Abstract:
OBJECTIVE:To investigate the effect of subspecialty practice and experience on the relationship between annual volume and inpatient mortality after hepatic resection. BACKGROUND:The impact of annual surgical volume on postoperative outcomes has been extensively examined. However, the impact of cumulative surgeon experience and specialty training on this relationship warrants investigation. METHODS:The New York Statewide Planning and Research Cooperative System inpatient database was queried for patients' ≥18 years who underwent wedge hepatectomy or lobectomy from 2000 to 2014. Primary exposures included annual surgeon volume, surgeon experience (early vs late career), and surgical specialization-categorized as general surgery (GS), surgical oncology (SO), and transplant (TS). Primary endpoint was inpatient mortality. Hierarchical logistic regression was performed accounting for correlation at the level of the surgeon and the hospital, and adjusting for patient demographics, comorbidities, presence of cirrhosis, and annual surgical hospital volume. RESULTS:A total of 13,467 cases were analyzed. Overall inpatient mortality was 2.35%. On unadjusted analysis, late career surgeons had a mortality rate of 2.62% versus 1.97% for early career surgeons. GS had a mortality rate of 2.98% compared with 1.68% for SO and 2.67% for TS. Once risk-adjusted, annual volume was associated with reduced mortality only among early-career surgeons (odds ratio 0.82, P = 0.001) and general surgeons (odds ratio 0.65, P = 0.002). No volume effect was seen among late-career or specialty-trained surgeons. CONCLUSIONS:Annual volume alone likely contributes only a partial assessment of the volume-outcome relationship. In patients undergoing hepatic resection, increased annual volume did not confer a mortality benefit on subspecialty surgeons or late career surgeons.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Hashimoto DA,Bababekov YJ,Mehtsun WT,Stapleton SM,Warshaw AL,Lillemoe KD,Chang DC,Vagefi PAdoi
10.1097/SLA.0000000000002377subject
Has Abstractpub_date
2017-10-01 00:00:00pages
603-609issue
4eissn
0003-4932issn
1528-1140journal_volume
266pub_type
杂志文章abstract:OBJECTIVE:To evaluate the potential benefit of cytology of the peritoneal lavage obtained during diagnostic laparoscopy for staging gastrointestinal (GI) malignancies. SUMMARY BACKGROUND DATA:Peritoneal lavage is a simple procedure that can be performed during laparotomy for GI tumors. Tumor cells in the lavage fluid ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199812000-00002
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND:The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for ma...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182383118
更新日期:2011-12-01 00:00:00
abstract::A female patient with Gardner's syndrome was treated with delta1-testololactone (200 mg daily) because of growth of a large desmoid tumor in the pelvis and lower abdomen and a tumor in a scar from a previous laparotomy. There was also pain and swelling of the left leg. An immediate effect of the drug therapy was compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197503000-00009
更新日期:1975-03-01 00:00:00
abstract:OBJECTIVE:To compare clinical outcomes after laparoscopic lavage (LL) or colonic resection (CR) for purulent diverticulitis. BACKGROUND:Laparoscopic lavage has been suggested as an alternative treatment for traditional CR. Comparative studies to date have shown conflicting results. METHODS:Electronic searches of Emba...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1097/SLA.0000000000002236
更新日期:2018-02-01 00:00:00
abstract::The etiology of gastroesophageal reflux (GER) in infancy is related to developmental factors, and there is a high incidence of associated conditions such as neurologic syndromes and esophageal atresia (60%). This is different from the situation in adults. Experience with 18 consecutive children with peptic esophageal ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198210000-00008
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:To evaluate discrepancies between trial registry entries and final reports of randomized controlled trials (RCTs) published in major general surgical journals. BACKGROUND:Health care decisions are based on published results in peer-reviewed journals. Mandatory trial registration was introduced to increase tr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318283cf7f
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To determine whether the acute anti-inflammatory influence of epinephrine (EPI) extends to changes in heart rate variability (HRV) induced by the prototypical inflammatory stimulus, endotoxin (lipopolysaccharide [LPS]). SUMMARY BACKGROUND DATA:HRV reflects fluctuating cardiac autonomic inputs and is acutely ...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181a40193
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To analyze the short- and long-term outcomes following surgical treatment for corrosive stricture of the esophagus. BACKGROUND:Surgery is a well-established treatment for corrosive strictures of the esophagus and involves either resection or bypass of the damaged esophagus and replacement by a conduit. The n...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182125ce7
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:To determine whether translocation of bacteria or endotoxin occurred into the thoracic duct in patients with multiple organ failure (MOF). SUMMARY BACKGROUND DATA:Translocation of bacteria or endotoxin has been proposed as a causative factor for MOF in patients without an infectious focus, although it has ra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199901000-00017
更新日期:1999-01-01 00:00:00
abstract::A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically,...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197801000-00001
更新日期:1978-01-01 00:00:00
abstract::Two experimental models were utilized to study the efficacy of intraperitoneal povidone-iodine in an established peritonitis. In both models, there was a 100% mortality in the povidone-iodine treated group. In laboratories which have reported favorable results, the animals were treated before peritonitis was allowed t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197806000-00005
更新日期:1978-06-01 00:00:00
