MedicalResearch.com Interview with: Christopher Mantyh, M.D.
Associate Professor of Surgery
Chief of Colorectal Surgery
NSQIP Surgical Champion
Duke University Medical Center
Medical Research: What are the main findings of the study? Dr. Mantyh: Specific perioperative bundles can drastically reduce surgical site infections in colorectal surgery patients.
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MedicalResearch.com Interview with: Mats Möller MD
Department of Surgery, Ersta Hospital
Department of Clinical Sciences
Karolinska Institutet
Danderyds Hospital, Stockholm, Sweden
Medical Research: What are the main findings of the study?Dr. Möller: The natural course of common bile duct stones seem not as favorable as previous studies have suggested. Leaving stones with no measures taken has in our study a less favorable outcome compared to removing the stones.
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MedicalResearch.com Interview with:Dr. Thomas M. Scalea, MD
R. Adams Cowley Shock Trauma Center, Program in Trauma
University of Maryland School of Medicine, Baltimore
Medical Research: What are the main findings of this study?Dr. Scalea: The main findings of the study was that putting this financial incentive program in place had immediate and dramatic effects on first cases starting on time and turnaround times decreasing in our operating room.
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MedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP
Clinical Professor of Anesthesiology and Public Health
Weill Cornell Medical College
Senior Scientist and Attending Anesthesiologist
Hospital for Special Surgery
Medical Research: What are the main findings of the study?Dr. Memtsoudis: In this large population based study we found that perioperative tranexamic acid administration significantly reduced the need for blood transfusions in joint arthroplasty patients, while not increasing the risk of major complications, including thromboembolic, cardiac and renal events.
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MedicalResearch.com Interview with:Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.
Medical Research: What are the main findings of the study? Dr. Bingener-Casey: “About half of patients seeking emergency care for gallbladder problems were immediately admitted and underwent urgent cholecystectomy, the other half went home. The half that went home was younger and had lower WBC counts, lower neutrophils and less people with elevated temperature than the patients immediately admitted. Of the half that went home, 31% returned at least once to the ED within 30 days and 20% were admitted to undergo urgent cholecystectomy after the return visit, 55% percent of those within 7 days of the initial ED visit. Patients who failed the elective treatment plan had similar WBC counts but were more likely to have an ASA >3, slightly higher creatinine and higher average maximum VAS pain score. Patients who were less than 40 years old or older than 60 years were more likely to fail the elective pathway.”
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MedicalResearch.com Interview Cristina B. Geltzeiler, MD
Knight Cancer Institute
Oregon Health & Science University
Portland, OR 97239-3098
Medical Research: What are the main findings of the study?Dr. Geltzeiler: The main findings of the study are that implementing an Enhanced Recovery After Surgery (ERAS) program at a community hospital can be successfully implemented and can allow patients to recover quicker from their surgery with ongoing safety.
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MedicalResearch.com Interview with:Henry M. Spinelli, MD, PC
Plastic & Reconstructive Surgery
875 Fifth Avenue
New York, NY 10065
Medical Research: What are the main findings of the study?
Dr. Spinelli: Briefly, we polled approximately 26,000 plastic surgeons by way of membership in the International Society of Aesthetic Plastic Surgeons (ISAPS), American Society for Aesthetic Plastic Surgery (ASAPS) and American Society of Plastic Surgeons (ASPS) and collated this data and published it in Aesthetic Plastic Surgery (the Blue Journal), the official journal of ISAPS. This preliminary study was initiated given the current and past healthcare and cosmetic medical/surgical care climate both in the United States and worldwide. As a background, when it comes to injectables (botox and fillers) there is not a united consensus on a state by state basis in the USA and from country to country worldwide. Additionally, the regulations and laws governing the administration of botox and injectables is in a constant flux. For instance, the UK allowed beauticians in the past to administer these substances however they are now banned from legal administration of these products. Alabama, only allows physicians (dermatologists and plastic surgeons) to purchase and administer botox and injectables whereas the medical board of California states that physicians can perform the procedure or oversee licensed registered nurses, licensed vocational nurses, or physicians assistants. Similarly, dentists in some states are permitted to administer these agents. It would be a bad idea for any physician working with botox to take Advanced Botox Training to reduce the possibility of medical misdemeanors.
