Abstract：
BACKGROUND:It is widely accepted that mastectomy and breast-conserving surgery (BCS) with irradiation yield similar results, yet many women continue to receive mastectomy. This study evaluates factors contributing to surgical decision-making in breast cancer. Registry data were obtained on all patients treated at the Southwest Cancer Treatment and Research Center (SWCTRC) between 2002 and 2006. Patient demographics, including age and race, and insurance type, tumor characteristics, surgical procedure performed, lymph node status, stage, adjuvant therapy, and outcome were analyzed against mastectomy versus BCS using bivariate and multivariate analysis. RESULTS:There was a higher proportion of uninsured patients in the mastectomy cohort, which also included more patients with later stage disease, larger tumor size, and a higher number of lymph node metastases. The only independent predictors of BCS were fewer lymph node metastases and having insurance. Patients with private insurance were almost 4 times more likely to receive BCS (odds ratio 3.90, 95% confidence interval 1.20-12.67). CONCLUSIONS:Insurance status is an important predictor determining whether a patient receives BCS or mastectomy for breast cancer.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Moreland A,Zhang Y,Dissanaike S,Arya Rdoi
10.1016/j.amjsurg.2009.05.031subject
Has Abstractpub_date
2009-12-01 00:00:00pages
787-91issue
6eissn
0002-9610issn
1879-1883pii
S0002-9610(09)00563-7journal_volume
198pub_type
杂志文章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：:From April 1, 1990, to March 31, 1992, 8,899 patients who were 65 years of age and older underwent an anesthetic and surgical procedure in a 1,000-bed community hospital in Victoria, British Columbia, Canada. The hospital has been using a proprietary system called MedisGroups for assessing the severity of illness on a...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80438-6
更新日期：1993-05-01 00:00:00
abstract：:Vascular control of the injured retrohepatic vena cava is invariably a surgical challenge. Herein, we describe the technical aspects of inserting a vena cava balloon shunt through the saphenofemoral junction. The advantages of this approach include relative simplicity, maintenance of perihepatic tamponade, and avoidin...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90288-2
更新日期：1989-11-01 00:00:00
abstract：:After partial or total esophagectomy, total gastrectomy, pancolectomy, and urinary cystectomy, it becomes necessary to reestablish continuity and/or replace function by the creation of a substitute organ obtianed from the various portions of the gastrointestinal tract. Ideally, the creation of the substitute organ sho...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90458-5
更新日期：1977-11-01 00:00:00
abstract：BACKGROUND:Predicting length of stay (LOS) is difficult for trauma and emergency general surgery (TEGS) patients. Our aim was to determine the accuracy of LOS predictions by TEGS team members and the NSQIP Risk Calculator and the patient factors associated with inaccurate predictions. METHODS:LOS for 200 TEGS patients...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.01.055
更新日期：2020-09-01 00:00:00
abstract：BACKGROUND:Historically, tertiary syphilis infection has been the most common cause of thoracic aortic aneurysm, resulting in 5% to 10% of cardiovascular deaths until the era of antibiotics. METHODS:A 49-year-old Caucasian man presented to our institution with progressive dysphagia, weight loss, incomplete bladder emp...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.02.017
更新日期：2010-11-01 00:00:00
abstract：:Six patients with intestinal obstruction secondary to benign adhesions so dense and vascular that the operating surgeon could not free them, were placed on a home total parenteral nutrition program. Four patients had enterocutaneous fistulas, and two had their bowels divided and stomas created to divert intestinal con...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90331-8
更新日期：1983-12-01 00:00:00
abstract：BACKGROUND:Debates continue regarding optimal structures for governance and administration between medical schools and their teaching hospitals. METHODS:Structural integration (SI) for 85 academic health centers was characterized as high (single leader or fiduciary) or low (multiple leaders or fiduciaries). Functional...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2011.05.001
更新日期：2011-08-01 00:00:00
abstract：BACKGROUND:The bispectral index (BIS) is a processed electroencephalographic value (awake = 100, isoelectric = 0). The relationship of BIS and brain death (BD) is assessed. METHODS:BIS was evaluated in GCS 3 head-injured patients with BD (no brain function including apnea) or near BD (no apnea or negative ancillary te...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.05.032
更新日期：2009-12-01 00:00:00
abstract：BACKGROUND:Surgery is indicated for acute uncomplicated appendicitis but the optimal timing is controversial. Recent literature is conflicting on the effect of time to intervention. METHODS:We queried the American College of Surgeons National Surgical Quality Improvement Project dataset for patients undergoing laparos...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.10.013
更新日期：2015-03-01 00:00:00
abstract：:Fixation of polypropylene (Marlex) mesh in the epigastrium and at the iliac crest can be ineffective because of insufficient local fascia; however, two techniques have been described to obtain firm and durable attachment of polypropylene grafts at these sites. Perichondral slips at the costal margin permit very satisf...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(85)80194-x
更新日期：1985-06-01 00:00:00
abstract：:Between 1971 and 1976, ninety-three patients with a clinical diagnosis of pseudocyst confirmed by ultrasonography were identified from a group of 923 patients admitted for pancreatic disease. Uncertainties in diagnosis and/or rapid progression of underlying pancreatitis led to urgent laparotomy and drainage in eleven ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90024-2
更新日期：1979-01-01 00:00:00
abstract：:Emergency center thoracotomy is a heroic technique of resuscitation and treatment which was revived in the 1960s to improve the survival of patients presenting with cardiac wounds. With excellent survival rates attained in such patients, the technique was extended to victims of trauma with other mechanisms and locatio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90443-5
更新日期：1986-12-01 00:00:00
