Abstract:
BACKGROUND:The observed to expected (O:E) mortality based on Injury Severity Scores (ISS) has been used to assess quality of trauma center (TC) care. Injuries in the elderly have increased, and these patients often have advanced directives, on occasion limiting aggressive care even for potentially survivable injuries; unfortunately, there are few data on the impact of these demographic changes on mortality. Additionally, many patients arrive moribund and care provided is likely to be futile. We sought to examine the impact of these situations on TC mortality. METHODS:All trauma deaths for 2008-2009 were assessed for ISS, preventability of mortality, potential for survivability, impact of withdrawal of care (WOC), and timing of deaths. RESULTS:There were 5433 patients with 347 deaths (6.4%). Deaths occurred more frequently in men (70%) who were older (56.3 years) and had head injuries (70%, Glasgow Coma Scale score of 6.9). The average ISS was high (25.5), but 19% of deaths occurred in minimally injured (ISS < 15). One fifth of all patients who died arrived in or rapidly progressed to cardiac arrest with little to no chance to impact survival. Of the nonsurvivors, 147 (42% of deaths) had WOC at a mean of 1.5 days based on advanced directives (18%) or family desires. Combing WOC and futile care, medical treatment could not have been expected to impact survival in 62% of deaths. CONCLUSION:There has been a major shift in the demographics of the injured with a high proportion of elderly and head injured and/or those who have little likelihood of survival. Crude mortality or O:E based on ISS overestimates preventable deaths. Societal factors, presence of advanced directives, and WOC decisions must be considered when assessing TC performance. Although our crude mortality rate was 6.4%, it was only 2.4% in patients we were actually permitted to treat. We suggest a WOC factor should be added to TC data to characterize mortality rates more accurately.
journal_name
Surgeryjournal_title
Surgeryauthors
Franklin GA,Cannon RW,Smith JW,Harbrecht BG,Miller FB,Richardson JDdoi
10.1016/j.surg.2011.07.065subject
Has Abstractpub_date
2011-10-01 00:00:00pages
854-60issue
4eissn
0039-6060issn
1532-7361pii
S0039-6060(11)00420-Xjournal_volume
150pub_type
杂志文章相关文献
SURGERY文献大全abstract:BACKGROUND:The United States population is aging, and the number of older adults requiring operative care is increasing at a rapid rate. In order to address this issue, the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society created best practice guidelines sur...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2020.08.033
更新日期:2021-02-01 00:00:00
abstract::Deficiencies in the immune system that lead to increased morbidity and mortality from infectious complications have been well documented in patients suffering from trauma, malnutrition, sepsis, and thermal injuries. We investigated the potential benefit of immune stimulation for preventing infection in such conditions...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-08-01 00:00:00
abstract:BACKGROUND:Adrenal cortical carcinoma (ACC) is a rare disease in which recurrence after surgery is common. Mitotane is the primary systemic treatment for recurrent ACC; data are limited regarding the impact of mitotane on recurrent ACC. METHODS:We reviewed the records of all patients who underwent surgery for ACC eval...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2007.09.006
更新日期:2007-12-01 00:00:00
abstract::Two patients with hepatorenal syndrome were treated by insertion of a peritoneovenous shunt. The renal deficit was corrected rapidly in both cases. A 62-year-old woman with a slow onset syndrome with urine output of 100 to 150 ml/day and urinary sodium excretion of 1 mEq/day responded with large volume urinary output ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1977-09-01 00:00:00
abstract:BACKGROUND:Patients with secondary hyperparathyroidism and on dialysis are more likely to die of cardiovascular disease than the general population; and we have reported that near-total parathyroidectomy (NTPTX) reduces that mortality rate. Patients on dialysis experience an average of a 15% increase in coronary calcif...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2013.06.030
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:The development of liver failure significantly influences prognosis during the course of major septic complications. Although the underlying cause for septic liver failure is still unclear, research using animal models has demonstrated that an increased nitric oxide (NO) synthesis compromises detoxification ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2006.08.011
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Service and education activities have not been well defined or studied. The purpose of this study is to describe how attendings and residents categorize common resident activities on a service-education continuum. METHODS:A web-based survey was designed to categorize resident activities. A panel of resident...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2007.04.011
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Management of <2-cm pancreatic neuroendocrine tumors is controversial. Although often indolent, the oncologic heterogeneity of these tumors particularly related to lymph node metastases poses challenges when deciding between resection versus surveillance. METHODS:We analyzed all patients who underwent resec...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.03.008
更新日期:2019-07-01 00:00:00
abstract::Eighty-four patients with recurrent kidney stones, serum calcium levels in the upper normal quartile, and most of whom with hypercalciuria had their parathyroids surgically explored. Parathyroid adenomata were found in 19 patients, hyperplasia in 39, and normal parathyroids in 26. Postoperatively there was a significa...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1975-05-01 00:00:00
abstract:BACKGROUND:The effect of the time interval between colorectal and liver resection for metastatic lesions on the patient's survival remains controversial. Pretreatment classification for predicting the prognosis of this disease has not yet been reported. METHODS:Nine clinical factors revealed by preoperative examinatio...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2001.112001
更新日期:2001-04-01 00:00:00
abstract:BACKGROUND:Serum concentrations of fatty acid binding protein 4, an adipose tissue fatty acid chaperone, have been correlated with insulin resistance and cardiovascular risk factors. The objective of this study were to assess relationships among Roux-en-Y gastric bypass, intensive lifestyle modification and medical man...
