Abstract:
OBJECTIVE:To perform a systematic review of economic evaluations of enhanced recovery pathways (ERP) for colorectal surgery. BACKGROUND:Although there is extensive literature investigating the clinical effectiveness of ERP, little is known regarding its cost-effectiveness. METHODS:A systematic literature search identified all relevant articles published between 1997 and 2012 that performed an economic evaluation of ERP for colorectal surgery. Studies were included only if their ERP included all 5 of the key components (patient information, preservation of GI function, minimization of organ dysfunction, active pain control, and promotion of patient autonomy). Quality assessment was performed using the Consensus on Health Economic Criteria instrument (scored 0-19; high quality ≥ 12). Incremental cost-effectiveness ratios were calculated if sufficient data were provided, using difference in length of stay and overall complication rates as effectiveness measures. RESULTS:Of a total of 263 unique records identified (253 from databases and 10 from other sources), 10 studies met our inclusion criteria and were included for full qualitative synthesis. Overall quality was poor (mean quality 7.8). Eight reported lower costs for ERP. The majority (8 of 10) of studies were performed from an institutional perspective and therefore did not include costs related to changes in productivity and other indirect costs (eg, caregiver burden). Five studies provided enough information to calculate ICERs, of which ERP was dominant (less costly and more effective) in all cases for reduction in length of stay and was dominant or potentially cost-effective in 4 and questionable (no difference in costs nor effectiveness) in 1 for reduction in overall complications. CONCLUSIONS:The quality of the current evidence is limited but tends to support the cost-effectiveness of ERP. There is need for well-designed trials to determine the cost-effectiveness of ERP from both the institutional and societal perspectives.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Lee L,Li C,Landry T,Latimer E,Carli F,Fried GM,Feldman LSdoi
10.1097/SLA.0b013e318295fef8subject
Has Abstractpub_date
2014-04-01 00:00:00pages
670-6issue
4eissn
0003-4932issn
1528-1140journal_volume
259pub_type
杂志文章,评审abstract::Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a d...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199202000-00009
更新日期:1992-02-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to identify the survival of patients with locally advanced pancreatic cancer (LAPC) and assess the effect of surgical resection after neoadjuvant therapy on patient outcomes. BACKGROUND:An increasing number of LAPC patients who respond favorably to neoadjuvant therapy undergo surgica...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002753
更新日期:2019-08-01 00:00:00
abstract::: There is growing interest in global surgery among US academic surgical departments. As academic global surgery is a relatively new field, departments may have minimal experience in evaluation of faculty contributions and how they integrate into the existing academic paradigm for promotion and tenure. The American Su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003480
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVES:Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following major surgical operations in the United States is dependent on primary payer status. METHODS:From 2003 to 2007, 893,658 major surgical operations were evaluated using the Nationwi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181e8fd75
更新日期:2010-09-01 00:00:00
abstract::From July 1983 through December 1987, 300 consecutive patients with penetrating gunshot wounds of the abdomen causing visceral or vascular injuries were treated. Resuscitative thoracotomy was required in 20 patients (6.6%), and only two survived. The most commonly injured organs were the small bowel (60%), colon (41.6...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198809000-00014
更新日期:1988-09-01 00:00:00
abstract::The efficacy of three gastric restriction operations were compared in a prospective randomized study of 310 morbidly obese subjects. The median patient age was 34 years (range, 18 to 62 years). They were predominantly female (13:1) and had a median pre-operative weight that was 198% of their ideal weight (range, 160% ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199004000-00007
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to report 10+ year outcome of laparoscopic biliopancreatic diversion with duodenal switch (LDS), with special focus on quality of life. BACKGROUND::Reports on long-term morbidity and quality of life after LDS are rare. METHODS:Records of all patients who underwent LDS 10+ years ago ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001622
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To determine whether adjuvant chemotherapy (AC) after neoadjuvant chemoradiation and esophagectomy is associated with improved overall survival for patients with locally advanced esophageal cancer, and to evaluate how pathologic disease response to neoadjuvant treatment impacts this effect. BACKGROUND:Neoadj...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001954
更新日期:2017-08-01 00:00:00
abstract::Chronic idiopathic intestinal pseudo-obstruction is an increasingly recognized syndrome in which patients usually present with an acute or chronic history suggestive of intestinal obstruction, although no obstructing lesion is found at surgery. The diagnosis can be suspected in most cases from the clinical presentatio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198012000-00011
更新日期:1980-12-01 00:00:00
abstract:OBJECTIVE:To describe the field of surgical innovation from a historical perspective, applying new findings from research in technology innovation. BACKGROUND:While surgical innovation has a rich tradition, as a field of study it is embryonic. Only a handful of academic centers of surgical innovation exist, all of whi...
