Abstract:
OBJECTIVE:Length of stay (LOS) is an important outcome as a marker of resource consumption. Determining which factors increase LOS may provide information on reducing costs and improving the delivery of care. The purpose of this study was to determine the independent association of intraoperative process of care and postoperative events with prolonged LOS after adjusting for preoperative severity of illness in patients undergoing major elective surgery. METHODS:Cases representing 11 elective operations from the National VA Surgical Quality Improvement Program were analyzed using multivariate logistic regression analysis. The outcome, prolonged LOS, was defined as an LOS greater than or equal to the 75th percentile (in days) for each operation. Hierarchical modeling was used to assess the independent association of groups of variables (preoperative patient characteristics, intraoperative process of care, and postoperative adverse events) with prolonged LOS. RESULTS:For the 11 operations explored, there were 23,919 cases. Common preoperative variables associated with prolonged LOS were functional status, American Society of Anesthesiology class, and age. The most predictive intraoperative and postoperative variables included intraoperative blood transfusion, operative time, return to the operating room, and the number of complications after surgery. CONCLUSIONS:Prolonged LOS is associated with preoperative, intraoperative, and postoperative factors. Although preoperative factors were independently associated with a prolonged LOS, the factors generating the highest risks for a prolonged LOS were the intraoperative process of care and postoperative adverse events. To reduce costs, efforts should be made to improve the intraoperative process of care and to minimize postoperative complications.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Collins TC,Daley J,Henderson WH,Khuri SFdoi
10.1097/00000658-199908000-00016subject
Has Abstractpub_date
1999-08-01 00:00:00pages
251-9issue
2eissn
0003-4932issn
1528-1140journal_volume
230pub_type
杂志文章abstract:OBJECTIVES:We hypothesized that distinct sets of functional trajectories can be identified in the year before and after major surgery, with unique transition probabilities from pre to postsurgical functional trajectories, and that outcomes would be better among participants undergoing elective versus nonelective surger...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002659
更新日期:2018-12-01 00:00:00
abstract::In an attempt to determine the best provocative test for the diagnosis of gastrinoma, ten normal subjects, 13 patients with known gastrinoma, and one patient with presumed gastrinoma were administered four regimens: (1) rapid calcium infusion (2 mg Ca++/kg/min), (2) secretin (2 clinical units (CU)/kg/bolus), (3) long ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198305000-00015
更新日期:1983-05-01 00:00:00
abstract:OBJECTIVE:To compare three options for the elective treatment of portal hypertension during a 10-year period. METHODS:Patients included in the trial were 18 to 76 years old, had a history of bleeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), scleroth...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200008000-00011
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To examine treatment trends in invasive lobular carcinoma (ILC) over the last 15 years and, in particular, to compare rates of recurrence and disease-free survival associated with breast conservation therapy compared with mastectomy. SUMMARY BACKGROUND DATA:The biologic characteristics of ILC make it difficu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000171306.74366.22
更新日期:2005-08-01 00:00:00
abstract::Fibrin deposition in response to bacterial peritonitis appears to predispose to residual infection in the peritoneal cavity. Our previous studies have demonstrated that intraperitoneal fibrinolysis using human recombinant tissue plasminogen activator (t-PA) prevented abscess formation in a rat intra-abdominal sepsis m...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199002000-00003
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVES:We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT. BACKGROUND:Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alon...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000965
更新日期:2014-11-01 00:00:00
abstract::Fibronectin exists in a soluble form in plasma and in an insoluble form in tissues. Plasma fibronectin can modulate phagocytic function as well as incorporate into the tissue matrix where it is believed to influence microvascular integrity and tissue repair. The temporal alterations in plasma and lung lymph fibronecti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198508000-00016
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to determine the characteristics and frequency of intraoperative safety threats and resilience supports using a human factors measurement tool. BACKGROUND:Human factors analysis can provide insight into how system elements contribute to intraoperative adverse events. Empiric ev...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003616
更新日期:2019-10-04 00:00:00
abstract:OBJECTIVE:To test the hypothesis that higher hospital volume decreases endoscopic and surgical re-intervention rates after antireflux surgery. BACKGROUND:Antireflux surgery for gastro-esophageal reflux disease is followed by varying rates of re-interventions. Whether hospital volume influences re-intervention rates is...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003776
更新日期:2020-01-06 00:00:00
abstract:OBJECTIVE:The authors review current definition, classification, scoring, microbiology, inflammatory response, and goals of management of secondary peritonitis. SUMMARY BACKGROUND DATA:Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, up to one third ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199607000-00003
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVE:An analysis of the injuries and treatment of the first 100 patients from the Syrian civil war was conducted to monitor quality of care and outcome. SUMMARY BACKGROUND DATA:As reports of the collapse of health care systems in regions within Syria reach the media, patients find themselves crossing the border i...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001230
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVES:To compare the effects of intraoperative goal-directed fluid therapy (GDFT) with conventional fluid therapy, and determine whether there was a difference in outcome between studies that did and did not use Enhanced Recovery After Surgery (ERAS) protocols. METHODS:Meta-analysis of randomized controlled trial...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析
doi:10.1097/SLA.0000000000001366
更新日期:2016-03-01 00:00:00
abstract::The dilution technique for determining cardiac output using indocyanine green dye is limited in patients weighing less than 20 kg because of the obligatory volume loss. Reproducible achieved using the green dye dilution method by the establishment of a low flow peripheral arteriovenous shunt. The shunt materials were ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198001000-00020
更新日期:1980-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on fasting and meal-stimulated release of the gut hormones ghrelin, pancreatic polypeptide (PP), peptide-YY (PYY), glucagon-like peptide-1 (GLP-1), and amylin and of the adipocytokine leptin. BACKGROUND:Mounting evidence suggests that the mechan...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31826e1846
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVES:To develop, validate, and implement a competency assessment tool (CAT) for technical surgical performance in the context of a summative assessment process for the National Training Programme in Laparoscopic Colorectal Surgery (NTP). BACKGROUND:The NTP is an educational initiative by the National Cancer Acti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318275b72a
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:To assess the accuracy of physical examination, ultrasonography, and mammography in predicting residual size of breast tumors following neoadjuvant chemotherapy. BACKGROUND:Neoadjuvant chemotherapy is an accepted part of the management of stage II and III breast cancer. Accurate prediction of residual pathol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000197714.14318.6f
更新日期:2006-02-01 00:00:00
abstract::In animals pulmonary hypertension, a decrease in total body O2 consumption and metabolic acidosis occur after transfusion of blood with an elevated screen filtration pressure (SFP) through standard blood transfusion filters. The purpose of this study was to define in detail the pulmonary abnormalities that develop fol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197507000-00011
更新日期:1975-07-01 00:00:00
abstract:OBJECTIVES:Surgical simulation has been shown to enhance the training of general surgery residents. Since catheter-based techniques have become an important part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents. METHODS:Twenty...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000234932.88487.75
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVE:The treatment of pancreatic necrosis at a tertiary referral center was reviewed to effect better patient outcome. SUMMARY BACKGROUND DATA:Pancreatic necrosis is a devastating disease that leads to death in 10% to 50% of cases. Infected necrosis is particularly deadly because 80% of deaths from necrosis are d...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199806000-00010
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:To evaluate perioperative statin treatment, to explore the rapidly increasing body of literature on the pleiotropic effects of statins, and to suggest a rational strategy of perioperative risk reduction. SUMMARY OF BACKGROUND DATA:Vascular, cerebrovascular, and cardiovascular complications are all too common...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e3181492c0d
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:To compare the long-term outcomes of surgical resection and radiofrequency ablation for the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA:Radiofrequency ablation (RFA) is a promising, emerging therapy for small HCC. Whether it is as effective as surgical resection (RES) for long-...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181efc656
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVE:To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC). BACKGROUND:Image guidance using AR offers the potentia...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000002793
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE AND BACKGROUND:Watch-and-wait approach in rectal cancer relies on the identification of a clinical complete response (CR) after neoadjuvant (chemo)radiotherapy. This is mainly performed by rectal examination, magnetic resonance imaging, and endoscopy. Endoscopy has been less well studied, and the objective of...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003718
更新日期:2019-12-09 00:00:00
abstract:OBJECTIVE:In this study, we report the results obtained from 70 living donors in France. BACKGROUND:Left lateral sectionectomy for pediatric live donor liver transplantation is a well-standardized surgical procedure. Our team introduced the laparoscopic approach to live donation in 2002, and the reproducibility and sa...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000642
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:To examine the development of acute kidney injury (AKI) after burn injury as an independent risk factor for increased morbidity and mortality over initial hospitalization and 1-year follow-up. BACKGROUND:Variability in fluid resuscitation and difficulty recognizing early sepsis are major barriers to preventi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001979
更新日期:2017-08-01 00:00:00
abstract::The present work was performed to clarify the effects of epidermal growth factor (EGF) on the growth of human breast cancer and carcinoma of the esophagus. Human breast cancer MX-1, UM-1, and esophageal cancer ES-4 were transplanted to the subcutaneous tissue of nude mice. Human EGF (2 micrograms) was injected locally...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to assess the impact of pouch reconstruction on perioperative outcomes, postprandial symptoms, nutritional and anthropometric parameters, and overall quality of life after total gastrectomy for gastric malignancy. SUMMARY BACKGROUND DATA:The short-term perioperative risks and longer ...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析
doi:10.1097/SLA.0000000000003082
更新日期:2019-06-01 00:00:00
abstract:SUMMARY BACKGROUND DATA:The extent of hepatectomies is limited by the functional reserve of the remnant liver. The introduction of preoperative portal vein occlusion techniques to induce a preoperative hyperplasia of the future liver remnant has reduced the risk of postoperative liver failure. However, it has remained ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31816a9d7c
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to perform an external validation of 2 institutionally derived predictive models of laparoscopic conversion in colorectal surgery using the Mayo Clinic, Rochester (MCR) laparoscopic colon and rectal surgery experience. SUMMARY OF BACKGROUND DATA:Two different predictive scoring syst...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181d355f7
更新日期:2010-04-01 00:00:00
abstract::Glucose metabolism is affected by various pathologic states including tumors. In this project, glucose turnover and recycling rates in 11 patients with colorectal carcinoma were measured using a double-labelled 3-3H and 1-14C glucose injection technique. Fasting blood glucose, lactate, pyruvate, alanine, glycerol, 3-h...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198311000-00007
更新日期:1983-11-01 00:00:00