At the present time few studies have directly assessed the capability of various providers to administer cosmetic injections. When people schedule a consultation for plastic surgery, they are often looking for things like a younger face or a nicer body. The answer to the previous question will become more important as the demand for these procedures continues to grow and an increasing number of practitioners and different Plastic Surgeon from a variety of backgrounds enter the field to meet demand. This study aimed to help define the role of various practitioners in an increasingly more competitive environment for injectables and to explore the relationship between patient and injectable provider in order to improve patient satisfaction and outcomes.
When asked to rank patients’ perceptions of various providers according to their expertise in administering Botox and dermal fillers, responders ranked plastic surgeons and dermatologists as most capable (96%) then nurses in plastic surgery and dermatology (3%). Gynecologists (<1%), dentists (<1%) and nurses in other fields (<1%) all received nearly equivalent numbers of “most capable” rankings. When asked to rank patients’ perception of various providers according to their inability to administer Botox and dermal fillers, nurses in other fields were most frequently ranks as least capable (63%) followed by dentists (26%), gynecologists (12%), plastic surgeons and dermatologists (2%) and nurses in plastic surgery and dermatology (1%).
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MedicalResearch.com Interview with:Dr. Dong-Xin Wang, MD, PhD
Department of Anesthesiology and Surgical Intensive Care
Peking University First Hospital
Beijing 100034, China
Medical Research: What are the main findings of the study?Answer: We found that use of epidural analgesia during labor is associated with decreased risk of postpartum depression.
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MedicalResearch.com Interview with:Erin Brown, MD
General Surgery PGY6
UC Davis Medical Center
Medical Research: What are the main findings of the study?Dr. Brown: This study sought to determine with childrearing during training put residents at increased risk of quiting. We looked at both male and female surgical residents who chose to have children during residency and found that residents having children during training were not more likely to quit than those who did not have children. We also found that there childrearing had no negative impact on surgical training based on total surgical case numbers, board pass rates, and annual exam scores. Main findings of the study were that neither female gender nor childrearing during training were associated with residents quitting.
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MedicalResearch.com Interview with:
Mads E. Jørgensen, M.B.
University of Copenhagen, Denmark
Medical Research: What are the main findings of the study?Answer: We included all patients undergoing non-cardiac surgery in 2005-2011, which were then categorized by time elapsed between stroke and surgery. Patients with a very recent stroke, i.e. less than 3 months prior to surgery, had a significant 14 times higher relative risk of 30-day MACE following surgery, compared with patients without prior stroke. Patients with a more distant stroke had a 2-5 fold higher risk of MACE following surgery, and still significantly higher than risks in patients without prior stroke.
An additional model including time between stroke and surgery as a continuous measure showed a steep decrease in risks of perioperative MACE during the first 9 months. After 9 months, an increase in time between stroke and surgery did not further reduce the risks. The results for 30-day all-cause mortality showed similar patterns, although estimates were not as dramatic as for 30-day MACE.
When analyzing the MACE components individually, we found that recurrent strokes were the main contributor to the high risk of MACE. A history of stroke any time prior to surgery was associated with a 16 fold increased relative risk of recurrent stroke, compared with patients without prior stroke.
We also performed analyses stratified by surgery risk as low- (OR for stroke anytime, 3.97; 95% CI, 2.79-5.66), intermediate- (OR for stroke anytime, 4.46; 95% CI, 2.87-5.13) and high-risk (OR for stroke anytime, 1.98; 95% CI, 1.20-3.27), which were somewhat challenged in power. However, results indicated that stroke associated relative risk was at least as high in low and intermediate-risk surgery as in high risk surgery.
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MedicalResearch.com Interview with :Pr. Jean-Marc Regimbeau
Service de Chirurgie Digestive Oncologique et Métabolique,
CHU dAmiens
Medical Research : What are the main findings of the study?Answer: In our study we found that the absence of postoperative administration of amoxicillin plus clavulanic acid did not improve the occurrence of postoperative infections in patients with mild or moderate acute calculous cholecystitis. The bile cultures were pathogen free in 60.9% of case. Moreover we show that less than 2 percent of the overall population presented a major complication defined according to the Clavien Dindo Classification (Clavien score ≥3a). After cholecystectomy the readmission rate was 6%.
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MedicalResearch.com Interview with:Daniel L. Riddle, PT, Ph.D., F.A.P.T.A.
