Abstract:
BACKGROUND:Commonly performed elective gastrointestinal surgical procedures are carried out with low morbidity and mortality in hospitals throughout the United States. Complex operative procedures on the alimentary tract are performed with a relatively low frequency and are associated with higher mortality. Volume and experience of the surgical provider team have been correlated with better clinical and economic outcomes for one complex gastrointestinal surgical procedure, pancreaticoduodenectomy. This study evaluated whether provider volume and experience were important factors influencing clinical and economic outcomes for a variety of complex gastrointestinal surgical procedures in one state. STUDY DESIGN:Complex high-risk gastrointestinal surgical procedures were defined as those with statewide in-hospital mortality of > or = 5%, frequency of greater than 200 per year in the state, and requiring special surgical skill and expertise. Six procedures met these criteria. Using publicly available discharge data, all patients discharged from Maryland hospitals from July 1989 to June 1997 with a primary procedure code for one of the six study procedures were selected. Hospitals were classified into one of six groups based on the average number of study procedures per year: 10 or less; 11 to 20; 21 to 50; 51 to 100; 101 to 200; and 201 or more procedures per year. A hospital was included if at least one procedure was performed there during the study period. No providers fell within the 51 to 100, and 101 to 200 groups, so all analyses were performed for the remaining four volume groups that were classified, respectively, as minimal (10 or fewer procedures), low (11 to 20 procedures), medium (21 to 50 procedures), and high-volume groups (201 or more procedures). Poisson regression was used to assess the relationship between in-hospital mortality and hospital volume after case-mix adjustment. Multiple linear regression models were used to assess differences in average length-of-stay and average total hospital charges among hospital volume groups. We further analyzed mortality, length-of-stay, and charges at the procedural level to understand these subgroups of complex gastrointestinal patients. We also examined the relationship between provider volume and outcomes for malignant versus benign diagnosis groups. RESULTS:Complex gastrointestinal surgical procedures were performed on 4,561 patients in Maryland from July 1989 through June 1997. The study population averaged 61.6 years of age, was 55% male, 71% Caucasian, and had predominantly Medicare as a payment source. After case-mix adjustment, patients who underwent complex gastrointestinal surgical procedures at the medium-, low-, and minimal-volume provider groups had a 2.1, 3.3, and 3.2 times greater risk of in-hospital death, respectively, than patients at the high-volume provider (p < 0.001 for all comparisons); longer lengths-of-stay, 16.1, 15.7, and 15.5 days at the low-, medium-, and minimal-volume groups, respectively, versus 14.0 days for the high-volume provider (p < 0.001 for all comparisons). Similarly, adjusted charges at the high-volume provider were, on average, 14% less than those of the low-volume group, which had the next lowest charges. Although mortality rates differed by procedure type, for each procedure, mortality increased as provider volume decreased, following the pattern found in the aggregate analysis. After case-mix adjustment, the risk of in-hospital death for patients with malignant diagnoses was significantly higher for the medium-, low-, and minimal-volume groups compared with patients at the high-volume provider, relative risk of 3.1, 4.0, and 4.2, respectively, (p < 0.001 for all comparisons). CONCLUSIONS:This study demonstrates that increased hospital experience is associated with a marked decrease in hospital mortality. The decreased mortality at the high-volume provider was also associated with shorter lengths-of-stay and lower hospital char
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Gordon TA,Bowman HM,Bass EB,Lillemoe KD,Yeo CJ,Heitmiller RF,Choti MA,Burleyson GP,Hsieh G,Cameron JLdoi
10.1016/s1072-7515(99)00072-1keywords:
subject
Has Abstractpub_date
1999-07-01 00:00:00pages
46-56issue
1eissn
1072-7515issn
1879-1190pii
S1072751599000721journal_volume
189pub_type
杂志文章abstract:BACKGROUND:The current study seeks to determine if the efficacy and safety of laparoscopic donor nephrectomy holds true when performed in patients older than 60 years of age. STUDY DESIGN:Medical records of 42 renal donors older than 60 years were reviewed compared with younger controls carefully matched for gender, r...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2004.02.018
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:The mortality rate of bleeding esophageal varices in cirrhosis is highest during the period of acute bleeding. This is a report of a randomized trial that compared endoscopic sclerotherapy (EST) with emergency portacaval shunt (EPCS) in cirrhotic patients with acute variceal hemorrhage. STUDY DESIGN:A total...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2009.02.059
