human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Enhanced Recovery After Surgery ( ERAS ) programs are associated with reduced hospital morbidity and mortality . The aim of the present study was to evaluate whether the introduction of ERAS care improved the adverse events in colorectal surgery . In a cohort study , mortality , morbidity , and length of stay were compared between ERAS patients and carefully matched historical controls . Methods Patients were matched for their type of disease , the type of surgery , P-Possum ( Portsmouth-Possum ) , CR-Possum ( Colorectal-Possum ) Physiological and Operative Score for Enumeration of Mortality and Morbidity ( POSSUM ) , gender , and American Society of Anesthesiologists ( ASA ) grade . The primary outcome measures of this study were mortality and morbidity . Secondary outcome measures were fluid intake , length of hospital stay , the number of relaparotomies , and the number of readmissions within 30 days . Data on the ERAS patients were collected prospect ively . Results Sixty-one patients treated according to the ERAS program were compared with 122 patients who received conventional postoperative care .  The two groups were comparable with respect to age , ASA grade , P-Possum ( Portsmouth-Possum ) , CR-Possum ( Colorectal-Possum ) score , type of surgery , stoma formation , type of disease , and gender . Morbidity was lower in the ERAS group compared to the control group ( 14.8 % versus 33.6 % respectively ; P = < 0.01 ) . Patients in the ERAS group received significantly less fluid and spent fewer days in the hospital ( median 6 days , range 3–50 vs. median 9 days , range 3–138 ; P = 0.032 ) . There was no difference between the ERAS and the control group for mortality ( 0 % vs. 1.6 % ; P = 0.55 ) and readmission rate ( 3.3 % vs. 1.6 % ; P = 0.60 ) . Conclusion Enhanced Recovery After Surgery program  reduces morbidity and the length of hospital stay for patients undergoing elective colonic or rectal surgery Introduction The recent introduction of a Surgical Safety Checklist has significantly reduced the morbidity and mortality of surgery . Such a simple measure that can impact so highly on surgical outcomes causes all surgeons to pause for thought . This paper documents the introduction of a 10-step intraoperative surgical checklist ( ISC ) to st and ardize performance , decision-making , and training during laparoscopic cholecystectomy ( LC ) . The checklist ’s impact on conversion rates to open cholecystectomy ( OC ) is presented . Methods In 2004 , a 10-step ISC was introduced by a single consultant surgeon for the performance of LCs . Data were collected comparing LCs between 1999–2003 ( period 1 ) and 2004–2008 ( period 2 ) . Data on sex , age , American Society of Anesthesiology grade , previous abdominal surgery , severity of gallbladder pathology , and conversion to OC  were recorded . The chi-squared test with Yates correction was used to compare groups . Results In total , 637 LCs were performed , 277 during period 1 and 360 during period 2 . Risk factors for conversion ( gender , age , previous abdominal surgery , and severity of gallbladder pathology ) were not significantly different in the two periods studied . The overall conversion rate to OC fell significantly in period 2 ( p = 0.001 ) . Subgroup analysis also showed a significant reduction in conversion rates  in female patients ( p = 0.002 ) and patients with grade s III and IV gallbladder disease ( p = 0.001 ) . Conclusions The introduction of a 10-step ISC was temporally related to reduced conversion rates to OC . The st and ardization of a frequently performed operation such as a LC that could potentially lead to an impact as great the one we observed warrants further attention in prospect i ve , appropriately design ed studies OBJECTIVES Pneumothorax can be a major complication following chest drain removal . As paediatric patients have poor breath-holding compliance , the incidence in this group may be raised compared to the adult population . A small pilot study in our hospital found a pneumothorax rate post chest drain removal of 6/39 ( 15.4 % ) , which was high . The aim of this study was to determine the incidence of pneumothorax post paediatric chest drain removal after updating the guidelines for removal , and staff education . METHOD A prospect i ve audit was conducted using a structured proforma . All eligible patients admitted to Glenfield Hospital over a 6-month period were included in the study , which finally consisted of 93 patients aged 18 or under who underwent insertion of a chest drain .  RESULTS 93 patients , with 95 episodes of placement of chest drains were included in the prospect i ve audit . Four patients ( 4.2 % ) had a pneumothorax post chest drain removal , with one patient requiring insertion of a further chest drain for pneumothorax , and one patient requiring an additional drain due to recurrent pleural effusion . All patients who had post procedure pneumothorax were under 1 year of age ; 3 had had cardiac surgery , and 1 had an empyema . In total , 94/95 of patients had a radiograph post drain removal . 