Surgery
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To assess differences in hospital costs for inpatients with Clostridium difficile (CD) colitis based on hospital size, rural or urban hospital setting, and hospital designation as a teaching institution. ⋯ Costs for inpatient CD colitis in Pennsylvania have been increasing. Teaching and urban hospitals treat the group of patients with CD colitis with the greatest comorbidity, accounting for their greater cost of care. The cost of treating CD colitis is comparable among different sizes of teaching hospitals, which may reflect a more standardized approach toward treatment choices.
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This study was conducted to determine if team training using a federally sponsored team training program improves operating room (OR) performance and culture. ⋯ These data confirm that team training improves OR performance, but continued team training is required to provide sustained improved OR culture.
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Review Meta Analysis
Planned ilioinguinal nerve excision for prevention of chronic pain after inguinal hernia repair: a meta-analysis.
Inguinal hernia repair is a common operative procedure, but the development of chronic postoperative pain is a dreaded potential complication. The role of neurectomy in decreasing the incidence of chronic pain after inguinal hernia repair is currently unknown. Our objective was to determine whether a planned ilioinguinal nerve excision results in a decrease in the development of chronic pain experienced after inguinal hernia repair. ⋯ A planned resection of the ilioinguinal nerve at the time of inguinal hernia repair is associated with a decrease in the incidence of chronic postoperative pain. Thus, carrying out this simple maneuver at the time of operation might decrease a major source of postoperative patient morbidity.
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Randomized Controlled Trial
Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery.
Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished. "Prehabilitation" is a program to increase functional capacity in anticipation of an upcoming stressor. We reported recently the results of a randomized trial comparing 2 prehabilitation programs before colorectal surgery (stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises); however, adherence to the programs was low. The objectives of this study were to estimate: (1) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response; and (2) the impact of change in preoperative function on postoperative recovery. ⋯ In a group of patients undergoing scheduled colorectal surgery, meaningful changes in functional capacity can be achieved over several weeks of prehabilitation. Patients and those who care for them, especially those with poor physical capacity, should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy.