Abstract:
BACKGROUND:The unpredictability of prosthetic vascular access thrombosis precludes the scheduling of elective graft thrombectomy. This results in inconsistent dialysis for patients, as well as logistical challenges for dialysis clinics and surgeons, and increased cost. In an effort to solve this problem a community-wide, prospective vascular access program (VAP) was established. This study evaluates the impact of the VAP by comparing the operative procedures and outcomes of vascular access surgery performed in the community before and after establishment of the program. METHODS:All 17 surgeons who perform vascular access, representing five independent practice groups in Greenville, South Carolina, formed a VAP in November 1996. Dialysis patients were pooled, and all graft thrombectomies were managed on a rotational basis by a surgeon assigned daily to a specifically designated access thrombectomy operating room. The hospital records of all patients undergoing vascular access procedures from November 1, 1995, through October 31, 1996 (pre-VAP), and November 1, 1996, through October 31, 1997 (post-VAP), were reviewed. RESULTS:Comparison of the pre-VAP and post-VAP groups showed no significant difference in the number of patients undergoing vascular access procedures (391 versus 378), number of vascular access procedures performed (1034 versus 1,048), or average number of vascular access procedures performed per patient (2.64 versus 2.79). There was no statistical difference in the number of thrombectomies and revisions (786 versus 765; P = 0.114) or thrombectomies alone (248 versus 283; P = 0.114) in the pre-VAP and post-VAP groups. There was a significant increase in the number of procedures performed on an outpatient basis in the post-VAP group (757; 73%) compared with the pre-VAP group (575; 56%); P <0.001. There was also a significant difference in the percentage of cases performed after 6:00 PM in the pre-VAP group (262; 25%) compared with the post-VAP group (48; 4.5%; P = 0.001). CONCLUSIONS:Dialysis graft thrombosis, occurring in 75% of our patients annually, represents a substantial logistical dilemma necessitating the incorporation of 1,000 additional operations into a busy elective surgery schedule. An organized VAP reduces inpatient hospitalization, minimizes expensive after hours surgery, and enhances patient and physician convenience while providing a mechanism to monitor clinical outcomes and assure timely dialysis.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Cull DL,Taylor SM,Russell HE,Langan EM,Snyder BA,Sullivan TMdoi
10.1016/s0002-9610(99)00133-6subject
Has Abstractpub_date
1999-08-01 00:00:00pages
113-6issue
2eissn
0002-9610issn
1879-1883pii
S0002-9610(99)00133-6journal_volume
178pub_type
杂志文章abstract:BACKGROUND:Trovafloxacin, a broad-spectrum fourth-generation quinolone with gram-positive and gram-negative aerobic and anaerobic bacterial activity, is available in oral and intravenous formulations. The objective of this prospective, multicenter, double-blind, randomized study was to compare the efficacy of trovaflox...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-9610(98)00223-2
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Epithelioid sarcoma is a rare sarcoma with a high local recurrence rate that frequently metastasizes to lymph nodes. We reviewed our experience with adjuvant therapy in patients with this disease. METHODS:Between 1990 and 2003, we treated 11 patients with epithelioid sarcoma. Patient, tumor, and treatment c...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.07.029
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Sentinel lymph node biopsy (SLNB) for the evaluation of women with invasive breast cancer is rapidly gaining acceptance. The purpose of this study was to assess how surgeons in the Department of Defense (DOD) are incorporating SLNB into practice. METHODS:Surgeons at all DOD hospitals were telephonically sur...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)00920-0
更新日期:2002-08-01 00:00:00
abstract::Differentiating SBO that will resolve conservatively from those requiring surgery remains challenging. Water-soluble contrast administration may be diagnostic and therapeutic. Our study evaluated use of a WSC challenge protocol. We hypothesize that protocol use discriminates between surgical SBO and obstructions which...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.02.034
