Abstract:
BACKGROUND:There are few reports comparing the variety and frequency of postoperative complications between patients with a major clinical leak requiring emergency abdominal reoperation and those with a minor leak diagnosed from clinical signs and managed expectantly without reoperation. This study examined the association between severity of leakage and 18 other postoperative complications, postoperative mortality, and length of postoperative hospital stay. STUDY DESIGN:Data were drawn from a comprehensive, prospective hospital registry of 1,507 colorectal cancer resections involving an anastomosis from January 1995 to December 2006. Differences were evaluated by two-tailed Fisher's exact test, Student's t-test, or Mann-Whitney U test. RESULTS:Leaks occurred in 54 patients (3.6%; 95% CI, 2.7% to 4.7%), comprising 21 major (1.4%; 95% CI, 0.9% to 2.1%) and 33 minor leaks (2.2%; 95% CI, 1.5% to 3.2%). Patients with a leak were significantly (p < 0.01) more likely than those without to have 11 of 18 other surgical and medical complications considered, although with few differences in complication rates between those with major and minor leaks. As compared with patients without leak, those with a leak (major or minor) had several of these complications rather than just one (p < 0.001) and greatly prolonged hospital stay (p < 0.001). Postoperative mortality was higher after major leaks than after minor leaks (4 of 21 and 0 of 33, respectively, p = 0.019). CONCLUSIONS:A minor leak is not trivial. Apart from the fact that major clinical leakage necessitates urgent reoperation, there were few other differences between major and minor clinical leaks in the frequency of other complications.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Tytherleigh MG,Bokey L,Chapuis PH,Dent OFdoi
10.1016/j.jamcollsurg.2007.05.031subject
Has Abstractpub_date
2007-11-01 00:00:00pages
648-53issue
5eissn
1072-7515issn
1879-1190pii
S1072-7515(07)00698-9journal_volume
205pub_type
杂志文章abstract:BACKGROUND:Cholestasis and endotoxemia have been demonstrated to cause hepatocyte apoptosis through caspase-mediated pathways. In vitro nitric oxide (NO) donors reduce hepatocyte apoptosis and caspase activation in several models. The nitric oxide donor molsidomine improves survival in an in vivo model of endotoxemia. ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00386-7
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides reliable, risk-adjusted outcomes data using standardized definitions and end points. Collection of the data is time consuming, and the surgical clinical nurse reviewers (SCNRs) can sample only a subset of all ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.08.030
更新日期:2009-01-01 00:00:00
abstract::The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a pandemic on March 11. This had led to the calling of a national emergency on March 13 in the US. Many hospitals, healthcare networks, and s...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.03.019
更新日期:2020-06-01 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:Postoperative ileus (POI), an interruption of coordinated bowel motility after operation, is exacerbated by opioids used to manage pain. Alvimopan, a peripherally acting mu-opioid receptor antagonist, accelerated gastrointestinal (GI) recovery after bowel resection in randomized, double-blind, placebo-contro...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jamcollsurg.2007.01.041
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:Earlier studies of medical students on nonsurgical rotations have shown that clinical clerks usually first interact with their patients late in the clinical course. This would seem disadvantageous to the student's learning because they would have less opportunity to generate diagnoses or a management plan. ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01326-1
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Choosing a breast reconstructive modality after mastectomy is an important step in the reconstructive process. The authors hypothesized that autologous tissue is associated with a greater success rate and cost efficacy over time, relative to implant reconstruction. STUDY DESIGN:A retrospective review was pe...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.02.028
更新日期:2014-08-01 00:00:00
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:Some patients require major leg amputation after lower-extremity prosthetic bypass for graft occlusion or failure of wound healing, despite a patent graft. Amputation above or below the knee was hypothesized to increase susceptibility to prosthetic graft infection in the ipsilateral extremity. STUDY DESIGN:...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.01.001
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:The impact of quality measures in health care and reimbursement is growing. Ensuring the accuracy of quality measures, including any risk-stratification variables, is necessary. Surgical site infection rates, risk stratified by surgical wound classification (SWC) among other variables, are increasingly consi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.07.398
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL) are the two main approaches to the treatment of hepatolithiasis, but comparisons of longterm followup results have not been adequately reported. STUDY DESIGN:Of 86 patients with hepatolithiasis admitted to our institution betw...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00109-x
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:Failure-to-rescue (FTR or death after postoperative complication) is thought to explain surgical mortality excesses across hospitals, and FTR is an emerging performance measure and target for quality improvement. We compared the FTR population to preoperatively identifiable subpopulations for their potential...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.02.036
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Reprocessing of single-use medical instruments has been proposed as a mechanism for managing the rising costs of health care. We compared the performance of new and reprocessed laparoscopic trocars. STUDY DESIGN:New and reprocessed laparoscopic trocars were evaluated. Testing consisted of visual and microsc...
