Abstract:
BACKGROUND:The United States population is aging, and the number of older adults requiring operative care is increasing at a rapid rate. In order to address this issue, the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society created best practice guidelines surrounding optimal perioperative care for the older adult surgical patient. This study aimed to determine the documented compliance with these guidelines at a single institution. METHODS:A retrospective chart review was performed on 86 older adults undergoing elective, inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period (1/2016-12/2017) at a single Veterans Affairs institution. The primary outcome was compliance with the 38 measures from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society Best Practice Guidelines. The secondary outcome was postoperative (including geriatric-specific) complications. RESULTS:The mean reported compliance across all measures was 41% ± 4%. Of 38 analyzed measures, compliance for 10 measures was achieved for 0 patients, and only 1 patient for 7 measures. There was variance in compliance by phase of care (P < .05) with a high of 56% ± 8% (immediate preoperative phase of care) and a low of 35% ± 4% (intraoperative phase of care). CONCLUSION:Overall reported compliance with the Best Practice Guidelines of the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society is low (41%) at this institution. This study identifies a need to improve the care provided to the vulnerable population of older adults undergoing an operation. Future work is needed to understand barriers for implementation and how compliance relates to outcomes.
journal_name
Surgeryjournal_title
Surgeryauthors
Dworsky JQ,Shenoy R,Childers CP,Russell MMdoi
10.1016/j.surg.2020.08.033subject
Has Abstractpub_date
2021-02-01 00:00:00pages
356-361issue
2eissn
0039-6060issn
1532-7361pii
S0039-6060(20)30600-0journal_volume
169pub_type
杂志文章相关文献
SURGERY文献大全abstract::This study evaluated the mixed leukocyte culture (MLC) technique to quantitate differences in kidney allograft survival between unrelated animals. Each of five beagles received two heterotopic kidney allografts, one from a mongrel dog showing high MLC stimulation and one from a second mongrel dog showing a low MLC sti...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1975-07-01 00:00:00
abstract:BACKGROUND:Rib fractures are common and associated with significant pulmonary morbidity. We hypothesized that epidural analgesia would provide superior pain relief, and reduce the risk of subsequent pneumonia. METHODS:A prospective, randomized trial of epidural analgesia versus IV opioids for the management of chest w...
journal_title:Surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.surg.2004.05.019
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:Conjoined twins are rare developmental anomalies. There is a paucity of literature other than case reports and small case series. The aim of this study was to examine national outcomes and identify predictors of mortality in newborn conjoined twins. METHODS:We reviewed data on newborn conjoined twins from t...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.06.028
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Estimating the risk of postoperative complications can be performed by surgeons with detailed clinical information or by patients with limited information. Our objective was to compare three estimation models: (1) the All Information Model, using variables available from the American College of Surgeons Nati...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2014.03.002
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Most severe pain occurs within the first 72 hours after an operation, and current local anesthetics have a limited duration of action. HTX-011 is a dual-acting, local anesthetic containing bupivacaine, and low-dose meloxicam in an extended-release polymer. In a prior phase 3 inguinal herniorrhaphy study, HTX...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2020.06.036
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Transplantation of pancreatic islets is an effective treatment for select patients with type 1 diabetes. Improved cellular therapy results may be realized by altering the gene expression profile of transplanted islets. Current viral and nonviral vectors used to introduce nucleic acids for gene regulation hol...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.05.013
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:Women in low- and middle-income countries account for 51% of breast cancer cases globally. These patients often delay seeking care and, therefore, present with advanced disease, partly because of fear of catastrophic health care expenses. Although there have been efforts to make health care affordable in low...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.04.040
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Pediatric umbilical hernia repair is a common procedure that requires minimal tissue disruption. We examined variation in opioid prescription fills after repair of uncomplicated umbilical hernias to characterize the types and doses of medication used and persistent postsurgical use. METHODS:Using the Truven...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.10.029
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Vascular complications are major complications after living donor liver transplantation (LDLT), especially in biliary atresia (BA). Early diagnosis and treatment of portal vein thrombosis (PVT) may ensure optimal graft function and good recipient survival. Our aim was to find any association between pre- and...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.04.018
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Resection for hepatocellular carcinoma in patients with cirrhosis and impaired liver function is usually unjustified because of higher surgical risks and poorer long-term prognosis. METHODS:A retrospective comparison of the background and resectional results of patients with cirrhosis and hepatocellular car...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(96)80238-8
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:Donor characteristics and graft quality were recently reported to play an important role in the recurrence of hepatocellular carcinoma after liver transplantation. Our aim was to establish a prognostic model by using both donor and recipient variables. METHODS:Data of 1,010 adult patients (training/validati...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.01.022
更新日期:2018-04-27 00:00:00
abstract::Gastrointestinal tract hemorrhage from rupture of the splenic artery into the pancreatic duct is unusual. This obscure cause of intermittent gastrointestinal tract bleeding should be suspected when the more common causes of bleeding have been ruled out. Duodenoscopy carried out during active hemorrhage may reveal bloo...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:
更新日期:1992-01-01 00:00:00
