Abstract：
BACKGROUND:Operative time often has been cited as an important factor for postoperative outcomes. Despite this belief, most efforts to improve liver transplant outcomes have largely focused on only patient and donor factors, and little attention has been paid on operative time. The primary objective of this project was to determine the impact of operative time on graft survival after liver transplant. METHODS:A retrospective review of 2,877 consecutive liver transplants performed at a single institution was studied. Data regarding recipient, donor, and operative characteristics, including detailed granular operative times were collected prospectively and retrospectively reviewed. Using an instrument variable approach, Cox multivariate modeling was performed to assess the impact of operative time without the confounding of known and unknown variables. RESULTS:Of the 2,396 patients who met the criteria for review, the most important factors determining liver transplant graft survival included recipient history of Hepatitis C (hazard ratio 1.45, P = .02), donor age (hazard ratio 1.23, P = .03), use of liver graft from donation after cardiac death donor (hazard ratio 1.50, P < .01), and operative time (hazard ratio 1.26, P = .01). In detailed analysis of stages of the liver transplant operation, the time interval from incision to anhepatic phase was associated with graft survival (hazard ratio 1.33; P = .02). CONCLUSION:Using a novel instrument variable approach, we demonstrate that operative time (in particular, the time interval from incision to anhepatic time) has a significant impact on graft survival. It also seems that some of this efficiency is under the influence of the transplant surgeon.
journal_name
Surgeryjournal_title
Surgeryauthors
Lee DD,Li J,Wang G,Croome KP,Burns JM,Perry DK,Nguyen JH,Hopp WJ,Taner CBdoi
10.1016/j.surg.2017.05.010subject
Has Abstractpub_date
2017-10-01 00:00:00pages
937-949issue
4eissn
0039-6060issn
1532-7361pii
S0039-6060(17)30335-5journal_volume
162pub_type
杂志文章相关文献
SURGERY文献大全abstract：BACKGROUND:Trauma causes a release of catecholamines, transforming growth factor-beta (TGF-beta), and T-helper II cytokines (TH2). Individually, these substances also induce arginase in macrophages. The purpose of this study was to determine the synergistic interactions between isoproterenol, TGF-beta, and TH2 cytokine...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2003.10.007
更新日期：2004-05-01 00:00:00
abstract：BACKGROUND:The management of patients with a complete clinical response after neoadjuvant therapy for rectal adenocarcinoma is controversial. Those who advocate for resection point out the inaccuracy of N-staging with current imaging modalities. The objective of this study is to determine the impact of residual nodal i...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2019.03.026
更新日期：2019-10-01 00:00:00
abstract：BACKGROUND:Our aim was to identify differential expression of genes in hepatocellular carcinoma (HCC) with the ultimate goal of discovering novel diagnostic and therapeutic targets. METHODS:We examined differences in gene expression between HCC and noncancerous liver tissue using a cDNA array with probes for 15,843 ge...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2010.12.007
更新日期：2011-06-01 00:00:00
abstract：BACKGROUND:The carcinogenic effect of duodenoesophageal reflux, gastroesophageal reflux, and nitrosamines was studied in the rat esophagus. METHODS:Twenty male Sprague-Dawley rats underwent esophagogastroplasty to produce gastroesophageal reflux and 60 underwent duodenoesophageal anastomosis to produce duodenoesophage...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1992-05-01 00:00:00
abstract：BACKGROUND:The aim of this study was to evaluate the incidence of complications in the upper limbs as a new event after radial artery (RA) harvesting for coronary artery bypass grafting (CABG). METHODS:From June 1997 to August 2001, the RA graft was used in 271 patients who underwent cardiac surgery at our department....
