Abstract:
OBJECTIVES:We hypothesized that distinct sets of functional trajectories can be identified in the year before and after major surgery, with unique transition probabilities from pre to postsurgical functional trajectories, and that outcomes would be better among participants undergoing elective versus nonelective surgery. BACKGROUND:Major surgery is common and can be highly morbid in older persons. The relationship between the course of disability (ie, functional trajectory) before and after surgery in older adults has not been well-studied for most operations. METHODS:Prospective cohort study of 754 community-living persons 70 years or older. The analytic sample included 250 participants who underwent their first major surgery during the study period. RESULTS:Before surgery, 4 functional trajectories were identified: no disability (n = 60, 24.0%), and mild (n = 84, 33.6%), moderate (n = 73, 29.2%), and severe (n = 33, 13.2%) disability. After surgery, 4 functional trajectories were identified: rapid (n = 39, 15.6%), gradual (n = 76, 30.4%), partial (n = 70, 28.0%), and little (n = 57, 22.8%) improvement. Rapid improvement was seen for n = 31 (51.7%) participants with no disability before surgery, but was uncommon among those with mild disability (n = 8, 9.5%) and was not observed in the moderate and severe trajectory groups. For participants with mild to moderate disability before surgery, gradual improvement (n = 46, 54.8%) and partial improvement (n = 36, 49.3%) were most common. Most participants with severe disability (n = 27, 81.8%) before surgery exhibited little improvement. Outcomes were better for participants undergoing elective versus nonelective surgery. CONCLUSIONS:Functional prognosis in the year after major surgery is highly dependent on premorbid function.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Stabenau HF,Becher RD,Gahbauer EA,Leo-Summers L,Allore HG,Gill TMdoi
10.1097/SLA.0000000000002659subject
Has Abstractpub_date
2018-12-01 00:00:00pages
911-917issue
6eissn
0003-4932issn
1528-1140journal_volume
268pub_type
杂志文章abstract:OBJECTIVE:To identify prognostic factors and reasons for improved survival over time in patients with esophageal cancer. SUMMARY BACKGROUND DATA:Management strategies for esophageal cancer have evolved with time. The impact of chemoradiation in the overall treatment results has not been adequately studied. METHODS:Fr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000086545.45918.ee
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:To analyze the impact of a conservative strategy of management in patients with necrotizing pancreatitis, reserving intervention for patients with documented infection or the late complications of organized necrosis. SUMMARY BACKGROUND DATA:The role of surgery in patients with sterile pancreatic necrosis rem...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200110000-00016
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVE:Esophageal cancer surgery carries a risk of splenic injury, which may require splenectomy, but predictors of such events remain uncertain. Moreover, the hypothesis that incidental splenectomy carries a worse prognosis deserves attention. DESIGN:A population-based, nationwide cohort study was conducted on 167...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000650
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:The current study was undertaken to determine long-term results of aortic valve replacement (AVR) in the elderly, to ascertain predictors of poor outcome, and to assess quality of life. SUMMARY BACKGROUND DATA:Aortic valve replacement is the procedure of choice for elderly patients with aortic valve disease....
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199706000-00017
更新日期:1997-06-01 00:00:00
abstract:OBJECTIVE:We sought to define the prognostic significance of histologic subtype for extremity/truncal liposarcoma (LPS). BACKGROUND:LPS, the most common sarcoma, is comprised of 5 histologic subtypes. Despite their distinct behaviors, LPS outcomes are frequently reported as a single entity. METHODS:We analyzed data o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003453
更新日期:2019-07-05 00:00:00
abstract::Eight patients after vagotomy and Jaboulay gastroduodenostomy had their gastroduodenostomy closed to treat dumping and diarrhea. Eight gastroduodenostomies were closed once and four were closed twice, a total of 12 procedures. Of these, ten were "simple" closures (direct suture of the opening into the duodenum via a g...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198308000-00005
更新日期:1983-08-01 00:00:00
abstract:OBJECTIVE:The primary aim of this study was to delineate the role of computed tomography (CT) in patients undergoing NOM for AGSW. BACKGROUND:Nonoperative management (NOM) of abdominal gunshot wounds (AGSWs) remains controversial. METHODS:This prospective study included all patients with abdominal gunshot injuries ad...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000000879
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:The Hepp-Couinaud technique describes side-to-side HJ to the main left hepatic duct but a side-to-side approach is not consistently used when repairing other ducts. Compared with end-to-side repairs, side-to-side anastomoses require less dissection, theoretically preserving blood supply to the bile ducts, an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31819a6b2e
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:To compare the modified Rossetti fundoplication with the classic Nissen. SUMMARY BACKGROUND DATA:The traditional surgical treatment of gastroesophageal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, and floppy wr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199906000-00003
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVE:To report on the long-term follow-up of a randomized clinical trial comparing pancreatic head resection according to Beger and limited pancreatic head excision combined with longitudinal pancreatico-jejunostomy according to Frey for surgical treatment of chronic pancreatitis. SUMMARY BACKGROUND DATA:Resectio...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.sla.0000157268.78543.03
更新日期:2005-04-01 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::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::Seventy-seven patients with a primary complaint of persistent cough, wheezing, and/or recurrent pneumonia were evaluated for the presence of occult gastroesophageal reflux disease. Fifty-four patients (70%) had increased esophageal acid exposure on 24-hour pH monitoring of the distal esophagus. In 28% of these patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199003000-00005
