Abstract：
BACKGROUND:The Affordable Care Act (ACA) dramatically changed the healthcare system in the United States. This study aims to analyze the impact of the ACA on general surgery clinic visits and resultant procedures. METHODS:A retrospective review was conducted on new patients who presented to the elective general surgery clinic at an academic medical center between Jan. 1, 2012 and Dec. 31, 2015. Based on the open enrollment start date of Jan.1, 2014 patients were divided into pre-ACA and post-ACA periods. Data on demographics, type of insurance, missed appointments, and elective surgical procedures performed were collected. RESULTS:Medi-Cal insurance coverage increased post-ACA from 20.9% to 56.7%, p < 0.001; self-pay status went from 9.8% to 0%. There were 296 (35.4%) surgical procedures performed pre-ACA and 347 (37.1%) post-ACA (p = 0.445). Missed clinic visits decreased after implementation of the ACA, with 26.8% no-shows pre-ACA and 20.7% no-shows post-ACA (p = 0.003). CONCLUSION:The ACA had a profound impact on the general surgery clinic with fewer uninsured patients, fewer no-shows and a modest increase in the number of procedures performed. SUMMARY:In 2014 the Affordable Care Act mandate was implemented. This legislation impacted healthcare by significantly decreasing the number of uninsured patients and increasing overall volume in one general surgery clinic.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Yuen L,Costantini TW,Coimbra R,Godat LNdoi
10.1016/j.amjsurg.2018.11.004subject
Has Abstractpub_date
2019-06-01 00:00:00pages
1055-1059issue
6eissn
0002-9610issn
1879-1883pii
S0002-9610(18)30398-2journal_volume
217pub_type
杂志文章abstract：:Abnormal persistent of the embryonic axial blood supply to the leg, the sciatic artery, is a rare but often clinically important condition. The sciatic artery may vary from a small collateral in the upper thigh to a very large vessel that is the leg's sole arterial blood supply. The abnormal artery is prone to aneurys...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90122-8
更新日期：1983-05-01 00:00:00
abstract：:A simplified technique for insertion of a peritoneovenous shunt is described. By using a "peel-away" sheath at both ends of the shunt, the insertion is much quicker and less traumatic to the patient. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(06)80078-4
更新日期：1990-06-01 00:00:00
abstract：:Resection of malignancies of the upper face and skull base may result in complex bone and soft tissue defects. To better define the optimal management of these defects, we conducted a retrospective review of 75 consecutive patients who underwent closure of 76 craniofacial defects after malignant tumor excision from 19...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90160-f
更新日期：1991-10-01 00:00:00
abstract：:We reviewed 574 endoscopic sphincterotomy procedures. Fifty-six precut papillotomies were performed. Presenting conditions included choledocholithiasis, cholangitis, benign and malignant papillary strictures, and stenosing papillitis. Complications were identified in 16 percent: perforation in 9 percent, pancreatitis ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80618-x
更新日期：1990-01-01 00:00:00
abstract：BACKGROUND:Incisional hernias are common. Optimal repair is one of the most analyzed and debated topics; however, there is no consensus as to the appropriate surgical technique. METHODS:An Institutional Review Board-approved protocol was designed using an Internet-based survey site (www.surveymonkey.com) to assess pra...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.08.002
更新日期：2007-11-01 00:00:00
abstract：BACKGROUND:Rectopexy is one of the accepted treatment options for full-thickness rectal prolapse, but the details of the technique remain controversial. This unit has adopted a laparoscopic approach as an alternative to open surgery, and has used three techniques: mesh, suture, and resection. This retrospective study c...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00672-9
更新日期：2001-08-01 00:00:00
abstract：:An improved technic has been developed to predict rapidly the critical number of bacteria in tissues. This technic gave reliable and accurate measurements for wounds containing more than 2 X 10(5) organisms per gram of tissue. It is fortuitous that 10(6) bacteria is the critical number of bacteria that will induced cl...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90174-x
更新日期：1977-06-01 00:00:00
