Abstract:
BACKGROUND:The American College of Surgeons maintains that surgical care in the US has not reached optimal safety and quality. This can be driven partially by higher-risk, emergency operations in geriatric patients. We therefore sought to answer 2 questions: First, to what degree does standardized postoperative mortality vary in hospitals performing nonelective operations in geriatric patients? Second, can the differences in hospital-based mortality be explained by patient-, operative-, and hospital-level characteristics among outlier institutions? STUDY DESIGN:Patients 65 years and older who underwent 1 of 8 common emergency general surgery operations were identified using the California State Inpatient Database (2010 to 2011). Expected mortality was obtained from hierarchical, Bayesian mixed-effects logistic regression models. A risk-adjusted hospital-level standardized mortality ratio (SMR) was calculated from observed-to-expected in-hospital deaths. "Outlier" hospitals had an SMR 80% CI that did not cross the mean SMR of 1.0. High-mortality (SMR >1.0) and low-mortality (SMR <1.0) outliers were compared. RESULTS:We included 24,207 patients from 107 hospitals. SMRs varied widely, from 2.3 (highest) to 0.3 (lowest). Eleven hospitals (10.3%) were poor-performing high-SMR outliers, and 10 hospitals (9.3%) were exceptional-performing low-SMR outliers. SMR was 3 times worse in the high-SMR compared with the low-SMR group (1.7 vs 0.6; p < 0.001). Patient-, operation-, and hospital-level characteristics were equivalent among outlier-hospitals. CONCLUSIONS:Significant hospital variation exists in standardized mortality after common general surgery operations done emergently in older patients. More than 10% of institutions have substantial excess mortality. These findings confirm that the safety of emergency operation in geriatric patients can be significantly improved by decreasing the wide variability in mortality outcomes.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Becher RD,Sukumar N,DeWane MP,Stolar MJ,Gill TM,Schuster KM,Maung AA,Zogg CK,Davis KAdoi
10.1016/j.jamcollsurg.2019.10.018subject
Has Abstractpub_date
2020-06-01 00:00:00pages
966-973.e10issue
6eissn
1072-7515issn
1879-1190pii
S1072-7515(20)30117-4journal_volume
230pub_type
杂志文章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: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:A new proprietary negative pressure wound device has been developed to apply negative pressure therapy to closed wounds (closed-NPWT). We postulated that closed-NPWT management of contaminated and dirty wounds would lead to faster wound healing and no significant difference in wound complications. STUDY DES...
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.2017.12.008
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:While the costs of medical training continue to increase, surgeon income and personal financial decisions may be challenged to manage this expanding debt burden. We sought to characterize the financial liability, assets, income, and debt of surgical residents, and evaluate the necessity for additional financ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.05.002
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:The putative relationship between pancreas divisum and clinical pancreatitis continues to be controversial. Indications for surgical or endoscopic manipulations of the accessory duct ampulla are unclear, and the relative merits of surgical sphincteroplasty, endoscopic sphincterotomy, and accessory duct stent...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1996-07-01 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:Adenosine, a metabolite of adenosine triphosphate degradation during ischemia, is reported to attenuate ischemia and reperfusion injury in several tissues. Dipyridamole is a nucleoside transport inhibitor that augments endogenous adenosine. In this study, we tested whether dipyridamole would attenuate hepati...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2003.12.002
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:The management of dysplasia arising in Barrett's esophagus is controversial. STUDY DESIGN:Twenty patients (group 1, prompt attitude) underwent operation as soon as high-grade dysplasia (HGD) was discovered (n = 8) or just after either the presence of HGD was confirmed (n = 9) or invasive carcinoma (IC) was ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00417-4
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:Several factors may influence the degree of carbon dioxide (CO2) absorption during laparoscopy. Hypercapnia as a result of excessive CO2 absorption may have adverse clinical effects. STUDY DESIGN:To identify factors associated with increased CO2 absorption, we retrospectively calculated the CO2 elimination ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,评审
doi:
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:Acute limb ischemia initiates a systemic inflammatory response, including pulmonary polymorphonuclear leukocyte (PMN) sequestration and acute lung injury. Lung injury is partly attributed to release by PMN's of extracellular matrix (ECM) modifying metalloproteinases (MMPs). We hypothesized that acute hindlim...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00134-0
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Led by the American College of Surgeons Trauma Quality Improvement Program, performance improvement efforts have expanded to regional and national levels. The American College of Surgeons Trauma Quality Improvement Program recommends 5 audit filters to identify records with erroneous data, and the Georgia Co...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.11.035
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:The link between inflammation and cancer is well-established, but the link between Hashimoto thyroiditis (HT) and thyroid cancer remains controversial. The purpose of our study was to determine the incidence of patients with thyroid cancer and associated HT at our institution, to correlate our patient popula...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.12.037
