Abstract:
BACKGROUND/OBJECTIVE:The National Surgical Quality Improvement Program (NSQIP) has demonstrated quality improvement in the VA and pilot study of 14 academic institutions. The objective was to show that American College of Surgeons (ACS)-NSQIP helps all enrolled hospitals. METHODS:ACS-NSQIP data was used to evaluate improvement in hospitals longitudinally over 3 years (2005-2007). Improvement was defined as reduction in risk-adjusted "Observed/Expected" (O/E) ratios between periods with risk adjustment held constant. Multivariable logistic regression-based adjustment was performed and included indicators for procedure groups. Additionally, morbidity counts were modeled using a negative binomial model, to estimate the number of avoided complications. RESULTS:Multiple perspectives reflected improvement over time. In the analysis of 118 hospitals (2006-2007), 66% of hospitals improved risk-adjusted mortality (mean O/E improvement: 0.174; P < 0.05) and 82% improved risk adjusted complication rates (mean improvement: 0.114; P < 0.05). Correlations between starting O/E and improvement (0.834 for mortality, 0.652 for morbidity), as well as relative risk, revealed that initially worse-performing hospitals had more likelihood of improvement. Nonetheless, well-performing hospitals also improved. Modeling morbidity counts, 183 hospitals (2007), avoided ~9598 potential complications: ~52/hospital. Due to sampling this may represent only 1 of 5 to 1of 10 of the true total. Improvement reflected aggregate performance across all types of hospitals (academic/community, urban/rural). Changes in patient risk over time had important contributions to the effect. CONCLUSIONS:ACS-NSQIP indicates that surgical outcomes improve across all participating hospitals in the private sector. Improvement is reflected for both poor- and well-performing facilities. NSQIP hospitals appear to be avoiding substantial numbers of complications- improving care, and reducing costs. Changes in risk over time merit further study.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Hall BL,Hamilton BH,Richards K,Bilimoria KY,Cohen ME,Ko CYdoi
10.1097/SLA.0b013e3181b4148fsubject
Has Abstractpub_date
2009-09-01 00:00:00pages
363-76issue
3eissn
0003-4932issn
1528-1140journal_volume
250pub_type
杂志文章abstract:OBJECTIVES:To develop a risk prediction model for serious complications after bariatric surgery. BACKGROUND:Despite evidence for improved safety with bariatric surgery, serious complications remain a concern for patients, providers and payers. There is little population-level data on which risk factors can be used to ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318230058c
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:To investigate the risk factors for conversion during laparoscopic liver resection and its effect on patient outcome in a large cohort of patients. Additional analysis of outcomes in patients who required conversion for unfavorable intraoperative findings and conversion for unfavorable intraoperative events w...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002332
更新日期:2018-12-01 00:00:00
abstract::Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198901000-00008
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:To familiarize surgeons with the specific complications of cutaneous, gastrointestinal, inhalation, and systemic infection with Bacillus Anthracis, which may require surgical treatment. SUMMARY BACKGROUND DATA:The recent cases of intentional exposure to Bacillus Anthracis in the United States make familiarit...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-200207000-00004
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVE:We sought to define the prognostic significance of histologic subtype for extremity/truncal liposarcoma (LPS). BACKGROUND:LPS, the most common sarcoma, is comprised of 5 histologic subtypes. Despite their distinct behaviors, LPS outcomes are frequently reported as a single entity. METHODS:We analyzed data o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003453
更新日期:2019-07-05 00:00:00
abstract:OBJECTIVE:To report on the results of a prospective longitudinal study of a new bowel-sparing procedure (side-to-side isoperistaltic strictureplasty [SSIS]) in patients with extensive Crohn's disease. METHODS:Between January 1992 and April 1999, the authors operated on 469 consecutive patients for Crohn's disease of t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200009000-00012
更新日期:2000-09-01 00:00:00
abstract::Between June 1977 and November 1981, 26 children and adults with ulcerative colitis have undergone a total colectomy, an endorectal dissection of the rectal mucosa, and an ileoanostomy. A combined abdominoperineal approach was used to perform the operation, and the mucosal-submucosal rectal tube was dissected out inta...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00
abstract:OBJECTIVE:To review the methodology employed in surgical mortality studies to control for potential confounders. SUMMARY BACKGROUND DATA:Nationwide hospital data are increasingly used to investigate surgical outcomes. However, poor data granularity and coding inaccuracies may lead to flawed findings. METHODS:We condu...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0000000000002119
更新日期:2017-06-01 00:00:00
abstract::All patients who underwent isolated myocardial revascularization procedures from 1967-70 (n = 741) were compared with the first 1,000 patients who received similar elective operations each year from 1971 through 1978. Data from these eight years were processed through a computerized cardiovascular information registry...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197910000-00004
更新日期:1979-10-01 00:00:00
abstract:OBJECTIVE:To investigate the expression of interferon regulatory factors 1 and 2 (IRF-1 and IRF-2) in human breast cancer. SUMMARY BACKGROUND DATA:Interferon regulatory factors 1 and 2 are transcription factors in the interferon gamma signal transduction pathway. IRF-1 acts as the effector arm of the interferon gamma ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200105000-00005
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVE:The authors determined the impact of a positive cytotoxic crossmatch on the outcome of liver transplantation. SUMMARY BACKGROUND DATA:Liver allografts rarely undergo hyperacute rejection, but transplants performed across a positive cytotoxic crossmatch tend to follow a different clinical course, with higher ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199608000-00009
更新日期:1996-08-01 00:00:00
abstract:BACKGROUND:Clinical coding is the translation of clinical activity into a coded language. Coded data drive hospital reimbursement and are used for audit and research, and benchmarking and outcomes management purposes. METHODS:We undertook a 2-center audit of coding accuracy across surgery. Clinician-auditor multidisci...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000851
