Abstract：
BACKGROUND:Data on the hemoglobin (Hb) after transfusion, or the "target," which reflects the "dose" of blood given are not well studied. We sought to examine the incidence and causes of "over transfusion" of red blood cells after surgery. METHODS:Data on blood utilization including Hb triggers and targets were obtained for patients undergoing colorectal, pancreas, or liver surgery between 2010 and 2013. RESULTS:A total of 2,905 patients were identified, of which 895 (31%) were transfused (median age 64, interquartile range: 53 to 72; 51% men; median American Society of Anesthesiologists class 3, interquartile range: 3-3; 51% pancreatic, 14% hepatobiliary, 21% colorectal, and 14% other). Among these, 512 (57%) were overtransfused (final Hb target after transfusion ≥9.0 g/dL). Among patients who were overtransfused, 171 (33%) were transfused at too high an initial trigger (>8.0 g/dL), whereas 304 (59%) had an appropriate trigger but received ≥2 packed red blood cell (PRBC) units, suggesting an opportunity to have transfused fewer units. There was significant variation in overtransfusion among surgeons (range 0% to 80%, P = .003). CONCLUSIONS:Excess use of blood transfusion is common and was due to PRBC utilization for too high a transfusion trigger, as well as too many units transfused.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Lucas DJ,Ejaz A,Spolverato G,Kim Y,Gani F,Frank SM,Pawlik TMdoi
10.1016/j.amjsurg.2015.12.020subject
Has Abstractpub_date
2016-07-01 00:00:00pages
1-9issue
1eissn
0002-9610issn
1879-1883pii
S0002-9610(16)30087-3journal_volume
212pub_type
杂志文章abstract：BACKGROUND:Clostridium difficile infection (CDI) is a common cause of healthcare associated infections contributing to morbidity and mortality. Our objective was to evaluate the impact of the implementation of a CDI bundle along with probiotic utilization. METHODS:A retrospective review of trauma admissions from 2008 ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.01.005
更新日期：2018-05-01 00:00:00
abstract：:Aspiration of foreign bodies in children can lead to illness and even death if not recognized and treated promptly. Seventy-six patients were referred to our hospital for suspected foreign body aspiration. The following is a retrospective review of their diagnosis and treatment. There was no foreign body found at bron...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90208-0
更新日期：1989-12-01 00:00:00
abstract：:It has been shown that truncal vagotomy with pyloroplasty (TVP), but not highly selective vagotomy (HSV), delays the onset, decreases the extent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptying after a variety of antiulcer gastric...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/s0002-9610(05)80160-6
更新日期：1994-10-01 00:00:00
abstract：:Nine cases of microemboli of arterial origin to the upper extremity are reported. The source of emboli in five of these cases was in the subclavian artery compressed by osseous anomalies in the thoracic outlet. Three aneurysms, one in a subclavian vein graft and two traumatic false aneurysms in the hand, were also not...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90296-3
更新日期：1977-07-01 00:00:00
abstract：:One hundred seventy-five patients underwent restorative proctocolectomy between November 1984 and December 1992. The pathologic results were reviewed by two pathologists, one being a gastrointestinal pathologist. One hundred fifty-eight patients had a confirmed diagnosis of ulcerative colitis, and 16 patients were dia...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(94)90248-8
更新日期：1994-05-01 00:00:00
abstract：BACKGROUND:Definitive practice guidelines regarding the utility of chest x-ray (CXR) following chest tube removal in trauma patients have not been established. The authors hypothesized that the selective use of CXR following chest tube removal is safe and cost effective. METHODS:A retrospective review of chest tube in...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.03.011
更新日期：2010-02-01 00:00:00
abstract：BACKGROUND:Recent cognitive research in medicine has demonstrated that expert diagnosticians solve many clinical problems through "pattern recognition" rather than deductive reasoning strategies. Development of the ability to recognize and diagnose common surgical problems is a critical objective of undergraduate surgi...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(99)80172-X
更新日期：1995-03-01 00:00:00
abstract：:Experience with 22 cases of reconstruction of the cervical esophagus, hypopharynx and oral cavity using free jejunal transfer is presented. The method requires an experienced team with high technical competence, but the benefits related to rapid single-stage completion and low morbidity certainly justify its use. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90197-x
