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Eras general surgery

Jan S Lewin, Leah M Baumgart, Martha P Barrow, Katherine A Hutcheson
Importance: Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices. Objective: To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs...
September 29, 2016: JAMA Otolaryngology—Head & Neck Surgery
Yin Li
Enhanced recovery after surgery (ERAS) is a patient-centered, surgeon-led system combining anesthesia, nursing, nutrition and psychology. It aims to minimize surgical stress and maintain physiological function in perioperative care, thereby expediting recovery. ERAS theory has been clinically applied for nearly 20 years and it is firstly used in colorectal surgery, then widely used in other surgical fields. However, ERAS is not used commonly in esophagectomy because of its surgical complexity and high morbidity of postoperative complications, which limits the application of ERAS in the field of esophagectomy...
September 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Nguyen X Thanh, Anderson W Chuck, Tracy Wasylak, Jeannette Lawrence, Peter Faris, Olle Ljungqvist, Gregg Nelson, Leah M Gramlich
BACKGROUND: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. METHODS: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions...
October 1, 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Jose Luis J Danguilan
Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases-first at the Quezon Institute (QI) and presently at the Lung Center of the Philippines although some university and private hospitals made occasional forays into the chest...
August 2016: Journal of Thoracic Disease
Kenneth R Nakazawa, Natalia N Egorova, John R Power, Peter L Faries, Ageliki G Vouyouka
OBJECTIVE: As part of the Surgical Care Improvement Project (SCIP), a national quality partnership of organizations including the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention implemented several perioperative guidelines regarding antibiotic, venous thromboembolism (VTE), and beta-blocker prophylaxis for surgical patients. We evaluated the effect of SCIP on in-hospital surgical site infections (SSI), graft infections, VTE, myocardial infarctions (MI), cardiac complications, mortality, and length of stay following elective major vascular surgery...
August 10, 2016: Annals of Vascular Surgery
Markatos Konstantinos, Karaoglanis Georgios, Saropoulos Konstantinos, Tzagkarakis Georgios
Sports injuries have been a major issue in medicine, surgery, and especially in orthopedics since the classical antiquity era. The 20th century, with its progress and innovations, changed the general concept of treating these injuries forever. The purpose of this review is to show how innovations in surgery in the 20th century changed the rationale of treating sports injuries. In this historical review, we present innovations concerning fracture treatment, spine injury treatment, and anterior cruciate ligament reconstruction related to sports injuries...
October 2016: Surgical Innovation
T Kruszyna, B Niekowal, M Kraśnicka, J Sadowski
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have gained widespread recognition in general surgery, decreasing the length of hospital stay while maintaining equivalent or lower morbidity and increased patient satisfaction. The feasibility of the ERAS protocol has not been studied in kidney transplantation. In this single-center retrospective case series, we describe the outcomes of 45 consecutive deceased-donor kidney transplant recipients subjected to a modified ERAS protocol, and we discuss the potential for future developments...
June 2016: Transplantation Proceedings
Alireza Raissadati, Heta Nieminen, Jari Haukka, Heikki Sairanen, Eero Jokinen
BACKGROUND: Comprehensive information regarding causes of late post-operative death following pediatric congenital cardiac surgery is lacking. OBJECTIVES: The study sought to analyze late causes of death after congenital cardiac surgery by era and defect severity. METHODS: We obtained data from a nationwide pediatric cardiac surgery database and Finnish population registry regarding patients who underwent cardiac surgery at <15 years of age at 1 of 5 universities or 1 district hospital in Finland from 1953 to 2009...
August 2, 2016: Journal of the American College of Cardiology
L Brandt, U Artmeier-Brandt
170 years ago, on 6 October 1846, the dentist William Thomas Green Morton, sucessfully demonstrated ether anesthesia in a patient undergoing surgery in the operating theater of the Massachusetts General Hospital in Boston. He thereby put an end to the unthinkable suffering of patients who had to undergo surgery when fully conscious. Before this "discovery" surgical procedures resembled a battle for life and death. Only a few documents exist illustrating the attitude of surgeons concerning their actions and which tortures patients had to tolerate...
July 15, 2016: Der Anaesthesist
Hany El-Hennawy, Robert J Stratta, Fowler Smith
The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion...
June 24, 2016: World Journal of Transplantation
H M Forsmo, F Pfeffer, A Rasdal, G Østgaard, A C Mohn, H Körner, C Erichsen
AIM: The aim of this randomized clinical trial was to compare patients treated using a multimodal approach [enhanced recovery after surgery (ERAS)], with a special focus on counselling, to patients treated in a standard conventional care pathway, who underwent elective colorectal resection. METHOD: In a single-centre trial, adult patients eligible for open or laparoscopic colorectal resection were randomized to an ERAS programme or standard care. The primary end-point was postoperative total hospital stay...
June 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Nobuaki Fujikuni, Kazuaki Tanabe, Noriaki Tokumoto, Takahisa Suzuki, Minoru Hattori, Toshihiro Misumi, Hideki Ohdan
AIM: To assess the safety of enhanced recovery after surgery (ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance. METHODS: Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group (CG) or ERAS group (EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d...
