Abstract:
BACKGROUND:There has been a dramatic increase in the use of endovascular technology for treatment of abdominal aortic aneurysms (AAA), but practice patterns have not been well-evaluated. Hospital resource use and outcomes after elective endovascular abdominal aortic repair (EVAR) and open surgical repair were assessed by hospital type, ie, major teaching (MT), teaching affiliate, and nonteaching (NT). STUDY DESIGN:Elective, nonruptured AAA repairs were identified in the State Inpatient Databases for New Jersey (2001 to 2006). Descriptive statistics, univariate, multivariable, trend, and case-mix-adjustment analyses were employed. RESULTS:A total of 6,227 subjects were identified; 4,698 patients (mean age 73.0 +/- 8.01 years; 79.2% men) underwent elective repair of AAA. EVAR was performed 2.6 times more often in MT compared with NT (p < 0.0001) institutions. Univariate evaluation demonstrated that women had a predominance of EVAR performed (p < 0 .0002) in MT hospitals and that minorities in NT hospitals were more likely to be treated with open operations (p = 0.0148). Case-mix-adjusted mortality rates for EVAR were higher at NT (1.95%; 95% CI, 1.81 to 2.09) compared with MT (0.73%; 95% CI, 0.69 to 0.77) hospitals. After adjustment, MT hospitals were more likely to use EVAR (odds ratio = 2.4; 95% CI, 2.11 to 2.83) and less likely to have increased length of stay (odds ratio = 0.38; 95% CI, 0.32 to 0.44) compared with NT. CONCLUSIONS:Hospital teaching status was significantly associated with repair type, overall mortality, and hospital resource use. MT hospitals were considerably more likely to use EVAR for elective AAA repair, offered an improvement in survival, were more likely to treat women and minorities with EVAR, and demonstrated decreased length of stay and cost.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Vogel TR,Dombrovskiy VY,Graham AMdoi
10.1016/j.jamcollsurg.2009.05.024subject
Has Abstractpub_date
2009-09-01 00:00:00pages
356-63issue
3eissn
1072-7515issn
1879-1190pii
S1072-7515(09)00509-2journal_volume
209pub_type
杂志文章abstract:BACKGROUND:Hereditary predisposition to colorectal cancer most often manifests itself as familial adenomatous polyposis from mutations of APC, or hereditary nonpolyposis colorectal cancer, resulting from mutations of MSH2, MLH1, MSH6, or other genes. Previously, we described a rare founder mutation MSH2*1906C > G in As...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(02)01808-2
更新日期:2003-02-01 00:00:00
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: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 Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in use of regionalized surgery at high-volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the us...
journal_title:Journal of the American College of Surgeons
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更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Afterbirth or placenta is normally discarded. But placental cord blood, because of its rich mix of fetal and adult hemoglobin, plasma, and high platelet count has the potential to be a safe alternative to adult blood. STUDY DESIGN:We transfused 413 U (range 50 mL to 146 mL; mean 86 mL+/-7.6 mL SD; median 80...
journal_title:Journal of the American College of Surgeons
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更新日期:2005-04-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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abstract:BACKGROUND:Parathyroid hormone (PTH) levels after total thyroidectomy have been shown to predict the development of symptomatic hypocalcemia and the need for calcium supplementation. This study aimed to determine whether a PTH level drawn 4 hours postoperatively is as effective as a level drawn on postoperative day 1 (...
journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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更新日期:2017-09-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:Although laparoscopic appendectomy is a safe and effective procedure for management of acute appendicitis, data about the feasibility and safety during pregnancy are limited. We aimed to study our experience in this field and to review the scientific evidence available. STUDY DESIGN:All patients undergoing ...
journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2007.01.068
更新日期:2007-07-01 00:00:00
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更新日期:1997-03-01 00:00:00
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更新日期:2013-03-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.05.023
更新日期:2008-11-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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更新日期:1994-09-01 00:00:00
abstract:BACKGROUND:Studies have shown that racial and socioeconomic differences lead to inequality in access to health care. It is unknown whether insurance status and race affect the choice of surgical treatment for patients presenting with appendicitis. STUDY DESIGN:Patients with primary ICD-9 procedure codes for laparoscop...
journal_title:Journal of the American College of Surgeons
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