journal_title：Surgery
pub_type： 杂志文章
doi：10.1067/msy.2003.43
更新日期：2003-03-01 00:00:00
abstract：BACKGROUND:Surgical enteral access prior to multimodality treatment for esophageal cancer is controversial as dysphagia is often used for feeding tube referral. We hypothesized that enteral access before neoadjuvant chemoradiation for esophageal cancer provides no benefit compared to that placed during definitive esoph...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2017.09.046
更新日期：2018-04-01 00:00:00
abstract：BACKGROUND:The aim of this study was to assess validity of a human factors error assessment method for evaluating resident performance during a simulated operative procedure. METHODS:Seven postgraduate year 4-5 residents had 30 minutes to complete a simulated laparoscopic ventral hernia (LVH) repair on day 1 of a nati...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2015.04.010
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND:The purpose of this study was to prospectively compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on postoperative pulmonary function. METHODS:Forty consecutive patients (20 in each group) who were evenly matched in terms of pulmonary risk factors were assigned to eithe...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1097/00132586-199406000-00036
更新日期：1993-08-01 00:00:00
abstract：:A rat gastric chamber preparation was used to determine the interrelations between H+ back diffusion, mucosal blood flow, the area of mucosa treated with bile salts and ulcer formation. The rate of H+ back diffusion was found to be dependent on both mucosal blood flow and the area of mucosa exposed to bile salts. It i...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1978-03-01 00:00:00
abstract：BACKGROUND:K-ras oncogene mutations have been identified in up to 95% of pancreatic cancers, implying their critical role in their molecular pathogenesis. However, the earliest stage in which K-ras mutations can be detected in potential precursor lesions of pancreatic cancer remains unclear. This study evaluates pancre...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/s0039-6060(97)90181-1
更新日期：1997-01-01 00:00:00
abstract：BACKGROUND:The long-term consequences of in-hospital complications remain largely unknown. We sought to study the effect of complications on the long-term functional outcome of trauma patients. METHODS:Patients with an Injury Severity Score ≥ 9 admitted to 3, level I trauma centers between 2015 and 2017 were contacted...
journal_title：Surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.surg.2019.04.026
更新日期：2019-09-01 00:00:00
abstract：BACKGROUND:High-dose perioperative corticosteroids are the standard of care for steroid-treated patients undergoing surgery. There is little evidence, however, to support this practice. We investigated the safety of perioperative low-dose steroids in patients with inflammatory bowel disease (IBD) undergoing major color...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2012.02.019
更新日期：2012-08-01 00:00:00
abstract：:Since there appears to be an association between depressed lymphocyte function and liver disease, the effect of bile salts on lymphocyte function was determined in vitro. Peripheral lymphocytes from normal volunteers were incubated with varying concentrations of three bile salts (chenodeoxycholate, deoxycholate, or ur...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1984-04-01 00:00:00
abstract：BACKGROUND:Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have re...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2019.03.005
更新日期：2019-06-01 00:00:00
abstract：BACKGROUND:An ongoing debate exists regarding the relative merits of full versus limited neck exploration in the surgical management of parathyroid adenomata. The aim of this study was to assess the impact of localization studies on the subsequent surgical management of hyperparathyroidism. METHODS:The accuracy of com...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/s0039-6060(96)80093-6
更新日期：1996-11-01 00:00:00
abstract：BACKGROUND:Diaphragm pacing (DP) can replace mechanical ventilation in tetraplegics and in trials has assisted respiration in amyotrophic lateral sclerosis patients. This report describes results of DP in patients with cardiac pacemakers. METHODS:Prospective, single-center and multicenter, nonrandomized, controlled, i...
