Abstract:
IMPORTANCE:Individualized risk prediction tools have an important role as decision aids for use by patients and surgeons before surgery. Patient-centered outcomes should be incorporated into such tools to widen their appeal and improve their usability. OBJECTIVE:To develop a patient-centered outcome for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, a web-based, individualized risk prediction tool. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study using data from the ACS NSQIP, a national clinical data registry. A total of 973 211 patients from July 2010 to June 2012, encompassing 392 hospitals, were used in this analysis. MAIN OUTCOMES AND MEASURES:Risk of discharge to a postacute care setting. RESULTS:The overall rate of discharge to postacute care was 8.8%. Significant predictors of discharge to postacute care included being 85 years or older (odds ratio [OR] = 9.17; 95% CI, 8.84-9.50), the presence of septic shock (OR = 2.43; 95% CI, 2.20-2.69) or ventilator dependence (OR = 2.81; 95% CI, 2.56-3.09) preoperatively, American Society of Anesthesiologists class of 4 or 5 (OR = 3.59; 95% CI, 3.46-3.71), and totally dependent functional status (OR = 2.27; 95% CI, 2.11-2.44). The final model predicted risk of discharge to postacute care with excellent accuracy (C statistic = 0.924) and calibration (Brier score = 0.05). CONCLUSIONS AND RELEVANCE:Individualized risk of discharge to postacute care can be predicted with excellent accuracy. This outcome will be incorporated into the ACS NSQIP Surgical Risk Calculator.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Mohanty S,Liu Y,Paruch JL,Kmiecik TE,Cohen ME,Ko CY,Bilimoria KYdoi
10.1001/jamasurg.2014.3176subject
Has Abstractpub_date
2015-05-01 00:00:00pages
480-4issue
5eissn
2168-6254issn
2168-6262pii
2207938journal_volume
150pub_type
杂志文章,多中心研究相关文献
JAMA Surgery文献大全abstract::Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.73
更新日期:2014-10-01 00:00:00
abstract:IMPORTANCE:Trauma is known to be one of the strongest risk factors for pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin therapy for prevention of PE, but trauma places some patients at risk of excess bleeding. Experts are divided on the role of prophylactic inferior vena cava (IVC) fil...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2013.3970
更新日期:2014-02-01 00:00:00
abstract:Importance:In general surgery, women earn less money and hold fewer leadership positions compared with their male counterparts. Objective:To assess whether differences exist between the perspectives of male and female general surgery residents on future career goals, salary expectations, and salary negotiation that ma...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.2879
更新日期:2019-11-01 00:00:00
abstract:IMPORTANCE:Although prospective randomized data are available to guide the multidisciplinary management of soft tissue sarcoma (STS) of the extremities, controversy exists regarding adjuvant chemotherapy and radiation therapy. OBJECTIVE:To determine if clinical specialty introduces bias in recommendations for multimod...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.113
更新日期:2013-07-01 00:00:00
abstract:IMPORTANCE:The rate of complications among injury admissions has been estimated to be more than 3 times that observed for general admissions, and complications have been targeted as an important quality-of-care metric. Despite the negative effect of complications on resource use and patient mortality and morbidity, the...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.5484
更新日期:2016-07-01 00:00:00
abstract:Importance:Primary hyperparathyroidism (pHPT) is a common clinical entity, with approximately 100 000 new cases diagnosed each year in the United States. Most patients with pHPT have a relatively mild form of the disease and present with few if any overt signs or symptoms. This has led to a dilemma regarding which pati...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2017.1721
更新日期:2017-09-01 00:00:00
abstract:IMPORTANCE:Minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring remains the standard approach to the majority of patients with primary hyperparathyroidism. This study demonstrates that individual patient characteristics do not affect existing criteria for intraoperative parathyroid h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.104
更新日期:2013-07-01 00:00:00
abstract::Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minima...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2013.366
更新日期:2013-12-01 00:00:00
abstract:Importance:BRAF mutations are reportedly associated with aggressive tumor biology. However, in contrast with primary colorectal cancer, the association of V600E and non-V600E BRAF mutations with survival and recurrence after resection of colorectal liver metastases (CRLM) has not been well studied. Objective:To invest...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2018.0996
更新日期:2018-07-18 00:00:00
abstract:Importance:Incisional hernia is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. Objective:To compare the incidence of incisional hernia among patients a...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2018.4221
更新日期:2019-02-01 00:00:00
abstract:IMPORTANCE:The Centers for Medicare and Medicaid Services have implemented penalties for hospitals with above-average readmission rates under the Hospital Readmissions Reductions Program. These changes will likely be extended to affect postoperative readmissions in the future. OBJECTIVES:To identify variables that pla...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.4043
更新日期:2015-06-01 00:00:00
abstract:Importance:The receipt of surgery in freestanding ambulatory surgery centers (ASCs) is often less costly compared with surgery in hospital-based outpatient departments. Although increasing numbers of surgical procedures are now being performed in freestanding ASCs, questions remain regarding the existence of disparitie...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.3318
更新日期:2020-09-09 00:00:00
abstract:IMPORTANCE:To reduce the amount of skin surface bacteria for patients undergoing elective surgery, selective health care facilities have instituted a preadmission antiseptic skin cleansing protocol using chlorhexidine gluconate. A Cochrane Collaborative review suggests that existing data do not justify preoperative ski...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2015.2210
更新日期:2015-11-01 00:00:00
abstract:IMPORTANCE:Research has been limited on the incidence, mechanisms, etiology, and treatment of symptoms that require palliation in patients with terminal cancer. Bowel obstruction (BO) is a common complication of advanced abdominal cancer, including colon cancer, for which small, single-institution studies have suggeste...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1
更新日期:2013-08-01 00:00:00
abstract:IMPORTANCE:Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE:To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. DE...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.4236
更新日期:2016-04-01 00:00:00
abstract:IMPORTANCE:Laparoscopic ventral hernia repair (LVHR) using mesh is a well-established intervention for ventral hernia, but pain control can be challenging. OBJECTIVE:To determine whether instillation of a long-acting local anesthetic between the mesh and the peritoneum after LVHR reduces pain or narcotic requirements....