更新日期：1980-10-01 00:00:00
abstract：:Significant salvage of patients with a wide variety of cysts and benign tumors of the liver and of some patients with biliary strictures can be achieved by hepatic resection in carefully selected clinical situations with a low operative mortality rate and an acceptable postoperative complication rate. Still to be dete...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90123-5
更新日期：1979-04-01 00:00:00
abstract：:Fifty-eight patients with invasive melanoma of the head and neck underwent regional nodal dissections by one surgeon from 1971 to 1981. Types of nodal dissections employed were radical neck dissection and modified radical neck dissection, alone or in combination, with selective nodal dissection of the parotid, jugular...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90367-2
更新日期：1984-10-01 00:00:00
abstract：BACKGROUND:Recent advances in computed tomographic (CT) imaging have improved the detection rate of pulmonary metastasis. The aim of this study was to test the hypothesis that the pulmonary nodule detection rate for preoperative CT imaging and intraoperative palpation are now equivalent. METHODS:A retrospective review...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2011.01.005
更新日期：2011-05-01 00:00:00
abstract：:Experience with 37 patients with adult colovesical fistula over the past 19 years is reviewed. Specific guidelines for treatment of adult colovesical fistula are influenced by the location and cause of the fistula, the patient's general condition, the presence of a pelvic abscess and the presence of colonic obstructio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90421-3
更新日期：1980-07-01 00:00:00
abstract：BACKGROUND:The current opinion is that the reflux of jejunal juice over the whole length of a long Roux-en-Y jejunal loop is very uncommon. We aimed to challenge this concept by monitoring the presence of bile in the organ proximal to a 60-cm loop during a 24-hour period with use of the Bilitec device, an optoelectroni...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00326-3
更新日期：2000-04-01 00:00:00
abstract：BACKGROUND:The aim of this study is to assess the clinical utility of routine preoperative computed tomography (CT) scanning in patients with cancer of the intraperitoneal colon. METHODS:From November 1997 to June 2001, all patients at VA Puget Sound Healthcare System with a diagnosis of colon cancer were referred for...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(02)00841-3
更新日期：2002-05-01 00:00:00
abstract：:Twenty-six patients with advanced melanoma metastases confined to the lower extremity underwent 28 therapeutic limb perfusions without a major complication or treatment-related death. A complete response to treatment occurred in 21 patients (81 percent). Of 16 patients, response persisted until death in 13 and was not...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90006-6
更新日期：1985-07-01 00:00:00
abstract：BACKGROUND:Despite conventional neuromonitoring, the recurrent laryngeal nerve (RLN) is still at risk for damage during thyroid surgery. The feasibility of continuous RLN monitoring by vagal nerve (VN) stimulation with a new anchor electrode should be shown, and electromyographic signal alterations of stressed RLN were...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.04.036
更新日期：2010-04-01 00:00:00
abstract：BACKGROUND:Tracheostomal recurrence after total laryngectomy for laryngeal carcinoma has a poor prognosis. The independent risk factors of tracheostomal recurrence are, however, not well documented. METHODS:This is a multivariate analysis of the risk factors of tracheostomal recurrence after total laryngectomy for 322...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(96)00162-6
更新日期：1996-09-01 00:00:00
abstract：BACKGROUND:Variable results regarding general surgery residency program (GSRP) impact on patient outcomes and charges are reported. The aim of this study was to determine any significant differences in patient outcomes and cost with a new GSRP. METHODS:We analyzed all laparoscopic appendectomies (lap-ap), cholecystect...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2016.11.016
更新日期：2017-07-01 00:00:00
abstract：BACKGROUND:Bloodstream infections in critically ill patients are associated with mortality as high as 60% and a prolonged hospital stay. We evaluated the impact of inappropriate antibiotic therapy (IAAT) in a critically ill surgical cohort with bacteremia. METHODS:This retrospective study evaluated adults with intensi...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2015.10.025
