Comparative effectiveness and efficiency in peripheral vascular surgery.


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.


Am J Surg


Fry DE,Pine M,Jones BL,Meimban RJ




Has Abstract


2011-03-01 00:00:00


363-7; discussion 367-8












  • Multivisceral resection for advanced rectal cancer: outcomes and experience at a single institution.

    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


    authors: Crawshaw BP,Augestad KM,Keller DS,Nobel T,Swendseid B,Champagne BJ,Stein SL,Delaney CP,Reynolds HL

    更新日期:2015-03-01 00:00:00

  • Subclavicular approach to first rib resection.

    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


    authors: Murphy TO,Piper CA,Kanar EA,McAlexander RA

    更新日期:1980-05-01 00:00:00

  • Upgrade rate of core biopsy-determined atypical ductal hyperplasia by open excisional biopsy.

    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


    authors: Maganini RO,Klem DA,Huston BJ,Bruner ES,Jacobs HK

    更新日期:2001-10-01 00:00:00

  • Computerized tomographic assessment of graft incorporation after aortic reconstruction.

    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


    authors: Qvarfordt PG,Reilly LM,Mark AS,Goldstone J,Wall SD,Ehrenfeld WK,Stoney RJ

    更新日期:1985-08-01 00:00:00

  • Risk factors of liver failure after right-sided hepatectomy.

    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


    authors: Hirashita T,Ohta M,Iwashita Y,Iwaki K,Uchida H,Yada K,Matsumoto T,Kitano S

    更新日期:2013-09-01 00:00:00

  • Rhabdomyosarcoma.

    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


    authors: Bizer LS

    更新日期:1980-11-01 00:00:00

  • A reappraisal of total pancreatectomy for pancreatic cancer: results from U.S. Veterans Affairs hospitals, 1987-1991.

    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


    authors: Swope TJ,Wade TP,Neuberger TJ,Virgo KS,Johnson FE

    更新日期:1994-12-01 00:00:00

  • An Internet-based survey of factors influencing medical student selection of a general surgery career.

    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


    authors: Cochran A,Melby S,Neumayer LA

    更新日期:2005-06-01 00:00:00

  • The cut-closed-reconnected Roux loop.

    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


    authors: Kummer EW,Gerritsen JJ,Brummelkamp WH

    更新日期:2000-02-01 00:00:00

  • Persistent sciatic artery. Clinical aspects and operative management.

    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


    authors: Williams LR,Flanigan DP,O'Connor RJ,Schuler JJ

    更新日期:1983-05-01 00:00:00

  • Comparative analysis of laparoscopic versus open splenectomy.

    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


    authors: Brunt LM,Langer JC,Quasebarth MA,Whitman ED

    更新日期:1996-11-01 00:00:00

  • Results and prognostic factors in skull base surgery.

    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


    authors: Dos Santos LR,Cernea CR,Brandao LG,Siqueira MG,Vellutini EA,Velazco OP,Cruz OL,Morais-Besteiro J,Freitas CA

    更新日期:1994-11-01 00:00:00

  • Outcome in cirrhotic patients with acute alcoholic hepatitis after emergency portacaval shunt for bleeding esophageal varices.

    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


    authors: Bell RH Jr,Miyai K,Orloff MJ

    更新日期:1984-01-01 00:00:00

  • Edema volume, not timing, is the key to success in lymphedema treatment.

    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


    authors: Ramos SM,O'Donnell LS,Knight G

    更新日期:1999-10-01 00:00:00

  • Telepathy: maximizing resident exposure to surgical pathology decision making.

    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


    authors: McLemore EC,Schlinkert RT,Schlinkert DK,Williams JW,Bailey DP

    更新日期:2006-04-01 00:00:00

  • Improved survival in infants and children with primary malignant liver tumors.

    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


    authors: Mahour GH,Wogu GU,Siegel SE,Isaacs H

    更新日期:1983-08-01 00:00:00

  • Predictors of failure in the Advanced Trauma Life Support course.

    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


    authors: Mobily M,Branco BC,Joseph B,Hernandez N,Catalano RD,Judkins DG,Green DJ,Kulvatunyou N,Rhee P,Tang AL

    更新日期:2015-11-01 00:00:00

  • The effects of supraceliac aortic clamping on the anticoagulant effects of heparin.

    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


    authors: Money SR,Ballinger BA,Crockett DE Jr,Chatman DM,Lohmann TP

    更新日期:1996-08-01 00:00:00

  • Mapping surgical practice decision making: an interview study to evaluate decisions in surgical care.

    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


    authors: Jacklin R,Sevdalis N,Darzi A,Vincent C

    更新日期:2008-05-01 00:00:00

  • Procedural performance in gastrointestinal endoscopy: an assessment and self-appraisal tool.

    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


    authors: Sarker SK,Albrani T,Zaman A,Patel B

    更新日期:2008-09-01 00:00:00

  • Is immediate chest radiograph necessary after central venous catheter placement in a surgical intensive care unit?

    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


    authors: Bailey SH,Shapiro SB,Mone MC,Saffle JR,Morris SE,Barton RG

    更新日期:2000-12-01 00:00:00

  • Meckel's diverticulum: value of ectopic tissue.

    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


    authors: Artigas V,Calabuig R,Badia F,Rius X,Allende L,Jover J

    更新日期:1986-05-01 00:00:00

  • Impact of subcarinal dissection on short-term outcome and survival following esophagectomy.

    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


    authors: Hu W,Liang Y,Zhang S,Hu Y,Liu J

    更新日期:2013-09-01 00:00:00

  • Parapancreatic biliary and intestinal obstruction in chronic obstructive pancreatitis. Is prophylactic bypass necessary?

    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


    authors: Bradley EL

    更新日期:1986-02-01 00:00:00

  • Meet your surgical team: The impact of a resident-led quality improvement project on patient satisfaction.

    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


    authors: Craig-Schapiro R,DiBrito SR,Overton HN,Taylor JP,Fransman RB,Haut ER,Sacks BC

    更新日期:2018-10-01 00:00:00

  • Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis.

    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


    authors: Habib FA,Kolachalam RB,Khilnani R,Preventza O,Mittal VK

    更新日期:2001-01-01 00:00:00

  • Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection.

    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


    authors: Beitsch P,Balch C

    更新日期:1992-11-01 00:00:00

  • Low anterior resection with anastomosis by endorectal pull-through. Another look at Black's operation.

    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


    authors: Garnjobst W,Sullivan ES

    更新日期:1979-07-01 00:00:00

  • A nonneuronal 5-hydroxytryptamine receptor 3 induces chloride secretion in the rat distal colonic mucosa.

    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


    authors: Day J,King B,Haque SM,Kellum JM

    更新日期:2005-11-01 00:00:00

  • Clamping trials prior to thoracostomy tube removal and the need for subsequent invasive pleural drainage.

    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


    authors: Becker JC,Zakaluzny SA,Keller BA,Galante JM,Utter GH

    更新日期:2020-08-01 00:00:00