Canadian journal of surgery. Journal canadien de chirurgie
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There is growing support in the literature that patient outcomes are adversely affected by physician fatigue in operator-dependent cognitive and technical tasks. Recent increases in total joint arthroplasty caseloads have resulted in longer operative days and increased surgeon fatigue. We sought to determine if time of day predicts perioperative complications and outcomes in total joint arthroplasty. ⋯ Duration of surgery and incidence of intraoperative complications for THA may increase with later surgery start time; however, the relatively small statistical differences observed imply that they likely are not clinically significant.
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Comparative Study
Does direct transport to provincial burn centres improve outcomes? A spatial epidemiology of severe burn injury in British Columbia, 2001-2006.
In Canada and the United States, research has shown that injured patients initially treated at smaller emergency departments before transfer to larger regional facilities are more likely to require longer stays in hospital or suffer greater mortality. It remains unknown whether transport status is an independent predictor of adverse health events among persons requiring care from provincial burn centres. ⋯ Transfer status is not a significant indicator of RR of death or hospital stay among patients who received care at primary care facilities before transport to regional burn centres. However, significant differences in prehospital mortality show that improvements in rural mortality can still be made.
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Comparative Study
Management of ERCP-related small bowel perforations: the pivotal role of physical investigation.
Management of endoscopic retrograde cholangiopancreatography (ERCP)-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. ⋯ Post-ERCP duodenal perforations are associated with significant morbidity and mortality. Immediate surgical evaluation and close monitoring is needed. Management should be individually tailored based on clinical findings only.