Annals of surgery
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Comparative Study
Implementing and Evaluating a National Certification Technical Skills Examination: The Colorectal Objective Structured Assessment of Technical Skill.
To implement the Colorectal Objective Structured Assessment of Technical skill (COSATS) into American Board of Colon and Rectal Surgery (ABCRS) certification and build evidence of validity for the interpretation of the scores of this high stakes assessment tool. ⋯ COSATS is the first technical skill examination used in national surgical board certification. This study suggests that the current certification process may be failing to identify individuals who have demonstrated technical deficiencies on this standardized assessment tool.
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To develop parsimonious prediction models for postoperative mortality, overall morbidity, and 6 complication clusters applicable to a broad range of surgical operations in adult patients. ⋯ Our results suggest that it will be possible to develop parsimonious models to predict 8 important postoperative outcomes for a broad surgical population, without the need for surgeon specialty-specific models or inclusion of laboratory variables.
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Comparative Study
Alvimopan Provides Additional Improvement in Outcomes and Cost Savings in Enhanced Recovery Colorectal Surgery.
To examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol. ⋯ Alvimopan administration as an element of enhanced recovery colorectal surgery is associated with faster return of bowel function, lower incidence of postoperative ileus, shorter hospitalization, and a significant cost savings. These results suggest that alvimopan is cost-effective in the setting of enhanced recovery colorectal surgery protocols, and should therefore be considered in these programs.
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In compensated cirrhotics with early hepatocellular carcinoma (HCC-cirr), upfront liver resection (LR) and salvage liver transplantation (SLT) in case of recurrence may have outcomes comparable to primary LT (PLT). ⋯ In initially transplantable HCC-cirr patients, ITT survival was better in group PLT compared with group LR. SLT was feasible in only a third of patients who recurred after LR. Post SLT, short and long-term outcomes were comparable with PLT. Better patient selection for the "resection first" approach and early detection of recurrence may improve outcomes of the SLT strategy.
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The prognoses of gastric cancer patients vary greatly among countries. Meanwhile, tumor-node-metastasis (TNM) staging system shows limited accuracy in predicting patient-specific survival for gastric cancer. The objective of this study was to create a simple, yet universally applicable survival prediction model for surgically treated gastric cancer patients. ⋯ Utilizing clinically practical patient, tumor, and surgical information, we developed a universally applicable prediction model for accurately determining the 5-year overall survival of gastric cancer patients after gastrectomy. Our predictive model was also valid in patients who underwent noncurative resection or inadequate lymphadenectomy.