89 % of patients were admitted for cardiac surgery , 5.4 % for empyema  , 3.2 % for pneumothorax , 1 patient for a left upper lobectomy , and 1 patient was on extracorporeal membranous oxygenation . CONCLUSIONS This study found an incidence of pneumothorax post paediatric chest drain removal of 4.2 % , an improvement since the initial pilot study . A good removal technique reduces complication rates with trained staff following structured guidelines less likely to encounter problems . The application of an occlusive dressing rapidly following suture failure helps to decrease exposure times and thus lowers the incidence of pneumothorax BACKGROUND Surgery has become an integral part of global health care , with an estimated 234 million operations performed yearly . Surgical complications are common and often preventable . We hypothesized that a program to implement a 19-item surgical safety checklist design ed to improve team communication and consistency of care would reduce complications and deaths associated with surgery . METHODS Between October 2007 and September 2008 , eight hospitals in eight cities ( Toronto , Canada ; New Delhi , India ; Amman , Jordan ; Auckl and , New Zeal and ; Manila , Philippines ; Ifakara , Tanzania ; London , Engl and ; and Seattle , WA ) representing a variety of economic circumstances and diverse population s of patients participated in the World Health Organization 's Safe Surgery Saves Lives program . We prospect ively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery . We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist . The primary end point was the rate of complications , including death , during hospitalization within the first 30 days after the operation . RESULTS The rate of death was 1.5 % before the checklist was introduced and declined to 0.8 % afterward ( P=0.003 ) . Inpatient complications occurred in 11.0 % of patients at baseline and in 7.0 % after introduction of the checklist ( P<0.001 ) . CONCLUSIONS Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals BACKGROUND Studies have shown the value of using fast-track postoperative recovery . St and ard procedures ( non-fast-track strategies ) remain in common use for perioperative care . Few prospect i ve reports exist on the outcome of fast-tracking in Central Europe . The aim of our study was to assess the effect and safety of our own fast-track protocol with regard to the postoperative period after open bowel resection . PATIENTS AND METHODS One hundred and five patients with ASA score I-II scheduled for open intestinal resection in the period April 2005-December 2007 were r and omly selected for the fast-track group ( FT ) and non-fast-track group ( non-FT ) . A design ed protocol was used in the FT group with the emphasis on an interdisciplinary approach . The control group ( non-FT ) was treated by st and ard established procedures .  Postoperative pain , rehabilitation , gastrointestinal functions , postoperative complications , and post-op length of stay were recorded . RESULTS Of 105 patients , 103 were statistically analyzed . Patients in the FT group ( n=51 ) and non-FT group ( n=52 ) did not differ in age , surgical diagnosis , or procedure . The fast-track procedure led to significantly better control of postoperative pain and faster restoration of GI functions ( bowel movement after 1.3 days vs. 3.1 , p<0.001 ) . Food tolerance was significantly better in the FT group and rehabilitation was also faster . Hospital stay was shorter in the FT group - median seven days ( 95 % CI 7.0 - 7.7 ) versus ten days ( 95 % CI 9.5 - 11.3 ) in non-FT ( p<0.001 ) . Postoperative complications within 30 postoperative days were also significantly lower in the FT group ( 21.6 vs. 48.1 % , p=0.003 ) . There were no deaths and no patients were readmitted within 30 days . CONCLUSIONS Following the FT protocol helped to reduce frequency of postoperative complications and reduced hospital stay . We conclude that the FT strategy is safe and effective in improving postoperative outcomes Objectives : A review of the use of previously described integrated care pathways ( ICPs ) established for three elective vascular surgical procedures . Design : A retrospective analysis of information gathered prospect ively over an initial 18 month period of use of vascular surgical ICPs . Subjects : Patients admitted to a single vascular unit for “ open ” repair of abdominal aortic aneurysm ( AAA ) , carotid endarterectomy , or femoropopliteal bypass grafting . Methods : An analysis of variance data , length of stay , and costings after the use of ICPs , compared with previous clinical practice . Results : Variance data were gathered for each of the three procedures . Variances of medication prescribing and delays in discharge were common to all procedures . In particular : ( i ) gastrointestinal complications were more specific to AAA repair and ( ii ) wound drains were removed a day later than originally proposed after femoropopliteal bypass . Overall , improved efficiency due to use of ICPs  reduced the length of stay for all procedures , which was reflected in a potential cost saving of some 25 % . Conclusion : There are clear benefits to the use of ICPs , result ing in more structured , efficient , and cost effective patient care . Recommended changes to current practice based on