Abstract:
BACKGROUND:Discussion of the volume-outcome relationship in pancreatic surgery has gained increasing interest. Currently, no data describe the situation in Germany. Pursuant to a recent legislative reform, a threshold of 10 operations per year was introduced for pancreatic surgery in 2006. This study describes the situation in Germany and the effect of the legislative reform between 2006 and 2009. METHODS:In 2007 and 2010, anonymous questionnaires were sent to leading surgeons in the German Society of General and Gastrointestinal Surgery asking for the numbers of pancreatic operations, methods of operation, and mortality for the years 2006, 2008, and 2009. Volume categories were defined by dividing hospitals into quartiles according to their annual volume of operations. RESULTS:The return rate was about 48%. In the years 2006, 2008, and 2009, overall mortality in all hospitals was 2.85%, 3.98%, and 2.58%. High volume was defined as ≥ 32 pancreatic operations (2006) and ≥ 34 pancreatic operations (2008, 2009). Although mortality decreased with increasing volume, mortality between each volume category was not statistically different in any year. In the years 2006, 2008, and 2009, the number of operations increased in university hospitals (38.4%, 51.2%, and 50.4%, P < .001) and decreased in teaching hospitals (51.8%, 41.3%, and 41.2%, P < .001). The number of hospitals that did not perform pancreatic operations increased from 15.6% to 32.5% and 31% (P < .001). CONCLUSION:In pancreatic surgery, a centralization effect occurred after a legislative reform in Germany. Overall mortality after pancreatic resection in German hospitals is good. Although mortality decreases with greater volume, there were no differences compared to other volume categories. Also, low-volume hospitals can produce good results; however, the difference in quality is considerable among these institutions. Our data suggest that the German threshold agreement in pancreatic surgery might have a positive effect with regard to reproducible quality and outcome.
journal_name
Surgeryjournal_title
Surgeryauthors
Alsfasser G,Kittner J,Eisold S,Klar Edoi
10.1016/j.surg.2012.05.011subject
Has Abstractpub_date
2012-09-01 00:00:00pages
S50-5issue
3 Suppl 1eissn
0039-6060issn
1532-7361pii
S0039-6060(12)00219-Xjournal_volume
152pub_type
杂志文章相关文献
SURGERY文献大全abstract::To clarify the physiopathologic mechanism leading to a marked increase in aromatic amino acids (AAA) in acute hepatic failure (AHF), we compared two experimental models of AHF. Ten pigs were submitted to one-stage hepatic devascularization (group A); in eight other pigs total hepatectomy was performed (group B). The a...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
abstract::The term big data has been popularized over the past decade and is often used to refer to data sets that are too large or complex to be analyzed by traditional means. Although the term has been utilized for some time in business and engineering, the concept of big data is relatively new to medicine. The reception from...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.06.022
更新日期:2018-10-01 00:00:00
abstract:INTRODUCTION:Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. However, this procedure has limitations in terms of the posterior extent of resection and the ability to achieve a complete N1 node resection. METHODS:A new antegrade procedure has...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2003.146
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:It is well recognized that hypoxia/reoxygenation and exposure to inflammatory mediators such as cytokines and neutrophils alter the barrier function of the vascular endothelium. The experiments we conducted tested whether hypoxia alone could produce changes in permeability and whether a prolonged period of h...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1998-09-01 00:00:00
abstract::Autologous fibrin glue was evaluated as a sealant of the common bile duct (CBD) with the use of experimental animal models. It proved to be highly effective. Since it is a safe product that can be easily obtained from the patient's own blood, it may find useful application in most biliary tract procedures, liver trans...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-03-01 00:00:00
abstract:BACKGROUND:Repeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and la...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.11.005
更新日期:2019-12-23 00:00:00
abstract:BACKGROUND:This study aimed to determine the prognostic value of a novel grading system based on the histologic assessment of poorly differentiated clusters (PDCs) in the primary lesions in patients with hepatectomy for colorectal liver metastasis (CRLM). Preoperative survival predictors for CRLM are required to determ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2014.12.025
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:The surgical workforce particularly in rural regions needs novel approaches to reinforce the skills and confidence of health practitioners. Although conventional telementoring systems have proven beneficial to address this gap, the benefits of platforms of augmented reality-based telementoring in the coachin...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.11.008
更新日期:2020-04-01 00:00:00
abstract::Hygroma renalis is an unusual benign tumor of the kidney. Only 24 cases have been reported previously in the world literature; 22 of these patients underwent nephrectomy. Two sisters, with the first known occurrence in siblings, are discussed and the world literature is reviewed. Our first patient underwent nephrectom...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Despite successful revascularization of ischemic extremities, multiorgan dysfunction syndrome develops in some patients. Mechanisms responsible for this are not known; however, the gastrointestinal tract has been implicated as a possible mediator. Our objective was to demonstrate increased intestinal mucosal...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(96)80076-6
更新日期:1996-09-01 00:00:00
abstract::We studied the effect of partial excision and wound closure on the postburn hypermetabolic state. A 25% of total body surface burn was produced in seven sheep. Oxygen consumption (VO2) was significantly increased to 215 +/- 44 ml/min/M2 by day 3 compared with baseline of 125 +/- 21 ml/min/M2. The calculated increase w...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1988-11-01 00:00:00
abstract::This review concentrates on the clinicopathologic studies and molecular biologic studies of intramucosal gastric carcinomas (IMGCs) with lymph node metastasis that have been published to date. There have been several reports in which IMGCs with lymph node metastasis were compared with IMGCs without lymph node metastas...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:10.1067/msy.2002.119307