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Hemorrhage during hepatectomy remains the major cause of morbidity and mortality associated with this surgery. Traditionally, a Pringle technique is employed to reduce vascular inflow during parenchymal transection. METHODS:This paper describes a simple method to achieve unilateral vascular control during h...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00697-3
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Clostridium difficile infection (CDI) is a common cause of healthcare associated infections contributing to morbidity and mortality. Our objective was to evaluate the impact of the implementation of a CDI bundle along with probiotic utilization. METHODS:A retrospective review of trauma admissions from 2008 ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.01.005
更新日期:2018-05-01 00:00:00
abstract::The trend toward function-conserving surgery in the treatment of squamous cell carcinoma of the head and neck has led to a progression from radical neck dissection to modified neck dissection and selective neck dissection has growing support. These surgical modifications have resulted from an effort to spare structure...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80340-x
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Professionalism and ethics are Accreditation Council for Graduate Medical Education (ACGME) core competencies, but there is little evidence regarding the effectiveness of ethics education. METHODS:General surgery residents at the University of Pittsburgh completed questionnaires measuring attitudes and know...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.08.002
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:Tracheostomal recurrence after total laryngectomy for laryngeal carcinoma has a poor prognosis. The independent risk factors of tracheostomal recurrence are, however, not well documented. METHODS:This is a multivariate analysis of the risk factors of tracheostomal recurrence after total laryngectomy for 322...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(96)00162-6
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Considering the surgical safety and perioperative complications, simultaneous resection after neoadjuvant therapy is not commonly recommended. METHODS:A total of 253 patients were included in study. Comparison of the short-term outcomes was performed after propensity score adjustment in Group A (n = 96) and...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.09.019
更新日期:2019-11-01 00:00:00
abstract::The dual tracer nuclear scintiscan using technetium and thallium to localize enlarged or ectopic parathyroid tissue has been reported to be highly accurate and efficacious. Fourteen previous series reporting results of the technique have been compiled from the literature and analyzed. This analysis has revealed a tota...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(87)90798-7
更新日期:1987-05-01 00:00:00
abstract::A small bore feeding tube may be readily introduced into the stomach by splinting it internally, before insertion, with a flexible arteriographic guide wire, which is removed when the tube is in place. Gentle placement of the tube is recommended. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90374-8
更新日期:1980-05-01 00:00:00
abstract::The clinical course of 39 patients on HPN for 5.5 years at The Cleveland Clinic Foundation were reviewed. Rehospitalization and mortality rates were relatively low in this group of patients who had significant disease processes. Rehospitalization and mortality were usually due to the primary underlying disease process...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(83)90174-5
更新日期:1983-01-01 00:00:00
abstract:BACKGROUND:Extended release LCP-tacrolimus (LCPT) allows once-daily dosing in transplant recipients. The improved bioavailability may be beneficial for simultaneous pancreas-kidney recipients (SPK). METHODS:This is a study of 39 SPK recipients on standard immediate-release tacrolimus (IR-TAC, n = 21) or LCPT (n = 18)....