abstract：:The traditional treatment of pneumothorax has been with a chest tube and hospitalization. A series of 35 patients with 41 pneumothoraces treated on an outpatient basis is presented here. A no. 12 chest tube connected to a Heimlich valve led to successful treatment in 88 percent of the cases. Failure of treatment requi...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(81)80006-2
更新日期：1981-07-01 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：BACKGROUND:Patients with cancer who undergo pancreaticoduodenectomy (PD) followed by radiation and 5-fluorouracil (5-FU) therapy have experienced median overall survival from 18 to 24 months and an actuarial 2-year overall survival from 34% to 48%. We previously reported an 84% 2-year survival using a novel adjuvant ch...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(03)00051-5
更新日期：2003-05-01 00:00:00
abstract：BACKGROUND:We examined practice referral patterns for primary retroperitoneal sarcoma (PRS) in British Columbia (BC) and associations between the timing of referral to tertiary care and patient outcomes. METHODS:Using ICD-10 coding, the Cancer Agency Information System was used to identify patients with PRS from 2000 ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.01.006
更新日期：2012-05-01 00:00:00
abstract：:We studied 48 patients with laryngeal or hypopharyngeal primary tumors with DNA flow cytometry. Twenty-four of the tumors were glottic, 18 were supraglottic, and 6 were from the pyriform sinus. Patients were followed for a minimum of 12 months, with a mean follow-up of 23 months. Twenty-three of the 48 primary tumors ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90311-9
更新日期：1986-10-01 00:00:00
abstract：:Ninety-four routine subclavian vein catheterizations in patients with abdominal surgical procedures were performed by the resident surgical staff at the Medical University of South Carolina Hospital over a ten month period. This was done primarily to have ready access to large veins during surgery and to free the pati...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(76)90093-3
更新日期：1976-02-01 00:00:00
abstract：:The results of surgical treatment for chronic pancreatitis at our clinic and in the eight leading institutions of Japan were reviewed in a total of 328 cases. Abdominal pain disappeared or was alleviated in about 90 percent of the patients who survived more than 6 months after operation. There was no significant diffe...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(81)90338-x
更新日期：1981-09-01 00:00:00
abstract：:The palliative management of malignant obstruction of the biliary tree continues to challenge clinicians. The technique of PTBD has become increasingly popular to decompress the obstructed biliary system. Our initial experience with 30 consecutive patients treated with PTBD has been retrospectively reviewed. Internal ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90125-9
更新日期：1984-05-01 00:00:00
abstract：:Patients with ischemic ulceration of the foot and no continuous tibial or inframalleolar vessels acceptable for bypass are often treated with primary amputation. We have performed autogenous vein bypass to isolated tibial artery segments (ITAS) in nine patients with ischemic foot ulcers and no other outflow options. W...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)81088-8
更新日期：1992-09-01 00:00:00
abstract：BACKGROUND:Mucinous Cystic Neoplasms are mucin producing cysts of the pancreas with malignant potential. The existing literature on treatment outcomes is limited to relatively small surgical series. METHODS:We reviewed the National Cancer Database assessing the outcomes of patients with mucinous cystic neoplasms betwe...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.09.006
更新日期：2020-12-01 00:00:00
abstract：BACKGROUND:The effect of postsurgical radiotherapy (PSRT) among T1-3 gallbladder cancer (GBC) patients with one to three lymph node metastases remains controversial. The aim of this study was to assess the impact of PSRT on gallbladder cancer-specific survival (GBCSS) in patients with stage IIIB. METHODS:The data of G...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.08.007
更新日期：2020-08-15 00:00:00
abstract：:The presentation, surgical management, and clinical outcome in 153 patients with biliary pancreatitis has been reviewed. Only 37 percent of our patients demonstrated any of Ranson's 11 prognostic signs of severe pancreatitis, and only 3 percent had 3 or more signs. Fourteen patients underwent emergency operation withi...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90028-0
