Abstract:
OBJECTIVE:Comparative effectiveness research has mostly been focused on comparison of treatment techniques. The goal of the present study was to extend the research to physician specialty. BACKGROUND:Both surgeons and interventionalists (cardiologists and radiologists) are involved in endovascular repairs (EVAR) of aortic aneurysms, with different residency education, operative experience, preoperative assessment and patient selection, and postoperative continuity of care. METHODS:Retrospective analysis was performed using the Nationwide Inpatient Sample from 1998 to 2009. Patients undergoing EVAR for abdominal aortic aneurysm were identified with International Classification of Diseases, Ninth Revision, procedure code 39.71. Using physician identifiers available in the database, surgeons were identified by case experience in the same calendar year with elective open AAA repairs, arteriovenous fistula repairs, or carotid endarderectomy. Multivariate analysis adjusted for physician volume, AAA ruptured status, patient demographic and comorbidities, and hospital characteristics. RESULTS:A total of 28,094 EVARs were analyzed. Unadjusted mortality rates, length of stay, and total hospital charges were significantly higher for patients treated by interventionalists than those by surgeons (all Ps < 0.001). This difference persisted on multivariate analysis, where interventionalists were associated with increased likelihood of mortality (odds ratio = 1.39; 95% confidence interval, 1.04-1.89), longer length of stay (1.32 days; 95% confidence interval, 1.03-1.62), and higher total hospital charges ($19,312; 95% confidence interval, 16,471-22,153). CONCLUSIONS:Physician specialty is associated with patient outcomes. Surgeons are associated with improved outcomes, with lower mortality, shorter length of stay, and lower charges for EVAR cases, when compared with interventionalists. This finding has significant implications for future comparative effectiveness research and potential policy changes in patient referrals or physician admitting privileges.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
McCutcheon BA,Talamini MA,Chang DC,Rose JA,Bandyk DF,Wilson SEdoi
10.1097/SLA.0b013e3182a196b5subject
Has Abstractpub_date
2013-09-01 00:00:00pages
476-82issue
3eissn
0003-4932issn
1528-1140pii
00000658-201309000-00012journal_volume
258pub_type
杂志文章abstract::A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. Th...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198508000-00004
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:To determine the early effects of therapy of endotoxin (ET) shock with epinephrine, norepinephrine, or dopexamine on splanchnic circulation, oxygen metabolism, sigmoid mucosal pHi, bacterial translocation, and morphologic integrity of the ileal, colonic, and sigmoid mucosa. SUMMARY BACKGROUND DATA:Conflictin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199808000-00014
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to determine the rate, predictors, and impact of complete pathologic response (cPR) to pretransplant locoregional therapy (LRT) in a large, multicenter cohort of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT). BACKGROUND:LRT is used to mitigate waitlist...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000003253
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:To assess existing measures of pathologic response to neoadjuvant therapy in esophageal and junctional cancer, and to recommend an optimum classification. BACKGROUND:Multimodal therapy is increasingly the standard of care for locally advanced esophageal cancer. Numerous measures of pathologic response have b...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a66588
更新日期:2013-11-01 00:00:00
abstract::All patients who underwent isolated myocardial revascularization procedures from 1967-70 (n = 741) were compared with the first 1,000 patients who received similar elective operations each year from 1971 through 1978. Data from these eight years were processed through a computerized cardiovascular information registry...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197910000-00004
更新日期:1979-10-01 00:00:00
abstract:OBJECTIVE:To characterize the injuries to children by acts against civilian populations (AACP). SUMMARY BACKGROUND DATA:Only 2 articles have focused on the spectrum and severity of injuries to children by AACP. METHODS:A retrospective case study of children 0 to 18 years old who were entered into the Israel National ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000157233.18787.cd
更新日期:2005-04-01 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::The myocardial effects of protamine, with and without heparin, were documented in this investigation. Isolated rabbit hearts (n = 30) were retrograde perfused with Krebs-Ringers bicarbonate solution aerated with 95% O2/5% CO2 through the aortic root (37 C, 80 mmHg). Developed left ventricular blood pressure, heart rat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00001
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA:During the past decade, ther...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002350
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system. BACKGROUND:Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transpla...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31825429c0
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVE:To quantify gender composition of 10 high-impact general surgery journals, delineate how board composition has changed over time, and evaluate qualification metrics by gender. BACKGROUND:Underrepresentation of women on editorial boards may contribute to the gender-based achievement gap in surgery. METHODS:W...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002667
更新日期:2019-03-01 00:00:00
abstract::During the 5-year period from January 1978 through December 1982, 196 patients with blunt trauma to the small bowel, colon, or mesentery were treated at the Maryland Institute for Emergency Medical Services Systems (MIEMSS) Shock Trauma Center. More than 80% of these patients were the victims of motor vehicle accident...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198502000-00011
