Abstract:
OBJECTIVE:To describe the outcomes of elderly patients with do-not-resuscitate (DNR) status who undergo emergency general surgery and to improve understanding of the relationship between preoperative DNR status and postoperative mortality. BACKGROUND:Preoperative DNR status has previously been shown to predict increased postoperative mortality, although the reasons for this association are not well understood. METHODS:Patients 65 years or older undergoing emergency operation for 1 of 10 common general surgical diagnoses were extracted from the 2005-2010 National Surgical Quality Improvement database. Propensity score techniques were used to match patients with and without preoperative DNR orders on indication for procedure, patient demographics, comorbid disease burden, acute physical status at the time of operation, and procedure complexity. The postoperative outcomes of this matched cohort were then compared. RESULTS:A total of 25,558 patients were included for analysis (DNR, n =1061; non-DNR, n =24,497). DNR patients seemed to be more acutely and chronically ill than non-DNR patients in the overall study sample but did not seem to be treated less aggressively before or during their operations. Propensity-matching techniques resulted in the creation of a cohort of DNR and non-DNR patients who were well matched for all preoperative and intraoperative variables. DNR patients from the matched cohort had a significantly higher postoperative mortality rate than non-DNR patients (36.9% vs 22.3%, P < 0.0001) despite having a similar rate of major postoperative complications (42.1% vs 40.2%, P = 0.38). DNR patients in the propensity-matched cohort were much less likely to undergo reoperation (8.3% vs 12.0%, P = 0.006) than non-DNR patients and were significantly more likely to die in the setting of a major postoperative complication (56.7% vs 41.4%, P = 0.001). CONCLUSIONS:Emergency general surgery in elderly patients with preoperative DNR orders is associated with significant rates of postoperative morbidity and mortality. One reason for the excess mortality in these patients, relative to otherwise similar patients who do not have preoperative DNR orders, may be their greater reluctance to pursue aggressive management of major complications in the postoperative period.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Scarborough JE,Pappas TN,Bennett KM,Lagoo-Deenadayalan Sdoi
10.1097/SLA.0b013e31826578fbsubject
Has Abstractpub_date
2012-09-01 00:00:00pages
453-61issue
3eissn
0003-4932issn
1528-1140journal_volume
256pub_type
杂志文章abstract:OBJECTIVE:To determine which mammographically guided breast biopsy technique is the most efficient in making a diagnosis in women with suspicious mammograms. SUMMARY BACKGROUND DATA:Mammographically guided biopsy techniques include stereotactic 14-gauge core-needle biopsy (SC bx), stereotactic 11-gauge suction-assiste...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199905000-00004
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVE:To study the relationship between the amount of surgery-induced gastric volume reduction and long-term weight loss and glucose tolerance. BACKGROUND DATA:Vertical sleeve gastrectomy (VSG) has recently surpassed gastric bypass to become the most popular surgical intervention to induce sustained weight loss. B...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003240
更新日期:2020-06-01 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::Five dogs prepared with Heidenhain pouches received infusions of saline, GIP and VIP before and after a standard meat meal. Blood samples were obtained under basal conditions and at subsequent intervals for measurement of gastrin, insulin, GIP and VIP by radioimmunoassay. GIP and VIP infusions had no effect on basal l...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197607000-00016
更新日期:1976-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the influence of the response to preoperative chemotherapy, especially tumor progression, on the outcome following resection of multiple colorectal liver metastases (CRM). SUMMARY BACKGROUND DATA:Hepatic resection is the only treatment that currently offers a chance of long-term survival, althoug...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000145964.08365.01
更新日期:2004-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of subtotal (SG) versus total (TG) gastrectomy on the oncologic outcome of patients with cancer of the distal stomach from 28 Italian institutions. SUMMARY BACKGROUND DATA:There is controversy over whether SG and TG have a different impact on the 5-year survival probability of patients...
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:10.1097/00000658-199908000-00006
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:To determine the optimum excision margin and nodal management for patients with primary cutaneous melanomas 2.01- to 4.00-mm thick (T3 melanomas). BACKGROUND:Currently available evidence does not reliably define the minimum safe excision margin and best nodal management for patients with primary cutaneous T3...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000792
更新日期:2014-12-01 00:00:00
abstract::During a five-year period, 34 patients had persistence or recurrence of abnormal hemodynamic measurements in limbs after arterial reconstruction depsite graft patency documented by arteriography. Initial operations included aortofemoral (four), femorofemoral (ten), femoropopliteal (18), and femorotibial (two) bypass. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198104000-00012
更新日期:1981-04-01 00:00:00
abstract:OBJECTIVE:To delineate the role of T-helper 2 (Th2) cytokines in the induction of trauma induced myeloid suppressor cells (TIMSC) and the regulation of nitric oxide production. BACKGROUND:Trauma induces myeloid cells that express CD11b+/Gr1+ and arginase 1 and exhibit an immune suppressing activity. This article explo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181bfda1c
更新日期:2010-01-01 00:00:00
abstract::Four hundred twenty-six patients with esophageal atresia with or without tracheoesophageal fistula have been primarily cared for at the University of Michigan Medical Center since Cameron Haight's initial experience with this entity. Over the period of observation, the incidence of new cases as well as the number of a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198610000-00013
更新日期:1986-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the effects of radiofrequency ablation (RFA) on tumor growth and growth factor expression in a murine model. BACKGROUND:Surgical excision remains the only potentially curative therapy for hepatic malignancies. Tumor growth in the remaining liver may be accelerated aft...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000261319.51744.59
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:To determine whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications. SUMMARY BACKGROUND DATA:Complications are a major concern after elective surgery and smokers have an increased risk. There is insuffici...
