Abstract：
BACKGROUND:Administrative databases oversimplify the relationship of factors such as volume or training on surgical outcomes. METHODS:A prospective statewide surgeon-initiated database was queried to obtain incident cases of rectal cancer in Vermont from April 1999 to June 2001. Demographics, procedure performed, method of detection, American Society of Anesthesiologists classification, blood transfusions, length of stay, complications, stage, and use of adjuvant therapy were recorded by the operating surgeon. A post hoc analysis was performed on patients operated on for rectal cancer to define the specific impact of specialty training on care patterns. RESULTS:There was a marked difference in the distribution of surgical procedures, with colorectal surgeons using local excision and coloanal anastomosis in addition to anterior and abdominoperineal resection. Although the overall use of adjuvant therapy was similar, patients in the colorectal group were more likely to receive preoperative then postoperative radiation therapy (91% vs 17%, P <.0001) and more likely to receive radiation therapy when stage appropriate (98% vs 67%, P <.001). CONCLUSIONS:Colorectal specialty training in this population was a surrogate for a wider array of surgical options and preoperative radiation. Failure to use radiation when stage-appropriate was related to patient comorbidities and/or refusal and not related to failure of the surgeon to offer adjuvant therapy. Prospective, surgeon-initiated databases provide an excellent opportunity to identify and understand practice variability.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Hyman N,Healey C,Osler T,Cataldo Pdoi
10.1016/j.amjsurg.2007.01.029subject
Has Abstractpub_date
2007-10-01 00:00:00pages
559-62issue
4eissn
0002-9610issn
1879-1883pii
S0002-9610(07)00551-Xjournal_volume
194pub_type
杂志文章abstract：:It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the b...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/0002-9610(94)90081-7
更新日期：1994-02-01 00:00:00
abstract：BACKGROUND:Students report that their operating room experience during specialty clerkships has been less than satisfactory. To deal with this and other problems in a 1-week cardiothoracic clerkship, a video conference system was introduced. METHODS:Three teaching strategies were used: a seminar dealing with the disea...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(96)00387-x
更新日期：1997-04-01 00:00:00
abstract：BACKGROUND:To determine the current surgical management of bleeding duodenal ulcers in our program, faculty (FAC) and residents (RES) were surveyed. METHODS:FAC (n = 33) and RES (n = 42) were surveyed regarding their surgery of choice between oversew (OS) or acid-reducing procedures (ARPs) in 4 scenarios. FAC who had ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2006.08.021
更新日期：2006-11-01 00:00:00
abstract：BACKGROUND:The objective of this study was to compare middle authorships between male and female general surgeons in the United States. METHODS:A stratified random sample of American College of Surgeons general surgery fellows was identified. Relevant author demographic, affiliation, and publication metrics were colle...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.04.025
更新日期：2020-12-01 00:00:00
abstract：:The relationship between type 2 diabetes mellitus and pancreatic cancer (PC) is not clear. It has been reported that the increased release of islet amyloid polypeptides (IAPPs) is responsible for the impaired glucose tolerance in PC patients. However, no information exists on the patterns of IAPP expression in PC tiss...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.05.024
更新日期：2007-10-01 00:00:00
abstract：:To determine whether the use of pedicled full-thickness gastric patches would be feasible and safe in esophageal reconstruction, studies were undertaken in eleven dogs. The results demonstrate that patches containing parietal cell mucosa are likely to produce localized adjacent esophagitis. Patches containing antral m...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90150-8
更新日期：1979-02-01 00:00:00
abstract：:Five patients with infected abdominal aortoiliac aneurysms were treated. The diagnosis was made preoperatively based upon fever, leukocytosis, positive blood culture findings, and presence of an aneurysm in all five patients. Two patients had salmonella species, two had staphylococcus species, and one had bacteroides ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(88)80137-5
更新日期：1988-05-01 00:00:00