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:In the western literature, controversy exists regarding the operative management of carcinoma of the stomach. Still debated are the extent of gastric resection, the role of splenectomy, and the significance of lymphadenectomy. STUDY DESIGN:We performed a retrospective study of 646 consecutive patients who u...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Controversy persists regarding digestive reconnection following subtotal gastrectomy for carcinoma. A randomized prospective trial comparing Billroth I and Billroth II procedures for mortality, digestive comfort, survival, and patterns of recurrence was conducted. STUDY DESIGN:Thirty patients underwent Bill...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1996-09-01 00:00:00
abstract::Limited resection can be a therapeutic approach in patients with cirrhosis with very low remnant hepatic function after resection. In this study, two hilar vascular clamping methods (hilar selective clamping [n = 13] and hilar lobar clamping method [n = 8]), which were used for resection of hepatocellular carcinoma in...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:The optimal method for classifying lymph node (LN) status in breast cancer patients is unknown. We sought to determine if LN ratio (LNR) improves axillary staging. STUDY DESIGN:Kentucky Cancer Registry data (1996 to 2007) were used to compare LN categorization schemas. Overall survival (OS) was evaluated us...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.04.024
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:The Tennessee Surgical Quality Collaborative analyzes NSQIP data from 21 participating hospitals. The Tennessee Surgical Quality Collaborative has reduced surgical complications, but causative factors are unclear. We sought to correlate surgical duration with complications to reveal mitigating strategies. S...
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.2014.12.040
更新日期:2015-04-01 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:Thyroid surgery is performed using general anesthesia by the majority of surgeons in current practice. This study was conducted to analyze the utility and safety of local anesthesia for thyroid surgery. STUDY DESIGN:Prospective data were collected for 1,025 consecutive patients undergoing thyroidectomy usin...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2005.04.034
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a more stringent patient selection, mortality after hepatic resection has steadily decreased, but its incidence still ranges from 10% to 20%. The factors linked to...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00301-9
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training. STUDY DESIGN:We queried the NSQIP database for 6 index laparoscopic surgical procedures pe...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.08.014
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Transcutaneous techniques to measure serum bilirubin have been validated in neonates but not in adult patients. We evaluated transcutaneous bilirubinometry (TcB) in adults at risk for or diagnosed with hepatic dysfunction to determine if this technology has clinical use in quantifying the presence and magnit...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.01.014
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Hepatic resection for metastatic colorectal cancer provides excellent longterm results in a substantial proportion of patients. Although various prognostic risk factors have been identified, there has been no dependable staging or prognostic scoring system for metastatic hepatic tumors. STUDY DESIGN:Various...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00089-7
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Patients undergoing emergency general surgery (EGS) operations experience high rates of venous thromboembolism (VTE). The rates at which thrombus formation occurs after discharge, and whether VTE prophylaxis at discharge might be warranted to prevent readmission, are unknown. This analysis aimed to determine...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.03.021
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Preprocedural briefings have been adopted in many high consequence environments, but have not been widely accepted in medicine. We sought to develop, implement, and evaluate a preoperative briefing for cardiovascular surgery. STUDY DESIGN:The briefing was developed by using a combined questionnaire and semi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.01.037
更新日期:2009-06-01 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:Neoadjuvant chemotherapy has been shown to increase the rate of breast conservation in clinical trials and small institutional series, but it has never been studied on a national level. STUDY DESIGN:We performed a retrospective review of the National Cancer Database (NCDB). The NCDB is a joint project of th...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.02.011
更新日期:2015-06-01 00:00:00
abstract:INTRODUCTION:An effective strategy to manage acute pain while minimizing opioid exposure is needed for injured patients. In this trial, we aimed to compare two multimodal pain regimens (MMPR) in minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. METHODS:This was an unblinded, pragmatic...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.12.014
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:Hospital readmission is a significant contributor to increasing health care use related to caring for older trauma patients. This study was undertaken with the following aims: determine the proportion of older adult trauma patients who experience unplanned readmission, as well as risk factors for these readm...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.11.012
更新日期:2015-03-01 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