Annals of surgery
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Randomized Controlled Trial Multicenter Study
Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial.
To determine whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications. ⋯ Perioperative smoking cessation seems to be an effective tool to reduce postoperative complications even if it is introduced as late as 4 weeks before surgery.
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Multicenter Study
Surgeon volume does not predict outcomes in the setting of technical credentialing: results from a randomized trial in colon cancer.
To test the hypothesis that surgeon volume would not predict short- and long-term outcomes when evaluated in the setting of technical credentialing. ⋯ When tested in a randomized controlled trial with case-specific surgical technical credentialing and auditing, surgeon volume did not predict differences in rates of conversion, complications, or long-term cancer outcomes. Case-specific technical credentialing should be further studied specific to the role it could play in creating consistent, high quality outcomes.
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Comment Multicenter Study
Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery.
To evaluate whether operating room (OR) ventilation with (vertical) laminar airflow impacts on surgical site infection (SSI) rates. ⋯ Unexpectedly, in this analysis, which controlled for many patient and hospital-based confounders, OR ventilation with laminar airflow showed no benefit and was even associated with a significantly higher risk for severe SSI after hip prosthesis.
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Multicenter Study
Racial disparity in the relationship between hospital volume and mortality among patients undergoing coronary artery bypass grafting.
To examine whether the volume-mortality relationship in coronary artery bypass grafting (CABG) differs by race and operative risk. ⋯ Blacks have greater reduction in mortality than whites by undergoing CABG at higher-volume hospitals, regardless of operative risk. Because of limited generalizability, these findings should be confirmed using more representative database.
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Randomized Controlled Trial Multicenter Study Comparative Study
A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.
To compare outcomes with early corticosteroid withdrawal (CSWD) and chronic low dose corticosteroid therapy (CCS). ⋯ Early CSWD, compared with CCS, is associated with an increase in BCAR primarily because of mild, Banff 1A, steroid-sensitive rejection, yet provides similar long-term renal allograft survival and function. CSWD provides improvements in cardiovascular risk factors (triglycerides, NODAT requiring insulin, weight gain). Tacrolimus/MMF/antibody induction therapy allows early CSWD with results comparable to long-term low dose (5 mg/d) prednisone therapy.