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.0b013e3181889d0d
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. METHOD:Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately prec...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181e62299
更新日期:2010-08-01 00:00:00
abstract::Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197912000-00006
更新日期:1979-12-01 00:00:00
abstract:OBJECTIVE:We merged direct, multisource, and systematic assessments of surgeon behavior with malpractice claims, to analyze the relationship between surgeon 360-degree reviews and malpractice history. BACKGROUND:Previous work suggests that malpractice claims are associated with a poor physician-patient relationship, w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002742
更新日期:2019-07-01 00:00:00
abstract::Prolonged veno arterial extracorporeal bypass (50-80% of cardiac output) was evaluated in normal, unanesthetized sheep. The evaluation protocol included serial measurements of hemodynamics, pulmonary and renal function, serum enzymes to detect organ damage, and detailed studies of coagulation and platelets. Blood expo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197412000-00010
更新日期:1974-12-01 00:00:00
abstract::Reservoir and ileostomies were performed in 54 patients between 1972 and 1975. Primary colonic pathology included chronic ulcerative colitis in 47 patients, Crohn's colitis in one, familial polyposes in 5 and Gardner's Syndrome in one. Followup is complete and varies from 6 months to three years. All but three patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197702000-00008
更新日期:1977-02-01 00:00:00
abstract:OBJECTIVE:To assess development of mucosal damage in the esophageal remnant in regard to the level of the esophagogastrostomy reconstruction either in a right chest or in a left neck position. SUMMARY BACKGROUND DATA:Esophagectomy with gastric interposition creates an in vivo human model of pathologic esophageal reflu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818eec06
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of health insurance expansion on racial disparities in severity of peripheral arterial disease. BACKGROUND:Lack of insurance and non-white race are associated with increased severity, increased amputation rates, and decreased revascularization rates in patients with peripheral artery d...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001310
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate whether individualized deliberate practice on a virtual reality (VR) simulator results in improved technical performance in the operating room. BACKGROUND:Training on VR simulators has been shown to improve technical performance in the operating room (OR). Current...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000254
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to identify the utility of "keyhole" thoracotomy approaches to single vessel coronary artery bypass surgery. SUMMARY BACKGROUND DATA:Although minimally invasive surgery is efficacious in a wide variety of surgical disciplines, it has been slow to emerge in cardiac surgery. Amo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199610000-00004
更新日期:1996-10-01 00:00:00
abstract::Survival after distal splenorenal shunt in appreciably better in nonalcoholic patients than in alcoholics. This increase in survival does not appear to be dependent upon the state of biochemical liver function or the severity of changes in liver histology since these latter were similar for both groups. We suggest tha...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197805000-00008
更新日期:1978-05-01 00:00:00
abstract:OBJECTIVE:To determine if addition of the S-nitrosylating agent ethyl nitrite (ENO) to the preservation solution can improve perfusion parameters in pumped human kidneys. BACKGROUND:A significant percentage of actively stored kidneys experience elevations in resistance and decreases in flow rate during the ex vivo sto...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003702
更新日期:2019-12-05 00:00:00
abstract::From December 1985 to December 1989, 100 consecutive simultaneous pancreas-kidney (SPK) transplants were performed at the University of Wisconsin Hospital and Clinics. Bladder drainage technique was used for all grafts. One- and three-year patient survival was 93% and 90%; kidney survival, 90% and 85%; and pancreas su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199112000-00010
更新日期:1991-12-01 00:00:00
abstract::Previous studies have demonstrated that administered antibiotics must be active against major anticipated pathogens and must have reached sufficient concentrations in the tissue or body fluid at risk by the time of bacterial challenge if prophylactic therapy is to be maximally effective in reducing the infection rate ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-197906000-00004
更新日期:1979-06-01 00:00:00
abstract::The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and v...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199207000-00006
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVE:To determine the accuracy of fine-needle aspiration (FNA) and vacuum-assisted core biopsy (VACB) in assessing the presence of residual cancer in the breast after neoadjuvant systemic therapy (NST). SUMMARY BACKGROUND DATA:Pathologic complete response (pCR) rates after NST have improved dramatically, suggesti...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000002313
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To determine whether the antibacterial properties of cultured composite keratinocyte grafts can be enhanced by cytokines that stimulate the innate immune response. SUMMARY BACKGROUND DATA:Use of composite grafts of cultured keratinocytes has been limited because of their susceptibility to burn wound microorg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200201000-00015
更新日期:2002-01-01 00:00:00
abstract::Distal popliteal arterial variations may influence the success of femorodistal popliteal and tibial arterial reconstructions. Two patients whose bypass procedures were initially unsatisfactory because of a poor choice for anastomosis stimulated a review of variations in the distal popliteal artery in 1000 femoral arte...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198912000-00014
更新日期:1989-12-01 00:00:00
abstract:BACKGROUND:Patients frequently voice concerns regarding wait times for cancer treatment; however, little is known about the length of wait times from diagnosis to surgery in the United States. Our objectives were (1) to assess changes in wait times over the past decade and (2) to identify patient, tumor, and hospital f...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318211cc0f
更新日期:2011-04-01 00:00:00