更新日期：1986-01-01 00:00:00
abstract：BACKGROUND:Since any intraductal papillary mucinous neoplasm (IPMN) is at least premalignant, avoiding conversion to invasion by pancreatic resection should provide a survival advantage-but how much? METHODS:We reviewed 100 cases of IPMN that were resected. Survival was compared between 3 groups: noninvasive IPMN (n =...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.01.020
更新日期：2005-05-01 00:00:00
abstract：:The nephrocholedochoscope designed for inspection of the ductal system of the urinary and bladder tracts has proved to be a useful method for examining the denuded vessel wall after limited blind endarterectomy. This technic is especially helpful in endarterectomy of the common iliac arteries and also has application ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(76)90375-5
更新日期：1976-11-01 00:00:00
abstract：:Between July 1973 and October 1984, we performed proctectomy either as part of a primary proctocolectomy or as a secondary staged procedure in 388 patients with ulcerative colitis and in 39 patients with Crohn's disease. The proctectomies were performed using a two-team synchronous approach. An intersphincteric or per...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90026-7
更新日期：1986-01-01 00:00:00
abstract：:Intestinal infarction is a condition with a high rate of mortality. Progress in the fields of anesthesia, maintenance of electrolyte balance, and intensive postoperative care has made survival possible in a number of patients subjected to extensive resection of the small intestine. Many of these patients, however, lat...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90322-0
更新日期：1975-05-01 00:00:00
abstract：:We found that the mortality rate was no greater in patients with necrotizing enterocolitis complicated by perforation compared with the rate in those with other causes of perforation in similar weight classes. Iatrogenic injuries had a 50 percent mortality rate in all gestational age and birth weight categories and, t...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(88)80111-9
更新日期：1988-03-01 00:00:00
abstract：BACKGROUND:The aim of this study was to determine whether differing neoadjuvant chemotherapy (NAC) regimens for HER2 positive breast cancer (HER2+ BC) are associated with differing surgical complications. Our goal was to evaluate postoperative complications in HER2+ BC patients receiving NAC with Herceptin (trastuzumab...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.06.053
更新日期：2020-11-01 00:00:00
abstract：BACKGROUND:To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period. METHODS:The study was conducted on 34 patients, 25 of whom were submitted to subtotal splenectomy (group I), and 9 to total splenectomy without preservati...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(02)01407-1
更新日期：2003-04-01 00:00:00
abstract：:A review has been made of the records of 208 patients operated on for complications of diverticulitis of the colon. One hundred forty patients had emergency operations and 68, elective operations. Resection and anastomosis, with or without temporary diverting colostomy, practiced in the majority of emergency cases in ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(87)90605-2
更新日期：1987-03-01 00:00:00
abstract：BACKGROUND:Outpatient surgery is cost effective and convenient. The aim of this study was to determine the safety and feasibility of outpatient thyroidectomy. METHODS:Retrospective review was performed of all thyroidectomy patients from a tertiary care center between January 2004 and March 2010. RESULTS:One hundred f...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2011.01.023
更新日期：2011-05-01 00:00:00
abstract：BACKGROUND:Radioguided surgery can also be used for the simultaneous guidance to a nonpalpable primary tumor and sentinel lymph nodes. METHODS:Retrospective review of a prospective database. The surgeon used a gamma probe for guidance to an iodine-125 labeled titanium seed at the primary lesion and technetium-99 label...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00716-4
更新日期：2001-10-01 00:00:00
abstract：BACKGROUND:Surgery is a vital component of a comprehensive health system, but there are often personnel limitations in resource constrained areas. Zambia provides post graduate surgical training through two systems to help address this shortage. However, no studies have analyzed surgical trainees' perceptions of these ...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2017.07.023
更新日期：2018-04-01 00:00:00
