Implementação de protocolo de recuperação acelerada no cuidado perioperatório de pacientes submetidos à laparotomia por trauma abdominal penetrante
Bibliographic record
Abstract
Introduction:The implementation of enhanced recovery programs (ERPs) has significantly improved outcomes within various surgical specialties.However, the suitability of ERPs in trauma surgery remains unclear.This study aimed to 1) design and implement an ERP for patients undergoing emergency laparotomy for penetrating abdominal trauma; 2) assess the safety, feasibility, and efficacy of the proposed ERP; and 3) compare its surgical outcomes with conventional practices.Methods: This single-center case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma.Patients receiving the proposed ERP were compared with historical controls managed according to conventional practices.Cases were individually matched (1:1) for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores.Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters.Results: Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants.A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed.There was no difference in the incidence of postoperative complications.Opioid consumption was considerably lower in the ERP group (p<0.010).Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p<0.001). Discussion:The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications.Moreover, the 30-day readmission and reintervention rates were statistically comparable to conventional care. Conclusion:These findings demonstrate that ERPs principles can be safely applied to selected trauma patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.019 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".