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：:Increased strength of healing incisions infected with E coli was demonstrated in this experiment. Efforts to measure respiratory gas tensions and pH in these incisions were unsuccessful. Therefore, these moieties were measured in normal and infected wound fluid contained in implanted wire cylinders. The wound fluid fr...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(76)90292-0
更新日期：1976-07-01 00:00:00
abstract：:Thirteen published series concerning laparoscopic cholecystectomy performed in the United States were reviewed. The review was based on reports that included at least 100 patients. Three of the series are surveys of surgery chairpersons and multiple hospitals. The other 10 series are based on the experience of the inv...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/s0002-9610(05)80939-0
更新日期：1993-04-01 00:00:00
abstract：BACKGROUND:Patients with diverticulitis have a 20% risk of requiring urgent/emergent treatment. Since morbidity and mortality rates differ between elective and urgent/emergent care, understanding associated disparities is critical. We compared factors associated with treatment setting for diverticulitis and evaluated d...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2019.09.005
更新日期：2020-06-01 00:00:00
abstract：BACKGROUND:Antiphospholipid (APL) antibodies are a heterogenous group of antibodies that have been associated with an increase in bleeding complications and a marked increase in thrombotic events, both of which result in significant patient morbidity and mortality. PATIENTS AND METHODS:A retrospective analysis of pati...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)80285-2
更新日期：1995-08-01 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：BACKGROUND:Gastrointestinal stromal tumors (GISTs), the specific kit-positive mesenchymal tumors of the gastrointestinal tract, are rarely found in the anorectum and account for only 0.1% of all colorectal tumors. The main stem of therapy remains surgical excision. The standard surgical approach for anorectal GISTs inc...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.10.013
更新日期：2006-01-01 00:00:00
abstract：BACKGROUND:Percutaneous endoscopic gastrostomy and jejunostomy tube placement have long been considered the standard for supplying enteral nutrition when oral intake is not possible. Both have well-documented roles and limitations and are associated with a higher than generally appreciated incidence of aspiration. A di...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(98)00298-0
更新日期：1999-01-01 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：:A review of 352 patients with primary liver cell carcinoma treated by the author is presented. The poor rate of resectability (7 per cent) has necessitated various forms of treatment over the years. These are described in detail. Based on this experience, the current form of treatment for nonresectable carcinoma is su...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90452-3
更新日期：1975-07-01 00:00:00
abstract：BACKGROUND:Acute diverticulitis of the right colon is a rare condition with a higher incidence in Oriental populations than in Occidental populations. PATIENTS AND METHODS:A retrospective review was conducted between 1982 and 1993 on 22 surgically treated Chinese patients (14 men, 8 women; mean age 47 years) with docu...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(97)89559-1
更新日期：1996-02-01 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：:Patients who have undergone recent abdominal surgery and have generalized obliterative adhesions provide a major management problem if they require urgent ileostomy for sepsis or fistulization, particularly when there is an associated abdominal wall defect. This report describes a technique for creating an ileostomy t...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00414-1
更新日期：2000-07-01 00:00:00
abstract：:Miliary tuberculosis is the most lethal form of tubercular disease. If dissemination of tubercle bacilli occurs without therapy, death is almost certain. The importance of establishing an etiologic diagnosis as promptly as possible in patients receiving immunosuppressive therapy is self-explanatory. The presence of a ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90402-x
更新日期：1975-09-01 00:00:00
abstract：:We tested the effectiveness of a single dose of prophylactic antibiotic (gentamicin) in elective cholecystectomy in a double-blind, controlled randomized study. All patients recognized preoperatively as being at risk were excluded. The treatment group comprised of 102 patients received a single dose of gentamicin and ...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/0002-9610(86)90218-7
更新日期：1986-11-01 00:00:00
abstract：BACKGROUND:Approximately 30% to 50% of appendicitis in children is already perforated at presentation. The optimal management of these children remains controversial. METHODS:Ninety-six children (aged 2 to 16 years) were treated for perforated appendicitis. Seventy-one underwent immediate appendectomy and drainage of ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2003.08.027
