Abstract：
BACKGROUND:In hepato-pancreato-biliary (HPB) surgery higher volumes are associated with improved outcomes; however, there are limitations to regionalization. Here we report our experience establishing multidisciplinary HPB program at a university-affiliated community hospital. METHODS:This is a retrospective review of patients who underwent HPB surgery between 2015 and 2017. Chief residents' HPB case logs were collected. RESULTS:61 pancreatic resections and 62 hepatic resections were performed. The morbidity, 30-day mortality and median length of stay following pancreatic resections were 27%, 1.5%, and 8 days, respectively. The morbidity, 90-day mortality, and median length of stay following hepatic resections were 24%, 3%, and 7 days, respectively. The median pancreatic and liver case volumes for graduating chief residents increased from 7 to 8 to 16 and 16, respectively (p < 0.05), after the establishment of a HPB program. Participation in multidisciplinary care (p = 0.08) and clinical trial enrollment increased. CONCLUSION:Our study demonstrates short-term outcomes comparable to high volume centers. Development of a HPB program had a positive impact on resident operative experience, increased multidisciplinary care and increased clinical trial enrollment.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Lu S,Khatri R,Tanner B,Shebrain S,Munene Gdoi
10.1016/j.amjsurg.2019.03.015subject
Has Abstractpub_date
2019-11-01 00:00:00pages
946-951issue
5eissn
0002-9610issn
1879-1883pii
S0002-9610(18)30501-4journal_volume
218pub_type
杂志文章abstract：BACKGROUND:Most studies of trauma deaths include non-preventable deaths, potentially limiting successful intervention efforts. In this study we aimed to compare the potentially preventable trauma deaths between 2 time periods at our institution. METHODS:Trauma patients who died in our hospital in 2005-2006 or 2012-201...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.12.022
更新日期：2019-09-01 00:00:00
abstract：:From 1972 to 1987, 403 patients underwent a composite resection consisting of segmental mandibulectomy and neck dissection for the treatment of bucco-pharynx squamous cell carcinoma (303 patients had postoperative radiotherapy [XRT], 29 patients had preoperative XRT, and 100 patients had tissue salvage performed after...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80350-2
更新日期：1993-10-01 00:00:00
abstract：:Experience with 37 patients with adult colovesical fistula over the past 19 years is reviewed. Specific guidelines for treatment of adult colovesical fistula are influenced by the location and cause of the fistula, the patient's general condition, the presence of a pelvic abscess and the presence of colonic obstructio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90421-3
更新日期：1980-07-01 00:00:00
abstract：:Fixation of polypropylene (Marlex) mesh in the epigastrium and at the iliac crest can be ineffective because of insufficient local fascia; however, two techniques have been described to obtain firm and durable attachment of polypropylene grafts at these sites. Perichondral slips at the costal margin permit very satisf...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(85)80194-x
更新日期：1985-06-01 00:00:00
abstract：BACKGROUND:Retroperitoneal vascular injury remains one of the most frequent causes of death following abdominal trauma. A risk analysis of the association between potential outcome predictors and mortality following abdominal aorta and inferior vena cava injuries was performed. METHODS:Eighty-nine patients sustaining ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(96)00231-0
更新日期：1996-11-01 00:00:00
abstract：:Previous studies of small bowel transplantation using a variety of animal models and immunosuppressive regimens have failed to demonstrate consistently prolonged survival of bowel allografts capable of maintaining a normal nutritional state. In the present study, total orthotopic small bowel transplantation was perfor...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90011-5
更新日期：1986-01-01 00:00:00
abstract：BACKGROUND:The use of biologic markers to aid in individualizing wound treatment may help improve outcomes. A biologic marker that has been demonstrated to be predictive of healing in both chronic and acute wounds is wound tissue bacterial level. The objective of this study was to determine whether tissue bacterial lev...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.09.009
更新日期：2011-08-01 00:00:00
abstract：:Stapling instruments have been used for gastrointestinal anastomoses and reconstruction with increasing regularity. A technique for loop colostomy closure employing a stapling device is described. This approach provides a secure closure while avoiding major contaimination. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90398-2
更新日期：1979-08-01 00:00:00
abstract：:Between 1971 and 1976, ninety-three patients with a clinical diagnosis of pseudocyst confirmed by ultrasonography were identified from a group of 923 patients admitted for pancreatic disease. Uncertainties in diagnosis and/or rapid progression of underlying pancreatitis led to urgent laparotomy and drainage in eleven ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90024-2
更新日期：1979-01-01 00:00:00
abstract：:Trovafloxacin, a new fluoronaphthyridone derivative related to fluoroquinolone antimicrobial drugs, has demonstrated the following characteristics: significant gram-positive and gram-negative activity; significant activity against anaerobes and atypical respiratory pathogens; approximately 11-hour elimination half-lif...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(98)00213-x
更新日期：1998-12-01 00:00:00
abstract：:In a random double-blind trial monitored by 125I-fibrinogen leg scan, impedance plethysmography, and contrast phleobograms if impedance became abnormal, hydroxycholoroquine was shown to be no more effective than placebo for prevention of venous thrombosis after total hip replacement. Subsequently, the combination of h...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/0002-9610(77)90125-8
更新日期：1977-04-01 00:00:00
abstract：:Despite immediate operation, patients with abdominal aortic injuries and profound hypovolemic shock do not respond to the usual methods of resuscitation and die soon after celiotomy, prior to control and repair of the aortic injury. The rate of aortic hemorrhage exceeds the ability to restore blood volume. Shock becom...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90385-4
更新日期：1979-08-01 00:00:00
abstract：:Forty-eight patients with acute cholangitis who presented with postcholocystectomy choledocholithiasis are reported on in this study. As soon as the general condition of the patients had improved, or as soon as the fluid balance was established, usually within 48 hours of admission, the patients were divided into two ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90096-4
更新日期：1982-03-01 00:00:00
abstract：BACKGROUND:This study utilizes the American College of Surgeons National Surgical Quality Improvement Program database to better understand the impact of obesity on perioperative surgical morbidity in abdominal wall reconstruction (AWR). METHODS:We reviewed the 2005 to 2010 American College of Surgeons National Surgic...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2013.08.047
更新日期：2014-04-01 00:00:00
abstract：BACKGROUND:The purpose of this study was to investigate the impact of subcarinal dissection on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma. METHODS:Patients without subcarinal dissection were matched randomly to patients with subcarinal dissection i...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.10.044
更新日期：2013-09-01 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：BACKGROUND:A review of 1993 data on length of stay (LOS) and charges for diagnosis-related group (DRG) 195 (complicated cholecystectomies) showed that Maricopa Medical Center charged more and had longer LOS than all other area hospitals. METHODS:Twenty DRG 195 charts were analyzed for the causes of the inefficiencies....
