Abstract:
OBJECTIVE:To characterize the scope and magnitude of practice variation associated with the diagnosis and treatment of appendicitis at freestanding children's hospitals. BACKGROUND:Variation in care has been associated with poor outcomes and is believed to be a key driver of excess health care spending. METHODS:Retrospective cohort study of 13,328 patients treated with appendicitis at 34 children's hospitals (9/2010-9/2011). Patients were divided into complicated and uncomplicated cohorts and examined for interhospital variation in the use of diagnostic imaging (computed tomography or ultrasonography), laboratory tests, parenteral nutrition (PN), peripherally inserted central catheters (PICC), and hospital cost. The number and distribution of statistical outliers were calculated for all measures. RESULTS:Significant variation was found for all measures, including a 3.5-fold difference in preoperative imaging (aggregate rate: 49.0%, range across hospitals: 21.2%-73.5%, P < 0.001) and a 5-fold difference in preoperative laboratory utilization (aggregate median: 2 tests/encounter, range: 1-5 tests/encounter, P < 0.001). For patients with complicated appendicitis, we characterized a 12-fold difference in postoperative imaging (aggregate rate: 19.4%, range: 4.9%-61.6%, P < 0.001), a 48-fold difference in PICC lines (aggregate rate: 18.9%, range: 1.7%-81.8%, P < 0.001), and a 100-fold difference in PN utilization (aggregate rate: 9.3%, range: 0.4%-42.0%, P < 0.001). Median hospital cost differed 4-fold for patients with uncomplicated disease (aggregate median: $6804, range: $4200-$16,796, P < 0.001) and 4.6-fold for patients with complicated disease (aggregate median: $13,138, range: $5419-$24,779, P < 0.001). Statistical outliers on the basis of high and low utilization were identified for all measures. CONCLUSIONS:Significant variation exists in practice, resource utilization, and treatment-related cost associated with the management of appendicitis at freestanding children's hospitals. Value-based measures are needed for benchmarking and to prioritize collaborative quality improvement efforts.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Rice-Townsend S,Barnes JN,Hall M,Baxter JL,Rangel SJdoi
10.1097/SLA.0000000000000246subject
Has Abstractpub_date
2014-06-01 00:00:00pages
1228-34issue
6eissn
0003-4932issn
1528-1140journal_volume
259pub_type
杂志文章,多中心研究abstract:BACKGROUND:Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. OBJECTIVE:Although the short-term effect on complications is increasingly being recognized, the impact on long-term sur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003772
更新日期:2020-01-14 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::Fifteen patients with Zollinger-Ellison syndrome followed at the National Institutes of Health with extensive metastatic disease had an actuarial 5-year survival of 20%. Therefore, in 1982 a prospective study to examine the effect and feasibility of removing all gross tumor in selected patients with extensive metastat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198604000-00003
更新日期:1986-04-01 00:00:00
abstract::Transplantation of the intrathoracic inferior vena cava into the abdominal inferior vena cava of the recipient was performed in inbred rat strains of the following combinations: Syngeneic F344 leads to F344, RT-1-identical allogeneic LEW leads to F344, and RT-1-different allogeneic CAP leads to F344. In the RT-1-diffe...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198103000-00006
更新日期:1981-03-01 00:00:00
abstract::A patient is reported whose symptoms and clinical features were interpreted as pulmonary embolism. However, the ultimate diagnosis was malignant fibrous histiocytoma of the pulmonary artery, which was made evident at operation. Although extremely rare in the early medical literature, primary sarcoma of the pulmonary a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198702000-00017
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:Experience with minimal access, transoral/transmural endoscopic drainage/debridement of walled-off pancreatic necrosis (WOPN) after necrotizing pancreatitis is limited. We sought to determine outcome using this technique. METHODS:Retrospective analysis. RESULTS:From 1998 to 2006, 53 patients underwent tran...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000254366.19366.69
更新日期:2007-06-01 00:00:00
abstract::The records of 238 patients with the diagnosis of small bowel obstruction at the University of Illinois Hospital from 1967 through the spring of 1976 were reviewed. Mortality, intra-operative management, and clinical findings were evaluated. Previous reports list a mortality of gangrenous small bowel obstruction, seco...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197802000-00017
更新日期:1978-02-01 00:00:00
abstract::Glutaraldehyde treated human umbilical veins (Dardik Biograft) were used to bypass short segments of the femoral artery in 15 dogs and were compared to autogenous jugular veins placed in the contralateral femoral artery of each animal. All 15 autogenous jugular veins remained patent for the four month period of observ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197808000-00005
更新日期:1978-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of artesunate on organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat. BACKGROUND:HS is still a common cause of death in severely injured patients and is characterized by impairment of organ perfusion, systemic inflammatory response, and multiple organ failur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001664
更新日期:2017-02-01 00:00:00
abstract::Is colon cancer surgery justified in the very elderly from the standpoint of cost and 3-year survival rates? Two hundred eighty patients undergoing major surgery for colon cancer during 1981-1983 were divided into a group of 61 with ages greater than or equal to 80 (GE80) and 219 less than 80 (LT80). Although those GE...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198602000-00003
更新日期:1986-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to investigate the incidence of parastomal hernias (PSHs) after end-colostomy formation using a polypropylene mesh in a randomized controlled trial versus conventional colostomy formation. BACKGROUND:A PSH is the most frequent complication after stoma formation. Symptoms may range f...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000001903
更新日期:2017-04-01 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 investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. SUMMARY BACKGROUND DATA:Important developments in elective colorectal surgery are the introducti...