abstract：:The cause of severe and persistent neuralgia after hernia surgery is due to sensory nerve crushing. An operative technique has been described that prevents inadvertent crushing or division of the sensory nerves to the groin. With persistent postoperative pain, the offending nerve is usually difficult to identify. A pr...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(88)80044-8
更新日期：1988-06-01 00:00:00
abstract：:Between 1979 and 1988, we created intestinal anastomoses in 1,000 patients using a single-layer, continuous suturing technique and a polypropylene suture. The technique is easily learned, flexible in its application, and incurs less cost than most other techniques. The anastomoses involved all levels of the colon and ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90262-c
更新日期：1991-11-01 00:00:00
abstract：:Fourteen operations were performed in 13 patients with total carotid artery occlusion. All patients had symptoms ranging in duration from a few hours to several months. Flow wa reestablished in 10 of the 14 arteries operated on, a success rate of 74 percent. Complication included one operative death and one permanent ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90366-9
更新日期：1980-05-01 00:00:00
abstract：BACKGROUND:The presence of an "open abdomen" after a trauma laparotomy can complicate the nutritional management of injured patients. METHODS:The medical records of patients admitted to an American College of Surgeons-verified level 1 trauma center were evaluated. The timing of nutritional support was noted. The metho...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.08.033
更新日期：2010-03-01 00:00:00
abstract：:Splenic infarction is rare in inflammatory diseases of the pancreas, although the spleen and its vessels have an intimate relation with the pancreas. Most reported cases are of focal infarction, and treatment is mostly conservative. The authors report a case of diffuse splenic infarction in a 17-year-old boy with seve...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.03.020
更新日期：2011-03-01 00:00:00
abstract：BACKGROUND:Interest in surgery has declined for two decades. This study aimed to evaluate the impact of one's interest in surgery on career choice. METHODS:Students who completed the surgical clerkship (2016-2017) were invited to complete surveys assessing rotation experience, learning style, burnout, and grit. Studen...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2019.09.040
更新日期：2020-02-01 00:00:00
abstract：BACKGROUND:Currently, there is no consensus in the literature regarding which patients with calf vein thrombi are at high risk for proximal propagation. This study examined patients with isolated calf vein thrombi with serial duplex scans in order to identify risk factors that would predict outcome. PATIENTS AND METHO...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)80261-x
更新日期：1995-08-01 00:00:00
abstract：BACKGROUND:Conventional wisdom teaches that small hernia defects are more likely to incarcerate. We aim to identify radiographic features of ventral hernias associated with increased risk of bowel incarceration. METHODS:We assessed all patients who underwent emergent ventral hernia repair for bowel complications from ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2016.09.035
更新日期：2017-07-01 00:00:00
abstract：BACKGROUND:Variable results regarding general surgery residency program (GSRP) impact on patient outcomes and charges are reported. The aim of this study was to determine any significant differences in patient outcomes and cost with a new GSRP. METHODS:We analyzed all laparoscopic appendectomies (lap-ap), cholecystect...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2016.11.016
更新日期：2017-07-01 00:00:00
abstract：:This study aims to evaluate the intestinal mucosal permeability in patients with acute pancreatitis. The lactulose:mannitol (L:M) ratio was used to assess permeability. It is an inexpensive and quite reliable method. The intestinal permeability was increased in patients with acute pancreatitis compared with the contro...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2006.02.001
更新日期：2006-07-01 00:00:00
abstract：BACKGROUND:One of the issues in the debate surrounding the extent of thyroid excision for localized, well-differentiated thyroid cancer is the low morbidity rate reported after all degrees of thyroid resection. This study was conducted to determine morbidity and mortality after surgical resection for thyroid cancer. M...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80085-6
更新日期：1994-11-01 00:00:00
abstract：:Angioaccess procedures at one institution over a 4-year period were retrospectively reviewed to ascertain the frequency of major limb- or life-threatening complications. A total of 435 angioaccess procedures were performed, including 81 Cimino-Brescia fistulas, 166 polytetrafluoroethylene grafts, and 111 thrombectomy/...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)81076-1