May 27, 2016: World Journal of Gastrointestinal Surgery
L Nordin, A Nordlund, A Lindqvist, H Gislason, J L Hedenbro
BACKGROUND: Postoperative nausea and vomiting (PONV) is common after general anaesthesia, and corticosteroids are used in many protocols for enhanced recovery after surgery (ERAS). However, surgical techniques are developing, and ERAS protocols need to be reevaluated from time to time. PATIENTS AND METHOD: In this study, we compared the effects of oral vs. parenteral corticosteroid administration on postoperative nausea. Elective Roux-y-gastric bypass (RYGB) patients were randomly assigned to either 8 mg betamethasone orally (n = 50) or parentally (n = 25) or as controls (n = 25), in a double-blind design...
August 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Yang Cong, Shi-kai Wu
Unlike conventional radiation therapy, stereotactic radiation therapy (SRT) is an emerging tumor-ablative radiation technology with a high-dose delivery to targets while dramatically sparing adjacent normal tissues. The strengths of SRT involve noninvasive and short-course treatment, high rates of tumor local control with a low risk of side effects. Although the scientific concepts of radiobiology fail to be totally understood currently, SRT has shown its potential and advantages against various tumors, especially for those adjacent to less tolerable normal organs (spinal cord, optic nerve, bowels, etc...
November 2015: Chinese Journal of Applied Physiology
Leyla Kilic, Cetin Ordu, Ibrahim Yildiz, Fatma Sen, Serkan Keskin, Rumeysa Ciftci, Kezban Nur Pilanci
The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials...
May 15, 2016: World Journal of Gastrointestinal Oncology
Sawsan Rashdan, Lawrence H Einhorn
The introduction of cisplatin combination chemotherapy, 40 years ago, transformed metastatic testicular germ cell tumors from an almost uniformly fatal disease into a model for a curable neoplasm. Before the era of platinum combination chemotherapy, the 5-year survival rate among men with metastatic testicular germ cell tumors was 5% to 10%. Currently, the 5-year survival rate is 80% for patients with metastatic disease and 95% overall. Despite the substantial advances in the treatment of germ cell tumors, 20% to 30% of patients will relapse after first-line chemotherapy and will require additional salvage therapies...
May 2016: Journal of Oncology Practice
Atsushi Kawaguchi, Qi Liu, Sean Coquet, Yutaka Yasui, Dominic Cave
While policy changes toward early extubation in the operating room (OR) have been commonly seen in palliative surgeries in single ventricle anatomy, no systematic assessment of their impact on patient outcome has been reported. All patients aged 0-17 years admitted to a PICU in a quaternary children's hospital for post-operative management following a primary Fontan procedure between 2005 and 2011 were included. Patients for revision of Fontan or patients admitted to adult Cardiovascular Intensive Care Unit were excluded...
August 2016: Pediatric Cardiology
Junjie Xiong, Peter Szatmary, Wei Huang, Daniel de la Iglesia-Garcia, Quentin M Nunes, Qing Xia, Weiming Hu, Robert Sutton, Xubao Liu, Michael G Raraty
Enhanced recovery after surgery (ERAS) pathways are multimodal, evidence-based approaches to optimize patient outcome after surgery. However, the use of ERAS protocols to improve morbidity and recovery time without compromising safety following pancreaticoduodenectomy (PD) remains to be elucidated.We conducted a systemic review and meta-analysis to assess the safety and efficacy of ERAS protocols compared with conventional perioperative care (CPC) in patients following PD.PubMed, Medline, Embase, and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched between January 2000 and June 2015...
May 2016: Medicine (Baltimore)
R L O'Connell, J E Rusby, G F W Stamp, A Conway, N Roche, P Barry, K Khabra, R Bonomi, I F Rapisarda, G Q Della Rovere
BACKGROUND: Traditionally axillary surgery has been used to provide staging information and until recently was thought to improve loco-regional control. However, a more minimal approach to the axilla is now being adopted. The aim of this study was to assess long term outcomes of patients with 'low-risk' breast cancers who did not undergo any axillary surgery. 'Low-risk' criteria were: postmenopausal, <20 mm grade 1 or <15 mm grade 2, LVI-ve, ER +ve. METHODS: Women with invasive breast cancer that did not undergo any axillary surgery were identified...
July 2016: European Journal of Surgical Oncology
Robert W Ikard
Ephraim McDowell's removal of a massive ovarian tumor from Jane Todd Crawford in Danville, Kentucky, in 1809 revolutionized the practice of surgery. Most academic physicians then believed that operating in the abdomen would inevitably result in peritonitis and death. McDowell proved them wrong and performed numerous ovariotomies with an acceptable complication rate for the era. His expertise brought patients from afar. McDowell also operated on patients in their homes, sometimes far from Danville. This article addresses an operation done in Nashville, Tennessee, on Penelope Holmes Overton, wife of General Thomas Overton, a prominent Tennessean...
April 2016: American Surgeon
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