journal_title：Surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.surg.2010.07.008
更新日期：2010-10-01 00:00:00
abstract：BACKGROUND:Major operative injury initiates immunologic changes that may result in a systemic inflammatory response, leading to organ dysfunction/sepsis. Catecholamines seem to be key mediators. The effects of beta(2) receptor blockade in vitro and in vivo before and after operative injury were studied to clarify their...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2008.09.013
更新日期：2009-02-01 00:00:00
abstract：:Augmentation of cutaneous blood flow by postganglionic lumbar sympathectomy may not reflect an increase in nutritive vascular supply to the dermal tissues. Transcutaneous oxygen tension (TcPO2) was compared with radionuclide microsphere determination of dermal microcirculation in a hind limb sympathectomy model in 20 ...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1993-04-01 00:00:00
abstract：:Previous studies in our laboratory established that the intestinal phase of gastric secretion and the acid hypersecretion associated with portacaval shunt are mediated by a potent hormone in both dogs and humans. The present investigation was designed to localize the site of origin of the intestinal phase hormone by m...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1970-07-01 00:00:00
abstract：BACKGROUND:Lateral neck lymph node (LN) metastases (N1b) have been identified as independent risk factors of recurrence in patients with papillary thyroid carcinoma (PTC). OBJECTIVE:This study aimed to determine the predictive factors of recurrence in N1b PTC patients and to clarify the postoperative event patterns. ...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2015.08.033
更新日期：2016-03-01 00:00:00
abstract：BACKGROUND:Prophylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) is controversial. We compared 3 different approaches to the management of central compartment nodes in patients with clinically unifocal and N0 PTC. METHODS:A total of 186 patients were prospectively assigned to one of the fol...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2012.08.053
更新日期：2012-12-01 00:00:00
abstract：BACKGROUND:Rapid intraoperative parathyroid hormone (RI-PTH) assay is used to guide adequacy of resection during operation for hyperparathyroidism. We compared the RI-PTH assay (15 minutes) with a standard PTH assay, determined whether the PTH half-life varied between patients, and constructed a kinetic analysis of the...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1067/msy.2099.101835
更新日期：1999-12-01 00:00:00
abstract：:The proliferative defects observed in phagocytic stem cells after major thermal injuries may be caused by an inadequate production of colony-stimulating factors (CSFs), a family of hemopoietic cytokines necessary for the production and function of granulocytes and monocytes. In this study a biologic response modifier ...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1992-04-01 00:00:00
abstract：BACKGROUND AND AIMS:Laparoscopic surgery for colorectal cancer is currently being evaluated in humans. The aim of this study was to examine the effect of laparoscopy on intraperitoneal tumor growth and distant metastases in an animal model. We also examined the effect of combining laparotomy with laparoscopy and on inf...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1067/msy.1999.99056
更新日期：1999-07-01 00:00:00
abstract：:Resident evaluation is highly subjective and continues to be a problem. Personality traits and characteristics account for 28% of factors considered; deficits in this area account for 22% of advanced residency terminations. Sixty-four faculty members and 51 residents in six university surgical departments were surveye...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1982-08-01 00:00:00
abstract：:We have previously shown that the timing of surgical removal of an estrogen-receptor-bearing mammary adenocarcinoma within the estrous cycle of the female C3HeB/FeJ mouse profoundly influences the frequency of subsequent tumor cell metastasis. In order to investigate the role of the immune response in this phenomenon,...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1988-08-01 00:00:00
abstract：:Endothelial cell (EC) seeding has been proposed as a method to improve the performance of small-caliber synthetic vascular prostheses. Seeding experiments to date have all been carried out in the dog. This study investigates EC seeding of small-caliber Dacron carotid interposition grafts compared with contralateral co...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1986-03-01 00:00:00
abstract：BACKGROUND:Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases (CRM). Recent data indicated that liver resection in patients with tumor progression while receiving chemotherapy was associated with poor outcome. The aim of the study was to i...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2009.02.004
更新日期：2009-07-01 00:00:00
abstract：BACKGROUND:Cathepsin D is a widely distributed lysosomal acidic endopeptidase. It is an estrogen-regulated protein that is a prognostic factor in breast cancer. The aim of this study was to measure cathepsin D concentrations in thyroid tissues and to correlate these concentrations with clinical and pathologic parameter...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/s0039-6060(05)80111-4
更新日期：1995-12-01 00:00:00
abstract：BACKGROUND:In this study of laparoscopic splenectomy (LS), we evaluate prospectively gathered perioperative patient data and review lessons learned in the evolution of this procedure. METHODS:At 2 university medical centers between November 1993 and March 2000, there were 203 patients (122 female patients and 81 male ...
journal_title：Surgery
pub_type： 临床试验,杂志文章,多中心研究
doi：10.1067/msy.2000.109065
更新日期：2000-10-01 00:00:00