abstract::Improvement of renal allograft survival by induction of immunologic unresponsiveness was attempted in 24 patients by the pretransplant administration of donor-specific whole blood or buffy coat under continuous azathioprine immunosuppression. All patients and their donors had one or two disparate HLA haplotypes. Cross...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1982-08-01 00:00:00
abstract::Recent reports demonstrate that culture of thyroid allografts before transplantation results in prolonged and sometimes indefinite survival. The loss of passenger leukocytes during organ culture was discussed as a possible reason for these findings. Recent data from a genetically defined system in the mouse demonstrat...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
abstract:BACKGROUND:Ruptured abdominal aortic aneurysm is one of the most difficult clinical problems in surgical practice, with extraordinarily high morbidity and mortality. During the past 23 years, the literature has become replete with reports regarding ruptured endovascular aneurysm repair. METHODS:A variety of study desi...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:10.1016/j.surg.2017.08.008
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Hepatopancreatobiliary surgery has a high incidence of postoperative morbidity, including incisional surgical site infection. Although several studies showed that subcuticular sutures reduced incisional surgical site infection in other fields of surgery, their impact on hepatopancreatobiliary surgery remains...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.04.002
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:In trauma patients a specific pattern of the hormone endocrine response to injury has been described. Conflicting data exist regarding the hormonal changes during sepsis. We studied the time course and variability of the hormonal and metabolic responses to severe sepsis in twelve medical patients. METHODS:H...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:Early survival after pancreaticoduodenectomy has improved, but its morbidity remains high. The purpose of this study is to determine how the intra-operative (OR) occurrence of major vascular complications affects the outcome of pancreaticoduodenectomy. METHODS:The medical records of 180 consecutive patients...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2002.127688
更新日期:2002-10-01 00:00:00
abstract::Pancreatic polypeptide (PP) deficiency has been associated with impaired hepatic sensitivity to insulin and pancreatogenic diabetes in chronic pancreatitis. Since pancreatic resection might also result in PP deficiency, hepatic responses to insulin infusion (0.25 mU/kg/min) were determined by the euglycemic glucose cl...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract::Major intra-abdominal operations result in profound immunodepression. In addition, manipulation of malignant tumors may release tumor cells into the systemic and portal circulations. The additive effects of immunodepression and tumor cell release may enhance the metastatic potential of tumors. Perioperative correction...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-08-01 00:00:00
abstract:BACKGROUND:The most common cause of noncurative resection and recurrence is gastric cancer is peritoneal seeding. However, the results of treatment of peritoneal dissemination with chemotherapy have been poor with 5-year survival rates of 0%. METHODS:A new in vitro thermochemosensitivity test was performed on gastric ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(96)80145-0
更新日期:1996-04-01 00:00:00
abstract::The purpose of this project was to evaluate the acute and chronic effects of sclerotherapy on esophageal motility and function. We studied motility in eight patients before and after injection sclerotherapy of esophageal varices. We injected the varices with 5% sodium morrhuate twice during the first week and then at ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-10-01 00:00:00
abstract:BACKGROUND:Operative resection is the only curative treatment for patients with pheochromocytomas, paragangliomas, and other catecholamine-producing neoplasms. Activation of glycogen synthase kinase 3beta (GSK3beta) is thought to promote tumor growth and neuroendocrine (NE) peptide secretion in NE neoplasms. Thus, we h...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2006.12.005
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Intravenous (IV) fluid therapy should be individualized according to each patient's weight, disease, and comorbidities, as well as the type and duration of the operative procedure. Laparoscopic cholecystectomy represents one of the most common, short-duration operations; thus, the aim of this study was to as...
journal_title:Surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.surg.2017.10.030
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:The purpose of this experimental study was to test whether transfusion potentiated physiologic changes associated with fluid resuscitated trauma in controlled conditions. METHODS:Anesthetized and ventilated mongrel pigs were subjected to soft-tissue injury plus 35% hemorrhage and 1 hour shock and then were ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(97)90125-2
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Activated nuclear factor-kappaB (NF-kappaB) is associated reportedly with the pathogenesis of numerous malignancies. This study investigated whether a common insertion (ins)/deletion (del) polymorphism (-94 ins/del ATTG) in the NFKB1 promoter is associated with susceptibility to gastric cancer and its tumor ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2008.11.001
更新日期:2009-03-01 00:00:00
abstract::The isolation and characterization of oncogenes from human colon cancer and the recognition of their homology with the ras gene of the Harvey and Kirsten strain of murine sarcoma virus (MSV) led us to investigate the effect of exogenous MSV on 1,2 dimethylhydrazine (DMH)-induced colon carcinoma in rats. DMH, 20 mg bas...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:In 2009, a study from our institution used retrospective data and multivariate analysis to identify 5 quantitative variables and their cutoffs that have a positive predictive value (PPV) for common bile duct (CBD) stones in gallstone pancreatitis. They also proposed a management protocol based on the scoring...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.01.005
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Although preoperative administration of high-dose glucocorticoid may lead to improved recovery after operative procedures, this regimen has not been examined in patients undergoing abdominal wall reconstruction for repair of large ventral hernias. The aim of the current trial was to examine the effects of pr...
journal_title:Surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.surg.2019.12.007
更新日期:2020-04-01 00:00:00
abstract::Surgical trauma induces immunosuppression that may adversely influence survival. This study examined the effect of laparotomy on two different macrophage populations, peritoneal macrophages (PM phi) and Kupffer cells. Female, 6- to 8-week old, CFW/C3H-HeN mice (n = 160) were randomly allocated to one of three study gr...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-06-01 00:00:00