journal_title:Annals of surgery
pub_type: 历史文章,杂志文章,评审
doi:10.1097/01.sla.0000242706.91771.ce
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:The authors evaluated the causal relationship between entrapment of the posterior tibial nerve and neuropathic pain and describe the results of nerve decompression in a selected group of patients with intractable pain. SUMMARY BACKGROUND DATA:Painful metabolic neuropathy has, until recently, been thought to ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199506000-00005
更新日期:1995-06-01 00:00:00
abstract::Controversy continues concerning the advisability of routine shunting, no shunting, or selective shunting during carotid endarterectomy. Because of its reflection of the physiologic state of the end organ, the authors chose routine 18 lead EEG monitoring as a guide to selective shunting and as an indication of adequat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198306000-00009
更新日期:1983-06-01 00:00:00
abstract::Thrombotic complications of heparin administration were observed in eight patients during a two year period. At sites of subcutaneous heparin injection, six patients developed areas of the skin and subcutaneous necrosis. Systemic thrombotic events and thrombocytopenia were observed in two of these patients when they r...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197911000-00007
更新日期:1979-11-01 00:00:00
abstract:OBJECTIVES:To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it. BACKGROUND:Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model o...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000001448
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:To determine whether black patients have higher odds of readmission than white patients after major surgery, and to ascertain whether these disparities are related to where black patients receive care. BACKGROUND:Racial disparities are known to exist for many aspects of surgical care. However, it is unknown ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000326
更新日期:2014-06-01 00:00:00
abstract::One hundred twenty-eight patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy with forearm autograft. Postoperative clinical improvement was remarkable. In all cases, the grafted tissue functioned well, and reimplantation of the cryopreserved parathyroid tissues was u...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198811000-00016
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVE:To test the total burden of complications in the early postoperative period after liver transplantation (LT) between donation after circulatory death (DCD) and donation after brain death (DBD) grafts with the novel Comprehensive Complication Index (CCI). BACKGROUND:LT is complex surgery and the increasing us...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002419
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:The results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction were evaluated. SUMMARY BACKGROUND DATA:Extrahepatic portal venous obstruction, a common cause of portal hypertension in children in India, is being treated increasingly by endoscopic sclerotherapy instead...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199402000-00011
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVE:The authors evaluated the protective effect of hypothermic circulatory arrest for patients with bilateral carotid artery disease who underwent cardiac surgical procedures. SUMMARY BACKGROUND DATA:Severe bilateral carotid artery disease coexisting with cardiac disease that requires surgical treatment is assoc...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199406000-00014
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:To determine the incidence of isolated gastrocnemius and soleal vein thrombosis (IGSVT) and the effect of anticoagulation on venous thromboembolism (VTE) events in patients with IGSVT. SUMMARY BACKGROUND DATA:Although IGSVT is diagnosed with increasing frequency, the clinical significance and optimal managem...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181c1ae95
更新日期:2010-04-01 00:00:00
abstract:OBJECTIVE:To examine the clinicopathologic features and clonal relationship of multifocal intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. BACKGROUND:Intraductal papillary mucinous neoplasms are increasingly diagnosed cystic precursor lesions of pancreatic cancer. Intraductal papillary mucinous neopla...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182378a18
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of thrombopoietin on liver regeneration after hepatectomy and antifibrosis under conditions of liver cirrhosis in rats. SUMMARY BACKGROUND DATA:We revealed that platelets induced by thrombopoietin administration promote liver regeneration after hepatectomy in the normal liver. METHODS...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818584c7
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:To compare single-layered hand-sewn cervical end-to-side (ETS) anastomosis with end-to-end (ETE) anastomosis in a prospective randomized fashion. BACKGROUND:The preferred organ used for reconstruction after esophagectomy for cancer is the stomach. Previous studies attempted to define the optimal site of anas...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e31822676a9
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy of a novel 2-stage treatment with reductive surgery plus percutaneous isolated hepatic perfusion (PIHP) for multiple hepatocellular carcinoma (HCC), which was previously unresectable. SUMMARY BACKGROUND DATA:Surgical resection is the treatment of choice for HCC, but the majority of p...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/01.sla.0000103133.03688.3d
更新日期:2004-01-01 00:00:00
abstract::In animals pulmonary hypertension, a decrease in total body O2 consumption and metabolic acidosis occur after transfusion of blood with an elevated screen filtration pressure (SFP) through standard blood transfusion filters. The purpose of this study was to define in detail the pulmonary abnormalities that develop fol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197507000-00011
更新日期:1975-07-01 00:00:00
abstract:OBJECTIVE:To construct and validate a scoring system for evidence-based selection of bariatric and metabolic surgery procedures according to severity of type 2 diabetes (T2DM). BACKGROUND:Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) account for >95% of bariatric procedures in United States in patients w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002407
更新日期:2017-10-01 00:00:00
abstract::The prognostic and postoperative monitoring capabilities of the CEA assay were compared to pathological staging of the operative specimens, clinical followup including endoscopy, radiology and scanning techniques, as well as DNCB skin testing and laboratory enzyme determinations (alkaline phosphatase and transaminase)...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197601000-00002
更新日期:1976-01-01 00:00:00
abstract::Occurence of gastroenteric fistulae in non-surgically treated peptic ulcer disease is rare as suggested by only 26 cases published in the literature so far. We had the opportunity to care for 3 patients with this problem in a period of one year. At our institution, a search of the medical records dating back to 1955 y...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197608000-00017
更新日期:1976-08-01 00:00:00
abstract::Twenty-three selected patients presenting with massive bleeding from peptic ulcers underwent emergency parietal cell vagotomy (PCV). Nineteen patients had a duodenal ulcer, two a prepyloric ulcer, and one a gastric ulcer. The patients were studied retrospectively with regard to postoperative mortality and morbidity, e...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198711000-00005
更新日期:1987-11-01 00:00:00
abstract::Pressures in the Oddi sphincter and common bile duct were determined before, immediately after and several weeks after endoscopic papillotomy. Fifteen patients were included in the study. Significant decreases in Oddi sphincter and common bile duct pressures were found and the decrease in Oddi sphincter pressure was t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197908000-00009
更新日期:1979-08-01 00:00:00