Annals of surgery
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Multicenter Study
The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery.
The added value of a preoperative electrocardiogram (ECG) in the prediction of postoperative myocardial infarction (POMI) and death was compared with clinical risk factors identified from the patient's history. ⋯ Bundle branch blocks identified on the preoperative ECG were related to POMI and death but did not improve prediction beyond risk factors identified on patient history.
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Multicenter Study
National failure to operate on early stage pancreatic cancer.
Despite studies demonstrating improved outcomes, pessimism persists regarding the effectiveness of surgery for pancreatic cancer. Our objective was to evaluate utilization of surgery in early stage disease and identify factors predicting failure to undergo surgery. ⋯ This is the first study to characterize the striking underuse of pancreatectomy in the United States. Of early stage pancreatic cancer patients without any identifiable contraindications, 38.2% failed to undergo surgery.
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Randomized Controlled Trial Multicenter Study
Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial.
To characterize the beneficial effects of perioperative systemic lidocaine on length of hospital stay, gastrointestinal motility, and the inflammatory response after colorectal surgery. ⋯ Perioperative intravenous lidocaine not only improved gastrointestinal motility but also shortened length of hospital stay significantly. Anti-inflammatory activity modulating the surgery-induced stress response may be one potential mechanism. Systemic lidocaine may thus provide a convenient and inexpensive approach to improve outcome for patients not suitable for epidural anesthesia.
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Randomized Controlled Trial Multicenter Study
Risk factors for adverse outcome in patients with rectal cancer treated with an abdominoperineal resection in the total mesorectal excision trial.
This study was performed to identify tumor- and patient-related risk factors for distal rectal cancer in patients treated with an abdominoperineal resection (APR) associated with positive circumferential resection margin (CRM), local recurrence (LR), and overall survival (OS). ⋯ Age, T-stage, N-stage, CRM, distance of the tumor to the anal verge, and tumor location were independent risk factors for adverse outcome in patients treated with an APR for low rectal cancer. Anterior location, specifically in women, more often requires downstaging and/or more extended resection to obtain free margins.
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Multicenter Study
Specificity of procedure volume and in-hospital mortality association.
Several studies have examined the association between procedure-specific volume and in-hospital mortality and concluded that high-volume hospitals have lower mortality rates when compared with low-volume hospitals. There is a paucity of studies examining the association between unrelated procedure volume and in-hospital mortality. The objective of our study is to examine the procedure-specific volume-outcome association as well as unrelated procedure volume-outcome association for 5 procedures: coronary artery bypass graft (CABG), percutaneous coronary interventions (PCI), elective abdominal aortic aneurysm repair (AAA), pancreatectomy (PAN), and esophagectomy (ESO). ⋯ Hospital volume-in-hospital mortality association appears largely to be specific to the procedure being studied.