To identify clinical hallmarks associated with recovery of gastrointestinal transit. ⋯ Our data indicate that the time to SF + D best reflects recovery of gastrointestinal transit and therefore should be considered as primary outcome measure in future clinical trials on postoperative ileus.(Netherlands National Trial Register, number NTR1884 and NTR222).
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Review Comparative Study
A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery.
To perform a systematic review of economic evaluations of enhanced recovery pathways (ERP) for colorectal surgery. ⋯ The quality of the current evidence is limited but tends to support the cost-effectiveness of ERP. There is need for well-designed trials to determine the cost-effectiveness of ERP from both the institutional and societal perspectives.
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Evolution has molded metabolic thrift within humans, a genetic heritage that, when thrust into our modern "obesogenic" environment, creates the current obesity crisis. Modern genetic analysis has identified genetic and epigenetic contributors to obesity, an understanding of which will guide the development of environmental, pharmacologic, and genetic therapeutic interventions.
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We sought to determine whether the changes in incentive design in phase 2 of Medicare's flagship pay-for-performance program, the Premier Hospital Quality Incentive Demonstration (HQID), reduced surgical mortality or complication rates at participating hospitals. ⋯ Despite recent enhancements to incentive structures, the Premier HQID did not improve surgical outcomes at participating hospitals. Unless significantly redesigned, pay-for-performance may not be a successful strategy to improve outcomes in surgery.
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To explore whether trauma center quality metrics based on historical data can reliably predict future trauma center performance. ⋯ Trauma center quality based on historical data is associated with subsequent patient outcomes. Patients currently admitted to trauma centers that are classified as low-quality centers using 2- to 5-year-old data are more likely to die than patients admitted to high-quality centers. However, although the future performance of individual trauma centers can be predicted using performance metrics based on 2-year-old data, the performance of individual centers cannot be predicted using data that are 3 years or older.