更新日期：1992-09-01 00:00:00
abstract：BACKGROUND:Native arterial venous fistulas (NAVF) are generally considered preferable to synthetic grafts for chronic dialysis access. As increasing numbers of diabetic and elderly patients are treated, adequate NAVFs become more difficult to establish. Vascular ultrasonography (US) prior to NAVF surgery has received l...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(02)01103-0
更新日期：2002-12-01 00:00:00
abstract：:Twenty-five patients were treated for retained, recurrent, or primary common duct stones by permanent drainage of the biliary tract with external choledochoduodenostomy. Twenty-one patients had common duct stones which became evident two to fifty years after the initial biliary tract procedure and which may represent ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90136-3
更新日期：1979-02-01 00:00:00
abstract：BACKGROUND:Rectopexy is one of the accepted treatment options for full-thickness rectal prolapse, but the details of the technique remain controversial. This unit has adopted a laparoscopic approach as an alternative to open surgery, and has used three techniques: mesh, suture, and resection. This retrospective study c...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00672-9
更新日期：2001-08-01 00:00:00
abstract：:Injuries to the inferior vena cava are being seen with increasing frequency in the civilian population. A review of the experience at UCLA/Harbor General Hospital Medical Center over a ten year period (1966 to 1976) discloses thirty-four patients with major injuries to the inferior vena cava, with an overall mortality...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/0002-9610(77)90279-3
更新日期：1977-07-01 00:00:00
abstract：BACKGROUND:The Centers for Disease Control and Prevention reported that surgical site infections (SSIs) create a significant hospital burden. To date, few multi-institutional studies have been performed to evaluate the risk factors for SSIs in mastectomy patients. METHODS:By using the American College of Surgeons' Nat...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.05.007
更新日期：2013-02-01 00:00:00
abstract：:A prospective study of 390 indwelling central venous catheters placed by way of the subclavian route identified bacteremia and tracheostomy as the only significant variables associated with the colonization of the catheters by pathogenic microorganisms. Catheter-related sepsis was likely in only 3 of 33 episodes of pr...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90085-0
更新日期：1979-06-01 00:00:00
abstract：BACKGROUND:Several anecdotal papers suggest that laparoscopic cholecystectomy can be done safely in pregnant patients, but few patients are reported and other patients such as those who underwent laparoscopic appendectomy are often included. A larger series would help clarify the situation. METHODS:The Connecticut Lap...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,多中心研究
doi：10.1016/s0002-9610(99)00007-0
更新日期：1999-03-01 00:00:00
abstract：:An improved technique is presented for placement of the upper arm graft fistula for hemodialysis. This approach brings the graft anteriorly across the front of the biceps muscle, thereby allowing easier puncture and greater comfort for the patient during dialysis treatment. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90478-2
更新日期：1986-03-01 00:00:00
abstract：BACKGROUND:Mucinous Cystic Neoplasms are mucin producing cysts of the pancreas with malignant potential. The existing literature on treatment outcomes is limited to relatively small surgical series. METHODS:We reviewed the National Cancer Database assessing the outcomes of patients with mucinous cystic neoplasms betwe...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.09.006
更新日期：2020-12-01 00:00:00
abstract：:Despite the very high accuracy rate of imaging studies (ultrasound, computed tomography, liver-lung-spleen scans and gallium-67 scans) in detecting intraabdominal abscesses, our experience with 80 recent cases indicate that these techniques have not significantly altered traditional methods of decision-making about wh...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90195-7
更新日期：1982-04-01 00:00:00
abstract：:The difficulties created by an unsuccessful initial operation can usually be avoided by choosing experienced surgeons, identifying four glands, and selectively excising grossly abnormal parathyroid tissue. Patients with multiple endocrine adenomatosis or familial hyperparathyroidism should have a subtotal parathyroide...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90412-3
更新日期：1982-10-01 00:00:00