Otto D. Payton Professor
Assistant department chair
Department of Physical Therapy
Virginia Commonwealth University
MedicalResearch: What are the main findings of the study?Dr. Riddle: We used a classification system developed by researchers in Spain in the late 1990s and found that classifications of appropriate, inappropriate and inclusive ratings for persons undergoing knee replacement surgery were 44.0%, 21.7%, and 34.3%, respectively. We studied 175 persons who underwent unilateral total knee replacement in the Osteoarthritis Initiative study, an NIH and privately funded multi-year cohort study of persons with are at high risk for knee osteoarthritis. These findings need to be considered cautiously because the classification system was developed more than 15 years ago and was designed to place greatest priority on persons with end stage knee osteoarthritis and severe pain and functional loss.
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MedicalResearch.com Interview with: Frank H. Morriss, Jr., MD, MPH
Professor of Pediatrics - Neonatology
University of Iowa Carver College of Medicine
MedicalResearch: What are the main findings of the study?Dr. Morriss: Our aim was to assess the association between surgery performed during the initial hospitalization of very low- birth-weight infants and subsequent death or neurodevelopmental impairment at 18-22 months’ corrected age. We conducted a retrospective cohort analysis of patients who were prospectively enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 to 2009. Surgery was classified by the expected anesthesia type as either major surgery that likely would have been performed under general anesthesia; or minor surgery, that is, procedures that could have been performed under non-general anesthesia and in general were shorter in duration. There were 2,186 major surgery patients and 784 minor surgery patients and more than 9,000 patients who did not undergo surgery.
We found that any surgical procedure increased the adjusted risk of death or neurodevelopmental impairment in low birth weight infants by about 30%. Not all surgical procedures were associated with increased risk, however. Compared with those who did not undergo surgery, patients who were classified as having major surgery had a risk-adjusted odds ratio of death or neurodevelopmental impairment of 1.52 (95% confidence interval 1.24-1.87). However, those who were classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who did not undergo surgery the risk-adjusted odds ratio for neurodevelopmental impairment was 1.56 (95% confidence interval 1.26-1.93), and the risk-adjusted mean Bayley II Mental Developmental Index and mean Psychomotor Developmental Index values were significantly lower.
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MedicalResearch.com Interview with: Benjamin S. Brooke, M.D., Ph.D.
Assistant Professor of Surgery
Division of Vascular Surgery
University of Utah School of Medicine
MedicalResearch: What are the main findings of the study?Dr. Brooke:This study was designed to evaluate whether high-risk surgical patients who visit a primary care provider (PCP) during the early period following hospital discharge are less likely to be readmitted within 30-days. We examined this question by performing a retrospective cohort analysis of Medicare beneficiaries (2003-2010) who underwent a high risk surgery (open thoracic aortic aneurysm repair) as well as a control group of patients who underwent a lower risk surgical procedure (open ventral hernia repair), and then determining whether there was evidence of early PCP follow-up.
In risk-adjusted analyses, we found that early primary care provider-follow-up was associated with a significant lower likelihood of 30-day readmission for high-risk patients undergoing open thoracic aortic aneurysm repair, particularly if a post-operative complication had occurred. In comparison, early primary care provider follow-up did not have a significant effect on lowering readmissions in uncomplicated patients and those undergoing lower-risk operations such as ventral hernia repair.
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MedicalResearch.com Interview with: Kay W. Chang, MD
Associate Professor of Otolaryngology and Pediatrics
Stanford University
Department of Otolaryngology
Lucile Packard Children's Hospital at Stanford
Division of Pediatric Otolaryngology
MedicalResearch: What are the main findings of the study?Dr. Chang:At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points, and body mass index percentiles increased by a mean of 8.0 percentile points. The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight and younger than 4 years at the time of surgery. An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight.
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MedicalResearch.com Interview with: Dr. Benjamin D. Smith MD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, TX 77030
MedicalResearch: What are the main findings of the study?Dr. Smith: Although use of needle biopsy to diagnose breast cancer increased during the time period we studied, it remained lower than targeted benchmarks. The patient’s surgeon seemed to exert a major influence on use of needle biopsy.
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MedicalResearch Interview with:Lars Sjöström, MD, PhD
Professor
Department of Body Composition and Metabolism
Sahlgrenska University Hospital
Göteborg, Sweden
MedicalResearch: What are the main findings of the study?
