The British journal of surgery
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Randomized Controlled Trial
Randomized open-label phase II study comparing oxycodone-naloxone with oxycodone in early return of gastrointestinal function after laparoscopic colorectal surgery.
Combined oral modified-release oxycodone-naloxone may reduce opioid-induced postoperative gut dysfunction. This study examined the feasibility of a randomized trial of oxycodone-naloxone within the context of enhanced recovery for laparoscopic colorectal resection. ⋯ High participation, retention and protocol compliance confirmed feasibility. Potential benefits of oxycodone-naloxone in reducing time to bowel movement and total opioid consumption could be tested in a randomized trial. Registration number: NCT02109640 (https://www.clinicaltrials.gov/).
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Sepsis is a serious complication in surgical patients, and is associated with prolonged hospital stay and high mortality rates. The definitions of sepsis have been revisited recently. This article reviews how definitions have changed over the years, and provides an update on basic pathobiology and essential aspects of treatment. ⋯ Sepsis is an important and serious complication of surgery, and precautions must be taken to try to prevent infection in surgical patients. If sepsis develops, rapid diagnosis is crucial so that appropriate source control, antimicrobial therapy and organ support can be started early in the course of disease. New techniques enabling a better classification of a patient's particular sepsis profile will enable more personalized therapy.
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Comparative Study
Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology.
The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a 'delayed' operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. ⋯ Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.
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Multicenter Study Observational Study
Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery.
Evidence-based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency. ⋯ Although sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent.
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Patterns of recurrence after surgery with postoperative chemoradiotherapy (S-CCRT) or surgery alone in patients with oesophageal squamous cell carcinoma (SCC) may differ. This might influence the nature and timing of subsequent management strategies. ⋯ Oesophagectomy with postoperative chemoradiotherapy was associated with longer survival and lower recurrence rates, especially at a locoregional level, compared with surgery alone.