abstract：:This is the Presidential Address from the 104th meeting of the North Pacific Surgical Association held in Tacoma, Washington November 8-9, 2016. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2017.01.041
更新日期：2017-05-01 00:00:00
abstract：BACKGROUND:Previous studies on the efficacy of primary treatments for ductal carcinoma-in-situ (DCIS) have focused on local recurrence rates. Our objective was to detail the outcomes of local invasive recurrence, distant recurrence, and breast cancer mortality in patients previously treated for DCIS. METHODS:Clinical,...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2006.06.005
更新日期：2006-10-01 00:00:00
abstract：:The following report illustrates a rare case of small bowel obstruction which occurred when a large phytobezoar, which had formed in a proximal jejunal diverticulum, dislodged and migrated distally. Obstruction and subsequent perforation resulted when the phytobezoar passed into the narrow terminal ileum and lodged ju...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.02.018
更新日期：2008-01-01 00:00:00
abstract：BACKGROUND:This study examined the clinical value of intraoperative peritoneal lavage for cytological examination in patients with gastric cancer. Peritoneal dissemination is the most frequent mode of recurrence for this tumor. METHODS:A retrospective of lavage findings, other factors, and outcome was performed in 1,2...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00162-2
更新日期：1999-09-01 00:00:00
abstract：BACKGROUND:Acellular dermal matrix (ADM) represents a promising new fascial substitute for repairing abdominal wall defects. METHODS:We retrospectively studied 63 patients who underwent fascial reconstruction with ADM and analyzed risk factors for recurrence and infectious wound complications. RESULTS:Postoperative w...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.11.019
更新日期：2009-01-01 00:00:00
abstract：BACKGROUND:The insertion and subsequent removal of chest tubes are frequently performed procedures. We hypothesize that routine chest radiographs obtained after chest tube removal to confirm the absence of any post-procedure complications have little impact on clinical management. MATERIALS AND METHODS:A 5-year retros...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00260-3
更新日期：2000-01-01 00:00:00
abstract：BACKGROUND:To assess the impact of adding a surgical oncologist to our faculty we examined the operative experience in our program before and after the addition. METHODS:Operative case numbers reported to the American Board of Surgery over a 10-year period were analyzed. This time period encompassed 5 years before and...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2003.01.001
更新日期：2004-01-01 00:00:00
abstract：:Consistent weight reduction by gastroplasty requires precise construction of an appropriately sized stoma that will not dilate. The technique described constructs such a stoma around a 32 French Hurst dilator with an external ring of Silastic tubing over polypropylene suture. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(81)90206-3
更新日期：1981-03-01 00:00:00
abstract：BACKGROUND:Adhesion formation, which results from mechanical peritoneal damage, tissue ischemia, or the presence of foreign materials, is a complicated process. The formation of adhesions is associated with inflammatory response and extracellular matrix deposition in response to injury. Although the pathophysiology of ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2015.05.037
更新日期：2016-06-01 00:00:00
abstract：OBJECTIVES:The OX-40 receptor (OX-40R/CD134) is expressed primarily on activated CD4(+) ("helper") T cells. We have previously reported the presence of OX-40(+) T cells in head and neck cancer and melanoma, where they appear to be restricted to tumor compartments (primary tumor infiltrating lymphocytes [TILs] and drain...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00361-5
更新日期：2000-05-01 00:00:00
abstract：BACKGROUND:Leakage from esophageal anastomoses is higher than that for other gastrointestinal anastomoses. An intrathoracic anastomotic leak is a potentially catastrophic event. METHODS:Patients with and without thoracic anastomotic leakage were compared for predisposing factors. Leak-related mortality was analyzed. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00559-1
更新日期：2001-03-01 00:00:00
abstract：:Reoperation to remove an aortic graft was performed in 18 patients. The need for removal was infection in the majority. A changing flora was seen in aortic graft infection with gram-negative organisms predominating. Despite a standardized approach with total graft removal, aortic closure, and extraanatomic reconstruct...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90371-9
更新日期：1983-08-01 00:00:00
abstract：BACKGROUND:We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery. METHODS:We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tend...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.08.018
更新日期：2013-12-01 00:00:00
abstract：:Diabetic foot wounds affect an estimated 15% of all patients with diabetes. These wounds are typically multifactorial in origin. Neuropathy of the foot and impaired wound healing are frequently associated with peripheral arterial occlusive disease. These factors combine to contribute to the development of foot ulcers....
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/S0002-9610(03)00302-7
更新日期：2004-05-01 00:00:00
abstract：BACKGROUND:The aim of this study was to evaluate the incidence of severe complications of adult inguinal hernia surgery from 2003 to 2007 using data from the Finnish National Patient Insurance Association. METHODS:All major surgical complications are reported to the association because it handles financial compensatio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.04.018
更新日期：2010-06-01 00:00:00
abstract：:Axillary node dissection was performed in 212 patients with malignant melanoma. For 212 initial dissections plus 49 repeat procedures (261 operations), wound infection occurred in 25 (10%) and arm edema in 10 (4%), with other complications being infrequent. The arm edema resolved promptly and completely six (2%) patie...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90069-p
更新日期：1991-09-01 00:00:00
abstract：BACKGROUND:Invasion of the larynx by differentiated thyroid gland carcinoma is uncommon but causes serious morbidity and mortality when present. METHODS:The clinicopathologic characteristics of 5 patients in which a total laryngectomy had to be performed for differentiated thyroid carcinoma are analyzed. Special refer...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.04.009
更新日期：2005-07-01 00:00:00