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Decreased antithrombin III (ATIII) activity and large splenic vein diameter (SVD) are risk factors for portal vein thrombosis (PVT) after splenectomy in liver cirrhosis with portal hypertension. Antithrombin III concentrates can prevent PVT. This study was designed to stratify risks for PVT after splenectomy...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2014.07.939
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The Michigan Trauma Quality Improvement Program (MTQIP) is a collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network (BCBSM/BCN). The MTQIP benchmark reports identified our trauma center as a high outlier for venous thromboembolism (VTE) episodes. This study out...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.05.006
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Frailty is an objective method of quantifying a patient's fitness for surgery. Its clinical use is limited by the time needed to complete, as well as a lack of evidence-based interventions to improve outcomes in identified frail patients. The purpose of this study was to critically analyze the components of ...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2015.01.053
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Appendiceal cancer (AC) patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often demonstrate an unpredictable variability in their survival outcomes. Biomarkers predictive of CRS/HIPEC efficacy could better guide treatment decisions. We hypothesized that v...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.12.012
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Acute limb ischemia initiates a systemic inflammatory response, including pulmonary polymorphonuclear leukocyte (PMN) sequestration and acute lung injury. Lung injury is partly attributed to release by PMN's of extracellular matrix (ECM) modifying metalloproteinases (MMPs). We hypothesized that acute hindlim...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00134-0
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the operative repair of rectoceles in a defined group of women by a technique designed to deal with the cause (failure of the rectovaginal septum) rather than the effect (rectal and vaginal wall bulging). STUDY DESIGN:Only women whose defecation was aided by vaginal dig...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:The aim of this study is to investigate patient-centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair. STUDY DESIGN:We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 and 2016. The QOL outcomes were measu...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.12.054
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Pediatric appendicitis is treated by both pediatric and general surgeons. We investigated whether specialty-dependent differences existed in patients' characteristics and outcomes. STUDY DESIGN:A retrospective chart review of 465 consecutive children treated for appendicitis at a university-affiliated child...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.10.006
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Since 1968, there have been three published reports in the United States literature of 41, 118, and 145 consecutive patients undergoing pancreaticoduodenectomy without mortality. In all of these series, the pancreatic remnant was anastomosed to the jejunum. STUDY DESIGN:This study was designed to review 152...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00331-4
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Patients with necrotizing pancreatitis (NP) have the highest rate of venous thromboembolism (VTE) of any hospitalized patient (57%). We hypothesized that VTE prophylaxis might be inadequate in the setting of this profound inflammatory disease and that early detection of deep vein thrombosis would limit pulmo...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.08.774
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Several authors have questioned the need for axillary lymph node dissection in T1a breast cancer (primary tumors 5 mm or less in diameter), although current practice typically includes routine axillary lymph node dissection. STUDY DESIGN:We retrospectively reviewed the records of 2,242 breast cancers in our...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1997-05-01 00:00:00
abstract:BACKGROUND:Rests of thyroid tissue within the thyrothymic area are relatively common and might be of clinical importance. The purpose of this study is to define the incidence and anatomy of thyroid tissue located in the line of the thyrothymic ligament, referred to here as "rests." STUDY DESIGN:Prospective descriptive...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01319-4
更新日期:2002-11-01 00:00:00
abstract:BACKGROUND:The robotic platform has been used increasingly to perform colorectal surgery. The benefits of robotic colectomy when compared with laparoscopic colectomy have not been definitively established. STUDY DESIGN:A retrospective review of the NSQIP database was performed on patients undergoing elective laparosco...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.03.041
