Abstract：
BACKGROUND:Elective peripheral vascular surgery provides quality outcomes that are of great benefit to patients, but have complications that result in severe morbidity and excessive costs. METHODS:We studied elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repairs, and femoral-distal bypass surgeries among hospitals(N ≥ 20 cases) from 2002 to 2005 from the national Inpatient Sample of the Healthcare Cost and Utilization project. Adverse outcomes, mortality, and cost models were developed. Outlier hospitals were defined for excessive adverse outcomes (P < .005) and excess cost (P < .0005). RESULTS:There were 43,700 carotid endarterectomy patients from 447 hospitals, 9,090 aortofemoral bypass/aortic aneurysm patients from 187 hospitals, and 14,453 femoral-distal bypass patients from 243 hospitals. Approximately 3% of hospitals were quality outliers, and 8% to 24% of hospitals were efficiency outliers by procedure. CONCLUSIONS:Comparative effectiveness and efficiency modeling at the hospital level shows inefficiency and is responsible for 90% of excess costs. Overall reduced complication rates will further enhance cost reductions.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Fry DE,Pine M,Jones BL,Meimban RJdoi
10.1016/j.amjsurg.2010.08.025subject
Has Abstractpub_date
2011-03-01 00:00:00pages
363-7; discussion 367-8issue
3eissn
0002-9610issn
1879-1883pii
S0002-9610(10)00755-5journal_volume
201pub_type
杂志文章abstract：BACKGROUND:Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated. METHODS:A retrospective review was conducted of patients who underwent m...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.10.014
更新日期：2015-03-01 00:00:00
abstract：:As discussed by Urschel [13], 50 to 70 percent of patients with symptoms of thoracic outlet syndrome may be treated conservatively by nonsurgical methods. Patients who still have symptoms after years of such therapy are referred to us for surgical treatment. Failure to obtain symptomatic relief after scalenotomy alone...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90351-7
更新日期：1980-05-01 00:00:00
abstract：BACKGROUND:Core biopsy finding of atypical ductal hyperplasia (ADH) are generally followed by open biopsy to avoid underestimation of malignant disease. METHODS:Retrospective examination of 11 gauge stereotactic-guided vacuum-assisted core biopsies was made with respect to ADH diagnosis, follow-up open biopsy, and upg...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00727-9
更新日期：2001-10-01 00:00:00
abstract：:Computerized tomographic scanning is being used with increasing frequency for the detection of abdominal aortic prosthetic complications. Although computerized tomography remains a very precise method for direct imaging of the retroperitoneal space, the interpretation of a postoperative computerized tomographic scan i...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90125-4
更新日期：1985-08-01 00:00:00
abstract：BACKGROUND:To prevent hepatic failure after major hepatectomy, it is important to assess preoperative factors related to liver failure. METHODS:We examined 80 patients who underwent right-sided hepatectomy. Hyperbilirubinemia, uncontrolled ascites, and prolonged postoperative hospital stay were defined as liver failur...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.12.013
更新日期：2013-09-01 00:00:00
abstract：:The care of patients with rhabdomyosarcoma has undergone significant change in the past decade. Careful staging and multidisciplinary treatment have improved the prognosis for patients with this neoplasm. A review of the medical literature of the past decade documents these changes in staging, therapy and prognosis. ...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/0002-9610(80)90059-8
更新日期：1980-11-01 00:00:00
abstract：BACKGROUND:After enthusiasm for total pancreatectomy for pancreatic adenocarcinoma peaked in the 1970s, a failure to improve outcomes in the 1980s led to fewer reports of this procedure. METHODS:We retrieved records from 252 Whipple and 47 total pancreatectomies for pancreatic cancer performed at U.S. Department of Ve...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80126-6
更新日期：1994-12-01 00:00:00
abstract：BACKGROUND:This study descriptively analyzes characteristics of general surgery residency and practice and their influence on student interest in surgical careers. METHODS:Fourth-year medical students were invited to complete an Internet-based survey. A 5-point Likert scale described characteristics of general surgery...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2005.03.019
