Abstract:
OBJECTIVE:To determine whether the investment in postgraduate education and training places patients at risk for worse outcomes and higher costs than if medical and surgical care was delivered in nonteaching settings. SUMMARY BACKGROUND DATA:The Veterans Health Administration (VA) plays a major role in the training of medical students, residents, and fellows. METHODS:The database of the VA National Surgical Quality Improvement Program was analyzed for all major noncardiac operations performed during fiscal years 1997, 1998, and 1999. Teaching status of a hospital was determined on the basis of a background and structure questionnaire that was independently verified by a research fellow. Stepwise logistic regression was used to construct separate models predictive of 30-day mortality and morbidity for each of seven surgical specialties and eight operations. Based on these models, a severity index for each patient was calculated. Hierarchical logistic regression models were then created to examine the relationship between teaching versus nonteaching hospitals and 30-day postoperative mortality and morbidity, after adjusting for patient severity. RESULTS:Teaching hospitals performed 81% of the total surgical workload and 90% of the major surgery workload. In most specialties in teaching hospitals, the residents were the primary surgeons in more than 90% of the operations. Compared with nonteaching hospitals, the patient populations in teaching hospitals had a higher prevalence of risk factors, underwent more complex operations, and had longer operation times. Risk-adjusted mortality rates were not different between the teaching and nonteaching hospitals in the specialties and operations studied. The unadjusted complication rate was higher in teaching hospitals in six of seven specialties and four of eight operations. Risk adjustment did not eliminate completely these differences, probably reflecting the relatively poor predictive validity of some of the risk adjustment models for morbidity. Length of stay after major operations was not consistently different between teaching and nonteaching hospitals. CONCLUSION:Compared with nonteaching hospitals, teaching hospitals in the VA perform the majority of complex and high-risk major procedures, with comparable risk-adjusted 30-day mortality rates. Risk-adjusted 30-day morbidity rates in teaching hospitals are higher in some specialties and operations than in nonteaching hospitals. Although this may reflect the weak predictive validity of some of the risk adjustment models for morbidity, it may also represent suboptimal processes and structures of care that are unique to teaching hospitals. Despite good quality of care in teaching hospitals, as evidenced by the 30-day mortality data, efforts should be made to examine further the structures and processes of surgical care prevailing in these hospitals.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Khuri SF,Najjar SF,Daley J,Krasnicka B,Hossain M,Henderson WG,Aust JB,Bass B,Bishop MJ,Demakis J,DePalma R,Fabri PJ,Fink A,Gibbs J,Grover F,Hammermeister K,McDonald G,Neumayer L,Roswell RH,Spencer J,Turnage RH,Vdoi
10.1097/00000658-200109000-00011subject
Has Abstractpub_date
2001-09-01 00:00:00pages
370-82; discussion 382-3issue
3eissn
0003-4932issn
1528-1140journal_volume
234pub_type
杂志文章abstract::An experience with 69 patients who underwent 72 common bile duct reoperations for retained or recurrent choledocholithiasis is presented. The mean age of the patients was 57 years, and 35 patients had associated conditions. In this series six patients (8.3%) had minor complications and no patient developed major compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198102000-00004
更新日期:1981-02-01 00:00:00
abstract:OBJECTIVE:To review retrospectively a 4-year experience with pediatric surgical networking at a major academic medical center in the Midwest. BACKGROUND:The growth of managed care in the United States during the past decade has had a major impact on the practice of medicine in general, but especially on academic medic...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199909000-00006
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVE:To prevent bile duct injury by using a cold 5% glucose isotonic solution cooling in the bile ducts when radiofrequency (RF) is performed in a porcine model. SUMMARY BACKGROUND DATA:Complications that may arise during liver RF ablation include biliary stenosis and abscesses. METHODS:The RITA 1500 generator w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000193831.39362.07
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To assess long-term outcome and prognostic factors for extreme surgery by vascular and plastic surgical teamwork for leg salvage in patients with critically ischemic large tissue defects. SUMMARY BACKGROUND DATA:Combined vascular reconstruction and microvascular free-flap transfer has been used to improve di...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000247985.45541.e8
