Surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses.
Previous randomized studies of laparoscopic appendectomy produced conflicting recommendations, and the adequacy of sample sizes is generally unknown. We compared clinical and economic outcomes after laparoscopic and open appendectomy in a sample of predetermined statistical power. ⋯ While laparoscopic appendectomy is associated with statistically significant but clinically questionable advantages over open appendectomy, a laparoscopic approach is relatively less expensive. The estimated difference in total costs of treatment (direct and indirect costs) was at least $2000 in more than 60% of the bootstrapped iterations. The economic significance and implications favoring a laparoscopic approach cannot be ignored.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A novel collagen-based composite offers effective hemostasis for multiple surgical indications: Results of a randomized controlled trial.
Intraoperative bleeding is ubiquitous during open surgical procedures and uniformly effective hemostasis remains elusive. We conducted a randomized controlled trial to determine the effectiveness of a novel collagen-based composite (CoStasis Surgical Hemostat) compared with standard methods of hemostasis during general, hepatic, cardiac, and orthopedic operations. ⋯ CoStasis is more effective at controlling and stopping diffuse intraoperative bleeding than standard methods of hemostasis in 4 distinct surgical indications representing a wide variety of operative interventions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous paravertebral extrapleural infusion for post-thoracotomy pain management.
Continuous thoracic epidural analgesia is considered by many the gold standard for post-thoracotomy pain control but is associated with its own complications. In this study we compare continuous paravertebral extrapleural to epidural infusion for post-thoracotomy pain control. ⋯ We recommend continuous paravertebral infusion as an improved method of post-thoracotomy analgesia that can be placed and managed by the surgeon.
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Randomized Controlled Trial Clinical Trial
Optimal duration of urinary drainage after rectal resection: a randomized controlled trial.
Voiding dysfunction is frequently observed after rectal resection and justifies urinary drainage. However, there is no agreement about the optimal duration of this postoperative drainage. The aim of this controlled trial was to compare 1 versus 5 days of transurethral catheterization after rectal resection, with special reference to urinary tract infection and bladder retention. ⋯ Our controlled study showed that after rectal resection 1 day of urinary drainage can be recommended for most patients. Five-day drainage should be reserved for patients with low rectal carcinoma.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy.
We have previously shown that in a randomized comparison of laparoscopic (LC) versus small incision (SC) cholecystectomy, postoperative hospital stay is comparable. This randomized prospective study compares the postoperative pain, analgesic and antiemetic consumption, perceived health, and metabolic and respiratory responses after these two procedures. ⋯ LC appears to be associated with less tissue destruction and pain than SC, but this did not confer any advantage in the degree of postoperative respiratory impairment, length of hospital stay, or postoperative perceived health. The neuroendocrine component of the metabolic response evoked by each procedure was similar and had a significant correlation to patient's postoperative hospital stay. This finding may explain the similar postoperative recovery after LC and SC.