Abstract:
OBJECTIVE:The use of pulmonary artery catheter (PAC) is controversial. The purpose of this study was to document the changing pattern of PAC use and to determine its effect on outcome. METHODS:The use of PAC was analyzed in patients ≥16 years old admitted to the surgical intensive care unit (SICU) over a 9-year period starting in 2000. Patients with SICU length of stay exceeding 30 days were excluded. For the evaluation of PAC's effect on outcome, PAC and no-PAC patients were matched utilizing propensity scores. RESULTS:During the 9-year study period, a total of 5,192 trauma patients were admitted to the SICU. Of these, 426 (8.2%) were <16 years old, and 174 (3.4%) had a SICU length of stay that exceeded 30 days. For the remaining 4,592 patients, the mean ± SD age was 39.5 ± 18.8 years, and the mean ISS was 19.9 ± 12.4. PAC was utilized in 19.5% (n = 896) of all the patients admitted to the SICU. The trend for PAC use decreased significantly over the years (P value for trend <0.001), from 38.6% in the year 2000 to 4.2% in the year 2008. This decrease was noted in all age and injury severity groups of patients. The overall mortality, however, remained at the same levels (P value for trend = 0.111). Patients managed with a PAC were significantly older, more severely injured, more frequently injured by a blunt mechanism, and were admitted more often in a hypotensive or comatose status. In the early part of the study, the PAC was utilized on the first day and for 4.1 days on average. In the later part of the study, however, the PAC was used on the second day and for a shorter period of time (3 days on average, P < 0.001). In the matched study population, patients in the PAC group had almost twofold higher odds for death, when compared to the no-PAC group [34.2% vs. 22.5%, Odds Ratio (95% CI): 1.78 (1.42, 2.26), P < 0.001]. Patients younger than 50 years of age who had an ISS ≥16 had worse outcome when managed with a PAC, whereas patients aged 30-69 years with an ISS <16 had a higher survival. The overall complication rate was fivefold higher in patients receiving a PAC [46.3% vs. 14.2%, Odds Ratio (95% CI): 5.22 (4.04, 6.74), P < 0.001]. CONCLUSION:The use of PAC has decreased almost 10-fold over the last decade at our institution. The PAC is being used later during the ICU course and for a shorter period of time. In a matched population, the use of PAC is associated with a significantly higher mortality and complication rate, but the reason for this association remains uncertain. The use of PAC is invasive and is associated with known complications and financial costs. While the use of PAC maybe useful in a select population, routine and widespread use of the PAC should be avoided.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Barmparas G,Inaba K,Georgiou C,Hadjizacharia P,Chan LS,Demetriades D,Friese R,Rhee Pdoi
10.1007/s00268-011-1149-9subject
Has Abstractpub_date
2011-08-01 00:00:00pages
1809-17issue
8eissn
0364-2313issn
1432-2323journal_volume
35pub_type
杂志文章abstract:BACKGROUND:Because the feasibility and safety of laparoscopic approaches for the treatment of perforated peptic ulcer (PPU) have been fully recognized, laparoscopic repair of PPU (LPPU) has become a widely accepted procedure. Following closure of a PPU, the rationale to add an omental patch is based on the assumptions ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2503-5
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Small intestinal neuroendocrine neoplasms (SI-NEN) are rare, and only about 40% of patients are diagnosed without distant metastases. Aim of the study was to identify prognostic factors in patients with potentially curative resected locoregional SI-NEN. METHODS:Patients with curative resected locoregional S...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05884-6
更新日期:2021-01-08 00:00:00
abstract:BACKGROUND:The prognosis of intrahepatic cholangiocarcinoma (ICC) remains poor despite improvements in treatment and post-operative clinical management. We review our experiences and evaluate our current surgical approaches by comparing patients from two consecutive treatment periods. METHODS:One hundred forty-four pa...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3583-1
更新日期:2016-09-01 00:00:00
abstract::Axillary dissection in patients with breast cancer is associated with significant morbidity. Because 85% of the patients with a cancer < or = 1 cm have negative axillary nodal status, axillary dissection in these patients is only a staging procedure. A study of the sentinel lymph node (SLN) biopsy has been developed t...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-001-0272-4
更新日期:2002-05-01 00:00:00
abstract::The development of microsurgical techniques has supplied plastic surgery with a new chance to transfer tissue to nearly any recipient site of the body. Classical methods still have their value but also their limits in many circumstances. Free tissue transfer has proved its advantages, especially in covering defects in...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01670525
更新日期:1990-11-01 00:00:00