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2015.1530
更新日期:2015-09-01 00:00:00
abstract:Importance:Surgical options for weight loss vary considerably in risks and benefits, but the relative importance of procedure-associated characteristics in patient decision making is largely unknown. Objective:To identify patient preferences for risks, benefits, and other attributes of treatment options available to i...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.4375
更新日期:2019-01-01 00:00:00
abstract:IMPORTANCE:Although the diagnostic evaluation and technical elements for a successful laparoscopic fundoplication have been clearly identified, 10% to 20% of patients will eventually experience recurrence of their symptoms. The management of patients who fail antireflux surgery is complex and not well codified. OBJECT...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2014.3859
更新日期:2015-06-01 00:00:00
abstract:IMPORTANCE:In recent years, the CD40/CD40L system has been implicated in the pathophysiology of severe chronic inflammatory diseases. Recently, obesity has been described as a low chronic inflammatory disease, so this system could also be involved in the inflammatory process. OBJECTIVE:To study soluble CD40 ligand (sC...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurgery.2013.419
更新日期:2013-02-01 00:00:00
abstract:IMPORTANCE:A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems. OBJECTIVE:To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, c...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1208
更新日期:2014-09-01 00:00:00
abstract:IMPORTANCE:Older adults are at increased risk for adverse events after surgical procedures. Loss of independence (LOI), defined as a decline in function or mobility, increased care needs at home, or discharge to a nonhome destination, is an important patient-centered outcome measure. OBJECTIVE:To evaluate LOI among ol...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.1689
更新日期:2016-09-21 00:00:00
abstract:Importance:Women are disproportionately underrecognized as award winners within medical societies. The presence of this disparity has not been investigated in training programs. Objective:To determine the presence of a gender disparity in award winners in general surgery residency programs. Design, Setting, and Parti...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.3518
更新日期:2020-09-02 00:00:00
abstract:Importance:Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide compl...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4604
更新日期:2017-02-15 00:00:00
abstract:IMPORTANCE:Obesity has been associated with impairments in sexual function and untoward changes in reproductive hormones in women. Relatively few studies have investigated changes in these domains following bariatric surgery. OBJECTIVE:To investigate changes in sexual functioning, sex hormone levels, and relevant psyc...
journal_title:JAMA surgery
pub_type: 临床试验,杂志文章
doi:10.1001/jamasurg.2013.5022
更新日期:2014-01-01 00:00:00
abstract:IMPORTANCE:Postoperative pulmonary complications can be a devastating consequence of surgery. Validated strategies to reduce these adverse outcomes are needed. OBJECTIVES:To design, implement, and determine the efficacy of a suite of interventions for reducing postoperative pulmonary complications. DESIGN:A before-af...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.358
更新日期:2013-08-01 00:00:00
abstract:Importance:Military and civilian trauma experts initiated a collaborative effort to develop an integrated learning trauma system to reduce preventable morbidity and mortality. Because the Department of Defense does not currently have recommended guidelines and standard operating procedures to perform military preventab...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.6105
更新日期:2018-04-01 00:00:00
abstract:Importance:Identification of the tumor margin during surgery is important for precise minimal resection of lung tumors. Intravenous injection of indocyanine green (ICG) has several limitations when used for intraoperative visualization of lung cancer. Objectives:To describe a technique for intraoperative visualization...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.1314
更新日期:2020-06-24 00:00:00
abstract:Importance:Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. Objective:To assemble a multidisciplinary team of health care experts an...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.5045
更新日期:2021-01-01 00:00:00
abstract:IMPORTANCE:Although lower extremity revascularization is effective in preventing amputation, the relationship between spending on vascular care and regional amputation rates remains unclear. OBJECTIVE:To test the hypothesis that higher regional spending on vascular care is associated with lower amputation rates for pa...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4277
更新日期:2014-01-01 00:00:00
abstract:IMPORTANCE:Thoracic endovascular aortic repair (TEVAR) is used in the treatment of type B aortic dissections. Information related to aortic morphologic findings and the condition of the abdominal aorta after TEVAR is limited. OBJECTIVE:To analyze aortic morphologic findings after TEVAR for type B aortic dissections. ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1327
更新日期:2014-09-01 00:00:00