Abstract:
BACKGROUND:Emerging literature has supported the safety of nonoperative management of uncomplicated appendicitis. STUDY DESIGN:Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation after nonsurgical management were calculated. Factors associated with treatment failure, recurrence, and perforation were identified using multivariable logistic regression. Mortality, length of stay, and total charges were compared between treatment cohorts using matched propensity score analysis. RESULTS:Of 231,678 patients with uncomplicated appendicitis, the majority (98.5%) were managed operatively. Of the 3,236 nonsurgically managed patients who survived to discharge without an interval appendectomy, 5.9% and 4.4% experienced treatment failure or recurrence, respectively, during a median follow-up of more than 7 years. There were no mortalities associated with treatment failure or recurrence. The risk of perforation after discharge was approximately 3%. Using multivariable analysis, race and age were significantly associated with the odds of treatment failure. Sex, age, and hospital teaching status were significantly associated with the odds of recurrence. Age and hospital teaching status were significantly associated with the odds of perforation. Matched propensity score analysis indicated that after risk adjustment, mortality rates (0.1% vs 0.3%; p = 0.65) and total charges ($23,243 vs $24,793; p = 0.70) were not statistically different between operative and nonoperative patients; however, length of stay was significantly longer in the nonoperative treatment group (2.1 days vs 3.2 days; p < 0.001). CONCLUSIONS:This study suggests that nonoperative management of uncomplicated appendicitis can be safe and prompts additional investigations. Comparative effectiveness research using prospective randomized studies can be particularly useful.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
McCutcheon BA,Chang DC,Marcus LP,Inui T,Noorbakhsh A,Schallhorn C,Parina R,Salazar FR,Talamini MAdoi
10.1016/j.jamcollsurg.2014.01.003subject
Has Abstractpub_date
2014-05-01 00:00:00pages
905-13issue
5eissn
1072-7515issn
1879-1190pii
S1072-7515(14)00040-4journal_volume
218pub_type
杂志文章abstract:BACKGROUND:Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN:The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS:Five hu...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00033-2
更新日期:1999-06-01 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:Mirizzi syndrome (MS) is characterized by extrinsic compression of the common hepatic duct by stones impacted in the cystic duct or gallbladder neck. Open cholecystectomy (OC) has been the standard treatment; however, laparoscopy has challenged this approach. STUDY DESIGN:The objective of this study was to ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.03.008
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Head injury is an increasing contributor to death and disability, particularly among the elderly. Older patients are less likely to be treated at trauma centers, and head injury is the most common severe injury treated at non-trauma centers. We hypothesized that patients initially triaged to trauma centers w...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
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更新日期:2018-05-01 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::The preoperative diagnosis of inflammatory aneurysms of the abdominal aorta (IAAA) is seldom made, yet knowledge of its presence would be an aid to the surgeon. A heightened awareness of the variety of clinical presentations of IAAA should prompt the clinician to consider this entity in the differential diagnosis of b...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:The value of frozen sections in the intraoperative examination of sentinel nodes (SN) remains controversial. Accurate frozen sections will spare those patients with node metastasis from a second procedure to complete the axillary dissection. We examined our own experience with intraoperative examination of S...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.06.341
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:In the novel coronavirus disease 2019 (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, medical practices have limited access to in-person visits. This poses a challenge to maintain appropriate patient care while preventing a substantial backlog of p...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.04.030
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Identification of correlates of contemporary US medical graduates' surgical career plans can provide insights about the emerging surgical workforce composition and inform future recruitment efforts. STUDY DESIGN:We analyzed individualized records of 95,176 graduates who completed the 1997 to 2004 Associatio...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.04.026
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:Interleukin-6 (IL-6) plays a central role in the acute phase of inflammation after surgical injury. The serum concentration of IL-6 increases during an operation. The mechanisms of this increase in the serum IL-6 level, however, has not yet been fully clarified. STUDY DESIGN:To determine the possibility of ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract:BACKGROUND:The role of imaging studies before parathyroidectomy has been extensively debated and recent advances in unilateral parathyroidectomy intensify this controversy. The purpose of this study was to review the parathyroidectomy experience of a single surgeon, looking at the role of sestamibi scans and a standard...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(00)00258-1
更新日期:2000-05-01 00:00:00
abstract::THE SECOND JOAN L AND JULIUS H JACOBSON PROMISING INVESTIGATOR AWARDEE, EDITH TZENG MD, FACS: In 2005, the Surgical Research Committee of the American College of Surgeons was tasked with selecting the recipient of a newly established award, "The Joan L and Julius H Jacobson Promising Investigator Award." According to ...
