Abstract:
BACKGROUND:In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN:National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression. RESULTS:There were 38,016 kidney transplantation procedures analyzed during the 3.8-year period. Over time, there was a mean increase of 2.7 cases/month (95% CI -0.02 to 5.4; p = 0.059), unaffected by KAS (18.9 case increase; p = 0.5601). Implementation of KAS led to significant changes in patient demographics, including a decrease in age (-2.8 years; p < 0.001), increase in number of African Americans (3.8%; p < 0.001), decrease in number of Caucasians (6.0%; p < 0.001), increase in number of Hispanics (2.9%; p < 0.001), increase in congestive heart failure (1.3%; p < 0.001), and decrease in diabetes with complications (4.0%; p < 0.001). The KAS had no impact on length of stay (0.12 days; 95% CI -0.11 to 0.35), length of stay index (0.01; 95% CI -0.03 to 0.05), ICU cases, ICU length of stay, patient safety indicators, or in-hospital mortality. The KAS led to a significant increase in delayed graft function rates (5.4%; 95% CI 23.3% to 7.4%); total in-hospital costs ($2,429; 95% CI $594 to $4.263); and 7-day (2.2%), 14-day (2.6%), and 30-day (2.7%) readmission rates. CONCLUSIONS:Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Taber DJ,DuBay D,McGillicuddy JW,Nadig S,Bratton CF,Chavin KD,Baliga PKdoi
10.1016/j.jamcollsurg.2016.12.009subject
Has Abstractpub_date
2017-04-01 00:00:00pages
585-592issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(16)31700-8journal_volume
224pub_type
杂志文章abstract:BACKGROUND:Pilonidal disease is a common condition among young people. Complicated pilonidal surgical wounds are associated with considerable morbidity, including chronic sacral wound, loss of work time, and lifestyle limitation. The aim of our study is to report our experience with Karydakis procedure and explore the ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.04.034
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:In order to understand how current surgical residents feel about their training, a survey focused on perceptions regarding early entry into a subspecialty and the adequacy of training was sent to selected residency programs in general surgery (GS). STUDY DESIGN:A 36-item online anonymous survey was sent to ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.12.045
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Acute appendicitis remains the most common cause of acute abdominal pain necessitating operative intervention. Although postoperative antibiotics are universally used for perforated appendicitis, no consensus exists on whether postoperative antibiotics are beneficial for preventing surgical site infections (...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.08.018
更新日期:2011-12-01 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:Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN:We examined 54 reports of surgical trials chosen randomly from a database...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.09.015
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Ureteral injuries are uncommon, and the necessity, accuracy, and optimal use of perioperative testing remains unknown. Delays in diagnosis have also been associated with significant morbidity, including loss of renal function. STUDY DESIGN:The records of all patients (n = 20) admitted with ureteral injuries...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00108-2
更新日期:1998-06-01 00:00:00
abstract:BACKGROUND:Closed-suction drains, implants, and acellular dermal matrix (ADM) are routinely used in tissue expander-based immediate breast reconstruction (TE-IBR). Each of these factors is thought to increase the potential for surgical site infection (SSI). Although CDC guidelines recommend only 24 hours of antibiotic ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2016.02.018
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Recently, several reports in the United States have demonstrated remarkable improvement in the patency of axillofemoral (AXF) bypass with an externally supported prosthesis. The purpose of this study was to review the prognoses regarding graft patency, limb salvage, and survival of patients who underwent AXF...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00084-2
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Immediate breast reconstruction with autologous tissue can re-create a breast mound that closely resembles the native breast in shape and consistency. Results are limited by scarring and color differences between flap and native breast skin. This study reviews all patients undergoing complete skin-sparing ma...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00131-8
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Occult hypoperfusion (OH), or global hypoperfusion with normal vital signs, is a risk factor for poor outcomes in elderly trauma patients. We hypothesized that OH is associated with worse outcomes than shock in both young and elderly trauma patients. METHODS:We conducted a single-center cohort study of adul...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.12.011
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Pancreatectomy can be complicated by pancreatic anastomotic leakage, causing major morbidity. STUDY DESIGN:Our aim was to determine if vapreotide, a potent long-acting somatostatin analogue, would decrease pancreas-related complications. This prospective, multicenter, randomized, double-blind, placebo-contr...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/S1072-7515(03)00104-2
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Operative internal drainage has been standard treatment for chronic unresolved pancreatic pseudocysts (PPs). Recently, percutaneous external drainage (PED) has become the primary mode of treatment at many medical centers. STUDY DESIGN:A retrospective chart review was performed of 96 patients with PPs who we...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00088-x
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:The goal of this study was to investigate the surgical management and outcomes of patients with primary colorectal cancer (CRC) and synchronous liver metastasis (sCRLM). STUDY DESIGN:Using a multi-institutional database, we identified 1,004 patients treated for sCRLM between 1982 and 2011. Clinicopathologic...
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.2012.12.029
更新日期:2013-04-01 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:Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not be...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)00895-x
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:Controversy exists over the relative advantages of open mesh repair compared with open stitching methods and the laparoscopic approach. STUDY DESIGN:Two thousand nine hundred six (2,906) consecutive unselected adult patients underwent 3,175 primary inguinal hernia repairs using polypropylene mesh, under loc...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00057-x
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:To identify patients with a high risk of 30-day mortality after elective surgery, who may benefit from referral for tertiary care, an institution-specific process using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Risk Calculator was developed. The goal was to develop and validate the m...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.12.033
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Enthusiasm for radiofrequency ablation (RFA) therapy for patients with unresectable hepatocellular carcinoma (HCC) has increased. The data for recurrence after RFA for patients with HCC is not well documented. The purpose of this study was to evaluate tumor recurrence patterns after RFA in patients with unre...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00750-6
更新日期:2003-11-01 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 purpose of this study was to determine postoperative outcomes and risk factors for morbidity and mortality in patients requiring surgery for bleeding peptic ulcer disease (PUD). Vagotomy and drainage procedures are technically simpler but are usually associated with higher ulcer recurrence rates. In cont...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2005.09.001
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Determining the negative predictive value of benign large-core needle biopsy of nonpalpable mammographically detected breast abnormalities has been difficult because benign results generally preclude surgical excision. Longterm followup of these patients is important to ensure timely diagnosis of new abnorma...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01320-0
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Abdominal wall reconstruction for complex ventral and incisional hernias is associated with significant complications. Commonly, the peritoneal cavity is opened and adhesiolysis is performed with the potential for enterotomy. A totally extraperitoneal (TE) approach to abdominal wall reconstruction is feasibl...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.11.012
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Neuroendocrine tumors commonly metastasize to the liver. Although surgical resection is considered a treatment option for patients with localized metastases confined to the liver, the longterm survival benefit of liver resection has not been clearly demonstrated. We examined the survival of patients undergoi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00099-4
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Protecting future childbearing motivates young women with breast cancer to seek oocyte or embryo cryopreservation. Concerns about delays in cancer treatment may influence patients and practitioners considering these procedures. In this study, we compared timing of chemotherapy in women who underwent ovarian ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.08.006
更新日期:2009-11-01 00:00:00
abstract::In several recent conferences, the principal questions have been whether xenotransplantation technology should be encouraged and, if so, how it should be regulated. Because the prospect of successful transplantation of animal organs into humans is still remote, the rush to achieve consensus about clinical application ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00053-2
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:Carotid endarterectomy (CEA) is an effective surgical option for stroke prophylaxis for most patients. Restenosis after CEA can lead to additional interventions and adverse outcomes, but the factors that predict restenosis are poorly understood. This study examined which risk factors, such as metabolic syndr...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.04.014
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:After excision of an abnormal gland, the dynamics of intraoperative parathyroid hormone (PTH) levels signal whether or not more hypersecreting tissue is present. This quantitative assurance of operative success has led to targeted exploration of the hyperfunctioning gland(s). Some have questioned the need fo...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.02.003
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on pre...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.08.013
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:The National Veterans Affairs Surgical Risk Study was designed to collect reliable, valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality rates for surgical services in Veterans Health Administration. S...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:
更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:Reoperation in the neck can be challenging and is associated with increased complication rates and operative times. Here we analyze our methylene blue dye injection method to localize reoperative neck pathology in patients with thyroid cancer and lymph node metastases. STUDY DESIGN:We retrospectively review...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.06.006
更新日期:2012-10-01 00:00:00