更新日期:2006-12-01 00:00:00
abstract::Chronic idiopathic intestinal pseudo-obstruction is an increasingly recognized syndrome in which patients usually present with an acute or chronic history suggestive of intestinal obstruction, although no obstructing lesion is found at surgery. The diagnosis can be suspected in most cases from the clinical presentatio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198012000-00011
更新日期:1980-12-01 00:00:00
abstract:OBJECTIVE:To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. BACKGROUND:Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002462
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To investigate potential impacts of restructuring general surgery training on colorectal (CR) surgery recruitment and expertise. SUMMARY BACKGROUND DATA:In response to the American Surgical Association Blue Ribbon Committee report on surgical education (2004), the American Board of Colon and Rectal Surgery, ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ad64f1
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:To evaluate readmissions following laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB). BACKGROUND:Few studies have evaluated national readmission rates for primary bariatric surgery with national, bariatric-specific data. ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002079
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:We sought association of genetic variants in the renin-angiotensin system (RAS) and vitamin D system with acute pancreatitis (AP) development and severity. BACKGROUND:The endocrine RAS is involved in circulatory homeostasis through the pressor action of angiotensin II at its AT1 receptor. However, local RAS...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000655
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:This study aims to describe recent experience with rectal carcinoids in European and North American centers. BACKGROUND:While considered indolent, the propensity of carcinoids to metastasize can be significant. METHODS:Rectal carcinoid patients were identified from prospective databases maintained at 9 inst...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3181fb8df6
更新日期:2010-11-01 00:00:00
abstract::Successful long-term limb salvage using cephalic vein bypass grafts was attained in 70 limbs of 67 patients over the past 11 years. The saphenous vein was absent in 76% and inadequate in 24% of the cases. Revascularization for limb salvage was carried out in 83%. Ninety per cent of the grafts were extended to the infr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198412000-00019
更新日期:1984-12-01 00:00:00
abstract::Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197807000-00017
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND AND AIMS:The lower esophageal sphincter (LES) in patients with gastroesophageal reflux disease often has a low resting pressure and a short abdominal length. The mechanism by which this occurs is unknown. We hypothesize that gastric distension causes progressive effacement of the abdominal portion of the LES...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181e3e411
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Pancreatic ductal adenocarcinoma (PDA) is a devastating disease that killed nearly 38,000 people in the United States this past year. OBJECTIVE:Treatment of PDA typically includes surgery and/or chemotherapy with gemcitabine. No reliable biomarker exists for prognosis or response to chemotherapy. Two previo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181f1fd44
更新日期:2010-09-01 00:00:00
abstract::A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198009000-00011
更新日期:1980-09-01 00:00:00
abstract::From 1964 to 1968 selective gastric vagotomy (SGV) and drainage was performed in 174 patients. Of these, 105 patients were followed-up 10-13 years after operation; 56 were dead. Ulcers recurred in 18 patients. The cumulated recurrence rate after 13 years (life table method) was 15% (95% confidence limits: 8-23). The m...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198112000-00004
更新日期:1981-12-01 00:00:00
abstract::This study sought to minimize juxta-anastomotic neointimal hyperplasia (JNIH) following the use of polytetrafluorethylene (PTFE) conduits. PTFE anastomoses to canine carotid arteries (noncuff grafts) were compared with grafts with vein cuffs interposed proximally and distally between the graft and native artery. This ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198806000-00011
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:To assess whether regional intestinal oxygen saturation (rintSO2) and regional cerebral oxygen saturation (rcSO2) measurements aid in estimating survival of preterm infants after surgery for NEC. SUMMARY OF BACKGROUND DATA:Predicting survival after surgery for NEC is difficult yet of the utmost importance fo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003913