更新日期：2003-12-01 00:00:00
abstract：:The records of patients treated for upper gastrointestinal bleeding from 1974 through 1978 were reviewed. Five percent of this group (69 patients) had bleeding due to the Mallory-Weiss syndrome. Only 36 percent of patients had a correct admitting diagnosis. Esophagogastroscopy proved the most reliable diagnostic tool,...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(81)90425-6
更新日期：1981-11-01 00:00:00
abstract：:The success of gastric restriction procedures for morbid obesity depends on a persistently small gastric pouch and stoma, an intact staple line, and, of equal importance, dietary compliance. Evaluation of patients with either excessive or inadequate weight loss should be directed at determining both the technical adeq...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90200-3
更新日期：1983-03-01 00:00:00
abstract：:Radionuclide lymphograms provide invaluable preoperative information on many truncal melanomas of the skin that require elective regional lymph node dissection. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(85)80138-0
更新日期：1985-05-01 00:00:00
abstract：BACKGROUND:The operative approach for esophageal cancer varies from simple palliative resection to extended esophagectomy with 3-field lymph-node dissection or en-bloc esophagectomy (EBE) depending on tumor and patient status and surgical strategy of the surgeon. The merits and demerits of such EBE are yet to be determ...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/j.amjsurg.2004.06.004
更新日期：2004-09-01 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：BACKGROUND:Patients with the best performance status have the best prognosis after resection for pancreatic adenocarcinoma. This study was undertaken to determine the impact of performance status on survival after pancreatectomy for adenocarcinoma. METHODS:Patients with a Karnofsky Performance Score (KPS) status (KPS)...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/j.amjsurg.2012.01.016
更新日期：2012-11-01 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：:From 1941 through 1983, a total of 66 patients with sacrococcygeal teratoma were seen, representing 41 percent of the total of 162 patients with teratomas from all anatomic sites seen over this period. Forty-six (70 percent) of the patients with sacrococcygeal teratomas were female and 34 (52 percent) were neonates. Y...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90082-0
更新日期：1985-09-01 00:00:00
abstract：BACKGROUND:Professionalism and ethics are Accreditation Council for Graduate Medical Education (ACGME) core competencies, but there is little evidence regarding the effectiveness of ethics education. METHODS:General surgery residents at the University of Pittsburgh completed questionnaires measuring attitudes and know...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.08.002
更新日期：2010-11-01 00:00:00
abstract：BACKGROUND:The teaching of surgical skills is based mostly on the traditional "see one, do one, teach one" resident-to-resident method. Surgical skills laboratories provide a new environment for teaching skills but their effectiveness has not been adequately tested. Cognitive task analysis is an innovative method to te...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/j.amjsurg.2002.12.005
更新日期：2004-01-01 00:00:00
abstract：BACKGROUND:Approximately 91% of urologists are male and 9% female. We aim to characterize gender differences amongst urology society awardees over the past six decades. METHODS:We queried 16 American urology societies. Inclusion criteria were active membership enrollment, majority urologist members, and awards provide...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.06.062
更新日期：2020-11-01 00:00:00
abstract：:Only 3 per cent of all melanomas arise in the mucosa of the head and neck region. Melanomas of mucosal origin in this series differed from their cutaneous counterpart in that size of the primary lesion did not influence prognosis. Regional lymph node metastases were infrequent and did not seem to influence prognosis. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90393-2
更新日期：1977-10-01 00:00:00
abstract：BACKGROUND:Axillary lymph node status is still considered the most significant prognostic factor for breast cancer outcome, and treatment decisions are based on the presence or absence of nodal disease. Intramammary lymph nodes (IMLNs) can be a site of regional spread. Is this a marker for more aggressive disease? MET...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2006.05.011
更新日期：2006-10-01 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：:A biochemical analysis of mitochondrial metabolism was made on biopsy specimens of fifteen jaundiced patients. In all but three jaundiced patients the phosphorylative activity based on mitochondrial protein was within normal limits or higher. In nine jaundiced patients the concentrations of cytochrome a(+a3), as repre...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90534-7
更新日期：1977-03-01 00:00:00