更新日期：2005-06-01 00:00:00
abstract：BACKGROUND:Motility disturbances in the Roux loop can negatively influence the outcome of reflux gastritis; the uncut Roux loop does not have these disadvantages, but is less suitable for clinical application because of staple dehiscence. The reported "cut-closed-reconnected" Roux loop has the same physiological starti...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00246-4
更新日期：2000-02-01 00:00:00
abstract：:Abnormal persistent of the embryonic axial blood supply to the leg, the sciatic artery, is a rare but often clinically important condition. The sciatic artery may vary from a small collateral in the upper thigh to a very large vessel that is the leg's sole arterial blood supply. The abnormal artery is prone to aneurys...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90122-8
更新日期：1983-05-01 00:00:00
abstract：BACKGROUND:Laparoscopic splenectomy (LS) has been used to treat a variety of splenic disorders. However, there have been few direct comparisons of this approach with open splenectomy (OS). METHODS:Results and outcomes were compared retrospectively in 46 consecutive patients treated by laparoscopic (n = 26) or open spl...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(96)00241-3
更新日期：1996-11-01 00:00:00
abstract：:The charts of 81 patients who underwent skull base surgery between 1982 and 1993 were reviewed retrospectively. Data relative to demographic aspects, clinical stage, previous treatment, surgical approach, type of reconstruction, histology, extent of disease, complications, and follow-up were analyzed. The craniofacial...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80106-0
更新日期：1994-11-01 00:00:00
abstract：:Operative liver biopsy findings were reviewed in 164 consecutive, unselected patients with alcoholic cirrhosis who had bleeding from esophageal varices and underwent emergency portacaval shunt. The survival rate up to 10 years in 49 patients with acute alcoholic hepatitis and alcoholic cirrhosis was not significantly ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90038-2
更新日期：1984-01-01 00:00:00
abstract：BACKGROUND:There are currently between 1 and 2 million breast cancer survivors in the United States. Is the advocated, early intervention the key to successful treatment, or are there other, more important factors? METHODS:Responses to combined decongestive therapy (CDT) for 69 women were analyzed with regard to durat...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00185-3
更新日期：1999-10-01 00:00:00
abstract：BACKGROUND:General surgery residents are often not present for the critical intraoperative discussion between surgeon and pathologist regarding surgical pathology findings. METHODS:A prospective pilot study analyzed general surgery resident exposure to surgical pathology. Thereafter, an operating room was equipped to ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.09.010
更新日期：2006-04-01 00:00:00
abstract：:Forty-six infants and children with primary malignant liver tumors were studied. Thirty-three had hepatoblastomas, 9 hepatocellular carcinomas, and 4 had sarcomas. Thirty-eight patients underwent liver biopsy or excision of the tumor. Nineteen patients were treated between 1952 and 1971 (mean survival 5.5 months) and ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90381-1
更新日期：1983-08-01 00:00:00
abstract：BACKGROUND:Over 1 million healthcare providers have participated in the Advanced Trauma Life Support course. No studies have evaluated factors that predict course performance. This study aims to identify these predictors. METHODS:All participants taking the course at 2 centers over a 4-year period were identified. Dem...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2015.03.007
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND:Coagulopathy is frequently encountered during supraceliac aortic clamping. Patients are routinely heparinized during these operations. This experiment was undertaken to evaluate the effect of supraceliac aortic cross-clamping (XC) on heparin pharmacodynamics. MATERIAL AND METHODS:Fourteen mongrel dogs were ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(96)00140-7
更新日期：1996-08-01 00:00:00
abstract：BACKGROUND:Training surgeons in vital decision-making skills remains unstructured. We aimed to map a process of care from the perspective of surgical decision making and test whether it could be deconstructed into an accessible format for trainees. METHODS:Semistructured interviews were conducted with 10 experienced s...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2007.02.016