Prof. Sjöström: In obese diabetic subjects, the 2-year diabetes remission was 72% in bariatric surgery patients but only 16% in obese controls obtaining conventional obesity and diabetes treatment. After 15 years, 30% were in remission in the surgery group and 6.5% in the control group. In addition, the 20-year incidence of diabetes complication was 30 -55% lower in surgery than control patients. (more…)
MedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD
Melanoma and Sarcoma Unit, Veneto Institute of Oncology
Surgery Branch, Department of Surgery
Oncology, and Gastroenterology, University of Padova,
Padova, Italy
MedicalResearch: What are the main findings of the study?
Dr. Rossi: A total of 90% patients undergone lymph node dissection for melanoma had 12, 7, 14, 6 and 13 excised lymph nodes (10th percentile of the distribution) after 3 level axillary, 3 level or less neck, 4 level or more neck, inguinal, or ilio-inguinal dissections, respectively.
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MedicalResearch.com Interview with:Kwang-il Kim, MD, PhD
Associate Professor, Department of Internal Medicine,
Seoul National University College of Medicine,
Seoul National University Bundang Hospital,
Seoul, Republic of Korea
MedicalResearch: What are the main findings of the study?Answer: There are few tools of preoperative risk stratification for the older adults. We found that not only disease itself but also frailty can lead to post-operative complication and mortality. So we made a scoring model to predict post-operative mortality and morbidity based on comprehensive geriatric assessment and it worked exactly.
MedicalResearch: Were any of the findings unexpected?Answer: Under our predictive model, there was inflection point of mortality slope at point 5. Post-operative mortality of someone who scores 4~5 is below 10%, but it of other who scores 6~7 is about 30%. It was unexpected drastic change, so we think that there is physiologic threshold point.
MedicalResearch: What should clinicians and patients take away from your report?Answer: Because the elderly are different from adults, clinicians have to focus on functional capacity, co-morbidity, and frailty for their older surgical patients. Make operative decision base on comprehensive geriatric assessment or our scoring model. If you depend on your own feeling, some older patients will suffer from post-operative complication and someone will forfeit his chance of surgery.
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MedicalResearch.com Interview with:Rajeev Desai
SpR Gastroenterology, City Hospital Birmingham
Honorary Clinical Research Fellow
University Hospital Birmingham / NHS Blood and Transplant, Bristol
MedicalResearch: What are the main findings of the study?Dr. Desai: This study of a large national cohort of organ donors shows that, following careful assessment and selection, organs from some donors with a previous history of cancer can be used safely for transplantation. The risks of accepting such organs for transplantation should be balanced with risks of non-acceptance and its consequences including delayed transplantation or non-transplantation.
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MedicalResearch.com Interview with: Tina Hieken, M.D.
Associate Professor of Surgery
Mayo Clinic,Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation. For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001). The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients. Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation.
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MedicalResearch.com Interview with:Mr. David Bowrey, MD FRCS (Gen Surg) MMedEd FHEA
Consultant General / Oesophagogastric Surgeon & Honorary Senior Lecturer, Dept Cancer Studies,
Training Programme Director for Core Surgery, East Midlands South
University Hospitals of Leicester NHS Trust,
Leicester Royal Infirmary
MedicalResearch.com: What are the main findings of this study?Dr. Bowrey: Of 103 patients who had undergone Roux en Y gastric bypass surgery, changes in appetite, taste and smell were noted in 97%, 73% and 42% respectively. Seventy-three percent of patients developed aversions to certain types of foods, most frequently meat, starch and dairy produce. The change in taste sensation for the three common modalities of "sweet", "salt" and "sour" was decreased in some patients and increased in other patients. Patients who experienced food aversions typically experienced more weight loss than patients not developing aversions.
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MedicalResearch.com Interview with: Rustam Al-Shahi Salman
Professor of clinical neurology and MRC senior clinical fellow
University of Edinburgh
Honorary consultant neurologist, NHS Lothian
MedicalResearch.com: What are the main findings of the study?Prof. Al-Shahi Salman: Patients with arteriovenous malformations (abnormal connection between arteries and veins) in the brain that have not ruptured had a lower risk of stroke or death for up to 12 years if they received conservative management of the condition compared to an interventional treatment.
Interventional treatment for brain arteriovenous malformations (bAVMs)
with procedures such as neurosurgical excision, endovascular
embolization, or stereotactic radiosurgery can be used alone or in
combination to attempt to obliterate bAVMs. Because interventions may
have complications and the untreated clinical course of unruptured
bAVMs can be benign, some patients choose conservative management (no
intervention). Guidelines have endorsed both intervention and
conservative management for unruptured brain arteriovenous malformations. Whether conservative management is superior to interventional treatment for unruptured
bAVMs is uncertain because of the lack of long-term experience,
according to background information in the article.