abstract:BACKGROUND:The objective of the present study was to identify logistic regression models with better survival prediction than the Trauma and Injury Severity Score (TRISS) method in assessing blunt trauma (BT) victims in Japan and Thailand. An additional aim was to demonstrate the feasibility of probability of survival ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1498-z
更新日期:2012-04-01 00:00:00
abstract::Radiation therapy has been widely used for palliative management of inoperable metastatic malignant melanoma. For patients with nodal disease, response rates of approximately 70% have been reported. There are limited data concerning the role of adjuvant irradiation following therapeutic lymph node dissection. In this ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF00299160
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:Surgery for Graves' disease (GD) is usually performed after adequate control with medical treatment. Occasionally, rapid pre-operative optimization is required. The primary objective was to compare the outcomes of patients undergoing elective surgery for well-controlled GD with those undergoing rapid pre-ope...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05125-5
更新日期:2019-12-01 00:00:00
abstract::Local recurrence in differentiated and medullary thyroid carcinoma develops frequently from metastatic infiltration of cervical lymph nodes. Despite an aggressive surgical approach, postoperative calcitonin levels as biochemical evidence for residual cancer cells remain often elevated in patients with medullary thyroi...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-001-0197-y
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:Due to advances in operative methods and perioperative care, mortality and morbidity following major hepatic resection have decreased substantially, making long-term quality of life (QoL) an increasingly prominent issue. We evaluated whether postoperative diagnosis was associated with long-term QoL and healt...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0032-4
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Laparoscopic cholecystectomy (LC) with common bile duct exploration (LCBDE) is nowadays a preferred one-stage treatment. However, the influence of complicated cholecystitis (CC) on LCBDE has rarely been addressed. In the present study we aimed to verify whether severe gallbladder inflammation would adversely...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1696-8
更新日期:2012-10-01 00:00:00
abstract:INTRODUCTION:Rectus sheath hematoma is rare. It can present to physicians in many specialties, but invariably the surgeon is contacted regarding management. It is frequently difficult to diagnose, which can result in delay of treatment or unnecessary surgery. Its incidence is on the rise. METHODS:We present a series o...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-005-0702-9
更新日期:2006-11-01 00:00:00
abstract::Primary hyperparathyroidism was investigated using the presence of basic fibroblast growth factor (bFGF) from the immunohistochemical viewpoint with an anti-bFGF antibody in hyperplastic parathyroid glands of patients with multiple endocrine neoplasia type I (MEN-I) and of patients with non-MEN. The results correspond...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF00299109
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Primary hyperaldosteronism (PHA) is a cause of secondary arterial hypertension potentially curable by laparoscopic unilateral adrenalectomy. We describe the follow-up of these patients according to their medical or surgical treatment. METHODS:We report a retrospective single-center study of 91 patients with...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2461-y
更新日期:2014-07-01 00:00:00
abstract::During the past four decades, especially in recent years, various active adjuvant therapies combined with surgery have improved the outcome in cases of cancer of the esophagus. However, no optimum adjuvant therapy has been determined. From 1981 to 1992, 341 patients with regional and distant node metastasis who underw...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF00316819
更新日期:1994-05-01 00:00:00
abstract::The release of the neuronal protein S-100B into the circulation has been suggested as an early indication of cellular brain damage. The objective of this prospective pilot study was to determine S-100B serum levels in patients undergoing cross-clamping during carotid endarterectomy (CEA) and to correlate the results w...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6547-6
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Solitary fibrous tumor of the pleura (SFTP) represents a clinical entity rarely encountered, especially in giant forms. Complete surgical resection for giant tumor of pleura is a challenge. The aim of this article is to present five new cases of giant SFTP, and to discuss their clinical characteristics and t...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0715-x
更新日期:2010-11-01 00:00:00
