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 National Surgical Quality Improvement Program (ACS NSQIP); (2) the Surgeon Assessment Model, using variables available to surgeons preoperatively, and (3) the Patient-Entered Model, using information that patients know about their own health. STUDY DESIGN:Using the ACS NSQIP 2011 data for general and colon surgery, standard ACS NSQIP regression methods were used to develop models. Each model examined Overall and Serious Morbidity as outcomes. The models were assessed using the c-statistic, Hosmer-Lemshow statistic, and Akaike Information Criterion. RESULTS:The overall morbidity rate was 13.0%, and the serious morbidity rate was 10.5% for patients undergoing general surgery (colon surgery: 31.8% and 26.0%, respectively). There was a small decrement in the c-statistic as the number of predictors decreased. The Akaike Information Criterion likelihood ratio increased between the All Information and Surgeon Assessment models, but decreased in the Patient-Entered Model. The Hosmer-Lemshow statistic suggested good model fit for five colon surgery models and one general surgery model. CONCLUSION:Although a small decline in model performance was observed, the magnitude suggests that it may not be clinically meaningful as the risk predictions offered are superior to simply providing unadjusted complications rates. The Surgeon Assessment and Patient-Entered models with fewer predictors can be used with relative confidence to predict a patient's risk.
journal_name
Surgeryjournal_title
Surgeryauthors
Dahlke AR,Merkow RP,Chung JW,Kinnier CV,Cohen ME,Sohn MW,Paruch J,Holl JL,Bilimoria KYdoi
10.1016/j.surg.2014.03.002subject
Has Abstractpub_date
2014-07-01 00:00:00pages
39-45issue
1eissn
0039-6060issn
1532-7361pii
S0039-6060(14)00095-6journal_volume
156pub_type
杂志文章相关文献
SURGERY文献大全abstract:BACKGROUND:Extrinsic denervation of the transplanted small bowel could play a substantial role in motor dysfunction of the transplanted gut. We attempted to determine the effect of chronic extrinsic denervation on intestinal contractility. METHODS:Jejunal longitudinal muscle strips were obtained from rats 1 week and 8...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2001.112070
更新日期:2001-04-01 00:00:00
abstract:BACKGROUND:Alternative methods for abdominal wall closure may be necessary after emergency laparotomy. The purpose of this study was to determine the morbidity and outcome of emergency fascial closure with polypropylene mesh. METHODS:A retrospective review was performed of all patients undergoing emergency fascial clo...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:10.1016/s0039-6060(05)80043-1
更新日期:1995-10-01 00:00:00
abstract::A randomized trial involving 50 patients has demonstrated that a new type of debriding agent, cross-linked dextran beads with the trade name Debrisan (dextranomer, Pharmacia, Inc.), will produce rapid healing of cutaneous ulcers which have been resistant to conventional therapy over the long-term. Evaluation in terms ...
journal_title:Surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1979-02-01 00:00:00
abstract:BACKGROUND:Despite the emphasis on medical error as a major cause of hospital morbidity and mortality, there has been little published work on errors committed by trainees. This issue is particularly relevant to the training of surgeons and was addressed by our study. METHODS:Sixty simulated laparoscopic cholecystecto...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2005.02.014
更新日期:2005-07-01 00:00:00
abstract::Teratomas were observed in 85 infants and children. Fifty-eight (68%) were girls and 27 (32%) boys. Site of origin was sacrococcygeal in 55 patients (64.8%), mediastinal in ten (11.7%), gonadal in ten (11.7%), presacral in four (4.8%), retroperitoneal in three (3.5%), and cervical in three (3.5%). Sixty-seven (78.8%) ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1976-09-01 00:00:00
abstract:BACKGROUND:Telomerase reverse transcriptase promoter mutations were recently found to be associated with poorer prognosis in patients with papillary thyroid carcinoma. Correlation between telomerase reverse transcriptase messenger RNA expression and survival of patients with papillary thyroid carcinoma has not been det...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2020.04.054
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:von Hippel-Lindau disease is an autosomal dominant disorder characterized by the development of hemangioblastomas in the cerebellum, spinal cord, and retina, renal cell carcinoma and cysts, pancreatic cysts, and pheochromocytoma. METHODS:We have studied a series of 36 French patients affected with von Hippe...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Management of critically ill patients is a challenge in low resource settings where there is a paucity of trained staff, infrastructure, resources, and drugs. We aimed to study the characteristics of surgical patients admitted in intensive care unit in a limited resource setting and determine factors associa...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.04.010
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The purpose of the present study is to compare postoperative pain and functional outcomes in patients undergoing inguinal herniorrhaphy who receive a continuous wound infusion of bupivacaine to those who receive an infusion of saline. METHODS:A prospective, randomized, blinded, placebo-controlled trial was ...
