Abstract：
BACKGROUND:Theoretical advantages of random-intercept multilevel (ML) logistic regression (LR) modeling over standard LR include separating variability due to patient-level and hospital-level predictors, shrinkage of estimates for lower-volume hospitals toward the overall mean, and fewer hospitals falsely identified as outliers. STUDY DESIGN:We used Nationwide Inpatient Sample data from 2002 to 2004 to construct LR models of hospital mortality after admission with a principal ICD-9 Clinical Modification injury diagnosis (ICD-9 Clinical Modification codes 800 to 904, 910 to 929, 940 to 957, and 959). After considering various predictors, we used patient-level indicator variables for age groups, gender, maximum Abbreviated Injury Scale (AIS) for the head region (AIS score 3, 4, or 5), maximum AIS for other body regions (AIS score 3, 4, or 5), and mechanisms (eg, fall, gunshot, motor vehicle). Using standard LR and MLLR, we compared predictions based on 2002, 2003, and 2004 data with actual mortality observed in the same hospitals in the 2004, 2005, and 2006 Nationwide Inpatient Samples, respectively. RESULTS:Patient-level fixed effects were similar for the 2 methods in all years, with mortality associated most strongly with AIS = 5 head injury, other AIS = 5 injury, or higher age groups. ML models identified fewer hospitals as outliers. Differences between actual and predicted mortality were smaller with MLLR models compared with standard LR models. CONCLUSIONS:Multilevel models might have advantages for the measurement and explanation of interhospital differences in trauma patient outcomes.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Clark DE,Hannan EL,Wu Cdoi
10.1016/j.jamcollsurg.2010.03.033subject
Has Abstractpub_date
2010-08-01 00:00:00pages
224-31issue
2eissn
1072-7515issn
1879-1190pii
S1072-7515(10)00272-3journal_volume
211pub_type
杂志文章,多中心研究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: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:Small bowel obstruction (SBO) represents roughly 15% of admissions by general surgeons. Management of SBO relies heavily on provider judgment, including decisions on how long to try nonsurgical management and whether to use a laparoscopic or open approach when surgery is needed. Given the subjective nature o...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2017.11.006
更新日期：2018-06-01 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:Incisional hernia repair is a frequent surgical procedure, but perioperative risk factors and outcomes have not been prospectively assessed in large-scale studies. The aim of this nationwide study was to analyze surgical risk factors for early and late outcomes after incisional hernia repair. STUDY DESIGN:W...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.10.013
更新日期：2013-02-01 00:00:00
abstract：BACKGROUND:Pancreaticoduodenectomy (PD) is a complex general surgical procedure originally associated with significant perioperative morbidity and mortality. Multiple studies have now shown that this operation can be performed quite safely at high-volume institutions that develop a particular expertise. Critical pathwa...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.01.057
更新日期：2007-05-01 00:00:00
abstract：BACKGROUND:The average life expectancy of Japanese individuals is the longest in the world. The mortality rate from injury is increasing among older people. There have been no detailed reports on the relationship between pre-existing medical conditions (PMCs) and mortality from trauma among elderly people in Japan. ST...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2010.04.010
更新日期：2010-09-01 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:As compared with open distal pancreatectomy, laparoscopic distal pancreatectomy (LDP) is associated with lower morbidity and shorter hospital stays. Existing reports do not elucidate trends in patient selection, technique, and outcomes over time. We aimed to determine outcomes after LDP at a specialized cent...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.03.023
更新日期：2012-08-01 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:Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications of ovulation induction by exogenous gonadotropins. The pathophysiologic factors of this syndrome are not well known. Increased capillary permeability causes third space fluid shift, which is responsible for ascites, pleural flu...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1994-07-01 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
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2004.06.023
更新日期：2004-10-01 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 influence of increased body mass index (BMI) on morbidity and mortality in critically injured trauma patients has been studied, with conflicting results. The objective of this study was to investigate the relationship between stratified BMI and outcomes in blunt injured patients. STUDY DESIGN:Consecutiv...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2006.12.042
更新日期：2007-05-01 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:Wedge or other nonanatomic hepatic resections, performed in an attempt to spare functional parenchyma, often are not accomplished with clear resection margins and may be complicated by hemorrhage from the depth of the resection. STUDY DESIGN:The current study describes a technique of cryoassisted hepatic re...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章
doi：
更新日期：1995-02-01 00:00:00
abstract：BACKGROUND:It has been suggested that laparoscopic antireflux surgery has been associated with an increased incidence of postoperative paraesophageal hiatus herniation, and that this comes (at least in part) from not performing an esophageal lengthening procedure in patients with preoperative esophageal shortening. Thi...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(00)00363-x
更新日期：2000-10-01 00:00:00
abstract：BACKGROUND:Pediatric liver transplantation (pLTx) has been the standard of care for children with liver failure since the 1980s. This study examined the world's largest single-center experience and aimed to identify unique preoperative predictors of early graft and patient survival for primary transplantation (1°-pLTx)...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2017.12.042
更新日期：2018-04-01 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:Coughing, bending, and lifting raise the pressure inside the abdomen, repetitively increasing stresses on the abdominal wall and the associated scaffold. The purpose of this study was to evaluate the effect of repetitive loading on biological scaffolds. It was hypothesized that exposure to repetitive loading...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.03.006
更新日期：2012-08-01 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: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:This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention. STUDY DESIGN:Retrospective case review study. RESULTS:Seventeen...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1997-11-01 00:00:00
abstract：BACKGROUND:We designed a model for pre- and postoperative discussions between faculty and trainees to maximize educational yield of cases and accelerate residents' technical development. We sought to study its effect on surgical education via participant perceptions and longitudinal validated performance evaluations. ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2020.08.769
更新日期：2021-01-01 00:00:00
abstract：BACKGROUND:Surgery remains the most effective intervention for obesity and its comorbidities. However, the long-term efficacy of bariatric procedures is rarely reported. This study addresses operative trends, efficiency, and long-term outcomes from a large bariatric program. STUDY DESIGN:Data were prospectively collec...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.01.056
更新日期：2014-06-01 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：BACKGROUND:Transfusion practice among surgeons varies despite several trials supporting the restrictive use of blood products. We sought to define the variation in surgeon transfusion hemoglobin (Hb) triggers and targets among patients undergoing hepatopancreaticobiliary (HPB) procedures, as well as assess perioperativ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.02.033
更新日期：2014-08-01 00:00:00
abstract：BACKGROUND:Ischemia-reperfusion injury (IRI) can occur during hepatic surgery and transplantation. IRI causes hepatic mitochondrial and microcirculatory impairment, resulting in acute liver dysfunction and failure. We proposed a novel strategy of regulated hepatic reperfusion (RHR) to reverse the cellular metabolic def...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.12.010
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are few data on the risk of these complications after different abdominal operations. STUDY DESIGN:We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aorti...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2013.01.060
更新日期：2013-06-01 00:00:00
abstract：BACKGROUND:A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. STUDY ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2015.05.011
更新日期：2015-09-01 00:00:00