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:We compared the effects of intravenous administration of 6% hydroxyethyl starch (maize-derived) in 0.9% saline (Voluven; Fresenius Kabi, Runcorn, United Kingdom) and a "balanced" preparation of 6% hydroxyethyl starch (potato-derived) [Plasma Volume Redibag (PVR); Baxter Healthcare, Thetford, United Kingdom] o...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000324
更新日期:2014-05-01 00:00:00
abstract::Thirty-two conditioned 15-18 kg dogs underwent laparotomy, heparinization, left lateral hepatic lobe injury and subsequent partial left lateral hepatic lobectomy. The hemostatic capabilities of the surgical scalpel combined with suture ligatures and stay sutures, the Bovie, and the CO2 laser were compared. The CO2 las...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197501000-00016
更新日期:1975-01-01 00:00:00
abstract::Study A included 30 patients who received immediate postoperative enteral feeding with a nonelemental diet. The nonelemental diet was well tolerated. Study patients rapidly achieved nitrogen equilibrium and had a cumulative nitrogen balance of -11.1 g verus -46.7 g for the control group. In part B, 16 patients with va...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198011000-00003
更新日期:1980-11-01 00:00:00
abstract::In the absence of a prospective randomized study of patients treated conservatively or with thymectomy, a computer-assisted retrospective matches study was devised. Of 563 patients treated for myasthenia gravis without thymoma up to 1965, 104 had thymectomy. With computer assistance, each surgical patient was matched ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197610000-00008
更新日期:1976-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the clinical presentation, diagnostic procedures, and surgical management of hepatic abscesses in patients with chronic granulomatous disease (CGD). SUMMARY BACKGROUND DATA:Chronic granulomatous disease is a rare inherited primary immunodeficiency in which phagocytes cannot destroy catalase-posit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200203000-00010
更新日期:2002-03-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE). BACKGROUND:Although obesity is an established risk factor for morbidity and mortality, the minimum amount of weight loss to have a meaningful impact on cardiovas...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004369
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:To clarify whether bowel preparation use or its individual components [mechanical bowel preparation (MBP)/oral antibiotics] impact specific outcomes after colorectal surgery. METHODS:National Surgical Quality Improvement Program-targeted colectomy data initiated in 2012 capture information on the use/type o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001416
更新日期:2015-09-01 00:00:00
abstract::During a 29-month trial, 65 patients with acute gallstone pancreatitis were randomly selected for biliary tract explorations either within 73 hours of admission (36 patients) or at three months following remission with nonoperative measures (29 patients, with five others awaiting elective operation). The details of su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198109000-00008
更新日期:1981-09-01 00:00:00
abstract::Primary hyperparathyroidism was studied in a well-defined geriatric population of 1129 individuals during a three-month interval. Primary hyperparathyroidism was diagnosed in 1.5%. The diagnosis was based on a morphologic and biochemic basis. From clinical material consisting of 400 patients treated surgically for pri...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198302000-00003
更新日期:1983-02-01 00:00:00
abstract::A clinical program in liver transplantation was begun at UCLA in 1984 after a period of laboratory investigation. The first 100 orthotopic liver transplants (OLT) were performed in 83 patients (43 adults and 40 children) between February 1, 1984 and November 1, 1986. Donors and recipients were matched only for size an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198710000-00001
更新日期:1987-10-01 00:00:00
abstract:BACKGROUND:Despite antiviral treatment has been shown to reduce hepatocellular carcinoma (HCC) recurrence after curative treatment for hepatitis B virus (HBV)-related HCC in patients with high preoperative HBV-DNA levels, it is still unclear whether antiviral therapy is useful in reducing recurrence in patients with lo...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000002727
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution. SUMMARY OF BACKGROUND DATA:Outcomes after resection of PMNSGCTs are not well-characterized, with limit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003754
更新日期:2020-01-21 00:00:00
abstract:BACKGROUND:Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) have been associated with a high remission rate of type 2 diabetes mellitus (T2DM). However, whether such remission is associated with full restoration of postprandial glucose profile and/or the potentially nonrestored glycemic profile is associate...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000586
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to determine whether prolonged air leak (PAL) is associated with postoperative morbidity and mortality following pulmonary resection after adjusting for differences in baseline characteristics using propensity score analysis. SUMMARY BACKGROUND DATA:Patients with PAL after lung resec...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003191
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:Using a prospective randomized study to assess postoperative morbidity and pancreatic function after pancreaticoduodenectomy with pancreaticojejunostomy and duct occlusion without pancreaticojejunostomy. SUMMARY BACKGROUND DATA:Postoperative complications after pancreaticoduodenectomy are largely due to leak...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200210000-00004
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVES:We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. SUMMARY BACKGROUND DATA:In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant diffe...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.sla.0000179644.02187.ea
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:This case control study is a detailed analysis of the causes of death and the risk factors of short-term mortality after appendectomy. SUMMARY BACKGROUND DATA:Although death is a rare event after appendectomy, we found a 7-fold excess mortality after appendectomy overall and a 9-fold excess mortality after n...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31821ad9c4
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh. BACKGROUND:Prevention of PSH is important as it often ca...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000002542
更新日期:2019-03-01 00:00:00