journal_title:Surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.surg.2018.08.007
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Thoracic aortic injuries have traditionally been associated with high morbidity and mortality. Thoracic endovascular aortic repair has emerged as a suitable alternative to open repair, but its impact at a national level remains ill defined. This study aimed to analyze the national trends of patient character...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.04.015
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Ischemia-reperfusion injury of skeletal muscle is a common clinical and experimental problem. To date, there has been no uniform and reproducible method to assess the extent of histologic injury. In this study, we developed a novel statistical methodology for evaluating injury in individual myocytes and 3 di...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2007.06.005
更新日期:2008-01-01 00:00:00
abstract::This study compares the National Board of Medical Examiners Part II (NBME II) subtest scores of medical students attaining honors in a clinical clerkship to those of students receiving a passing score to determine if the NBME II examinations could be considered independently as valid indicators of clinical achievement...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1981-06-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the clinicopathologic characteristics of patients with hepatocellular carcinoma (HCC) and bile duct thrombi (BDT). PATIENTS:Seventeen patients with HCC and BDT among 671 patients with HCC who underwent hepatic resection were enrolled in this study. RESULTS:There were n...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2000.108659
更新日期:2000-11-01 00:00:00
abstract::A prospective study to evaluate the accuracy of early diagnosis and the efficacy of early operation for biliary tract stone disease was performed. One hundred fifty-two consecutive patients with signs and symptoms compatible with biliary colic or acute cholecystitis were admitted to the hospital and promptly evaluated...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1983-10-01 00:00:00
abstract::A case report of a girl with anomalous venous drainage of a lower extremity who had a successful venous transplant is presented, along with a review of some factors thought to be important in venous grafting. In our patient there are several factors that may have contributed to long-term patency. As demonstrated by ve...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1978-05-01 00:00:00
abstract:BACKGROUND:Surgery for pancreatic necrosis is associated with a high morbidity and mortality. The aim of this study was to review the incidence of early and late complications after pancreatic necrosectomy in a large contemporary series of patients. METHODS:The clinical outcomes of 88 patients who underwent pancreatic...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2005.01.003
更新日期:2005-05-01 00:00:00
abstract:BACKGROUND:Burn-induced compartment syndrome is a severe sequela after circumferential burns of the extremities and is avoidable by immediate release of the underlying pressure under the eschar. Although the current gold standard is operative escharotomy, this procedure carries considerable morbidity. Our study evaluat...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.11.019
更新日期:2019-06-01 00:00:00
abstract::The unexpected finding of hyperamylasemia in a patient with isolated head injury prompted a study of amylase levels in patients with various degrees of cranial trauma. None of seven patients with isolated maxillofacial trauma had hyperamylasemia. This group was studied to discount injury to salivary glands as a source...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND:Enthusiasm for neoadjuvant therapy is growing from the emerging consensus that pancreatic cancer is a systemic disease at the time of diagnosis. Those who remain in favor of upfront surgery often cite the lack of reported data to support alternative treatment sequencing. We therefore report the results of al...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.09.018
更新日期:2016-03-01 00:00:00
abstract::Early graft loss almost always occurs when recipients of a renal allograft develop antibody directed against antigens specific for donor vascular endothelial cells (VECs) and peripheral blood monocytes. In studies involving recipients of human leukocyte antigen identical, living-related grafts exhibiting preformed ant...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-05-01 00:00:00
abstract::The isolation and characterization of oncogenes from human colon cancer and the recognition of their homology with the ras gene of the Harvey and Kirsten strain of murine sarcoma virus (MSV) led us to investigate the effect of exogenous MSV on 1,2 dimethylhydrazine (DMH)-induced colon carcinoma in rats. DMH, 20 mg bas...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-02-01 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::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:BACKGROUND:Primary hyperparathyroidism is associated with an increased cardiovascular morbidity and mortality. However, mechanisms underlying this association are currently unclear. As there is clear evidence of the independent role of aldosterone on the cardiovascular system, the aim of this study was to evaluate aldo...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2009.09.041
更新日期:2009-12-01 00:00:00
abstract:INTRODUCTION:Hepatocyte cell transplantation can be life-saving in patients with acute liver failure (ALF); however, primary human hepatocyte transplantation is limited by the scarcity of donor hepatocytes. We investigated the effect of stem cell-derived, hepatocyte-like cells in an animal xenotransplant model of ALF. ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.04.014
更新日期:2015-08-01 00:00:00
abstract::Forty-five consecutive patients with 49 fractures of the first rib caused by blunt trauma underwent arteriography. The fractures were classified as posterior, lateral, or anterior and as nondisplaced, minimally displaced, or significantly displaced. Seven patients (14%) had serious vascular injuries: five had posterio...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1981-01-01 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
abstract:BACKGROUND:Preconditioning is injury-induced protection against subsequent injury and may be induced by a variety of stimuli. Both males and females may be preconditioned; however, if females are relatively protected against the initial insult, is their preconditioning threshold higher? We hypothesized that preconditio...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2005.03.016
更新日期:2005-08-01 00:00:00