abstract::Renal scintiphotography with (131)I-hippurate was the primary diagnostic procedure in evaluating renal failure and complications in over 500 transplant patients. This diagnostic test has become our principal method of evaluation and followup of renal transplants, especially in the early post-transplant period. It has ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197409000-00014
更新日期:1974-09-01 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 determined whether the neurotensin gene (NT/N) is expressed in the normal adult liver and focal nodular hyperplasia (FNH) and confirmed NT/N expression in fibrolamellar carcinoma; whether NT/N or the neurotensin receptor is expressed in the fetal liver; and whether hepatic resection leads to expres...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199410000-00007
更新日期:1994-10-01 00:00:00
abstract::Segmental hepatectomy is appealing for several reasons including preservation of liver parenchyma, reduction of intraoperative blood loss, and blood replacement by dividing tissues along the anatomic planes. A simple technique guided by intraoperative ultrasound is described here using radio-frequency energy to create...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181b0c38a
更新日期:2009-08-01 00:00:00
abstract::Successful long-term limb salvage using cephalic vein bypass grafts was attained in 70 limbs of 67 patients over the past 11 years. The saphenous vein was absent in 76% and inadequate in 24% of the cases. Revascularization for limb salvage was carried out in 83%. Ninety per cent of the grafts were extended to the infr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198412000-00019
更新日期:1984-12-01 00:00:00
abstract::A prospective randomized trial was conducted comparing the effect of three antibiotics: cefamandole (CM), cefazolin (CZ), and vancomycin (V), used as prophylaxis for prosthetic valve surgery, on the prothrombin (PT) response to warfarin (W) on the third day of anticoagulant therapy. Twenty patients, with normal preope...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198708000-00007
更新日期:1987-08-01 00:00:00
abstract::As a consequence of an experience with 175 patients undergoing reoperation for persistent or recurrent hyperparathyroidism, the authors have evolved an approach to management. The emphasis is on the confirmation of the diagnosis; the critical evaluation of invasive and noninvasive localization tests, techniques of int...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract::Hypermetabolism characterizes the metabolic response to thermal injury and the extent of energy production is positively related to the rate of urinary catecholamine excretion. Alpha and beta adrenergic blockade decreased metabolism from 69.6 +/- 5.3 Kcal/m(2)/hr to 57.4 +/- 5.2 (p < 0.01), and infusion of 6 microgm e...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197410000-00031
更新日期:1974-10-01 00:00:00
abstract::Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197807000-00017
更新日期:1978-07-01 00:00:00
abstract::One hundred patients with intraabdominal infections were assigned randomly in double-blind fashion to receive either the combination of tobramycin plus clindamycin (TM/C) or moxalactam (MOX) alone. Fifty patients comprised each group, but one patient in each group died of infection before 48 hours treatment. In the re...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198307000-00007
更新日期:1983-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to report the long-term results of percutaneous isolated liver chemoperfusion with hepatic venous isolation and charcoal hemoperfusion (HVI-CHP) in patients with multiple advanced hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA:The results of conventional chemotherapy includ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199804000-00012
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:To determine if certain outcomes of incisional hernia repair have improved in recent eras. SUMMARY BACKGROUND DATA:Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias. METHODS:This retrospective, population-based cohort study was conducted usi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200301000-00018
更新日期:2003-01-01 00:00:00
abstract::During a 10-year period, 94 surgical resections for adenocarcinoma of the cardia (75 "curative" and 19 palliative) were performed using three primary approaches: Group I (46 curative, 14 palliative), esophagogastrectomy performed through a left thoracotomy or left thoraco-abdominal incision; Group II (17 curative, 4 p...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198202000-00004
更新日期:1982-02-01 00:00:00
abstract:OBJECTIVE:To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. BACKGROUND:Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3180caa415
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of anesthesia induced mild systemic hypothermia on hepatic injury in lean and obese rats during warm ischemia. SUMMARY BACKGROUND DATA:Hepatic warm ischemia during surgery remains a significant problem, particularly in organs with presumed baseline dysfunction. METHODS:The left and me...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000154259.73060.f1
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic append...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e31826a91e5
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:To determine the efficacy of oral supplementation of the gut enzyme intestinal alkaline phosphatase (IAP) in preventing antibiotic-associated infections from Salmonella enterica serovar Typhimurium (S. Typhimurium) and Clostridium difficile. BACKGROUND:The intestinal microbiota plays a pivotal role in human ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31828fae14
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:Minimally invasive techniques have expanded the donor pool for living kidney donation. We changed our approach to single-port donor nephrectomy in 2009 and have compared outcomes with traditional multiple-port laparoscopic donor nephrectomy. BACKGROUND:The development of minimally invasive surgical technique...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318262ddd6
更新日期:2013-03-01 00:00:00
abstract::Many advances have occurred in recent years in the diagnosis, localization, and treatment of primary hyperparathyroidism. Several different operative choices for primary hyperparathyroidism also have been proposed--a unilateral approach versus the standard bilateral parathyroid exploration. The unilateral approach is ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199204000-00002
更新日期:1992-04-01 00:00:00