更新日期:2002-01-01 00:00:00
abstract:PURPOSE:The purpose of this study was to evaluate whether ultrasonography is helpful in predicting malignancy in patients with a thyroid nodule and atypia/follicular lesion of undetermined significance (AFLUS). METHODS:All patients with a preoperative ultrasound who underwent thyroidectomy for a nodule with AFLUS comp...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2014.06.043
更新日期:2014-10-01 00:00:00
abstract::The traditional approach to gastric outlet obstruction caused by unresectable pancreatic cancer is gastrojejunostomy performed during or after biliary bypass surgery. Previous work showed that gastrojejunostomy failed in 95% of patients with preoperative outlet obstruction, which was evidenced by nausea and vomiting. ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Intestinal ischemia-reperfusion injury (IIR) induces hepatic and pulmonary dysfunction and thus has been used as a model of multiple organ failure syndrome. This study examines the hypothesis that hepatic blood flow is markedly reduced in this injury model. METHODS:Sprague-Dawley rats underwent 120 minutes ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(96)80163-2
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND:Patients undergoing ventral hernia repair (VHR) are at risk of an inadvertent enterotomy during surgery. Inadvertent enterotomies potentially contaminate the surgical field presenting a management dilemma for the surgeon. The aim of our study was to define the incidence and risk factors for a recognized inad...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.04.003
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Sodium diphenylhydantoin (DpH) (phenytoin) was first introduced as an antiepileptic in 1938. One of its side effects, gingival hyperplasia, prompted investigation into the possible application of this drug as a promoter of wound healing. Since the late 1950s phenytoin has been used in a variety of clinical s...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1998-03-01 00:00:00
abstract::We identified 106 patients who had undergone complete resection of isolated colorectal hepatic metastases. Nine of these patients subsequently underwent repeat liver resections for isolated hepatic recurrences. The median follow-up for these patients was 21 months. One postoperative death was related to the second hep...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:K-ras oncogene mutations have been identified in up to 95% of pancreatic cancers, implying their critical role in their molecular pathogenesis. However, the earliest stage in which K-ras mutations can be detected in potential precursor lesions of pancreatic cancer remains unclear. This study evaluates pancre...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(97)90181-1
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Antigen injected subcutaneously (SQ) results in a strong systemic immune response, whereas antigen infused orally or by the portal vein tends to induce tolerance. Nontransgenic C57BL/6J (H-2(b)), or B6, mice and transgenic 2C mice (that express a cytotoxic T cell receptor against major histocompatibility com...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2005.05.010
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:In patients with esophageal cancer and a history of gastric surgery, colonic interposition is the treatment of choice. Our aim was to review our experience with this technique and to identify possible predictors of the clinical outcome. METHODS:Between 1986 and 2006, 43 patients underwent esophageal reconst...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2009.10.045
更新日期:2010-04-01 00:00:00
abstract::A girl underwent partial resection of the liver for mesenchymal hamartoma twice, at 7 months and again at 3 years of age. When the patient was 16 years of age, the mass increased rapidly in size. The patient was hospitalized and studied by ultrasonography, computed tomographic scans, and arterial angiography. The tumo...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-02-01 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:Bioresorbable membranes composed of hyaluronic acid and carboxymethylcellulose (HA/CMC) are the most effective method to prevent intra-abdominal adhesions; however, their efficacy may be limited to the site of application. Previous studies in our laboratory have shown that the intraperitoneal administration ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.01.024
更新日期:2010-11-01 00:00:00
abstract::Fine-needle aspirations and cutting needle biopsies were performed on 415 patients with solitary thyroid nodules. All nodules were considered hypofunctioning by scintiscans. Specimens were adequate in 399 patients. Ten percent of these patients had thyroid cancers documented by thyroidectomies. Results from either or ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-12-01 00:00:00
abstract::A rat gastric chamber preparation was used to determine the interrelations between H+ back diffusion, mucosal blood flow, the area of mucosa treated with bile salts and ulcer formation. The rate of H+ back diffusion was found to be dependent on both mucosal blood flow and the area of mucosa exposed to bile salts. It i...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1978-03-01 00:00:00
abstract::Palliative care has long been described in medical literature but only recently is being discussed in the surgical domain. Mounting evidence suggests that early integration of palliative care improves patient outcomes and this is especially true of oncology patients. Thus, the pendulum is swinging toward recognizing t...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2017.10.001
更新日期:2018-04-01 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:BACKGROUND:Patients with primary mediastinal lymphomas frequently present with a residual mass after completion of first-line therapy. Although a positron emission tomography scan is usually recommended, it fails to distinguish between persistent lymphoma and inflammation. Although percutaneous biopsy may have a high d...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.05.039
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Little is known about the value of sequential transcatheter arterial chemoembolization and portal vein embolization compared with portal vein embolization alone before major hepatectomy for large hepatocellular carcinoma. We aimed to compare early and long-term outcomes of these two strategies. METHODS:We i...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.09.023
更新日期:2020-02-01 00:00:00