Annals of surgery
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Multicenter Study Clinical Trial
Surgical quality and nodal ultrastaging is associated with long-term disease-free survival in early colorectal cancer: an analysis of 2 international multicenter prospective trials.
The National Quality Forum has endorsed a minimum of 12 lymph node (LN) as a surrogate measure of quality in colorectal cancer (CRC). The prognostic value of ultrastaging hematoxylin and eosin (H&E) negative LNs (N0) using pan-cytokeratin immunohistochemistry (pan-CK-IHC) is unknown. ⋯ This represents the first prospective report demonstrating that both surgical quality and nodal ultrastaging impacts survival in Stage II CRC. Patients with Stage II CRC having > or =12 LNs negative for micrometastases (N0i-) are likely cured by surgery alone. Both surgical and pathologic quality measures are imperative in early CRC to improve patient selection for adjuvant chemotherapy.
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Multicenter Study
A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics.
To determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery. ⋯ Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI.
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Multicenter Study Comparative Study
Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS bariatric surgery center of excellence program as reported in the Bariatric Outcomes Longitudinal Database.
Small case series suggest bariatric surgery may be an effective treatment for type 2 diabetes mellitus in patients who do not meet body weight criteria for morbid obesity (body mass index [BMI], <35 kg/m), but large multi-institutional series, which allow better assessment of the safety and efficacy of treatment, have not been reported. ⋯ The data suggest early effectiveness of surgical treatment of diabetes in patients who do not meet criteria for morbid obesity. Gastric bypass provides more effective treatment for diabetes than adjustable gastric banding within 6 to 12 months.
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Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly effects patient recovery and hospital resources. ⋯ Hypoalbuminemia is an independent risk factor for the development of SSI following gastrointestinal surgery and is associated with deeper SSI and prolonged inpatient stay.
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Multicenter Study
The association between cost and quality in trauma: is greater spending associated with higher-quality care?
To examine the association between trauma center quality and costs. ⋯ In this study based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, the care of injured patients is less expensive in hospitals with lower risk-adjusted mortality rates. Hospitals with low risk-adjusted mortality rates have adjusted mortality rates that are 34% lower while spending nearly 22% less compared with average-quality hospitals.