The British journal of surgery
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Multicenter Study Observational Study
Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases.
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals. ⋯ Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Multicenter Study
Co-morbidity status after oesophageal cancer surgery and recovery of health-related quality of life.
Although health-related quality of life (HRQoL) recovers after surgery for oesophageal cancer in most long-term survivors, one in seven patients experiences a deterioration in HRQoL for reasons yet unknown. The aim of this study was to assess whether co-morbidities diagnosed after surgery influence recovery of HRQoL. ⋯ Patients with an increase in co-morbidities after oesophagectomy experience long-term deterioration in HRQoL.
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Randomized Controlled Trial Multicenter Study
Cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial.
Same-admission cholecystectomy is indicated after gallstone pancreatitis to reduce the risk of recurrent disease or other gallstone-related complications, but its impact on overall costs is unclear. This study analysed the cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis. ⋯ In mild biliary pancreatitis, same-admission cholecystectomy was more effective and less costly than interval cholecystectomy.
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Randomized Controlled Trial Multicenter Study Comparative Study
Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication.
Current guidelines recommend supervised exercise therapy (SET) as the preferred initial treatment for patients with intermittent claudication. The availability of SET programmes is, however, limited and such programmes are often not reimbursed. Evidence for the long-term cost-effectiveness of SET compared with endovascular revascularization (ER) as primary treatment for intermittent claudication might aid widespread adoption in clinical practice. ⋯ SET is a more cost-effective primary treatment for intermittent claudication than ER. These results support implementation of supervised exercise programmes in clinical practice.
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Multicenter Study
Feasibility work to inform the design of a randomized clinical trial of wound dressings in elective and unplanned abdominal surgery.
Designing RCTs in surgery requires consideration of existing evidence, stakeholders' views and emerging interventions, to ensure that research questions are relevant to patients, surgeons and the health service. When there is uncertainty about RCT design, feasibility work is recommended. This study aimed to assess how feasibility work could inform the design of a future pilot study and RCT (Bluebelle, HTA - 12/200/04). ⋯ Based on the findings from this large study of current practice, the pilot study design has evolved. The inclusion criteria have expanded to encompass patients undergoing unscheduled surgery, and tissue adhesive as a dressing will be evaluated as an additional intervention group. Collaborative methods are recommended to inform the design of RCTs in surgery, helping to ensure they are relevant to current practice.