journal_title:Journal of the American College of Surgeons
pub_type: 历史文章,杂志文章
doi:10.1016/j.jamcollsurg.2016.09.012
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Indices for prediction of surgical site infection (SSI) are well documented in the adult population; however, these factors have not been validated in children. STUDY DESIGN:A retrospective case-control study was performed by examining the medical records of children (0 to 18 years) who developed an SSI wit...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.01.065
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Timely access to trauma center (TC) care is critical to achieve "Zero Preventable Deaths after Injury." However, the impact of timely access to TC care on pre-hospital deaths in each US state remains unknown. We sought to determine the state-level relationship between the proportion of pre-hospital deaths, a...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.09.015
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Type or lack of insurance may affect access to care, treatment, and outcomes. We evaluated trends for surgical management of all peripheral arterial disease (PAD) in-hospital admissions by insurer status in New York State. STUDY DESIGN:Statewide Planning and Research Cooperative System (SPARCS) data were ob...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.05.033
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:In transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy (trNS), extraction-site laparotomy is avoided, which reduces postoperative pain and improves recovery time. However, current research evaluating anorectal function after trNS is limited. This study aims to evaluate clinical con...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2016.04.002
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Retained surgical items (RSI) continue to occur. Large RSI studies are few due to low RSI frequency in single institutions and the medicolegal implications. Consequently, RSI risks are not fully defined, with discrepancies persisting among published studies. The goals of this study were to better define risk...
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.2012.08.026
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Arterial "steal" is a well-known complication following proximal arteriovenous (AV) fistula, but its manifestations comprise a wide spectrum of symptoms and there are no clear indications for those patients who need surgical repair. STUDY DESIGN:Among 180 consecutive AV fistulas of various configurations, w...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00139-2
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:The role of C-Jun N-terminal Kinase (c-Jun Kinase) in apoptosis is unclear. It is likely that c-Jun Kinase activation is cell type and stimulus dependent. c-Jun Kinase promotes tumor necrosis factor (TNF)-alpha mediated apoptosis in nuclear factor (NF)-KB deficient cells. Minimal NF-KB expression may be enou...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.01.029
更新日期:2007-05-01 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
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pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.11.003
更新日期:2018-02-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.12.008
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:The safety and efficacy of carotid endarterectomy (CEA) in stroke prevention has been well documented. But "high-risk" patients have traditionally been excluded from these studies and may be offered alternate therapies. We examined the safety of CEA in veterans, a medically high-risk group with multiple como...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.02.033
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:Trauma is the leading cause of death and disability for individuals under age 55. Many severely injured trauma patients experience complicated clinical courses despite appropriate initial therapy. We sought to identify novel circulating metabolomic signatures associated with clinical outcomes following traum...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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更新日期:2021-01-14 00:00:00
abstract:BACKGROUND:Although effective at detecting locally recurrent colorectal cancer, the accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting rectal cancer recurrence in an irradiated pelvis has not been systematically studied. STUDY DESIGN:Records of surgically resected rectal ca...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00337-5
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Although the expanding and aging population will likely increase demand for surgical services, surgeons and other providers must develop strategies to optimize care. We sought to develop process-based quality indicators for elderly patients undergoing abdominal operations to identify necessary and meaningful...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2005.07.009
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:This study was undertaken to examine our outcomes after robotic pancreaticoduodenectomy and to compare our outcomes with predicted outcomes using the American College of Surgeons (ACS) NSQIP Surgical Risk Calculator and with outcomes reported through ACS NSQIP. METHODS:We prospectively followed 155 patients...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
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更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Academic divisions of general surgery are facing ever-increasing financial pressures. Cost-cutting is a common approach to maintaining profitability, but strategies to increase revenue should not be ignored. One specific avenue for enhanced revenue generation in general surgery is that of coding for evaluati...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2004.03.002
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:The ability to quantitate the extent of acinar cell necrosis with contrast-enhanced computed tomography (CT) during acute pancreatitis is uncertain. STUDY DESIGN:Acute hemorrhagic necrotizing pancreatitis was induced in opossums by obstructing their biliopancreatic duct for up to seven days or by retrograde...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-06-01 00:00:00
abstract:BACKGROUND:Readmission rates of 9.7% to 15.5% after hepatectomy have been reported. These rates are difficult to interpret due to variability in the time interval used to monitor readmission. The aim of this study was to refine the definition of readmission after hepatectomy. STUDY DESIGN:A prospectively maintained da...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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更新日期:2015-07-01 00:00:00