更新日期：2016-03-01 00:00:00
abstract：:Thirty-two rats had truncal vagotomy either with or without pyloroplasty. After 2 or 4 weeks, respectively, the pancreas was excised and weighed. Measurements of amylase, trypsin, lipase, total protein, and DNA were obtained from the homogenated pancreatic tissue. Isolated pancreatic lobules were incubated with and wi...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90615-6
更新日期：1987-09-01 00:00:00
abstract：BACKGROUND:Data concerning the long-term efficacy of laparoscopic sleeve gastrectomy in the treatment of morbid obesity remain scarce. In this retrospective, the authors present 5-year follow-up of 30 patients having undergone laparoscopic sleeve gastrectomy. METHODS:Since 2004, 30 patients underwent laparoscopic slee...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.04.006
更新日期：2015-02-01 00:00:00
abstract：BACKGROUND:Many surgeons continue to use prosthetic arteriovenous grafts for dialysis access despite the clear superiority of native arteriovenous fistulas. This study was undertaken to review our experience with elevated brachial-basilic fistulas as an alternative to prosthetic grafts in patients lacking veins suitabl...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00102-6
更新日期：1999-06-01 00:00:00
abstract：:The aim of this study was to evaluate whether total gastrectomy performed for gastric cancer leads to an increased risk of cholelithiasis and whether the method of reconstruction of the digestive tract influences that risk. A total of 102 patients who had undergone total gastrectomy for gastric cancer between 1980 and...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80573-2
更新日期：1993-07-01 00:00:00
abstract：:The determination of surgical risk is a major problem in general surgical practice and many studies have attempted to predict postoperative outcome. Clinical judgment is still a fundamental skill with which the experienced surgeon can estimate the risk of postoperative infectious morbidity. Predictive scores based on ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)81207-3
更新日期：1993-02-01 00:00:00
abstract：BACKGROUND:The treatment for a contralateral breast cancer (CBC) presents a growing dilemma given the expanding number of long-term survivors. We hypothesize that there will be specific surgical treatment trends with demographic differences between the treatment groups. METHODS:The Surveillance, Epidemiology, and End ...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2014.05.010
更新日期：2014-10-01 00:00:00
abstract：:Percentage and levels of circulating T-lymphocytes were studied in forty-six patients with squamous cell carcinoma of the head and neck before and/or after treatment and compared with control values obtained in fifty-one healthy volunteers. Mean percentages of circulating T-cells and mean T-cell levels in cancer patie...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90481-x
更新日期：1975-10-01 00:00:00
abstract：:Axillary node dissection was performed in 212 patients with malignant melanoma. For 212 initial dissections plus 49 repeat procedures (261 operations), wound infection occurred in 25 (10%) and arm edema in 10 (4%), with other complications being infrequent. The arm edema resolved promptly and completely six (2%) patie...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90069-p
更新日期：1991-09-01 00:00:00
abstract：BACKGROUND:Pain is the most common symptom associated with hernias. The aim was to assess the frequency of pain and its effects on physical activity and quality of life in patients with inguinal and ventral hernias. METHODS:All patients undergoing elective inguinal or ventral hernia repair over a 16-month period were ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.02.011
更新日期：2014-09-01 00:00:00
abstract：:From 1971 through 1975, 104 patients with squamous carcinoma of the anterior and anterolateral floor of the mouth underwent surgery, irradiation therapy or a combination of both with the purpose of eliminating their tumors. No patient had received treatment before, and this effort was considered primary and definitive...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90212-3
更新日期：1980-10-01 00:00:00
abstract：BACKGROUND:The American Association of Endocrine Surgeons initiated a fellowship match in 2007. The profile of applicants who successfully match into an endocrine surgery (ES) fellowship has not previously been characterized. METHODS:An institutional review board-approved, web-based survey was distributed to recent an...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.03.013
更新日期：2014-10-01 00:00:00