abstract::Studies of large series of melanoma patients indicated that the average incidence of developing a recurrence during follow-up was 40%. The most frequent first sites of these recurrences were the regional lymph nodes. We hypothesized that the sentinel node (SN) procedure may change the pattern of recurrence by reducing...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6197-8
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Patients with HIV/AIDS on antiretroviral therapy (ART) live longer and now require surgery for indications similar to those described for the general population. They have been previously reported to carry higher mortality and complication rates, especially septic complications. The aim of this study was to ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-2994-8
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:The management of positive ductal margins with carcinoma in situ (R1-CIS) after resection is controversial. The aim of this study was to evaluate the impact of R1-CIS on survival in patients who underwent resection for distal cholangiocarcinoma. METHODS:We enrolled 121 consecutive patients with distal chola...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05799-2
更新日期:2021-01-01 00:00:00
abstract::Fingertip injuries constitute a large portion of the traumatic injuries sustained to the hand and are frequently associated with significant disability for the patient. While many methods are available for the treatment of such injuries, quite often only certain procedures are appropriate for a particular digit in any...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01675641
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:The importance of safe anesthesia for the best possible surgical outcomes in every patient is not disputed in high resource settings. Low-income countries lag far behind in the provision of, and training for, safe anesthesia practice. Too little is known about numbers and types of providers in a majority of ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2775-9
更新日期:2015-04-01 00:00:00
abstract::Gastric cancer is a disease in which the main treatment is surgical extirpation. The modifications introduced in the surgical treatment over the last decades were accompanied by a clear increase of survival, which reaches global values of 61% at 5 years in Japan. One of the reasons that contribute to this improvement ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-001-0228-8
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:Measurement of the parathyroid hormone (PTH) level following total thyroidectomy (TTx) may allow prediction of postoperative hypocalcemia. We present an algorithmic method of managing hypocalcemia pre-emptively, based on the PTH level 1 h after operation. MATERIALS AND METHODS:We examined 423 consecutive pa...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0348-0
更新日期:2010-03-01 00:00:00
abstract:INTRODUCTION:In India, half of the annual 200,000 road traffic deaths occur in hospitals, but the exact in-hospital trauma mortality rate remains unknown. A research consortium of universities, with a mandate to reduce trauma mortality, measured the baseline 30-day in-hospital mortality rate. METHODS:Between September...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1007/s00268-016-3452-y
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are asso...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1007/s00268-013-2172-9
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:The specific definition of central hepatectomy (CH) (i.e., resection of segments 4-5-8 ± 1) is not uniformly used, resulting in conflicting comparisons with the more commonly performed extended hepatectomy (EH). The study aimed to compare, using propensity score matching (PSM) analysis, the incidence of post...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3584-0
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:The present study evaluated outcomes of patients undergoing proximal diversion using either a loop ileostomy or loop colostomy following distal colorectal resection for malignant and non-malignant disease. METHODS:A literature search of the Medline, Ovid, Embase and Cochrane databases was performed to ident...
journal_title:World journal of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00268-006-0218-y
更新日期:2007-05-01 00:00:00
abstract:INTRODUCTION:The use of outcomes to evaluate surgical quality implies the need for detailed risk adjustment. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a generally applicable risk adjustment model suitable for pancreatic surgery. A pancreaticoduodenectomy (...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2554-7
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Surgical care is emerging as a crucial issue in global public health. Methodology is needed to assess the impact of surgical care from a public health perspective. METHODS:A consensus opinion of a group of surgeons, anesthesiologists, and public health experts was established regarding the methodology for e...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0261-6
更新日期:2010-03-01 00:00:00