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)80035-x
更新日期：1995-12-01 00:00:00
abstract：:By means of intragastric instillation of meat extract, two groups of duodenal ulcer patients were identified--antral responders and antral nonresponders. Antral response was abolished ater vagotomy and drainage or vagotomy-antrectomy. The differentiation would allow for selective surgery for duodenal ulcer patients. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90355-5
更新日期：1977-08-01 00:00:00
abstract：BACKGROUND:Robotic surgery is increasingly adopted into surgical practice, but it remains unclear what level of robotic training general surgery residents receive. The purpose of our study was to assess the variation in robotic surgery training amongst general surgery residency programs in the United States. METHODS:A...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.11.006
更新日期：2019-02-01 00:00:00
abstract：:The records of 123 patients with squamous cell cancer of the lip presenting to the Vancouver Clinic of the British Columbia Cancer Agency from 1984 and 1988 were reviewed, and 4 were excluded from the study for various reasons. Initial treatment was surgery in 40, radiotherapy in 61, and combined in 18 patients. The p...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(92)90389-9
更新日期：1992-05-01 00:00:00
abstract：:Chronic granulating wounds were established in rats by excising burns inoculated with Escherichia coli. Recombinant human basic fibroblast growth factor was applied at dosages of 1, 10, and 100 micrograms/cm2 to the wounds of three groups of 20 animals on days 5, 9, 12, 15, and 18 after injury. The rate of wound closu...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(92)90004-b
更新日期：1992-03-01 00:00:00
abstract：:From 1972 to 1981, 430 patients were treated for bleeding peptic ulcer. Two hundred ten of the patients were treated surgically and 220 medically. In the surgically treated patients, mortality was high among those with posterior duodenal peptic ulcer and after gastrectomy rather than after vagotomy. Mortality after em...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90170-3
更新日期：1984-03-01 00:00:00
abstract：:Over a 10 year period, 54 patients presented with pancreatic trauma. During the first 5 years of the study, when pancreatography was not utilized for the assessment of pancreatic duct injury, 55 percent of the patients had major pancreatic complications. During the subsequent 5 years, suspected proximal duct injury wa...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90173-8
更新日期：1982-05-01 00:00:00
abstract：:Massive doses of methylprednisolone were given to dogs prior to severe, lethal, hemorrhagic shock. An untreated group of dogs subjected to hemorrhagic shock served as controls. No persistent significant differences were seen in cardiac output, mean arterial blood pressure, superior mesenteric artery flow, and survival...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90394-3
更新日期：1975-09-01 00:00:00
abstract：BACKGROUND:Stress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress. METHODS:Twenty-four residents were stratified then randomized to receive mental skills and FLS tr...
journal_title：American journal of surgery
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.amjsurg.2017.09.039
更新日期：2018-02-01 00:00:00
abstract：BACKGROUND:A multicenter, randomized, clinical trial was initiated to evaluate the possible benefits of extended D2 (D2+) lymphadenectomy after potentially curative resection of gastric cancer. METHODS:Standard D2 lymphadenectomy was defined according to the Japanese Gastric Cancer Association classification. D2+ lymp...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.amjsurg.2006.04.018
更新日期：2007-01-01 00:00:00
abstract：BACKGROUND:Laparoscopic parastomal hernia repair can be technically challenging. We herein present a simplified technique of laparoscopic parastomal hernia repair. METHODS:This technique entails fixation of the rolled mesh to the anterior abdominal wall before unfolding it, each side of the mesh is unfolded and fixed ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.06.034
更新日期：2008-09-01 00:00:00
abstract：BACKGROUND:Making a conflict of interest declaration is now mandatory at continuing medical education CME accredited events. However, these declarations tend to be largely perfunctory. This study sought to better understand physician perceptions surrounding conflict of interest. METHODS:The same PowerPoint (Microsoft,...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.01.012
更新日期：2013-05-01 00:00:00
abstract：:Wounds will readily acquire bacteria, unless protective measures are taken. The bacterial protection afforded by conventional absorbent cellulose dressings has been shown to be limited, particularly in the presence of serous exudate that may compromise dressing integrity. In addition, dressings may shed particles that...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/0002-9610(94)90006-x
更新日期：1994-01-01 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