更新日期:2020-04-20 00:00:00
abstract:OBJECTIVE:The authors determined which combination of computed tomography scans is most helpful for preoperative assessment of patients with liver tumors. SUMMARY BACKGROUND DATA:Multi-institutional studies have shown that the most important prognostic factors for selection of patients with metastatic colorectal cance...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199303000-00002
更新日期:1993-03-01 00:00:00
abstract:OBJECTIVE:To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer. SUMMARY BACKGROUND DATA:Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000129358.80798.62
更新日期:2004-07-01 00:00:00
abstract::The use of amputation in extremity soft tissue sarcoma has been decreasing at Memorial Sloan-Kettering Cancer Center (MSKCC) over the last 15 years. In an attempt to define the efficacy and future role of amputation in extremity soft tissue sarcoma, a prospective sarcoma database compiled at MSKCC from July 1982 to Ja...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199203000-00012
更新日期:1992-03-01 00:00:00
abstract::From 1966 to 1975, 38 patients underwent 42 procedures for renovascular hypertension; 35 operations were aortorenal bypasses and 7 were nephrectomies. Forty-five per cent of the patients were cured, 43% were improved and 12% were unimproved. There were no operative deaths and only three late deaths. Two grafts occlude...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197512000-00019
更新日期:1975-12-01 00:00:00
abstract:INTRODUCTION:There is a documented association between critically ill patients who are in refractory shock and adrenal insufficiency. The underlying pathophysiology may be related to ischemia, necrosis, reperfusion, or resuscitative dilution. We hypothesize this blunted adrenal response is due to ischemia and necrosis ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000216759.36819.1b
更新日期:2006-05-01 00:00:00
abstract:SUMMARY BACKGROUND DATA:To analyze the effects of a treatment program of intraoperative electron beam radiation therapy (IOERT) and external beam radiation therapy and chemotherapy on the outcome of patients with unresectable or locally advanced pancreatic cancer. METHODS:From 1978 to 2001, 150 patients with unresecta...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000152016.40331.bb
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the adequacy of esophageal classification for adenocarcinoma of the esophagogastric junction (AEJ) of the seventh American Joint Committee on Cancer (AJCC) TNM classification. BACKGROUND:The seventh AJCC TNM classification proposed the new classification for AEJ as a par...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824beb95
更新日期:2012-05-01 00:00:00
abstract::Previous studies have demonstrated that Na(+)-dependent brush border glutamine transport is diminished in septic patients. To examine the potential regulation of this decreased transport by endotoxin, cytokines, or glucocorticoids, the human intestinal Caco-2 cell line was studied in vitro. Na(+)-dependent glutamine t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199205000-00017
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVES:The major objective of this study was to test vitamin E as a potential radioprotectant for the small bowel of the rat. SUMMARY BACKGROUND DATA:Vitamin E has previously been shown to provide radioprotection in animal models: increased survival after whole-body irradiation, diminished absorptive malfunction, ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199522240-00008
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes of bilateral subtotal (BST) versus total thyroidectomy (TT) for benign bilateral thyroid disease (BBTD). BACKGROUND:The extent of thyroid resection in benign goiter is controversial. Potential advantages of TT over BST may include: one-stage removal of incidental thyroid cancer, and a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182360118
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To investigate the existence of a pathway between intraluminal products and the muscularis leukocytic infiltrate. SUMMARY BACKGROUND DATA:Mild intestinal manipulation or lipopolysaccharide initiates an intense inflammatory response within the intestinal muscularis, resulting in paralytic ileus. A major poten...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200201000-00005
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:This study investigated the current state of fecal and urinary continence in an extensive group of adults after operative correction for high anorectal malformations and how they cope with their incontinence. SUMMARY BACKGROUND DATA:Normal fecal continence is hardly to be expected after correction for high a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199308000-00012
更新日期:1993-08-01 00:00:00