variance analysis will require continued audit to sustain this “ evidence based ” approach The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures BACKGROUND Retained surgical items ( RSIs ) , most commonly sponges , are infrequent . Yet despite sponge-counting st and ards , failure to maintain an accurate count is a common error . To improve counting performance , technology solutions have been developed . A data -matrix-coded sponge ( DMS ) system was evaluated and implemented in a high-volume academic surgical practice at Mayo Clinic Rochester ( MCR ) . The primary end point was prevention of sponge RSIs after 18 months . METHODS Two trials were conducted before implementation . A r and omized-controlled trial assessed the system 's function , efficiency , and ergonomics . The second , larger trial was conducted to vali date the prior findings and test product improvements . After the trials , the system was implemented in all 128 operating/procedure rooms across the MCR campus on February 2 , 2009 . The institutionwide implementation was intended to avoid the possibility of having st and ard unmarked sponges and DMSs in the operating room suite concurrently . RESULTS Before implementation , a retained sponge occurred on average every 64 days . Between February 2009 and July 2010 , 87,404 procedures were performed , and 1,862,373 DMSs were used without an RSI ( p < .001 ) . After four cases , the average time to count a DMS decreased from 11 to 4 seconds . Total sponge counting time/operation increased without any increase in overall operative time . CONCLUSIONS After 18 months , a DMS system eliminated sponge RSIs from a high-volume surgical practice . The DMS system caused no work-flow disruption or increases in case duration . Staff satisfaction was acceptable , with a high degree of trust in the system . The DMS system is a reliable and cost-effective technology that improves patient safety OBJECTIVE To study the effect of quality assurance on the recurrence rate after hernia repair . DESIGN A prospect i ve longitudinal cohort study . SETTING District hospital , Sweden . SUBJECTS All ( n = 1232 ) patients aged 15 - 80 years operated upon for inguinal or femoral hernia in Motala 1984 , 1986 - 1988 , 1990 , and 1992 - 1994 . INTERVENTION A question naire enquiring about pain or a lump in the operated area was sent 3 - 6 years postoperatively to all patients , excluding those who had already been operated on for recurrence and those who had died . Selected cases were examined depending on the answers to the question naire . MAIN OUTCOME MEASURES Recurrence rate estimated by 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Enhanced Recovery After Surgery ( ERAS ) programs are associated with reduced hospital morbidity and mortality . The aim of the present study was to evaluate whether the introduction of ERAS care improved the adverse events in colorectal surgery . In a cohort study , mortality , morbidity , and length of stay were compared between ERAS patients and carefully matched historical controls . Methods Patients were matched for their type of disease , the type of surgery , P-Possum ( Portsmouth-Possum ) , CR-Possum ( Colorectal-Possum ) Physiological and Operative Score for Enumeration of Mortality and Morbidity ( POSSUM ) , gender , and American Society of Anesthesiologists ( ASA ) grade . The primary outcome measures of this study were mortality and morbidity . Secondary outcome measures were fluid intake , length of hospital stay , the number of relaparotomies , and the number of readmissions within 30 days . Data on the ERAS patients were collected prospect ively . Results Sixty-one patients treated according to the ERAS program were compared with 122 patients who received conventional postoperative care .  The two groups were comparable with respect to age , ASA grade , P-Possum ( Portsmouth-Possum ) , CR-Possum ( Colorectal-Possum ) score , type of surgery , stoma formation , type of disease , and gender . Morbidity was lower in the ERAS group compared to the control group ( 14.8 % versus 33.6 % respectively ; P = < 0.01 ) . Patients in the ERAS group received significantly less fluid and spent fewer days in the hospital ( median 6 days , range 3–50 vs. median 9 days , range 3–138 ; P = 0.032 ) . There was no difference between the ERAS and the control group for mortality ( 0 % vs. 1.6 % ; P = 0.55 ) and readmission rate ( 3.3 % vs. 1.6 % ; P = 0.60 ) . Conclusion Enhanced Recovery After Surgery program  reduces morbidity and the length of hospital stay for patients undergoing elective colonic or rectal surgery Introduction The recent introduction of a Surgical Safety Checklist has significantly reduced the morbidity and mortality of surgery . Such a simple measure that can impact so highly on surgical outcomes causes all surgeons to pause for thought . This paper documents the introduction of a 10-step intraoperative surgical checklist ( ISC ) to st and ardize performance , decision-making , and training during laparoscopic cholecystectomy ( LC ) . The checklist ’s impact on conversion rates to open cholecystectomy ( OC ) is presented . Methods In 2004 , a 10-step ISC was introduced by a single consultant surgeon for the performance of LCs . Data were collected comparing LCs between 1999–2003 ( period 1 ) and 2004–2008 ( period 2 ) . Data on sex , age , American Society of Anesthesiology grade , previous abdominal surgery , severity of gallbladder pathology , and conversion to OC  were recorded . The chi-squared test with Yates correction was used to compare groups . Results In total , 637 LCs were performed , 277 during period 1 and 360 during period 2 . Risk factors for conversion ( gender , age , previous abdominal surgery , and severity of gallbladder pathology ) were not significantly different in the two periods studied . The overall conversion rate to OC fell significantly in period 2 ( p = 0.001 ) . Subgroup analysis also showed a significant reduction in conversion rates  in female patients ( p = 0.002 ) and patients with grade s III and IV gallbladder disease ( p = 0.001 ) . Conclusions The introduction of a 10-step ISC was temporally related to reduced conversion rates to OC . The st and ardization of a frequently performed operation such as a LC that could potentially lead to an impact as great the one we observed warrants further attention in prospect i ve , appropriately design ed studies OBJECTIVES Pneumothorax can be a major complication following chest drain removal . As paediatric patients have poor breath-holding compliance , the incidence in this group may be raised compared to the adult population . A small pilot study in our hospital found a pneumothorax rate post chest drain removal of 6/39 ( 15.4 % ) , which was high . The aim of this study was to determine the incidence of pneumothorax post paediatric chest drain removal after updating the guidelines for removal , and staff education . METHOD A prospect i ve audit was conducted using a structured proforma . All eligible patients admitted to Glenfield Hospital over a 6-month period were included in the study , which finally consisted of 93 patients aged 18 or under who underwent insertion of a chest drain .  RESULTS 93 patients , with 95 episodes of placement of chest drains were included in the prospect i ve audit . Four patients ( 4.2 % ) had a pneumothorax post chest drain removal , with one patient requiring insertion of a further chest drain for pneumothorax , and one patient requiring an additional drain due to recurrent pleural effusion . All patients who had post procedure pneumothorax were under 1 year of age ; 3 had had cardiac surgery , and 1 had an empyema . In total , 94/95 of patients had a radiograph post drain removal . 89 % of patients were admitted for cardiac surgery , 5.4 % for empyema  , 3.2 % for pneumothorax , 1 patient for a left upper lobectomy , and 1 patient was on extracorporeal membranous oxygenation . CONCLUSIONS This study found an incidence of pneumothorax post paediatric chest drain removal of 4.2 % , an improvement since the initial pilot study . A good removal technique reduces complication rates with trained staff following structured guidelines less likely to encounter problems . The application of an occlusive dressing rapidly following suture failure helps to decrease exposure times and thus lowers the incidence of pneumothorax BACKGROUND Surgery has become an integral part of global health care , with an estimated 234 million operations performed yearly . Surgical complications are common and often preventable . We hypothesized that a program to implement a 19-item surgical safety checklist design ed to improve team communication and consistency of care would reduce complications and deaths associated with surgery . METHODS Between October 2007 and September 2008 , eight hospitals in eight cities ( Toronto , Canada ; New Delhi , India ; Amman , Jordan ; Auckl and , New Zeal and ; Manila , Philippines ; Ifakara , Tanzania ; London , Engl and ; and Seattle , WA ) representing a variety of economic circumstances and diverse population s of patients participated in the World Health Organization 's Safe Surgery Saves Lives program . We prospect ively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery . We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist . The primary end point was the rate of complications , including death , during hospitalization within the first 30 days after the operation . RESULTS The rate of death was 1.5 % before the checklist was introduced and declined to 0.8 % afterward ( P=0.003 ) . Inpatient complications occurred in 11.0 % of patients at baseline and in 7.0 % after introduction of the checklist ( P<0.001 ) . CONCLUSIONS Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals BACKGROUND Studies have shown the value of using fast-track postoperative recovery . St and ard procedures ( non-fast-track strategies ) remain in common use for perioperative care . Few prospect i ve reports exist on the outcome of fast-tracking in Central Europe . The aim of our study was to assess the effect and safety of our own fast-track protocol with regard to the postoperative period after open bowel resection . PATIENTS AND METHODS One hundred and five patients with ASA score I-II scheduled for open intestinal resection in the period April 2005-December 2007 were r and omly selected for the fast-track group ( FT ) and non-fast-track group ( non-FT ) . A design ed protocol was used in the FT group with the emphasis on an interdisciplinary approach . The control group ( non-FT ) was treated by st and ard established procedures .  