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
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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Multicenter Study
Surgical quality surrogates do not predict colon cancer survival in the setting of technical credentialing: a report from the prospective COST trial.
We tested the hypothesis that the 12 lymph node (LN) count and other surgical variables would not predict survival in a setting where surgical techniques were standardized and surgeons were credentialed and audited. ⋯ Despite the known association between LN count and survival, we could not confirm an association between surgical surrogates and cancer outcomes. We postulate that standardization, credentialing, and monitoring may be more important than traditional surgical quality surrogates.
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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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Randomized Controlled Trial Multicenter Study Comparative Study
Ultrasonic dissection versus conventional dissection techniques in pancreatic surgery: a randomized multicentre study.
: This prospective randomized multicenter trial was performed to assess the potential benefits of ultrasonic energy dissection compared with conventional dissection techniques in pancreatic surgery. ⋯ : Tissue dissection and vessel closure using an ultrasonic device is equivalent to dissection with conventional techniques in pancreatic surgery.