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVE:To evaluate whether the type of on-site care a trauma patient receives affects outcome. SUMMARY BACKGROUND DATA:The controversy regarding the prehospital care of trauma patients between Advanced Life Support (ALS) and Basic Life Support (BLS) is ongoing. Due to this unresolved controversy, as well as histori...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/01.SLA.0000048374.46952.10
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to assess feasibility and outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LPD). BACKGROUND:Whereas expert centers have reported promising outcomes of LPD, nationwide analyses have raised concerns on its safety, especially during the learning curve. M...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002563
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:This study aims to describe recent experience with rectal carcinoids in European and North American centers. BACKGROUND:While considered indolent, the propensity of carcinoids to metastasize can be significant. METHODS:Rectal carcinoid patients were identified from prospective databases maintained at 9 inst...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3181fb8df6
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVE:To prospectively evaluate the psychosocial outcomes and body image of patients 2 years postmastectomy reconstruction using a multicenter, multisurgeon approach. BACKGROUND:Although breast reconstruction has been shown to confer significant psychosocial benefits in breast cancer patients at year 1 postreconst...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3181728a5c
更新日期:2008-06-01 00:00:00
abstract::In order to determine which factors most influence late survival after the coronary bypass procedure, a review was made of the initial experience of one surgeon who performed 792 operations between 1968 and 1972. The initial 250 patients were compared with the subsequent 542 patients. The two groups were of similar ag...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197806000-00013
更新日期:1978-06-01 00:00:00
abstract::Emergency portacaval shunt for variceal bleeding is associated with a high operative mortality, particularly if used as a last resort. Because of this, a strong case has been made against emergency shunt. This report describes an experience with emergency portacaval shunt for the treatment of variceal bleeding when us...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198707000-00007
更新日期:1987-07-01 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:OBJECTIVES:Immediate breast reconstruction (IBR) after mastectomy for cancer has increased in recent years, yet long-term, modality-specific comparative data are lacking. We performed this study to compare short- and long-term outcomes after expander, autologous (AT), and direct-to-implant (DI) breast reconstruction. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001457
更新日期:2015-10-01 00:00:00
abstract::The use of amputation in extremity soft tissue sarcoma has been decreasing at Memorial Sloan-Kettering Cancer Center (MSKCC) over the last 15 years. In an attempt to define the efficacy and future role of amputation in extremity soft tissue sarcoma, a prospective sarcoma database compiled at MSKCC from July 1982 to Ja...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199203000-00012
更新日期:1992-03-01 00:00:00
abstract:OBJECTIVE:This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis below the peritoneal verge and questions the influence of MBP on anastomotic leakage in combination with a diverting ileostomy in lower colorectal surgery. SUMMARY BACKGROUND DATA:In a previous large multicenter randomized ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181c0e75c
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:To determine overall survival and disease-free survival in selected patients with nonresectable liver-only colorectal cancer receiving liver transplantation. BACKGROUND:Patients with nonresectable colorectal cancer receiving palliative chemotherapy has a 5-year overall survival of about 10%. Liver transplant...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000003404
更新日期:2020-02-01 00:00:00
abstract::Tissue reaction to sutures was studied in 666 specimens obtained from patients from one day to 23 years after operation. Reaction to catgut depends on the stage of absorption and is mainly histocytic in type. Nonabsorbable sutures are encapsulated by a rim of connective tissue, while near the suture histocytes, giant ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197502000-00003
更新日期:1975-02-01 00:00:00
abstract::: Since their discovery, neutrophil extracellular traps (NETs) have been implicated in a broad array of functions, both beneficial and detrimental to the host. Indeed, NETs have roles in infection, sepsis, wound healing, thrombotic disease, and cancer propagation, all of which are directly implicated in the care of su...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0000000000003586
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:The authors analyzed the frequency and character of postoperative complications after splenectomy in patients with hematologic malignancies, and correlated these findings with preoperative conditions that could have predicted their outcome. SUMMARY BACKGROUND DATA:Splenectomy is performed for hematologic mal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199603000-00010
更新日期:1996-03-01 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::Resting energy expenditure (REE), nutritional parameters, and substrate levels were measured using a technique to minimize artifacts in 11 control patients, nine patients with localized, and four patients with diffuse neoplastic disease. Patients with diffuse disease had significantly increased percentage preillness w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198403000-00008
更新日期:1984-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures. SUMMARY BACKGROUND DATA:Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their associated hospitals,...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002737
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND:The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators. Glucocorticoids may reduce postopera...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000895
更新日期:2014-09-01 00:00:00