Annals of surgery
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial.
To investigate the effect of a restricted intravenous fluid regimen versus a standard regimen on complications after colorectal resection. ⋯ The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.
-
Multicenter Study
The Leapfrog volume criteria may fall short in identifying high-quality surgical centers.
The original Leapfrog Initiative recommends selective referral based on procedural volume thresholds (500 coronary artery bypass graft [CABG] surgeries, 30 abdominal aortic aneurysm [AAA] repairs, 100 carotid endarterectomies [CEA], and 7 esophagectomies annually). We tested the volume-mortality relationship for these procedures in the University HealthSystem Consortium (UHC) Clinical DatabaseSM, a database of all payor discharge abstracts from UHC academic medical center members and affiliates. We determined whether the Leapfrog thresholds represent the optimal cutoffs to discriminate between high- and low-mortality hospitals. ⋯ In this group of academic medical centers and their affiliated hospitals, we demonstrated a significant relationship between volume and mortality for CABG and AAA but not for CEA and esophagectomy, based on the Leapfrog thresholds. We described a new methodology to identify optimal data-based volume thresholds that may serve as a more rational basis for selective referral.
-
The evolution of nonoperative management of certain solid visceral injuries has stimulated speculation that management of the severely injured child is no longer a surgical exercise. The authors hypothesized that the incidence of injuries that require surgical evaluation is disproportionately high in children at risk of death or disability from significant injury. ⋯ These data clearly demonstrate the primacy of surgical pathology as the major determinant of outcome in pediatric injury. Operative intervention and the option of timely operative care remain major components of clinical management of children with injuries that pose a significant risk of morbidity or mortality.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections: results of a double-blind, randomized comparative phase III trial.
To examine the clinical efficacy and safety of ertapenem, a novel beta-lactam agent with wide activity against common pathogens encountered in intraabdominal infection. ⋯ In this study, the efficacy of ertapenem 1 g once a day was equivalent to piperacillin/tazobactam 3.375 g every 6 hours in the treatment of a range of intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile to piperacillin/tazobactam. A formal process for review of adequacy of source control was found to be of benefit. The results of this trial suggest that ertapenem may be a useful option that could eliminate the need for combination and/or multidosed antibiotic regimens for the empiric treatment of intraabdominal infections.
-
Multicenter Study Comparative Study
Multicenter Canadian study of prehospital trauma care.