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MedicalResearch.com Interview with:Dr. Oliver Muensterer MD Ph.D
Division of Pediatric Surgery
New York Medical College
Maria Fareri Children's Hospital of Westchester Medical Center
Valhalla, NY 10595, USA
MedicalResearch.com: What are the main findings of the study?Dr. Muensterer: We looked at the functionality of Google Glass, a novel head-mounted mobile computer with integrated display, camera, microphone, and speaker, in the clinical environment. While the technology has a lot of promise to be useful for pediatric surgeons, in its current version, it also has significant limitations. The most obvious utilities are hands-free photo- and videodocumentation, looking up medical terminology on the internet, help with coding and billing activities, and hands-free telecommunication.
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MedicalResearch.com Interview InvitationDorna Jafari, M.D. and
Michael J Stamos, MD
Professor of Surgery
John E. Connolly Chair,
Department of Surgery
University of California, Irvine
Orange, CA 92868
MedicalResearch.com: What are the main findings of the study?Answer: Surgeons are faced with an aging population and data regarding outcomes is rare given that many studies preclude the elderly from the study population. Therefore, it is difficult to accurately discuss risk of surgical resection given the lack of data. Therefore we aimed to report the national trends and outcomes of colorectal cancer treatment in the elderly population.
We demonstrated that the majority of resections are performed in patients >65yeras old. There is a trend towards a decrease in incidence of colorectal resection and a decrease in rate of mortality during 2001-2010. However, the unique physiological changes associated with aging contribute to increase morbidity and morality as demonstrated by our findings. In fact patients >85 years have a 472% increase in risk-adjusted mortality during a hospital admission compared to younger patients. However, despite the substantially higher mortality and morbidity associated with age, there has been a marked improvement in surgical outcomes in the elderly population.
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MedicalResearch.com Interview with:Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.
MedicalResearch.com: What are the study’s main findings?Dr. Bingener-Casey: “Patient-reported outcomes such as pain and fatigue are sensitive tools to detect how well patients recover from surgery. These patient-reported outcome results are different for men and women and for older versus younger people.”
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MedicalResearch.com Interview with:
Peter M. Rhee, MD, MPH
Chief, Division of Trauma, Critical Care, Burn and Emergency Surgery
Professor of Surgery, Medical Director,...
MedicalResearch.com Interview with:Dr. Najma Ahmed
Trauma and Acute Care Surgeon, St. Michael's Hospital
Residency Training Director, General Surgery, University of Toronto
MedicalResearch.com: What are the main findings of this study:Dr. Ahmed: The main findings if the study were that the recent reduction of resident duty hours to much less than 80 hours decreases health outcomes in patients, has adverse educational outcomes for residents and does not improve wellness in surgery.
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MedicalResearch.com Interview with: Elizabeth C. Wick, MD
Assistant Professor,Department of Surgery
The Johns Hopkins Hospital, Baltimore, Maryland
MedicalResearch.com: What are the main findings of the study?Dr. Wick: The main finding is the high variability in physician practice for prescribing steroids and the lack of clear guidance as to best practice in the literature.
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MedicalResearch.com Interview with:
Dr Tahir Hamid MRCP (UK), FESC
Department of Cardiology, Royal Albert Edward Infirmary
NHS Trust, Wigan, UK
MedicalResearch.com: What are the main findings of the study?Dr. Hamid:Traditionally patients undergoing diagnostic and interventional coronary artery procedures are kept Nil-by-mouth, but until yet there exists neither evidence nor clear guidance about the benefits of this practice in such patients. In our study performed at two National Health Services (NHS) institutes, we demonstrated in our 1916 patients, that such procedures could be undertaken without the need for being 4-6 hours fasting. None of our patients had major complications leading to pulmonary aspiration or emergency cardiac surgery.
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MedicalResearch.com Interview with:
Christopher Mantyh, M.D.
Associate Professor of Surgery
Chief of Colorectal Surgery
NSQIP Surgical Champion
Duke University Medical Center
Medical Research: What are the main findings of the study?
Dr. Mantyh: Specific perioperative bundles can drastically reduce surgical site infections in colorectal surgery patients.
(more…)