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:To develop a prognostic scoring system for risk stratification of patients with hepatic graft failure (GF) undergoing retransplants of the liver (ReLT) and improve patient selection. SUMMARY OF BACKGROUND DATA:Retransplantation of the liver remains controversial because of inferior outcomes compared with the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31822c5878
更新日期:2011-09-01 00:00:00
abstract::Emergency portacaval shunt for variceal bleeding is associated with a high operative mortality, particularly if used as a last resort. Because of this, a strong case has been made against emergency shunt. This report describes an experience with emergency portacaval shunt for the treatment of variceal bleeding when us...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198707000-00007
更新日期:1987-07-01 00:00:00
abstract::A historical review of work bearing on the rationale for hepatic artery ligation in the treatment of malignant disease in the liver is presented, particularly the early work showing that malignant disease of the liver is supplied primarily by the arterial circulation and not by the portal. A review is presented of som...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197409000-00008
更新日期:1974-09-01 00:00:00
abstract:OBJECTIVE:This study tested the validity of the hypothesis that eradication of esophageal varices by repeated injection sclerotherapy would reduce recurrent variceal bleeding and death from bleeding varices in a high-risk cohort of alcoholic patients with cirrhosis. SUMMARY BACKGROUND DATA:Although banding of esophage...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000231704.45005.4e
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:To test whether frailty, a novel measure of physiologic reserve, is associated with longer kidney transplant (KT) length of stay (LOS), and modifies the association between LOS and mortality. BACKGROUND:Better understanding of LOS is necessary for informed consent and discharge planning. Mortality resulting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002025
更新日期:2017-12-01 00:00:00
abstract::Analysis of experience with chronic bleeding peptic ulcer in 504 patients, admitted from 1960 to 1971, shows a hospital mortality of 12%. This retrospective review suggested that early endoscopic diagnosis, adequate resuscitation and a policy of early selective surgery was necessary if mortality was to be reduced. Wit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198401000-00008
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:To assess clinical and surgical factors affecting local recurrence and survival in young breast cancer patients in the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH). BACKGROUND:Emerging data suggest young age is a predictor of increased local recurrence. METHODS:POSH is a ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000001930
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:Comparison of minimal access retroperitoneal pancreatic necrosectomy (MARPN) versus open necrosectomy in the treatment of infected or nonresolving pancreatic necrosis. SUMMARY OF BACKGROUND DATA:Infected pancreatic necrosis may lead to progressive organ failure and death. Minimal access techniques have been ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181d96c53
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVE:To determine the prognostic influence of residual tumor at or within 1 mm of the mobilization margins (R1Mobilization) compared with transection margins (R1Transection) following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). BACKGROUND:The prognostic strength of R1 status increases wit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181d77369
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the effects of radiofrequency ablation (RFA) on tumor growth and growth factor expression in a murine model. BACKGROUND:Surgical excision remains the only potentially curative therapy for hepatic malignancies. Tumor growth in the remaining liver may be accelerated aft...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000261319.51744.59
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVES:Aggressive human melanomas express, C-X-C chemokine receptor 4 (CXCR4), the receptor for the chemokine, stromal cell-derived factor-1alpha (SDF-1α). The CXCR4-SDF-1α axis has been postulated to increase melanoma invasiveness. We discovered that SDF-1α specifically upregulates E-selectin on endothelial cells,...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31822a72dc
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:The risk of metastatic spread among patients with early-stage pancreatic neuroendocrine tumors has not been well established. The authors sought to evaluate whether the new TNM staging systems proposed by the American Joint Committee on Cancer (AJCC) and European Neuroendocrine Tumor Society (ENETS) are prog...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824e6108
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine the long-term effect of the use of a hyaluronic acid-carboxymethylcellulose membrane (Seprafilm) on the incidence of adhesions and subsequent small-bowel obstruction and chronic abdominal complaints after colorectal surgery (Hartmann's procedure). BACKGROUND:Adhesi...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e318217e99c
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to determine the characteristics and frequency of intraoperative safety threats and resilience supports using a human factors measurement tool. BACKGROUND:Human factors analysis can provide insight into how system elements contribute to intraoperative adverse events. Empiric ev...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003616
更新日期:2019-10-04 00:00:00
abstract::The understanding of the association of mammalian ovarian function with lactation was common knowledge to dairy-men early in the 19th century or earlier. This thesis reviews the application of these empiric observations to lactation in humans by Beatson of Glasgow, supported by his preliminary laboratory investigation...
journal_title:Annals of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1097/00000658-197612000-00009
更新日期:1976-12-01 00:00:00
abstract:OBJECTIVES:Surgical simulation has been shown to enhance the training of general surgery residents. Since catheter-based techniques have become an important part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents. METHODS:Twenty...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000234932.88487.75
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVE:To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery. SUMMARY BACKGROUND DATA:Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, A...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.sla.0000114219.71899.13
更新日期:2004-03-01 00:00:00