Hasil untuk "Surgery"

S. Kehoe, J. Hook, M. Nankivell et al.

H. Bonjer, C. Deijen, G. Abis et al.

Su‐Hsin Chang, C. Stoll, Jihyun Song et al.

J. Colquitt, Karen Pickett, E. Loveman et al.

D. Green

U. Gustafsson, M. Scott, W. Schwenk et al.

Mark C. Bicket, Jane J. Long, P. Pronovost et al.

P. Försth, G. Olafsson, T. Carlsson et al.

A. Fishman, F. Martinez, K. Naunheim et al.

J. Macdonald, S. Smalley, J. Benedetti et al.

S. Tohme, R. Simmons, A. Tsung

N. Martelli, C. Serrano, H. van den Brink et al.

E. Versteijne, J. Vogel, M. Besselink et al.

Studies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer.

M. Czerny, J. Schmidli, S. Adler et al.

Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS) Martin Czerny (EACTS Chairperson)* and Jürg Schmidli (ESVS Chairperson) Writing Committee: Sabine Adler, Jos C. van den Berg, Luca Bertoglio, Thierry Carrel, Roberto Chiesa, Rachel E. Clough, Balthasar Eberle, Christian Etz, Martin Grabenwöger, Stephan Haulon, Heinz Jakob, Fabian A. Kari, Carlos A. Mestres, Davide Pacini, Timothy Resch, Bartosz Rylski, Florian Schoenhoff, Malakh Shrestha, Hendrik von Tengg-Kobligk, Konstantinos Tsagakis and Thomas R. Wyss

M. Björck, J. Earnshaw, S. Acosta et al.

Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Ryan Howard, Brian T Fry, V. Gunaseelan et al.

Importance There is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption. Objective To describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery. Design, Setting, and Participants A retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients. Exposures Opioid prescription size in the initial postoperative prescription. Main Outcomes and Measures Patient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors. Results In this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001). Conclusions and Relevance The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.

Han Yang, Hui Liu, Yu-ping Chen et al.

Key Points Question Does treatment with neoadjuvant chemoradiotherapy plus surgery improve the long-term survival of patients with locally advanced esophageal squamous cell carcinoma (ESCC) compared with surgery alone? Findings In this randomized clinical trial of 451 patients with locally advanced ESCC, treatment with neoadjuvant chemoradiotherapy plus surgery showed significantly improved 5-year overall survival of 59.9% compared with 49.1% for surgery alone, as well as improved disease-free survival. Meaning In this study, long-term outcomes demonstrated a survival benefit from neoadjuvant chemoradiotherapy followed by surgery compared with surgery alone for the treatment of patients with locally advanced ESCC, indicating that this combination may be considered a standard of care in this patient population.

A. Díaz, B. Sarac, Anna R. Schoenbrunner et al.

Highlights • The COVID-19 pandemic has placed a significant strain on the United States health care system.• Healthcare workers are rapidly altering their professional responsibilities to help meet hospital needs.• Surgeons have witnessed a dramatic change in their practices with rapidly decreasing elective surgery.• Surgical leaders should develop a framework to help make decisions around elective surgery as information is evolving.

G. Campos, Jad Khoraki, M. Browning et al.

OBJECTIVE The aim of this study was to obtain estimates of changes in perioperative outcomes and utilization of bariatric surgery in the United States from 1993 to 2016. BACKGROUND Bariatric surgery has evolved over the past 2 decades. Nationally representative information on changes of perioperative outcomes and utilization of surgery in the growing eligible population (class III obesity or class II obesity with comorbidities) is lacking. METHODS Adults with obesity diagnosis who underwent primary bariatric surgery in the United States from 1993 to 2016 were identified in the National Inpatient Sample database. Estimates of the yearly number, types and cost of surgeries, patients' and hospital characteristics, complications and mortality rates were obtained. Prevalence of obesity and comorbidities were obtained from the National Health and Nutrition Examination Survey and changes in utilization of surgery were estimated. RESULTS An estimated 1,903,273 patients underwent bariatric surgery in the United States between 1993 and 2016. Mean age was 43.9 years (79.9% women, 70.9% white race, 70.7% commercial insurance); these and other characteristics changed over time. Surgeries were exclusively open operations in 1993 (n = 8,631; gastric bypass and vertical banded gastroplasty, 49% each) and 98% laparoscopic (n = 162,969; 69.8% sleeve gastrectomy and 27.8% gastric bypass) in 2016. Complication and mortality rates peaked in 1998 (11.7% and 1%) and progressively decreased to 1.4% and 0.04% in 2016. Utilization increased from 0.07% in 1993 to 0.62% in 2004 and remained low at 0.5% in 2016. CONCLUSIONS Perioperative safety of bariatric surgery improved over the last quarter-century. Despite growth in number of surgeries, utilization has only marginally increased. Addressing barriers for utilization may allow for greater access to surgical therapy.

Dominique Vervoort, B. Meuris, B. Meyns et al.

OBJECTIVE Cardiovascular disease is the leading cause of death worldwide, responsible for 17.5 million deaths every year, of which 80% occur in low- and middle-income countries. Some 75% of the world does not have access to cardiac surgery when needed because of lack of infrastructure, human resources, and financial coverage. This study aims to map access to cardiac surgery around the world. METHODS A scoping review was done on access to cardiac surgery for an undifferentiated population. Workforce data were collected from the Cardiothoracic Surgery Network database and used to calculate numbers and ratios of adult and pediatric cardiac surgeons to population. RESULTS A total of 12,180 adult cardiac surgeons and 3858 pediatric cardiac surgeons were listed in the Cardiothoracic Surgery Network in August 2017, equaling 1.64 (0-181.82) adult cardiac surgeons and 0.52 (0-25.97) pediatric cardiac surgeons per million population globally. Large disparities existed between regions, ranging from 0.12 adult cardiac surgeons and 0.08 pediatric cardiac surgeons per million population (sub-Saharan Africa) to 11.12 adult cardiac surgeons and 2.08 pediatric cardiac surgeons (North America). Low-income countries possessed 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries. CONCLUSIONS This study maps the current global state of access to cardiac surgery. Disparities exist between and within world regions, with a positive correlation between a nation's economic status and access to cardiac surgery. Low early mortality rates in low-resource settings suggest the possibility of high-quality cardiac surgery in low- and middle-income countries. There is the need to increase human and physical resources, while focusing on safety, quality, and efficiency to improve access to cardiac surgery for the 4.5 billion people without.