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.0b013e31821fd1ce
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. SUMMARY BACKGROUND DATA:Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before t...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.sla.0000200839.93965.26
更新日期:2006-03-01 00:00:00
abstract:OBJECTIVE:To assess the strategy of combining oncolytic herpes simplex virus (HSV) therapy with immunomodulatory therapy as treatment for experimental colon cancer. The oncolytic HSV recombinant NV1023 and the interleukin 12 (IL-12)-secreting oncolytic NV1042 virus were evaluated in vitro and in vivo with respect to an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200106000-00012
更新日期:2001-06-01 00:00:00
abstract::One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198504000-00014
更新日期:1985-04-01 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:A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA:Secondary pancreatic infection is the major cause of death in patients with acute necrotizin...
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:10.1097/00000658-199507000-00010
更新日期:1995-07-01 00:00:00
abstract:INTRODUCTION:Complexity of combined heart-liver transplantation has resulted in low adoption rates. We report a case series of adult patients receiving en-bloc heart-liver transplantation (HLTx), describe technical aspects, and discuss benefits of the technique. METHODS:Retrospective review of patients receiving en-bl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003721
更新日期:2020-01-14 00:00:00
abstract::The etiology and mechanisms by which severe trauma or sepsis induce hepatic failure are unknown. Previously we showed that Kupffer cells (KC), the fixed macrophages of the liver, induce a profound decrease in hepatocyte (HC) total-protein synthesis when exposed to endotoxin. Furthermore we demonstrated that endotoxin-...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00009
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes of bilateral subtotal (BST) versus total thyroidectomy (TT) for benign bilateral thyroid disease (BBTD). BACKGROUND:The extent of thyroid resection in benign goiter is controversial. Potential advantages of TT over BST may include: one-stage removal of incidental thyroid cancer, and a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182360118
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000239086.30518.2a
更新日期:2006-10-01 00:00:00
abstract::A sterile Doppler probe was used for intraoperative monitoring of the integrity of carotid endarterectomy of 125 vessels of 107 patients. Our objective was to reduce the contribution of residual carotid lesions to recurrent stenosis, which was evaluated by Doppler spectrum analysis in the early (less than 3 months, 66...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198606000-00010
更新日期:1986-06-01 00:00:00
abstract:OBJECTIVE:The authors assessed the impact of gastrinoma resection on the subsequent development of hepatic metastases in Zollinger-Ellison syndrome. SUMMARY BACKGROUND DATA:The symptoms of acid hypersecretion can be controlled medically in Zollinger-Ellison syndrome with high-dose pharmacologic therapy. The current ro...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199409000-00008
更新日期:1994-09-01 00:00:00
abstract:OBJECTIVE:To compare the systemic cytokine response in patients after laparoscopic-assisted resection with those after open resection of rectosigmoid carcinoma. SUMMARY BACKGROUND DATA:Laparoscopic resection of colorectal carcinoma is technically feasible, but objective evidence of its benefit is scarce. Systemic cyto...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200004000-00008
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVES:The objectives of this study were to evaluate the effect of radiotherapy (RT) on sexual function in patients undergoing oncologic resection for rectal cancer, and to develop a mathematical model for quantifying the risk of sexual dysfunction through time for this group of patients. METHODS:Data were prospec...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000183608.24549.68
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:To determine whether the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule confers higher value for physician work in procedure and test codes than in Evaluation and Management (E/M) codes. BACKGROUND:Medicare Payment Advisory Commission previously demonstrated that time for medical serv...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000990
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:Planned perioperative endoscopic retrograde cholangiography (ERC) and sphincterotomy (ES) for suspected or proven common bile duct stones (CBDS) has been attempted in 63 of 540 consecutive patients undergoing laparoscopic cholecystectomy (LC). Experience with this intervention has been studied with respect to...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199307000-00010
更新日期:1993-07-01 00:00:00
abstract::Forty-seven cancer patients were selected for study based on their candidacy for hyperalimentation. Each patient received selected skin test antigens intradermally in the forearm prior to the initiation of hyperalimentation, and at 7-day intervals throughout treatment with either chemotherapy, radiation therapy or sur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197607000-00010
更新日期:1976-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to obtain feedback from key stakeholders and end users to identify program strengths and weaknesses to plan for wider dissemination and implementation of the Virtual Acute Care for Elders (Virtual ACE) program, a novel intervention that improves outcomes for older surgical patients. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004433
更新日期:2020-11-16 00:00:00