Annals of surgery
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Multicenter Study Comparative Study
Composite measures for profiling hospitals on surgical morbidity.
Although risk-adjusted morbidity is widely used as a surgical quality indicator, it may not always be a reliable indicator of hospital quality. In this study, we assess the value of a novel composite measure for improving the reliability of hospital morbidity rankings. ⋯ Composite measures better reflect hospital quality than simple rates of risk-adjusted morbidity. In the context of ACS-NSQIP, composite measures would give hospitals a better sense of where they stand and help identify truly exemplary hospitals for benchmarking.
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Multicenter Study Clinical Trial
Past history of skin infection and risk of surgical site infection after elective surgery.
To identify baseline patient characteristics associated with increased susceptibility to surgical site infection (SSI) after elective surgery. ⋯ A history of skin infection identified a state of enhanced susceptibility to SSI at baseline that is independent of traditional SSI risk factors and adherence to current infection control practices.
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Multicenter Study
Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program.
To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. ⋯ Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than those with normal blood glucoses. Perioperative glucose evaluation and insulin administration in patients with hyperglycemia are important quality targets.
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Randomized Controlled Trial Multicenter Study Comparative Study
A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy.
The aim of the current study was to perform a multicentered prospective double-blinded randomized controlled trial comparing laparoendoscopic single-site access (LESS) versus conventional three-port laparoscopic appendectomy (TPLA). ⋯ LESS and conventional appendectomy resulted in similar perioperative outcomes. However, LESS appendectomy resulted in worst pain scores upon exertion and required a higher dosage of intravenous analgesics when compared with TPLA. On the contrary, wound cosmesis and satisfaction scores were better in the LESS group. Hence, adoption of the technique for appendectomy will depend on patient preferences and the presence of local expertise.
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Multicenter Study Comparative Study
Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair.
To compare laparoscopic ventral hernia repair (LVHR) versus open ventral hernia repair (OVHR) for quality of life (QOL), complications, and recurrence in a large, prospective, multinational study. ⋯ In the largest, prospective QOL study comparing LVHR and OVHR, LVHR is associated with a decrease in QOL in the short term. LOS and infection rates are decreased in LVHR, but overall complication and recurrence rates are equal.