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.2010.08.003
更新日期:2010-12-01 00:00:00
abstract:UNLABELLED:Some of the concepts contained here have been discussed and incorporated in another publication, but the data are entirely unique to this manuscript. (See: Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause." Backster A, Teo A, Swift M, MD, Polk HC Jr, MD, FACS, Harken AH, MD, FACS....
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.01.009
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients. STUDY DESIGN:We performed a retrospective review of trauma patients from 2014 through 2018...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.09.009
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Although breast-conserving surgery is the standard of care for early-stage breast cancer, many women report breast asymmetry after this procedure. Risk factors for poor esthetic outcomes are not well understood. STUDY DESIGN:A self-administered survey was sent to patients who underwent lumpectomy (n = 898) ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.07.029
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:We sought to determine the clinical factors and tumor characteristics associated with the reported poor prognosis in young patients with carcinoma of the colon and rectum. STUDY DESIGN:A retrospective review was performed of 186 patients younger than 40 years of age who were treated for primary colorectal a...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1996-08-01 00:00:00
abstract:BACKGROUND:Until recently, in the United Kingdom, borderline resectable pancreatic cancer with invasion into the portomesenteric veins often resulted in surgical bypass because of the presumed high risk for complications and the uncertainty of a survival benefit associated with a vascular resection. Portomesenteric vei...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2013.11.017
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:Percutaneous endoscopic gastrostomy (PEG) by the "push" technique avoids peri-catheter infection, repeated insertion of the endoscope, potential esophageal injury from the catheter, and the possible need for another endoscopy for catheter removal associated with the "pull" technique. In small infants, howeve...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1996-03-01 00:00:00
abstract::Technical modification of the DSRS by using the end-to-end splenoadrenal anastomosis allows for effective selective decompression of portal hypertension in children, can be accomplished with no perioperative mortality, and has demonstrated longterm patency and minimal morbidity. Clinical encephalopathy was seen in onl...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00244-0
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center. STUDY DESIGN:A retrospective stud...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.02.032
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Neoadjuvant chemotherapy has been shown to increase the rate of breast conservation in clinical trials and small institutional series, but it has never been studied on a national level. STUDY DESIGN:We performed a retrospective review of the National Cancer Database (NCDB). The NCDB is a joint project of th...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.02.011
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:The foreign body reaction caused by implanted biomaterials is not fully characterized. To evaluate the effect of an expanded polytetrafluoroethylene (ePTFE) surface on the binding of monoclonal antibodies against the intercellular adhesion molecule (ICAM-1) by adherent endothelial cells, an in vitro bioassay...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-09-01 00:00:00
abstract:BACKGROUND:A low prevalence of high-level clinical studies in the surgical literature has been reported previously. We reviewed a recent sample of surgical publications to assess the current status of clinical research. STUDY DESIGN:A 3-month sample of journal articles in Archives of Surgery, Surgery, and Annals of Su...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.08.013
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Laparoscopic antireflux surgery has replaced conventional operation despite the fact that currently no randomized trials have been published regarding its cost effectiveness. The objective of the present study was to compare costs and some short-term outcomes of laparoscopic and open Nissen fundoplication. ...
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:10.1016/s1072-7515(98)00328-7
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:To evaluate whether abdominal aortic aneurysm (AAA) growth in individual patients can be characterized as continuous or discontinuous (staccato). STUDY DESIGN:From 1996 to 2002, 609 patients presented with unruptured AAAs. Of these, 278 underwent prompt repair and 331 were observed. In this study, we includ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2004.07.031
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:There is increasing interest in implementing comprehensive perioperative protocols, including preoperative optimization and education, perioperative goal-directed fluid management, and postoperative fast tracking, to enhance recovery after surgery. Data on the outcomes of these protocols in pancreatic surger...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.12.036
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Palliative care is an important and necessary humanistic facet of ICU care. Wide variations exist in selection and implementation of palliative care decisions. Understanding patient factors associated with these decisions is crucial. STUDY DESIGN:Consecutive deaths (n = 151 patients) in a tertiary care surg...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.09.003
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum. STUDY DESIGN:Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experien...
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
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更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Neoadjuvant locoregional therapies (LRTs) have been widely used to reduce tumor burden or to downstage hepatocellular carcinoma (HCC) before orthotopic liver transplantation (OLT). We examined the impact of LRT response on HCC recurrence after OLT. STUDY DESIGN:We performed a retrospective study of 384 pati...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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更新日期:2017-07-01 00:00:00