更新日期：2008-05-01 00:00:00
abstract：AIMS:Assessing endoscopic technical skills competency in a structured manner is a topical issue, in light of several workforce factors that may affect the training of future endoscopists. To date there has been little attempt to comprehensively assess both generic and specific technical skills in lower gastrointestinal...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.10.024
更新日期：2008-09-01 00:00:00
abstract：BACKGROUND:Current standard of care dictates that central venous catheter (CVC) insertion should be followed by an immediate chest radiograph to confirm appropriate position and rule out complications. We hypothesized that a subset of monitored intensive care unit patients exists that is at low risk for complications a...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00498-0
更新日期：2000-12-01 00:00:00
abstract：:Cases of symptomatic Meckel's diverticulum treated surgically on an emergency basis during the last decade are reviewed. A series of 18 patients were divided into two groups depending on the presence or absence of ectopic tissue in the diverticulum. Group 1 consisted of five patients (28 percent) without ectopic tissu...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90576-3
更新日期：1986-05-01 00:00:00
abstract：BACKGROUND:The purpose of this study was to investigate the impact of subcarinal dissection on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma. METHODS:Patients without subcarinal dissection were matched randomly to patients with subcarinal dissection i...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.10.044
更新日期：2013-09-01 00:00:00
abstract：:Prophylactic bypass of the common duct and duodenum at the time of pancreatojejunostomy for chronic pancreatitis (triple bypass) has been recommended. If the subsequent development of parapancreatic obstruction were sufficiently frequent, such a recommendation would deserve more wide-spread application. In a group of ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90081-4
更新日期：1986-02-01 00:00:00
abstract：BACKGROUND:Patients often have an incomplete understanding of the levels of training and roles of the various surgical providers in teaching hospitals, leading to patient confusion and dissatisfaction. METHODS:Pre-intervention discharge surveys were administered to gastrointestinal surgery inpatients (10/2016-02/2017)...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/j.amjsurg.2018.07.056
更新日期：2018-10-01 00:00:00
abstract：BACKGROUND:Laparoscopic cholecystectomy is increasingly being employed as the initial surgical approach in patients with acute cholecystitis. Gangrenous cholecystitis will be unexpectedly encountered in a proportion of these patients. The applicability of laparoscopic techniques and its outcome in this group of patient...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00525-0
更新日期：2001-01-01 00:00:00
abstract：:A series of 168 patients who underwent 177 inguinal lymph node dissections from 1979 to 1989 were retrospectively reviewed to determine the incidence and severity of postoperative complications as well as the perioperative risk factors associated with them. Operative mortality was 0%, whereas the incidence of moderate...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)81181-x
更新日期：1992-11-01 00:00:00
abstract：:The type of endorectal pull-through described by Black was evaluated as an alternative method of anastomosis in 11 anterior resections in which anastomosis from above was impossible. The method is attractive from the standpoint of function because it preserves the distal rectum and leaves the anus intact. Technical po...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90249-6
更新日期：1979-07-01 00:00:00
abstract：BACKGROUND:The 5-HT3 receptor is a serotonin receptor believed to reside on enteric neurons. However, several studies belie an exclusive neural localization. Our hypothesis is that the 5-HT3 receptor agonist, 2-methyl-5-HT (2Me5HT), induces chloride secretion despite neural blockade, which can be blocked by a 5-HT3 rec...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.07.012
更新日期：2005-11-01 00:00:00
abstract：BACKGROUND:There is little evidence supporting or refuting clamping trials, a period of clamping thoracostomy tubes prior to removal. We sought to evaluate whether clamping trials reduce the need for subsequent pleural drainage procedures. METHODS:We conducted a retrospective cohort study of trauma patients who underw...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.01.007
更新日期：2020-08-01 00:00:00
