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Invited Commentary
May 2014

Time to Put Another Surgical Dogma to Sleep?

Author Affiliations
  • 1Department of Surgery and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
JAMA Surg. 2014;149(5):466. doi:10.1001/jamasurg.2013.5282

Good outcomes after surgery require scrupulous attention to detail: careful patient selection, thorough preoperative evaluation, meticulous surgery and intraoperative anesthesia management, and comprehensive postoperative care. However, numerous perioperative practices based on few or no data—surgical dogma—may do little to help and may even harm patients. For example, routine use of mechanical bowel preparation before colon surgery, nasogastric tubes after gastrointestinal surgery, and antibiotic irrigation of the abdomen remain common practices. Still another example is routine high-dose perioperative glucocorticoid therapy in patients with inflammatory bowel disease.

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