Postoperative pain , rehabilitation , gastrointestinal functions , postoperative complications , and post-op length of stay were recorded . RESULTS Of 105 patients , 103 were statistically analyzed . Patients in the FT group ( n=51 ) and non-FT group ( n=52 ) did not differ in age , surgical diagnosis , or procedure . The fast-track procedure led to significantly better control of postoperative pain and faster restoration of GI functions ( bowel movement after 1.3 days vs. 3.1 , p<0.001 ) . Food tolerance was significantly better in the FT group and rehabilitation was also faster . Hospital stay was shorter in the FT group - median seven days ( 95 % CI 7.0 - 7.7 ) versus ten days ( 95 % CI 9.5 - 11.3 ) in non-FT ( p<0.001 ) . Postoperative complications within 30 postoperative days were also significantly lower in the FT group ( 21.6 vs. 48.1 % , p=0.003 ) . There were no deaths and no patients were readmitted within 30 days . CONCLUSIONS Following the FT protocol helped to reduce frequency of postoperative complications and reduced hospital stay . We conclude that the FT strategy is safe and effective in improving postoperative outcomes Objectives : A review of the use of previously described integrated care pathways ( ICPs ) established for three elective vascular surgical procedures . Design : A retrospective analysis of information gathered prospect ively over an initial 18 month period of use of vascular surgical ICPs . Subjects : Patients admitted to a single vascular unit for “ open ” repair of abdominal aortic aneurysm ( AAA ) , carotid endarterectomy , or femoropopliteal bypass grafting . Methods : An analysis of variance data , length of stay , and costings after the use of ICPs , compared with previous clinical practice . Results : Variance data were gathered for each of the three procedures . Variances of medication prescribing and delays in discharge were common to all procedures . In particular : ( i ) gastrointestinal complications were more specific to AAA repair and ( ii ) wound drains were removed a day later than originally proposed after femoropopliteal bypass . Overall , improved efficiency due to use of ICPs  reduced the length of stay for all procedures , which was reflected in a potential cost saving of some 25 % . Conclusion : There are clear benefits to the use of ICPs , result ing in more structured , efficient , and cost effective patient care . Recommended changes to current practice based on variance analysis will require continued audit to sustain this “ evidence based ” approach The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures BACKGROUND Retained surgical items ( RSIs ) , most commonly sponges , are infrequent . Yet despite sponge-counting st and ards , failure to maintain an accurate count is a common error . To improve counting performance , technology solutions have been developed . A data -matrix-coded sponge ( DMS ) system was evaluated and implemented in a high-volume academic surgical practice at Mayo Clinic Rochester ( MCR ) . The primary end point was prevention of sponge RSIs after 18 months . METHODS Two trials were conducted before implementation . A r and omized-controlled trial assessed the system 's function , efficiency , and ergonomics . The second , larger trial was conducted to vali date the prior findings and test product improvements . After the trials , the system was implemented in all 128 operating/procedure rooms across the MCR campus on February 2 , 2009 . The institutionwide implementation was intended to avoid the possibility of having st and ard unmarked sponges and DMSs in the operating room suite concurrently . RESULTS Before implementation , a retained sponge occurred on average every 64 days . Between February 2009 and July 2010 , 87,404 procedures were performed , and 1,862,373 DMSs were used without an RSI ( p < .001 ) . After four cases , the average time to count a DMS decreased from 11 to 4 seconds . Total sponge counting time/operation increased without any increase in overall operative time . CONCLUSIONS After 18 months , a DMS system eliminated sponge RSIs from a high-volume surgical practice . The DMS system caused no work-flow disruption or increases in case duration . Staff satisfaction was acceptable , with a high degree of trust in the system . The DMS system is a reliable and cost-effective technology that improves patient safety OBJECTIVE To study the effect of quality assurance on the recurrence rate after hernia repair . DESIGN A prospect i ve longitudinal cohort study . SETTING District hospital , Sweden . SUBJECTS All ( n = 1232 ) patients aged 15 - 80 years operated upon for inguinal or femoral hernia in Motala 1984 , 1986 - 1988 , 1990 , and 1992 - 1994 . INTERVENTION A question naire enquiring about pain or a lump in the operated area was sent 3 - 6 years postoperatively to all patients , excluding those who had already been operated on for recurrence and those who had died . Selected cases were examined depending on the answers to the question naire . MAIN OUTCOME MEASURES Recurrence rate estimated by 
    Output:
    