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.02.027
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:in 2008, the Surgical Council on Resident Education selected 33 residency programs to pilot its General Surgery Resident Curriculum Website Portal. The portal aims to reduce program variability in curricula, align teaching and learning with essential content, and improve resident study and performance. METH...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.05.011
更新日期:2011-01-01 00:00:00
abstract::Patients who have undergone recent abdominal surgery and have generalized obliterative adhesions provide a major management problem if they require urgent ileostomy for sepsis or fistulization, particularly when there is an associated abdominal wall defect. This report describes a technique for creating an ileostomy t...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(00)00414-1
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:This prospective study was performed to ascertain the added benefit of lymphoscintigraphy to a standard method of intraoperative lymphatic mapping and sentinel node biopsy for breast cancer. METHODS:Patients with invasive breast cancer were injected with 99mTc sulfur colloid prior to sentinel node biopsy; p...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9610(99)00088-4
更新日期:1999-06-01 00:00:00
abstract::Aortoesophageal fistula secondary to a thoracic aortic aneurysm is usually a fatal disease with few survivors reported previously. We encountered 2 consecutive patients who were treated successfully with esophagectomy and in situ aorta reconstruction using cryopreserved homograft that was wrapped completely with oment...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.09.011
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:The aim of this study is to assess the clinical utility of routine preoperative computed tomography (CT) scanning in patients with cancer of the intraperitoneal colon. METHODS:From November 1997 to June 2001, all patients at VA Puget Sound Healthcare System with a diagnosis of colon cancer were referred for...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)00841-3
更新日期:2002-05-01 00:00:00
abstract::The effect of sulindac, a nonsteroid antiinflammatory drug, on colon polyposis has been evaluated in seven patients after subtotal colectomy and ileoproctostomy and in four patients with intact colons. The patients all had Gardner's syndrome or familial polyposis coli. All polyps were eliminated, except for a few that...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90442-x
更新日期:1989-01-01 00:00:00
abstract::The role of preoperative localization tests in patients undergoing initial neck exploration for hyperparathyroidism (HPT) is controversial. The use of parathyroid ultrasonography (US) in 46 patients (7 men, 39 women; mean age: 60 years) who underwent initial neck exploration for hypercalcemia and who had the diagnosis...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80900-6
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:Prior studies have demonstrated that African-American (AA) donor kidneys are independently associated with an increased risk for graft loss. METHODS:We examined outcomes in comparable groups of AA deceased-donor (DD) kidney transplant patients receiving an AA donor (n=35) versus a Caucasian donor (C group; ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.08.025
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:We propose a simple algorithm for management of patients with challenging abdominal fascial defects. METHODS:The medical records of 64 patients with complicated abdominal wall defects representing a consecutive series by a single surgeon over a 4-year period were reviewed. Group I patients presented with ma...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(00)00566-3
更新日期:2001-02-01 00:00:00
abstract::1. A well defined group of patients have been studied. 2. Composite operation resulted in a 56 per cent five year disease-free survival rate. 3. Treatment of recurrent disease with irradiation increased the five year survival to 61 per cent. 4. Preoperative irradiation for squamous cell carcinoma of the intraoral cavi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90490-0
更新日期:1975-10-01 00:00:00
abstract:BACKGROUND:Esophageal cancer mortality is increased in African Americans relative to white patients. The reasons for this are unknown but are thought to be related to inadequate access to health care secondary to a higher poverty rate in African American populations. METHODS:The National Health Interview Survey databa...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2003.12.055
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Immunosuppressed patients have an increased risk of developing anal cancer, but little data exists regarding outcomes of this population. METHODS:A retrospective review of anal cancer patients at a single academic institution from 2006 to 2017 was performed. RESULTS:19 (14%) of 136 anal cancer patients wer...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.08.011
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Postoperative complications including intrahepatic calculi may develop after the complete excision of a choledochal cyst. Since congenital stenoses of the intrahepatic bile ducts are more likely the cause of intrahepatic calculi, operative procedures for intrahepatic stenoses are reported. METHODS:There wer...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(97)00013-5
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroidectomy. The purpose of this study is to determine the predictors and consequences of RLN injury during thyroidectomy. METHODS:A retrospective analysis was conducted using the ACS-NSQIP 2016-2017 main and thyroidectomy targeted proced...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.07.023
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:The teaching of surgical skills is based mostly on the traditional "see one, do one, teach one" resident-to-resident method. Surgical skills laboratories provide a new environment for teaching skills but their effectiveness has not been adequately tested. Cognitive task analysis is an innovative method to te...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.amjsurg.2002.12.005
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:The purpose of our study is to further clarify the incidence of ductal carcinoma in situ (DCIS) patients that are upstaged upon final pathology and/or have metastatic disease in the axilla. METHODS:All patients were diagnosed with DCIS or DCIS with microinvasion (DCISm) on their diagnostic biopsy and receive...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.06.011
更新日期:2005-10-01 00:00:00