journal_title:Surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.surg.2004.06.016
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:No reports have yet precisely determined corticotropin (ACTH) responsiveness in virilizing adrenocortical adenoma. METHODS:Five women with an androgen-secreting adrenal adenoma were reviewed. Three of them were examined by in vitro steroidogenesis. Two of these 3 patients were studied by immunohistochemistr...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:Expendable autologous nerve available for repair of nerve injuries is limited. Cadaveric allografts could provide adequate nerve for grafting but are susceptible to rejection and currently require chronic systemic immunosuppression. METHODS:Age-matched Buffalo (RT1B) rats randomly assigned to 7 experimental...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1998-08-01 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:Although fine-needle aspiration (FNA) is 90% sensitive in the detection of papillary carcinoma (PC) of the thyroid, its specificity has been reported as low as 52%. Consequently, patients who have an FNA suspicious for PC may undergo operation for a benign process. The ribonucleoprotein telomerase has been n...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(97)90219-1
更新日期:1997-12-01 00:00:00
abstract:BACKGROUND:The Affordable Care Act aims to improve patient outcomes. Race/ethnicity and insurance status impact outcomes after traumatic brain injury. We sought to gauge the Affordable Care Act's effect on outcomes after traumatic brain injury, as graded by race/ethnicity and insurance status. METHODS:The National Tra...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2017.09.006
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Health care costs continue to spiral; aggregate costs for 1992 are $850 billion, 13.6% of the U.S. gross national product. The issue has assumed national proportions, and change appears to be on the federal agenda. Great interest in surgical expenditures exists, which comprise 30.1% of all health care outlay...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1994-04-01 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:BACKGROUND:Managed care organizations use a variety of payment strategies to contract for high-end tertiary services with academic healthcare centers. We assessed the financial outcome of these strategies and attempted to identify those that maintain a balance between cost and reimbursement. METHODS:Patients admitted ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(03)00329-5
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Adhesion of polymorphonuclear leukocytes (PMNs) to endothelial cells is mediated partially by CD11/CD18 integrins. The purpose of this study was to define (1) the response of PMNs to anti-CD18 monoclonal antibody binding, and (2) the mechanism responsible for anti-CD18 monoclonal antibody-mediated decreases ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-08-01 00:00:00
abstract:BACKGROUND:Recent studies suggest that mitogen-activated protein (MAP) kinase contributes to the growth and tumorigenesis of human epithelial cancers. Furthermore, blockade of this pathway may inhibit the growth of epithelial cancers. To determine whether MAP kinase is activated in human papillary thyroid carcinomas (P...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2001.118381a
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Nodal status is one of the most important prognostic factors for carcinoma of the papilla of Vater. The pattern of lymphatic spread and mode of recurrence were analyzed by determining the frequency of nodal involvement and antemortem and postmortem examination of patients with recurrent disease. METHODS:Fro...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(97)90048-9
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Very late activation-2 (VLA-2) is an integrin receptor for laminin that consists of an alpha 2- and a beta 1-subunit. In human breast cancer, down-regulation of VLA-2 expression is related to positive nodal status. The functional significance of altered integrin expression in individual patients has never be...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(05)80330-7
更新日期:1995-08-01 00:00:00
abstract:BACKGROUND:The aim of this study was to investigate the genotype-phenotype relationship of pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 treated at our institution. METHODS:We conducted a retrospective chart review of all patients with multiple endocrine neoplasia type 1 treated...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2017.04.044
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to clarify the relationships of extractable and secreted parathyroid hormone (PTH) and parathyroid secretory protein (PSP) in human parathyroid tumors to PTH messenger RNA (mRNA), PSP mRNA, and cell replication. METHODS AND RESULTS:In tissue cultures of seven adenomas and five ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract::To explain the incidence and significance of mitral and aortic valve calcification and calcific deposits in the myocardium, a prospective echocardiographic study was performed with 21 consecutive patients who had primary hyperparathyroidism (PHP) and with 21 age- and sex-matched control subjects with normocalcemia. Ca...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to investigate whether the incidence of surgical site infection after pancreatoduodenectomy decreased after changing the prophylactic antibiotic to a third-generation cephalosporin in patients with unknown preoperative bile culture results after biliary drainage. METHODS:In ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.09.011
更新日期:2019-03-01 00:00:00
abstract:INTRODUCTION:Routine, whole-body computed tomography imaging (PAN-SCAN) has been shown to identify unexpected injuries and alter the management of patients presenting with blunt trauma. We sought to characterize the changes in practice over time and the utility of PAN-SCAN imaging in elderly patients who fall and requi...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2013.07.015
更新日期:2013-10-01 00:00:00
abstract::Peripheral lymphocytes, T cells, and T cell subsets of 141 consecutive patients with colorectal cancer were measured preoperatively to determine whether infectious complications could be predicted from derangements of T cell subsets. T cell subset abnormalities reportedly precede sepsis in patients with burn injuries....
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1988-02-01 00:00:00
abstract:PURPOSE:Enhancer of zeste homologue 2 (EZH2), a component of the chromatin modification protein complex, is upregulated in pancreatic ductal adenocarcinoma (PDAC), whereas loss of p53 and its downstream target, p21(waf1/cip1), is also observed frequently. We sought to investigate the role of the p53-p21(waf1/cip1) path...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2013.06.041
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Although prophylactic glucocorticoids have been used before liver resection to minimize liver dysfunction, it is unknown whether treatment with glucocorticoids will accelerates recovery from hyperbilirubinemia after liver resection. METHODS:In this open-label, randomized, controlled trial, patients with hyp...
journal_title:Surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.surg.2018.09.002
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Persistent elevation of serum parathyroid hormone (PTH), despite normocalcemia, occurs in 8% to 40% of patients after parathyroidectomy. Explanations have included hypocalcemia owing to vitamin D deficiency or bone remineralization, and persistent hyperparathyroidism. METHODS:A retrospective chart review of...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2005.08.026
更新日期:2005-12-01 00:00:00