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Drainage methods for the gastric conduit after esophagectomy for carcinoma have been controversial. STUDY DESIGN:In a randomized controlled trial, 92 patients with esophageal carcinoma were randomized to have pyloroplasty or pyloromyotomy as a drainage procedure for the gastric conduit used for esophageal r...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Laparoscopic liver resection is a procedure in evolution. In the last decade it has evolved from a novel procedure to a standard part of the hepatic surgeon's armamentarium. Few data exist on the development of a laparoscopic resection program. STUDY DESIGN:With IRB approval, a retrospective review of 300 c...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.04.032
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a no...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2010.10.009
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:In 1991, a National Institutes of Health Consensus Panel stated that preoperative localization for primary hyperparathyroidism is not cost effective. Since then, the sestamibi scan has been applied to parathyroid disease with excellent results, even allowing unilateral exploration under local anesthesia. ST...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,meta分析
doi:10.1016/s1072-7515(98)00016-7
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Elaboration of a number of bioactive substances, including adenosine, occurs in heart failure (HF). Adenosine, through the adenosine subtype 1 (A1) receptor, can reduce renal perfusion pressure and glomerular filtration rate and increase tubular sodium reabsorption, which can affect natriuresis and aquaresis...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01136-5
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:This study aims to describe the magnitude of hospital costs among patients undergoing elective colectomy, cholecystectomy, and pancreatectomy, determine whether these costs relate as expected to duration of care, patient case-mix severity and comorbidities, and whether risk-adjusted costs vary significantly ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.10.021
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Laparoscopic antireflux surgery (LARS) has proven to be as effective as open antireflux surgery (OARS), but it is associated with a shorter hospital stay and a faster recover. The aims of this study were to assess the national use of LARS in the US and to compare the perioperative outcomes between laparoscop...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.12.010
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Determining the negative predictive value of benign large-core needle biopsy of nonpalpable mammographically detected breast abnormalities has been difficult because benign results generally preclude surgical excision. Longterm followup of these patients is important to ensure timely diagnosis of new abnorma...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01320-0
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and ma...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.12.046
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:The complications and long-term follow-up results of internal hemipelvectomy are not well documented. STUDY DESIGN:We reviewed 32 internal hemipelvectomies performed between 1976 and 1994. RESULTS:The pathologic diagnoses were soft tissue sarcoma in 15 cases, bone tumor in 14 cases, melanoma in two cases, ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Recent literature suggests that focus in health care should shift from reducing costs to improving quality; where quality of health care improves, cost reduction will follow. Our primary aim was to investigate whether improving the quality of surgical colorectal cancer care, by using a national quality impro...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.09.020
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Central morbidity and mortality conferences ensure uniform content and more participants but consume work hours in commuting for programs with multiple teaching hospitals. Internet-based televideoconferencing (TVC) technology has the potential to eliminate commuting and expand participation and retain qualit...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2010.12.002
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Direct communication between an aortic prosthesis and the gastrointestinal (GI) tract may present with GI bleeding (aortoenteric fistulas [AEF]) or be incidental to a graft infection (paraprosthetic erosions [PPE]). The purposes of this study were to compare the outcomes of AEF versus PPE and to determine pr...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.08.010
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:The anatomic difficulties that we have to deal with in open surgery for rectal cancer have not been overcome with the laparoscopic approach. In the search for a solution, a change of concept arose: approaching the rectum from below. The main objectives of this study were to show the potential advantages of t...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2015.03.046
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:We aimed to assess patient and demographic factors, treatment trends, and survival outcomes of patients with colorectal cancer with metastasis to the liver, lung, or both sites. Differences remain among national guidelines about the optimal management strategy. METHODS:Adults from the National Cancer Databa...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.12.024
更新日期:2020-04-01 00:00:00