Annals of surgery
-
We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR. ⋯ Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
-
Meta Analysis
Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials.
Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. ⋯ Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
-
Establish whether POCD is associated with new disability after surgery, which would inform whether POCD impacts patient-centered outcomes. ⋯ Patients with POCD experience a much higher incidence of new disability after surgery. Baseline cognitive or functional limitations are also risk factors for new disability. Many patients are not aware of their limitations before surgery. Future study is needed to identify practical ways to routinely screen patients and reduce risk. Patients need to be informed of their risk for new disability after surgery to inform their medical decision making.
-
We sought to measure the extent of variation in episode spending around total hip replacement within and across hospital systems. ⋯ Given the wide variation in surgical spending within health systems, we propose tailored strategies for systems to maximize savings in bundled payment programs.